The fear of a hip replacement rejection is something I have seen patients ask surgeons before the procedure. Yet this is very rare and not really a ‘rejection’.
You may be wondering what could happen if your body rejects a hip prosthesis and what are the symptoms.
I will try to put your mind at rest in this article. Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: Sept, 2025. Written by Juliet Semakula, a diagnostic radiographer.
| Take home! hip replacement is one of the most common and effective forms of surgery, resulting in generally excellent outcomes. While the body doesn’t “reject” a hip replacement in the same way it might reject an organ transplant, it can react negatively to the implant, leading to complications which are also very rare. |
Before I go further to reassure you about how rare or common is hip prosthesis rejection, let’s understand the term ‘prosthesis rejection’
▶️What is prosthesis rejection?
Let’s first understand the difference between the term ‘rejection in the context of a hip replacement’ with ‘rejection of a transplanted organ’.
These two terms mean different things medically. For example, when you have had:
A transplanted organ. Your body’s immune response system may reject the transplanted organ usually because it is perceived as foreign.
which can lead to dysfunction or failure of the transplanted organ and when this happens it must be dealt with immediately.
Hip replacement rejection is not an immune response against a foreign object, but it refers to a failure of the implant to properly integrate with the bone and surrounding tissues.
Meaning your body reacts to the presence of the prosthesis which manifests itself as inflammation which can lead to swelling and pain in the hip joint and around the soft tissues.
Usually when a surgeon decides to remove a prosthesis, it is most often in the case of:
⚪Loosening (the replacement is no longer in place).
⚪wear.
⚪Infection.
⚪Allergy to metals.
▶️It is very rare to have to change or remove a prosthesis because modern implants are durable.
While hip replacement surgeries are generally successful and durable, replacing the original prosthesis is not uncommon, so it may not be accurate to say it is very rare.
Numerous studies have been carried out to monitor people’s progress in the days, months and years following a hip operation.
While 90% or more of hip replacements function well for 10 years and more, there could be a risk of needing a revision surgery over time especially in more active individuals.
Researchers in numerous studies have noted the frequency with which people need to be operated on again because of a problem with their prosthesis. This is normally referred to as ‘A replacement revision or change.
A research study done in the United States of America which followed up over 535 people who had a hip replacement for over 10 years (Kelmer,2021)
Here are some of the reasons that were noted, that prompted them to do a hip revision, repair or replacement
⚪37% had mechanical failure that may be caused by any activity level especially in younger, more active individuals the prosthesis can loosen from the bone which may need to be repaired.
⚪21% metallosis: Over time the artificial hip joint can wear down or degrade. The wear particles released from the implant may provoke an immune response that leads to inflammation and rejection
⚪10% may have Infection around the hip prothesis, this is relatively very rare but when it happens it may necessitate removal of the prosthesis.
⚪15% face Hip dislocation which is normally put back in place.
⚪3% aseptic loosening, where the implant becomes loose without any infection present.
⚪4% may feel pain and unexplained reason.
⚪10% have fractures around the prosthesis.
X-ray of the Hip prosthesis showing a new fracture around the prosthesis (image retrieved from Ortho bullets periprosthetic)
Working in x-ray, I have seen a few joint hip wear, dislocation and fractures around the prosthesis which requires a patient to go back to theatre for a repair, removal or replacement.
Here is another medical case study that is very rare, but it did happen in one of the hospitals in China (Wang 2020)
Patient concern:
A 64-year-old woman was admitted to hospital in China with a history of persistent hip pain that had started after she had undergone total hip replacement 4 years previously. In addition, she complained of swelling of the hip that had begun 2 months ago.
Diagnosis
Her pain and swelling were initially thought to be caused by an infection but was eventually diagnosed as inflammation caused by prosthesis loosening, which was in line with finding that her preoperative and intraoperative cultures showed no bacterial or fungal growth.
This case study posed many questions and difficulties during the diagnostic and treatment stages.
| What do we learn from this case study: ➡️The operative method and position of a joint prosthesis are extremely important. ➡️A poorly positioned prosthesis can worsen with wear. ➡️Wear particles then lead to long-term localized aseptic inflammation with swelling and fever and infection. ➡️A poorly positioned prosthesis can lead to the need for revision |
While most hip replacements are successful and last for many years, it’s important to be aware of these potential complications and the possibility of needing revision surgery.
As you can see, “rejection” of the prosthesis is not listed. Prosthesis revision is sometimes necessary, due to the listed sounding reasons.
▶️What are the symptoms you may have that may prompt a hip replacement? Which are also less common.
Here are some of the Symptoms of hip replacement rejection, also known as failure or loosening
🟠Pain is a common symptom and can range from a dull ache to sharp, stabbing sensations. It often worsens with activity and weight-bearing.
🟠Swelling and tenderness in the hip area can indicate inflammation and damage within the joint.
🟠Instability of the hip can manifest as a feeling of the hip joint giving way or even as a partial or complete dislocation.
🟠Bone loss: X-rays may show bone loss around the implant, indicating that the bone is not growing onto or around the implant as it should.
🟠Limited range of movement and stiffness when you move, preventing you to do your normal activities.
🟠Persistent groin, thigh, or hip pain, particularly if it worsens with activity.
🟠A grating, grinding, or popping sensation in the hip joint during movement, known as crepitus, can be a sign of bone-on-bone friction.
▶️Pain and swelling are not sufficient symptoms to diagnose rejection.
When you have had a hip replacement, you will feel pain after surgery, but this pain is not systematic.
You are usually given painkillers of varying strength a few days, or weeks to help with these pains which are normally associated with the thigh around the scar which can extend to the lower leg.
What you should know: these symptoms are not signs of rejection of your prosthesis.
These are normally signs of inflammation, which is completely normal after an operation. Remember it is an open reduction procedure where your hip will be cut and go through tissues.
Rarely do these symptoms alone require further tests such as X-rays or blood tests to ensure that all is well, as they are standard and not a sign of prosthesis rejection
Here is another article that explains all about how to deal with pain after a hip replacement and when you should consult a doctor.
▶️What happens when your body rejects a hip implant? Be in the known that any complications are often manageable.
If your body rejects a hip replacement, it means the implant is not integrating properly with your bone and surrounding tissues.
In situations like these you may be feeling pain and instability in the hip joint.
In most cases you should see your doctor to discuss with you the best options in your case on how to manage pain and treatment options available.
⚫What I see normally at my workplace, potentially patients are given a hip revision or replacement surgery
⚫Bone grafting: If significant bone loss has occurred, bone grafting using your bone from another body part or a donor is used to rebuild the bone before placing the new implant.
⚫Infection management: If infection is the cause of failure, the surgeon may need to perform a two-stage revision, removing the implant, inserting a temporary spacer with antibiotics, and then replacing the implant after the infection is cleared
⚫A mal-positioned prosthesis refers to a situation where a hip prosthesis is not placed in the ideal or intended location.
▶️In the rare cases where the prosthesis needs to be changed, it is on average 8 years after the operation.
Hip replacement rejection, though a concern for some, is relatively rare.
Modern hip replacements are designed to last for many years, and most patients experience significant pain relief and improved mobility after they have had a hip replacement.
If you think you have concerns with your hip replacement after years of having it, it is very important to see a doctor for a check-up because early intervention can prevent minor issues from becoming major problems.
▶️Your GP, Doctor or the specialist team who performed the surgery can reassure you if you have more concerns.
Patients are given instructions to always contact their GP, Doctor or specialist team after a hip replacement If any concerns arise during their recovery and after years of replacement.
For immediate concerns, such as signs of infection or blood clots, contacting NHS 111 if you are in the UK or seeking help online is recommended.
If you are elsewhere in the world, you still have numbers and places you can go to consult a specialist.
We have come to the end of this article, for any questions let’s meet in the comments section. Wishing you a quick recovery!🙋
You may also be interested in these articles.
⚫Pain relief after hip replacement.
⚫When to resume driving a car after a hip replacement.
⚫What is the total recovery time after a hip replacement.
⚫Dislocated hip: how can be fixed.
📚Source:
Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019 Feb 16;393(10172):647-654. doi: 10.1016/S0140-6736(18)31665-9. Epub 2019 Feb 14. PMID: 30782340; PMCID: PMC6376618.
Kelmer G, Stone AH, Turcotte J, King PJ. Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure. J Am Acad Orthop Surg. 2021 Jan 15;29(2):78-87. doi: 10.5435/JAAOS-D-19-00860. PMID: 32404682.
Wang J, Zhang M, Xu Y, Li X, Wang C, Gao X, Xu M, Li X, Li W, Wang J, Zhang Y, Wang G, Cao X. A rare case of inflammation after total hip arthroplasty due to a malpositioned prosthesis: A case report. Medicine (Baltimore). 2020 May 29;99(22):e20468. doi: 10.1097/MD.0000000000020468. PMID: 32481454; PMCID: PMC12245316.
Image source:
https://www.orthobullets.com/recon/5013/tha-periprosthetic-fracture