My total hip replacement lasted all of five years. It started loosening up and had to be removed. In the process I’m told that pieces of bone came out with it. I had to have a bone graft to fill in the holes. Does this happen very often?

A fair number of people may need a revision of their hip joint replacement. Loosening and infection are the most common reasons for implant failure. Poor bone quality and decreased bone density are major factors in implant loosening.

When the implant is removed, the surgeon must be careful to take out all existing cement and fibrous tissue. Every effort is made to make sure the joint surface is smooth and clean. This will help new bone to form around the revision implant.

It sounds like you had a procedure called impaction grafting. Morselized bits of donor bone are placed in the hole or defect. A special surgical hammer is used to tamp down the bone and press it into the hole.

When the hole is filled and smooth again, the surgeon places a trial cup-shaped implant in place to check the hip and leg position. If all is well and everything lines up, then cement is injected into the bone graft to seal it all together. Finally, a new cup is inserted.

With more and more older adults experiencing arthritis and needing joint replacements, surgeons expect to see this problem increasing over time. Patients are living long enough to require one (or even more) revision operations. The number of people who need extra care because of bone deficiencies has already increased greatly.