A revision hip or knee replacement is planned around the implant already in your body, so the specialist needs records from the first surgery as much as a description of the current problem. This guide sets out a nine-part case packet, where to find each piece, and why the plan should come before the price.
Why a revision request cannot start from a blank page
A first joint replacement is planned around a damaged natural joint. A revision is planned around something more complicated: an existing implant, the bone and soft tissue around it, whatever happened at the first operation, and the reason the joint is now failing. A surgeon looking at a revision case is trying to answer "what went wrong, what is still sound, and what will it take to fix?" Most of the evidence for those answers lives in records from the first surgery.
OrthoInfo describes revision knee and hip surgery as longer and more complex than the original operation, requiring extensive planning and often specialized implants and tools, with complex cases taking several hours (AAOS OrthoInfo, 2026). Revision implants often have longer stems, and bone loss may be addressed with metal augments or bone graft. If cement was used the first time, it has to be removed, which adds time. None of that can be estimated from a photo of a scar and a description of pain.
The case packet is what lets a revision specialist start with the real picture. The checklist above tracks the nine pieces; this guide explains each one and where to find it.
Do not decide the cause in the packet
A painful or poorly working joint replacement can have several explanations. OrthoInfo lists loosening of the implant from the bone, infection, instability, wear of the plastic parts, stiffness and fracture around the implant as reasons a knee may need revision (AAOS OrthoInfo, 2026). For hips it adds bone loss from wear particles (osteolysis), repeated dislocation, and reactions to metal debris, which are more common with metal-on-metal designs (AAOS OrthoInfo, 2026).
The treatment for each is different, and so is the price. That is why the packet presents evidence and symptoms rather than a conclusion. "My knee replacement is loose and I need a revision quote" invites a quote for an operation that may not be the right one. "Here is my history and records; what do you think is going on, and what would you need to confirm it?" invites an assessment.
The nine parts of the packet
| Item | Where to get it | Why the revision surgeon wants it |
|---|---|---|
| 1. Original procedure and date | Discharge summary or surgeon's letter | Sets the timeline: early problems and late problems point in different directions |
| 2. Original operative report | Medical records department of the first hospital | Approach used, fixation, anything unexpected during surgery |
| 3. Implant record | Implant stickers or labels in the chart; the hospital's records | Identifies the components, which affects what can be kept and what tools are needed |
| 4. Symptom history | You, written down | What changed, when, and what makes it better or worse |
| 5. Imaging over time | Radiology departments; your own discs | Comparing early and current images shows change around the implant |
| 6. Infection workup, if done | Ordering doctor; laboratory reports | Infection changes the whole plan |
| 7. Treatments since the first surgery | Your records and memory | What has already been tried and how it went |
| 8. Current health and restrictions | Primary care doctor | Fitness for a longer operation and recovery |
| 9. Your question | You | Tells the specialist what decision you need help with |
Items 1 to 3: the first operation
Request the full operative report, not just a discharge letter. It usually describes the approach, how the components were fixed (cemented or press-fit), and any difficulties during surgery. Ask the same hospital for the implant record: the labels or list identifying each component. Our separate guide to the joint implant passport explains what that record should contain. If the first surgery was years ago or in another country, start these requests early; they are often the slowest part of the packet.
If you cannot get the implant record, say so plainly in the packet, along with what you have already tried. The specialist should know in advance that it is missing rather than discover it at the consultation.
Item 4: a symptom history the surgeon can use
Write a short timeline, in your own words, covering:
- How the joint felt in the first months after the original surgery: did it ever feel good?
- When the current problem started, and whether it came on suddenly or gradually.
- Pain: where, when (at rest, at night, when you first stand up, when walking), and how it has changed.
- Instability: giving way, or for hips, any dislocations and how many.
- Stiffness or loss of motion.
- Any fall or injury, with the date.
- Any wound problems, fevers or courses of antibiotics since the first surgery.
Keep it to a page. Dates matter more than adjectives.
Item 5: imaging, old and new
OrthoInfo notes that X-rays are used to look for loosening or a change in the position of the components, and that a bone scan, MRI or CT may help clarify the cause of failure and the condition of the bone (AAOS OrthoInfo, 2026). For a revision assessment, a series is more valuable than a single image. If you can, include an X-ray from soon after the first surgery along with the most recent one, each with its report and date. Send the image files, not only the written reports.
Item 6: the infection question
Infection is one of the possibilities a revision surgeon will usually want to rule in or out early, because it changes the whole plan. OrthoInfo describes blood tests and joint aspiration (drawing fluid from the joint with a needle for laboratory testing) as the usual ways to check (AAOS OrthoInfo, 2026). If any of these tests have been done, include the reports. If they have not, do not worry; the specialist will decide what is needed. The point of this item is simply that results which already exist should travel with the packet.
Items 7 to 9: what has happened since, and what you are asking
List treatments since the first operation: physical therapy, bracing, injections, a manipulation under anesthesia for stiffness, any earlier revision or washout, and antibiotic courses. OrthoInfo notes that for instability or stiffness, revision is usually considered when measures such as bracing, therapy or manipulation have not helped (AAOS OrthoInfo, 2026), so the specialist needs to know what has been tried.
For current health, OrthoInfo describes a complete physical examination with your primary care doctor several weeks before revision surgery, and sometimes a specialist review for chronic conditions (AAOS OrthoInfo, 2026). Include a recent medication list and any major conditions now, rather than waiting for that visit.
Finish with your question. Good examples: "What do you think is causing this, and what tests would confirm it?" or "Another surgeon has recommended revision; do you agree, and what would you do differently?" For structuring a second opinion more broadly, see the second opinion builder.
Plan first, price second
A revision quote is only meaningful once a plan exists. If the cause is not settled, ask for a clinical review before a price. Once there is a plan, the quote needs to reflect what makes revisions different: a longer operation, specialized components, possible bone reconstruction, and a hospital stay that OrthoInfo describes as several days for most patients, with help at home needed for several days to several weeks (AAOS OrthoInfo, 2026).
If infection is confirmed, the plan may involve more than one operation. OrthoInfo describes a two-stage approach in which the implant is removed, a temporary antibiotic spacer is placed for several weeks with intravenous antibiotics, and a new implant is inserted at a second surgery (AAOS OrthoInfo, 2026). For anyone considering revision away from home, that can mean two trips or a long stay, and the packet's question should ask about it directly.
Frequently asked questions
What if I cannot get my original operative report or implant record?
Request them in writing from the hospital where the first surgery was done, and start early. If they cannot be found, say so in the packet. The specialist needs to know the records are missing before reviewing the case.
Does pain after a joint replacement always mean I need a revision?
No. Pain can have several causes, and not all of them are treated with revision surgery. That is why the packet presents your history and records and asks the specialist for an assessment rather than a price for a specific operation.
Should I get infection tests before contacting a revision specialist?
Not necessarily. Include any test results you already have. The specialist will decide which tests are needed, and in what order.
Is a revision quote comparable to a first-time joint replacement quote?
No. OrthoInfo describes revision as longer and more complex, often with specialized implants and a longer hospital stay. Compare revision quotes only with other revision quotes for the same plan.
Can a revision be done in a single trip abroad?
Sometimes, but not always. If infection is involved, OrthoInfo describes a two-stage approach with a temporary spacer for several weeks between surgeries. Ask the specialist what their plan would mean in trips and time away.
Compare a joint replacement plan or quote
Start with the joint, side, destination preference and timing. You do not need to upload the full medical record here.
Related joint-replacement guides
Orthopedic lead network
- AAOS OrthoInfo: Revision Total Knee Replacement (2026)
- AAOS OrthoInfo: Revision Total Hip Replacement (2026)
These sources support general joint-replacement preparation, procedure and medical-travel concepts. They do not establish a personal diagnosis, treatment recommendation, implant selection or travel-clearance date.