A hip replacement is designed to last for many years, but in some cases a second operation may be needed. One of the most common reasons is a periprosthetic joint infection (PJI). Although infections after hip replacement are uncommon, they require prompt treatment to protect the joint and restore mobility.

When an infection is confirmed, one of the key decisions is whether to perform a one-stage or two-stage revision. Both approaches aim to remove the infection and restore function, but they involve different surgical pathways. The right choice depends on the type of bacteria involved, the condition of the surrounding bone and soft tissues, and the patient’s overall health.

What is the difference between a one-stage and two-stage revision hip replacement?

A one-stage revision involves removing the infected implant, thoroughly cleaning the joint, and inserting a new hip replacement in the same operation, followed by antibiotics and rehabilitation.

A two-stage revision separates this into two operations. The implant is first removed and the joint cleaned, with an antibiotic-loaded spacer placed temporarily while a course of antibiotics is completed. Once the infection has cleared, a second operation inserts the new replacement.

Which approach is recommended?

One-stage revision is increasingly considered for carefully selected patients where the bacteria have been identified, soft tissues are in good condition, and the patient is medically stable. Avoiding a second major operation can shorten recovery and reduce time in hospital.

Two-stage revision remains the preferred option for more complex cases, including resistant bacteria, significant bone loss, or where the infecting organism is unknown. It is a well-established approach for managing difficult infections and continues to deliver reliable outcomes.

What does the research show?

Mr Alazzawi recently co-authored a 2025 study in Orthopedic Reviews examining long-term outcomes of single-stage versus two-stage revision for prosthetic joint infection, comparing infection clearance and treatment failure rates in demographically similar patient groups.

Separately, emerging 2025 evidence suggests that one-stage revision can achieve comparable infection control to two-stage procedures in appropriately selected patients, with the added benefits of fewer operations and faster rehabilitation. The INFORM trial, the first multicentre randomised controlled trial directly comparing both approaches, is currently recruiting and is expected to provide more detailed guidance on outcomes, quality of life, and cost-effectiveness.

As understanding of periprosthetic joint infection improves, treatment is becoming increasingly personalised. Whether one-stage or two-stage revision is recommended, the goal is the same: to eliminate infection, restore movement, and return patients to an active life.

If you have concerns about a previous hip replacement or have been diagnosed with a periprosthetic joint infection, Mr Alazzawi has extensive expertise in complex revision surgery and can provide a thorough assessment to determine the most appropriate treatment for your circumstances. Get in touch to book a consultation.

Mr Sulaiman Alazzawi is offering the Direct Anterior Approach (DAA) to total hip replacement, a modern surgical technique designed to support faster recovery while preserving the body’s natural anatomy. This minimally invasive, muscle-sparing approach reflects ongoing advances in hip surgery aimed at improving early outcomes for patients undergoing joint replacement.

What Is the Direct Anterior Approach to hip replacement?

Unlike traditional hip replacement techniques that involve detaching muscle to access the hip joint, the Direct Anterior Approach allows the surgeon to work between natural muscle planes.

By avoiding muscle cutting, the procedure reduces soft-tissue trauma and supports a more rapid return to movement. For many patients, this can translate into less postoperative pain, improved early mobility, and fewer movement restrictions during recovery.

Evidence for improved early outcomes

Clinical research supports these benefits. A study published in The Journal of Arthroplasty reported that patients undergoing total hip replacement via the Direct Anterior Approach experienced improved early functional outcomes, including reduced pain, faster rehabilitation, and shorter hospital stays compared with conventional approaches. Importantly, long-term outcomes were found to be comparable, meaning patients benefit from enhanced early recovery without compromising implant longevity or overall joint function.

Is it right for you?

As with all hip replacement techniques, the Direct Anterior Approach is not suitable for every patient. Factors such as hip anatomy, body shape, previous surgery and overall health must be carefully assessed. Mr Alazzawi places strong emphasis on individualised consultation, ensuring each patient is offered the most appropriate surgical approach for their condition, lifestyle and long-term goals.

The introduction of this minimally invasive approach further strengthens the range of advanced hip replacement options available under Mr Alazzawi’s care. It reflects an ongoing commitment to improving recovery, comfort and function while maintaining excellent long-term outcomes.

If you are unsure whether hip replacement surgery is right for you, book a consultation with Mr Alazzawi today for a thorough assessment.

Consultant orthopaedic surgeon Mr Sulaiman Alazzawi in collaboration with colleagues from the Complex Arthroplasty Unit at St George’s University Hospitals NHS Foundation Trust is an author on an important systematic review published in Archives of Orthopaedic and Trauma Surgery titled: “The impact of electronic cigarettes on the outcomes of total joint arthroplasty.”

Smoking tobacco is well-known to have negative consequences for major joint replacement surgery – including impaired wound healing, increased infection risk and poorer functional outcomes. The study extends this to include electronic cigarettes, which are frequently perceived as a safer alternative. The review was performed according to PRISMA guidelines and synthesises current data on e-cigarette vapour exposure, bone health, immune response and surgical outcomes.

Key findings show that e-cigarette vapour releases nicotine inconsistently, can depress immune function, impair wound healing and may prolong hospitalisation. The authors recommend that e-cigarette use be actively monitored before total hip and knee arthroplasty to reduce complication risks.

Mr Alazzawi commented: “This study is timely. Many patients and clinicians focus on tobacco smoking, but our findings highlight that vaping may also carry risks for complex joint surgery. We advise patients to follow their healthcare team’s lifestyle guidelines before and after surgery.”

For patients awaiting hip or knee replacement, the study emphasises not only surgical expertise, but also the role of comprehensive pre-operative preparation and lifestyle optimisation. For more advice, book an appointment with Mr Sulaiman Alazzawi.

The full text of the article can be accessed via PubMed (PMID: 39503768).

Joint replacement surgery has come a long way in recent decades. Once seen as a one-size-fits-all operation, it is now a highly personalised procedure, with new technologies helping surgeons achieve greater precision and better results.

Among the most exciting advances are robotic-assisted systems, such as MAKO, and computer-guided surgery. These techniques are designed to improve implant positioning, reduce complications, and improve long-term outcomes for patients.

Here, we’ll explore what these techniques involve.

How robotic and computer-aided joint surgery works

In traditional joint replacement, the surgeon relies on X-rays, manual instruments, and their own experience to plan and position the implant. While highly effective, this approach can sometimes leave small variations in alignment, which may affect how the new joint feels and performs.

Robotic and computer-assisted systems provide improved accuracy. Prior to surgery, advanced 3D imaging is used to create a detailed model of your joint. This allows the surgeon to plan the procedure in virtual detail, deciding the exact size, shape, and position of the implant. During the operation, the robotic or computer-guided system acts as a navigation tool, giving real-time feedback and ensuring that every cut and adjustment is made with millimetre precision.

It’s important to stress that the robot does not perform the surgery. The surgeon remains in full control at all times. The technology simply provides enhanced accuracy and guidance, helping to achieve the best possible result.

Why accuracy matters in joint replacement surgery

Accurate implant placement is one of the biggest predictors of long-term success in hip and knee replacement. A recent study on robotic-assisted knee replacement showed that these procedures resulted in more consistent alignment, fewer soft tissue releases, and better early function compared with conventional techniques. Patients reported faster improvement in mobility and overall satisfaction with their new joint.

Poorly positioned implants can lead to problems such as uneven wear, instability, or pain. By improving accuracy, robotic and computer-guided systems reduce the likelihood of these complications. They may also extend the life of the implant, meaning fewer patients will need revision surgery in the future.

For partial knee replacements, where precision is crucial, robotic systems have been shown to deliver especially strong results. Many patients describe the joint as feeling more natural, with smoother movement and greater confidence when returning to activity.

Questions to ask your surgeon

If you’re considering hip or knee replacement, it’s worth asking whether robotic or computer-assisted joint surgery might be an option for you. Here are some questions to take into your consultation:

Am I a good candidate for robotic-assisted surgery? Not every case requires or benefits from it, but in many patients, it can improve precision and outcomes.

How does the technology improve accuracy compared with conventional surgery? Ask your surgeon to explain in simple terms how it works in practice.

Are there any added risks or costs? While the technology is safe, it’s important to understand the practical aspects before making a decision.

For more information on the advantages of robotic-assisted surgery, you can also explore our page on robotic joint replacement.

As systems like MAKO become more widely available, patients will continue to benefit from joint replacements that are tailored, accurate, and designed to stand the test of time.

If you’re planning hip or knee replacement, asking about robotic or computer-assisted surgery is worthwhile. Schedule a consultation with Mr Alazzawi today to learn more.

 

Choosing the right orthopedic surgeon for hip or knee replacement surgery is a crucial decision that can significantly impact your outcomes, recovery time, and overall experience.

In this article, we share the key factors to consider when selecting a surgeon:

1. Specialisation and Experience

Certification: Ensure the surgeon is certified in orthopaedic surgery, specifically with a focus on joint replacement or arthroplasty. Certification indicates that the surgeon has met high standards and is up-to-date with the latest techniques.

Experience with Hip/Knee Replacements: Look for a surgeon who specialises in hip and knee replacements rather than a general orthopaedic surgeon. Ideally, they should have extensive experience with the specific procedure you’re undergoing.

Number of Surgeries Performed: Surgeons who perform a high volume of joint replacement surgeries typically have better outcomes. You may want to ask how many hip or knee replacements they perform annually.

2. Reputation and Reviews

Patient Testimonials: Look for reviews and testimonials from previous patients. Reviews can provide insights into the surgeon’s skills, bedside manner, and the overall experience.

Word of Mouth: Ask your primary care doctor, physical therapist, or family and friends for recommendations. Word-of-mouth referrals can be a great way to find a trusted surgeon.

3. Hospital Affiliation

Reputation of the Hospital: The hospital where the orthopaedic surgeon operates is just as important as their surgical skills. Look for a highly rated hospital for orthopaedic surgery, especially one known for its joint replacement program.

Hospital’s Joint Replacement Program: Find out whether the hospital or surgical centre has a specialised joint replacement program with dedicated staff, physical therapists, and aftercare.

4. Communication and Bedside Manner

Initial Consultation: Pay attention to how the surgeon communicates during your consultation. Do they listen to your concerns, answer your questions thoroughly, and explain the procedure in a way you understand? A surgeon with good communication skills can make the process less intimidating.

Transparency: A good surgeon should be open about the risks and benefits of surgery, as well as realistic expectations about the recovery process. They should explain not just the surgery, but also the alternatives if you’re not ready for surgery yet.

Availability: Ask how easily you can reach the surgeon if you have questions or concerns. A surgeon with a good support team who can assist you with pre- and post-operative questions is important.

5. Use of Advanced Technology

Robotic Surgery: If you’re interested in robotic-assisted surgery, check whether the orthopaedic surgeon is experienced in using robotic technology. Robotic surgery can offer greater precision and potentially fewer complications. *Mr Alazzawi offers MAKO Robotic Hip Surgery and MAKO Robotic Knee Surgery.

Custom Implants: Some surgeons use 3D imaging to create custom prosthetics tailored to your joint anatomy. If this is important to you, make sure your surgeon offers this option.

6. Post-Operative Care and Support

Recovery Plan: Inquire about the post-operative care plan. This includes pain management, physical therapy, and follow-up appointments. A surgeon who works with a team of physical therapists and rehabilitation specialists can help ensure a smoother recovery.

Follow-up Appointments: Understand how many follow-up appointments you’ll need and how easy it is to schedule them. Post-op care is essential for proper healing, and regular check-ins help catch any complications early.

7. Alternative Treatment Options

Non-Surgical Treatments: the surgeon should also discuss non-surgical options for treatment, such as physical therapy, injections or medications, before jumping straight to recommending surgery.

8. Location and Accessibility

Proximity: Choose a surgeon whose office and hospital are reasonably close to your home, especially if you will need frequent visits during the recovery process.

Convenient Scheduling: Some surgeons have long wait times, so make sure they can accommodate your needs in a timely manner, especially if you’re dealing with a lot of pain or discomfort.

If you’re considering a joint replacement and cannot find the answers you need, we’re happy to help. Please get in touch by calling 07765 190 703 to book a consultation with Consultant Orthopaedic Surgeon Mr Alazzawi.