Failed Total Hip Arthroplasty

A total hip replacement replaces the damaged portions of the hip joint with artificial components.

The procedure typically includes:

• A metal stem placed inside the femur
• A metal or ceramic ball attached to the stem
• A metal shell placed within the pelvis
• A plastic or ceramic liner inside the socket

Together, these components recreate the ball-and-socket function of a healthy hip. When everything is functioning properly, patients often forget they even have a hip replacement. That is exactly what most patients want. The challenge is that hip replacements are mechanical devices living inside an active human body. Just like the tires on a car or the roof on a house, components can eventually wear, loosen, or develop problems over time. Fortunately, modern implants are extremely durable, and many patients enjoy decades of excellent function before any issues arise.

There are several reasons a hip replacement may become painful or stop functioning properly.

Some problems occur early after surgery, while others develop gradually over many years.

Common causes include:

Implant Loosening

Over time, the bond between the implant and the surrounding bone can weaken. When an implant becomes loose, patients may develop pain with walking, standing, or weight-bearing activities.

Polyethylene Wear

The plastic liner within the hip replacement can gradually wear over time. Although modern materials have dramatically improved durability, wear remains a potential long-term cause of failure.

Instability or Dislocation

In some patients, the ball may partially or completely come out of the socket. This can lead to recurrent instability, fear of movement, and loss of confidence in the joint.

Infection

While uncommon, infection remains one of the most serious complications associated with hip replacement. Infections may occur shortly after surgery or even years later.

Periprosthetic Fractures

A fracture occurring around the hip replacement implant can disrupt the stability of the joint and require revision surgery.

Implant Position Problems

In some situations, component positioning may contribute to instability, abnormal wear, impingement, or persistent discomfort.

Metal Reactions

Certain older implant designs may generate debris that causes inflammation or soft tissue damage around the hip. One important point Dr. Tauchen emphasizes is that not every painful hip replacement has “worn out.” Pain after hip replacement can result from a variety of causes, which is why a careful evaluation is so important.

The symptoms of a failing hip replacement vary depending on the underlying cause.

Common symptoms include:

Groin Pain

Pain in the groin is often one of the most common warning signs that something may not be functioning properly.

Thigh Pain

Pain in the upper thigh can sometimes indicate implant loosening or stress within the bone.

Pain with Walking

Many patients notice increasing discomfort with weight-bearing activities.

Limping

A new limp after years of successful function should never be ignored.

Instability

Patients may feel as though the hip wants to give way, shift, or move abnormally.

Recurrent Dislocations

Some patients experience episodes where the hip repeatedly comes out of place.

Clicking or Mechanical Symptoms

Unusual sensations, popping, or mechanical symptoms can sometimes occur when components are no longer functioning normally.

Loss of Function

Often, the biggest clue is that patients stop trusting the hip. One of the most common comments Dr. Tauchen hears is:

“I had completely forgotten about my hip replacement for years, and now I’m thinking about it every day.”

That change is often worth investigating. Whether it is difficulty walking, exercising, traveling, golfing, cycling, or simply getting through a normal day comfortably, symptoms that interfere with quality of life deserve attention.

Diagnosing the cause of a painful hip replacement begins with listening.

Dr. Tauchen spends time understanding:

• When symptoms started
• Whether the hip ever functioned well
• What activities cause discomfort
• Whether pain is worsening
• Whether instability is present
• What previous treatments have been attempted

A detailed physical examination provides additional information regarding motion, strength, gait, leg lengths, and overall hip function. X-rays are usually the most important first step in evaluating a painful hip replacement. Many problems can be identified by carefully reviewing implant position, component fixation, bone quality, and signs of wear. Additional testing may include:

Blood Tests

Laboratory studies can help evaluate for infection or inflammation.

CT Scans

CT imaging may provide a more detailed assessment of implant positioning and surrounding bone.

Joint Aspiration

In some cases, fluid may be removed from the hip and analyzed to evaluate for infection.

Advanced Imaging

Specialized imaging studies may be helpful when the diagnosis remains unclear. The most important goal is identifying the specific cause of symptoms. A painful hip replacement is not a diagnosis. It is a symptom. The real question is why the hip hurts.

One of the biggest misconceptions patients have is that revision hip replacement surgery is simply a repeat of the original operation. In reality, revision surgery is often more complex and highly individualized. The surgical plan depends entirely on the underlying problem. Sometimes only a portion of the hip replacement needs to be exchanged. In other cases, multiple components may need to be revised.

The encouraging news is that modern revision techniques continue to improve, and many patients experience substantial pain relief and improved function after revision surgery. Dr. Tauchen believes the most important step is making the correct diagnosis before discussing treatment. Because the goal is never simply to fix an X-ray. The goal is to help patients regain confidence in their hip, return to the activities they enjoy, and stop organizing their lives around pain. Whether that means walking comfortably through the neighborhood, traveling without limitations, playing golf, riding a bike, or simply forgetting the hip replacement is even there, the focus remains the same: helping patients get back to living their lives.