Painful or Failed Total Hip Replacement Evaluation in Atlanta
Our orthopedic surgeons evaluate painful and failed total hip replacements for patients throughout Atlanta, Decatur, Snellville, Loganville, Sandy Springs and the surrounding East Metro region. Pain may result from implant loosening, polyethylene wear, component position, tendon irritation, altered hip mechanics or another condition requiring a careful and systematic workup.
Why Can a Total Hip Replacement Become Painful?
Hip replacements are mechanical implants fixed to bone. Pain may develop because of changes involving the cup, femoral stem, plastic liner, surrounding tendons or the position and reconstruction of the hip.
Loosening of the Cup or Stem
The acetabular cup or femoral stem may lose fixation to the surrounding bone. Loosening can produce pain with walking, standing or the first several steps after getting up.
Polyethylene Wear
Older hip replacements may have conventional plastic liners that gradually wear over many years. Small wear particles can contribute to bone loss around the implants, known as osteolysis, and may eventually lead to loosening.
Component Malposition
A cup or stem placed outside the desired position may contribute to abnormal loading, instability, impingement or accelerated wear of the bearing surfaces.
Iliopsoas Impingement
The iliopsoas tendon passes across the front of the hip. It may become irritated by a prominent or positioned acetabular component, producing groin pain when lifting the leg, climbing stairs or getting into a car.
Leg Length or Offset Changes
Excessive lengthening can create tightness, altered walking mechanics or discomfort. Excessive lateralization or increased offset may place additional tension on the tissues over the outside of the hip and contribute to trochanteric bursitis.
Other Causes
Pain may also arise from a fracture, instability, muscle or tendon injury, the lower back or, less commonly, infection around the replacement.
The Location and Timing of Pain Provide Important Clues
Pain patterns do not establish the diagnosis by themselves, but they can help direct the examination and imaging workup.
Thigh Pain
Pain along the front or side of the thigh may raise concern for the femoral stem, including stem fixation, stress transfer or loosening.
Groin Pain at Startup
Groin pain during the first several steps after standing may suggest a problem involving the acetabular cup, although iliopsoas irritation and other causes must also be considered.
Outer Hip Pain
Tenderness over the greater trochanter may reflect bursitis, gluteal tendon irritation or altered tension caused by changes in leg length or hip offset.
How We Evaluate a Painful Hip Replacement
The workup should be systematic. We review the original surgery when records are available, examine the patient, evaluate the implants and screen for infection before recommending revision surgery.
History and Physical Examination
We determine where the pain is felt, when it began and whether it occurs during startup, continuous walking, hip flexion or rest. The examination also evaluates gait, strength, leg lengths, hip motion, the lower back and tenderness around the greater trochanter.
Plain X-Rays
X-rays are an excellent first-line tool. They may reveal component migration, radiolucent lines, bone loss, polyethylene wear, fracture, abnormal cup position, changes around the stem or differences compared with prior studies.
Previous X-rays are especially valuable because subtle loosening may be easier to identify by comparing images over time.
ESR and CRP Blood Tests
We routinely consider erythrocyte sedimentation rate and C-reactive protein testing when evaluating an unexplained painful hip replacement. These tests help screen for inflammation and possible infection around the implant.
Abnormal results do not prove infection, but they may indicate that additional testing, including aspiration of the hip, is needed.
CT Scan
CT can provide detailed information about cup and stem position, implant rotation, osteolysis, bone loss and areas that may be difficult to assess fully on standard X-rays.
CT is commonly obtained without IV contrast for mechanical implant evaluation. Contrast may be added when a specific soft-tissue, vascular or infectious concern requires it.
Bone Scan as an Adjunct
A nuclear medicine bone scan may sometimes provide supporting information when loosening, fracture or abnormal bone activity remains uncertain. Bone scans are interpreted together with the history, X-rays and other tests because increased activity is not specific to one diagnosis.
MRI in Selected Cases
Conventional MRI may be limited by distortion from the metal implants. Modern metal-artifact-reduction techniques can sometimes evaluate the iliopsoas tendon, gluteal tendons, fluid collections and other surrounding soft tissues.
MRI is selected only when it is likely to answer a specific question that has not been resolved by the examination, X-rays or CT.
Does Every Painful Hip Replacement Require Revision?
No. Revision surgery is recommended only when the evaluation identifies a correctable implant-related problem and the expected benefit outweighs the risks of another operation.
Nonsurgical Treatment
Bursitis, muscle weakness, iliopsoas irritation and pain referred from the back may improve with therapy, activity modification, medication or a carefully targeted diagnostic injection.
Isolated Component Revision
When one implant is loose or malpositioned while the remaining components are well fixed, it may sometimes be possible to revise only the problematic side.
Liner and Head Exchange
In selected older implants with polyethylene wear, a liner and femoral head exchange may be considered when the cup and stem remain securely fixed and appropriately positioned.
Full Revision Hip Replacement
Loose, damaged, malpositioned or severely worn implants may require removal and replacement with revision components designed to obtain stable fixation in the remaining bone.
Hip Replacement Evaluation Across Atlanta and East Metro
Atlanta Bone and Joint Specialists evaluates patients from Atlanta, Decatur, Snellville, Loganville, Sandy Springs and communities throughout Fulton County, DeKalb County, Gwinnett County and Walton County. Patients may schedule an evaluation for persistent pain, implant wear, loosening, malposition or concerns about a previous hip replacement.
Expert Evaluation for Pain After Hip Replacement
Patients from Atlanta, Decatur, Snellville, Loganville, Sandy Springs and surrounding communities can schedule an evaluation for persistent pain, implant loosening, wear, malposition or other concerns after total hip replacement.
This information is educational and does not replace an individual medical evaluation. Diagnostic testing and treatment recommendations depend on symptoms, examination findings, implant history, imaging and laboratory results.