Special Medical Considerations When Evaluating the Painful Total Hip Arthroplasty

Many conditions can cause hip pain that is unrelated to a patient’s total hip arthroplasty. Individually, these conditions are relatively rare, but in aggregate, the question of whether a patient’s pain is secondary to his or her arthroplasty components is common. The pain mechanisms of referred nociceptive pain, neuropathic pain, and nociplastic pain provide a helpful overarching structure for organizing a broad differential diagnosis. Referred nociceptive and neuropathic pain are likely related to the lumbar spine, but there are many other etiologies that should be considered as well. The hip surgeon should also account for central sensitization which comes in many forms. Multidisciplinary teams can be helpful in the diagnosis and management of these complex conditions.