A total hip arthroplasty, or hip replacement, is a common and successful procedure designed to restore mobility and eliminate chronic joint pain. While most artificial joints function effectively for many years, components can degrade or complications may develop over time, leading to “failure.” Understanding the signs of a failing hip replacement is important for seeking timely medical intervention. Failure can manifest in several distinct ways, including implant loosening, mechanical breakdown, or periprosthetic joint infection.
Pain Signals and Changes in Mobility
Pain is the most frequent symptom indicating an issue with a hip replacement. This discomfort often presents as a new or worsening ache in the groin or upper thigh, a common location for implant-related pain. When the femoral stem loosens within the thigh bone, pain often becomes noticeable during weight-bearing activities like standing or walking.
A distinct symptom linked to component loosening is “start-up pain,” which occurs when the patient first rises from a seated position or begins to walk after rest. Pain that persists even when the joint is at rest, particularly at night, may signal inflammation or implant loosening. A noticeable change in gait, such as developing a limp, or a significant decrease in walking ability are functional red flags. This loss of function reflects the body’s attempt to protect the unstable or painful joint.
Signs of Mechanical or Structural Instability
Symptoms related to the physical breakdown or displacement of implant components involve specific sensations and noises within the joint. New sounds, such as clicking, grinding, popping, or squeaking during movement, suggest abnormal friction or contact between the prosthetic parts. These noises can be caused by excessive wear of the plastic liner or slight shifts in the implant position.
A feeling that the hip joint is unstable or might “give way” when bearing weight indicates structural compromise. This sensation, known as instability, often occurs due to component loosening from the bone or excessive wear. In severe cases, the artificial ball may partially or completely come out of the socket, resulting in recurrent dislocation. A sudden, noticeable shortening of the leg can also signal that the femoral component has subsided further into the bone due to loosening.
Recognizing Periprosthetic Joint Infection
Infection around the joint implant, known as periprosthetic joint infection (PJI), is a serious complication that can occur at any time after surgery. Acute PJI typically presents with clear, localized signs of inflammation at the surgical site. These include increased warmth, redness (erythema), and tenderness, often accompanied by drainage or pus from the wound.
Systemic symptoms, such as persistent fever, chills, and unusual fatigue, often accompany acute infections. However, many infections are chronic, particularly those caused by less aggressive bacteria, and may present more subtly. Chronic PJI may only manifest as persistent joint pain or implant loosening without typical signs of fever or local inflammation. In serious instances of chronic infection, a sinus tract or fistula—a channel connecting the infected joint space to the skin—may form, leading to persistent fluid drainage.
When to Contact Your Orthopedic Surgeon
Any new or worsening symptom related to your hip replacement should prompt a consultation with your orthopedic surgeon. Symptoms requiring immediate medical attention include signs of infection, such as fever, chills, or sudden, increased wound drainage. A sudden and complete inability to bear weight or the feeling of a complete dislocation warrants emergency evaluation.
For chronic, progressive issues like a persistent increase in pain with activity, night pain, or new clicking or grinding noises, schedule an appointment promptly. Providing your medical team with a detailed history of when the symptoms started and how they have changed is important for accurate diagnosis. Never ignore symptoms, as early detection of a problem can significantly improve the success of any necessary revision procedure.