Post-total hip arthroplasty imaging optimization through clinical scenarios in practice

Total hip arthroplasty (THA) remains a definitive therapeutic option for end-stage osteoarthritis and other causes of degenerative hip disease. A wide range of post-operative complications can broadly be categorized as time-related causes of failure after THA, often necessitating revision arthroplasty. Dislocation, surgical site infection, or metal allergic reaction are the most common complications during the early post-operative period. Aseptic mechanical loosening; pseudotumor-related complications such as aseptic lymphocytic dominant vasculitis associated lesion and adverse reaction to metal debris; and heterotopic ossification will usually occur at a later stage of the time period after hip arthroplasty. Periprosthetic joint infection or periprosthetic fracture in elderly patients can occur at any given point of time after THA. Timely diagnosis of these complications is essential, but equally important is the early prediction of potential complications using appropriate imaging modalities to reduce morbidity and improve patient outcomes. Radiologists must recognize the temporal evolution of complications following THA and often rely on subtle and early imaging findings. Serial radiographs remain the cornerstone of post-THA imaging, providing essential insight during the immediate post-operative period and long-term follow-up. In addition, both radiologists and referring surgeons must carefully select the most appropriate imaging modality and determine the next steps, especially when initial findings are equivocal. Immediate post-operative radiographic assessment plays a critical role in identifying patients at increased risk for complications such as dislocation. In this article, we present a comprehensive, clinical scenario-based review of complications following THA. We highlight common clinical scenarios and emphasize the selection and utility of various imaging modalities in the diagnostic pathway.