Mechanical
Loosening, wear, malposition, instability, stiffness or fracture may produce pain and loss of function.
Painful Joint Replacement
Painful or Failed Hip & Knee Replacement
Pain after a previous joint replacement does not automatically mean the implant has failed or that revision surgery is needed. The priority is to establish the cause.
Diagnosis before revisionClinical assessment · imaging · infection work-up where indicated
Quick Answer
Why can a joint replacement become painful?
Common causes include loosening, wear, infection, instability, stiffness, fracture around the implant, soft-tissue problems or pain arising from another source.
A structured assessment may include
- review of the original operation and implants
- clinical examination
- weight-bearing X-rays
- CT or other imaging when needed
- blood tests for infection
- joint aspiration or tissue sampling in selected cases
Possible Causes
Problems are not all treated the same way
Infection
Prosthetic joint infection can present in different ways and requires a specific diagnostic and treatment pathway.
Non-implant causes
Pain can come from tendons, the spine, another joint or other conditions even when the replacement itself is stable.
Does pain mean I need revision surgery?
No. Revision is considered only when there is a credible diagnosis and further surgery is expected to offer a worthwhile benefit. Revising a well-fixed replacement without understanding the pain source can expose a patient to risk without solving the problem.
How is infection investigated?
Depending on the clinical situation, investigation may include inflammatory blood markers, X-rays and joint aspiration for microbiology and cell analysis. Some cases require repeat testing or further sampling. Antibiotics can affect test results, so the pathway should be planned carefully.
When is urgent assessment needed?
After a recent joint replacement, fever, wound discharge, increasing redness, rapidly worsening swelling or pain, or feeling systemically unwell should prompt urgent contact with the treating team or NHS services. Chest pain or difficulty breathing requires emergency assessment.
Evidence & Further Reading
Independent patient information
The causes and investigation pathway reflect current NHS revision-joint information.
NHS — Hip replacement complications
Infection, dislocation, wear and when further surgery may be needed.
View NHS guidance →NHS — Knee replacement complications
Persistent pain, stiffness, instability, infection and later implant problems.
View NHS guidance →South Tees NHS — Revision hip and knee surgery
Common causes including wear, loosening, infection, fracture and instability.
View NHS information →Common Questions
Painful replacement FAQs
Can you give a second opinion on a painful replacement?
Yes. A second opinion can focus on confirming the likely diagnosis, reviewing existing investigations and explaining whether further tests or revision treatment are reasonable.
What should I bring?
Previous operation letters, implant details, recent imaging and reports, and any information about infection treatment or previous revision procedures are helpful when available.
Can a painful replacement be treated without surgery?
Sometimes. Treatment depends entirely on the cause. Not every painful replacement benefits from another operation.
