Large Total Joint Arthroplasty Complications in the Emergency Department: What the Radiologist Needs to Know

Large total joint arthroplasties (TJA), including total shoulder arthroplasty (TSA; anatomic [aTSA] and reverse [rTSA]), total knee arthroplasty (TKA), and total hip arthroplasty (THA), are among the most commonly performed and cost-effective orthopedic procedures in the United States. Utilization continues to rise due to an aging population with increasing functional demands, younger age at implantation, expanded indications, favorable clinical outcomes, and improved implant longevity. Despite excellent implant survivorship, complications remain clinically important. Imaging plays a central role in the evaluation of the painful arthroplasty, particularly in the emergency setting. Familiarity with normal postoperative appearances and characteristic imaging findings of complications is essential for accurate diagnosis and timely management. This review describes contemporary TSA, THA, and TKA designs and presents an imaging-based approach for evaluation of the painful arthroplasty in the emergency setting. The imaging findings of common complications, such as periprosthetic joint infection (PJI), aseptic loosening, osteolysis, instability, periprosthetic fracture (PPF) and component failure, are reviewed.