A Systematic Approach to the Preoperative Workup of Contemporary Modes of Failure for Total Hip Arthroplasty

Identifying the correct etiology of total hip arthroplasty (THA) failure is the critical first step in determining the most appropriate course of treatment. In many cases, the cause of failure may not be evident. Thus, a systematic approach to the failed THA is paramount to identifying the correct diagnosis. Many studies provide a detailed understanding of why THAs fail. However, a concomitant methodology to distinguish one failure modality from another is not readily available. In addition, the diagnosis of one mode of failure may lead a surgeon to inadvertently overlook other potential coexisting mode(s) of failure. In this article, we present a systematic approach for determining the cause of THA failure. The essence of this review article lies in the comprehensive worksheet that provides a clear framework to evaluate patients presenting with a failed or painful THA, especially in the absence of obvious causes. A systematic approach minimizes the chances of excluding pertinent information and concomitant modes of failure, which may lead to an inaccurate diagnosis and high likelihood of failure following revision surgery. This simple guide is intended to help residents, fellows, and surgeons in practice to avoid overlooking concomitant etiologies in a failed THA and thereby improve the chances of successful outcomes.