Your replacement still hurts. That deserves an answer.
A hip or knee replacement that hurts, feels unstable, or never felt right is telling you something. The job is to find out what — before anyone decides to operate again.
Diagnosis first. Always.
The single most important thing I can tell you is that not every painful joint replacement needs to be revised. A meaningful number of the painful replacements I see don’t need another operation at all — they need the actual cause identified and treated, and sometimes that cause isn’t the implant.
Revision is a bigger operation than the original, with a longer recovery and more that can go wrong. It is worth doing when it corrects the thing that is actually causing your pain. It is worth avoiding when it doesn’t. Telling those two situations apart is the entire value of this visit.
And if you’ve been told your replacement “looks fine” while you continue to hurt — that is a reading of an X-ray, not a diagnosis. Several of the most common causes of a painful replacement look perfectly normal on plain films.
Why a replacement hurts
These are the explanations worth working through, roughly in the order they need to be ruled in or out. The pattern of your pain — when it started, what provokes it, whether it is getting worse — narrows this list considerably.
Infection
The first thing to rule out, because it changes everything that follows. Low-grade infection can smoulder for months with nothing but pain and stiffness to show for it — no fever, no redness, normal-looking X-rays. It is diagnosed with bloodwork and, when indicated, aspirating the joint. Operating on an infected replacement without knowing it is one of the worst outcomes in this field.
Loosening
An implant that has lost its fixation to bone. Classically this hurts with the first few steps and eases as you get going, and it tends to worsen over time rather than plateau. Serial X-rays comparing against your earliest post-operative films are far more informative than any single image.
Instability
The hip that feels like it wants to give way or has dislocated; the knee that buckles on stairs or feels untrustworthy going downhill. Often a question of component position, soft-tissue balance, or ligament competence rather than the implant itself.
Malposition or size mismatch
A component placed outside the window that particular body tolerates, or one sized in a way that irritates surrounding tissue. Frequently explains a replacement that never felt right from the very first weeks, as opposed to one that was fine for years and then changed.
Wear or material reaction
The bearing surface wearing over many years, or in some implants a reaction to the material itself. This is a late finding — a concern for a replacement well into its second decade, not for one done last year.
The problem isn’t the replacement
This one gets missed constantly. Hip pain that is actually coming from the spine. Knee pain referred from an arthritic hip. Bursitis, tendon problems, or a neuropathic pain syndrome layered on top of a perfectly good implant. Revising a well-functioning replacement for pain generated somewhere else helps nobody, and it is not a rare mistake.
What it takes to answer this properly
You don’t need all of this before we talk — send what you have and our team will help you request the rest. But this is what a complete evaluation of a painful replacement generally involves:
- Your original operative report and the implant records — make, model, and sizes. This matters more than patients expect and is the item most often missing.
- Serial X-rays, ideally including films taken shortly after the original surgery, so change over time is visible rather than guessed at.
- Inflammatory bloodwork (ESR and CRP) as the initial screen for infection.
- Joint aspiration when the history or bloodwork raises any suspicion of infection.
- Advanced imaging — CT for component position, or metal-suppression MRI for soft tissue — when the plain films don’t answer the question.
- An examination of the joints above and below, because referred pain is a common and correctable explanation.
What I’ll tell you
- A specific working diagnosis, or an honest statement that we don’t have one yet and what it would take to get there
- Whether the operation you’ve been offered addresses the cause of your pain or only its location
- Whether waiting is safe in your situation, or whether something is actively getting worse
- What a revision would realistically improve — and, just as importantly, what it wouldn’t
- Whether a smaller procedure, or no procedure at all, is the better answer
Plenty of these visits end with the patient going back to their original surgeon with a clearer question than they arrived with. That’s a good outcome.
Video, in writing, or in person
Revision questions lean heavily on imaging, implant records, and the story of how the pain behaves — which makes them well suited to review at a distance. You can do this as a secure video visit, as a written opinion with no scheduled visit at all, or in person at either office. If answering your question genuinely requires hands-on examination, I’ll tell you that instead of guessing.
For the background on what these operations involve, see revision hip replacement and revision knee replacement. For second opinions on an operation you haven’t had yet, start at the second opinion overview.
Start here
Tell us what was done, when, and what it’s doing now. Our team will follow up to get you scheduled and help you track down your operative report and implant records if you don’t have them. You do not need to live nearby, and you do not need a referral.
Questions patients ask
My replacement still hurts but my surgeon says it looks fine. What now?
A normal-looking X-ray rules out some causes and none of the others. Infection, instability, component malposition, and referred pain from the spine or a neighboring joint can all produce a painful replacement that looks unremarkable on plain films. "It looks fine" is a reading of one image, not a diagnosis. If the pain is real and persistent, it deserves a workup rather than reassurance.
Does a painful joint replacement always need revision surgery?
No, and this is the most important thing to understand. A meaningful share of painful replacements do not need to be revised at all — the pain is coming from infection that needs treating, from soft tissue, or from another joint entirely. Revision is a bigger operation than the original with a longer recovery, and it only helps when it corrects the actual cause. Accurate diagnosis comes first, always.
How do you tell if a replacement is infected?
It starts with history and examination, then inflammatory bloodwork (ESR and CRP) as a screen, and joint aspiration when suspicion is raised. Low-grade infection is easy to miss because it often presents as nothing more than persistent pain and stiffness with normal-looking imaging. It has to be ruled out before any decision to operate again, because it completely changes the plan.
Why do you need my implant records?
Knowing the exact make, model, and sizes of what is already in place determines what a revision would involve, which components can be exchanged in isolation, and what needs to be available in the operating room. It is the single most useful document you can bring, and it is the one most patients do not have. Your original surgeon’s office or the hospital medical records department can provide the operative report.
Can you review a painful replacement without me traveling?
Yes. Revision questions are heavily driven by imaging, implant records, and history, which makes them well suited to review at a distance — by secure video visit or as a written opinion with no scheduled visit at all. If a hands-on examination turns out to be necessary to answer the question, we will tell you that rather than guess.
How long should I wait before getting another opinion?
If your replacement is getting worse rather than better, if you have new instability or giving way, or if you have any signs of infection such as fever, drainage, or a wound that will not settle, do not wait — call the office. Otherwise, persistent pain that has not improved over several months is a reasonable point to have someone else look, and there is no penalty for asking early.
What patients say after seeing Dr. Harb
“A really smooth operation — I was discharged the same day and basically able to walk easily within a day.”
“I walked into the surgical center in great pain and walked out with a new knee and a renewed person.”
“My full knee replacement is a big success — six months after surgery I’m hiking and kayaking again.”
5.0 rating based on 524 verified patient reviews
Read reviews on Google: Washington, D.C.Germantown
Find out why your replacement hurts
Schedule a consultation with Dr. Harb to discuss your hip or knee and build a plan to get you back to the activities you love.