Periprosthetic joint pain: Definition, Uses, and Clinical Overview

Periprosthetic joint pain Introduction (What it is)

Periprosthetic joint pain is pain felt in or around a joint that has an artificial implant.
It most often refers to symptoms after hip or knee replacement surgery.
Clinicians use the term to describe a problem area, not a single diagnosis.
It signals the need to consider implant-related and non-implant-related causes.

Why Periprosthetic joint pain used (Purpose / benefits)

Periprosthetic joint pain is a practical umbrella term used in orthopedics to organize evaluation after joint replacement. People can develop new pain, persistent pain, or returning pain months or years after an implant is placed. Because many different conditions can feel similar to patients, the term helps clinicians communicate clearly and work through a structured “differential diagnosis” (the list of possible causes).

From a clinical perspective, the purpose is to answer a few key questions safely and efficiently:

• Is the pain expected healing discomfort, or is it outside the expected recovery pattern?
• Is the implant stable and functioning as intended, or is there a mechanical problem?
• Is there inflammation or infection around the implant?
• Could the pain be referred from another region (for example, the spine) rather than coming from the replaced joint itself?

In that sense, Periprosthetic joint pain is not a treatment. It is a symptom category that supports consistent documentation, appropriate testing, and careful decisions about monitoring versus intervention. It is also used in research and quality improvement to track outcomes after arthroplasty (joint replacement).

Indications (When orthopedic clinicians use it)

Orthopedic clinicians commonly use the term Periprosthetic joint pain in scenarios such as:

• Persistent pain after hip or knee arthroplasty beyond the early recovery window
• New onset pain after a period of good function following joint replacement
• Pain associated with activity, weight-bearing, or specific movements after implant surgery
• Pain with swelling, warmth, redness, wound concerns, or systemic symptoms that raise concern for infection
• Pain after a fall, twisting injury, or other trauma in a person with an implant
• Pain with a feeling of instability, “giving way,” clicking, or mechanical catching sensations
• Unexplained decline in walking tolerance or function in an arthroplasty patient
• Preoperative planning for revision surgery (repeat joint replacement) when pain is a major symptom

Contraindications / when it’s NOT ideal

Periprosthetic joint pain is a useful label, but there are situations where it is not the best framing or where another approach may be more informative:

• No implant present: The term is specific to joints with prosthetic components.
• Clearly non-joint, non-implant pain patterns: For example, pain that is strongly consistent with a primary neurologic condition or vascular condition may be better described by that primary diagnosis, even if a joint replacement exists.
• Normal, expected early postoperative soreness: Early healing discomfort is often described in more specific postoperative terms; what counts as “expected” varies by clinician and case.
• Diffuse, systemic pain syndromes: Widespread pain conditions may require broader medical framing rather than an implant-centered label.
• When a specific diagnosis is already established: If the cause is known (for example, a confirmed fracture or a confirmed infection), clinicians typically use the specific diagnosis rather than the umbrella term.

This section does not mean that non-implant causes are “excluded.” In fact, part of evaluating Periprosthetic joint pain is actively considering sources outside the implant and surrounding bone.

How it works (Mechanism / physiology)

Periprosthetic joint pain does not have a single mechanism because it is not one disease. Instead, it describes pain generated from tissues in and around an implanted joint, or pain perceived there but originating elsewhere.

High-level mechanisms clinicians consider

• Mechanical sources: Pain related to movement, loading, or component interaction. Examples include loosening at the bone–implant interface, instability, component malposition, impingement, or wear-related problems. Mechanical pain often has an activity relationship, but patterns vary by clinician and case.
• Inflammatory or infectious sources: Inflammation of the synovium (joint lining), surrounding soft tissues, or bone can cause pain at rest, swelling, warmth, and stiffness. Infection is an important category because it can mimic other problems and may require different management pathways.
• Bone-related sources: Stress reactions, periprosthetic fracture (fracture around the implant), or bone loss can generate focal pain, especially with weight-bearing.
• Soft-tissue sources: Tendons, bursae, muscles, and scar tissue around the joint can be pain generators. After hip replacement, for example, the abductors, iliopsoas tendon, and trochanteric bursa region may be considered depending on symptoms.
• Referred pain: The hip and knee can “share” nerve pathways with the lumbar spine and pelvis. Lumbar radiculopathy, sacroiliac joint disorders, or other regional problems can feel like hip or knee pain even when the implant is functioning.

Relevant anatomy (hip-focused, with broader arthroplasty context)

• Hip joint structures: acetabulum (socket), femoral head/neck region, surrounding capsule, labrum (native hip), and periarticular muscles (gluteals/abductors, iliopsoas). In hip arthroplasty, the implant replaces the joint surfaces, but pain can arise from bone, soft tissues, and the interface between implant and bone.
• Periprosthetic tissues: bone surrounding the stem or cup, cement mantle (if cemented), fibrous tissue at interfaces, and local nerves.
• Knee arthroplasty parallels: similar principles apply—component fixation to bone, ligaments for stability, and soft tissues that can be irritated.

Onset, duration, and reversibility

• Onset: Symptoms may be immediate post-surgical, delayed, or sudden after an event (like trauma). Timing is clinically meaningful but does not point to a single cause by itself.
• Duration: Pain may fluctuate with activity and inflammation. Some causes are self-limited; others persist until the underlying issue is addressed.
• Reversibility: Because Periprosthetic joint pain is a descriptor, “reversibility” depends on the cause. Some causes may improve with time and rehabilitation; others may require procedural or surgical solutions. This varies by clinician and case.

Periprosthetic joint pain Procedure overview (How it’s applied)

Periprosthetic joint pain is not a single procedure. It is a clinical problem that typically triggers a stepwise evaluation and, when needed, targeted testing. A general workflow often looks like this:

1. Evaluation / exam – Review the surgical history (type of implant, timing, prior complications, prior imaging). – Clarify the pain story: onset, location (groin, thigh, buttock, knee), quality, activity relationship, rest/night pain, and functional limits. – Screen for systemic symptoms (feverish feeling, wound changes) and red flags (trauma, inability to bear weight). – Perform a focused exam: gait, range of motion, strength, leg length perception, tenderness points, and neurovascular checks.

2. Preparation (planning the workup) – Decide what questions need answering first: infection, fracture, loosening, instability, or referred pain. – Consider whether prior operative reports and implant information are needed; details can vary by material and manufacturer.

3. Intervention / testing – Imaging may include plain radiographs (X-rays) and, in selected cases, advanced imaging. The choice depends on the clinical question, the implant type, and local imaging capabilities. – Laboratory tests may be used when infection or inflammation is a concern. – Joint aspiration (drawing fluid from the joint) may be considered in some cases to help assess for infection; whether it is appropriate varies by clinician and case. – Additional evaluations may be used if referred pain is suspected (for example, spine or neurologic assessment).

4. Immediate checks – Clinicians correlate symptoms with exam findings and test results to narrow the cause. – They also look for findings that require urgent attention (for example, suspected fracture or severe infection).

5. Follow-up – A plan is usually made for monitoring, rehabilitation progression, further testing, or referral for surgical consultation if revision is being considered. – Follow-up timing and pathways vary by clinician, case complexity, and local practice patterns.

Types / variations

Periprosthetic joint pain can be described in several clinically useful ways. These categories help clinicians communicate, but they can overlap.

By timing

• Early postoperative pain: Pain soon after surgery may relate to healing, soft-tissue recovery, or early complications. What is “early” can differ by clinician and case.
• Persistent pain: Pain that does not improve as expected over time.
• Late or delayed pain: Pain that begins after a period of good function, sometimes years after implantation.

By suspected source (broad categories)

• Intrinsic (implant/joint-related): loosening, instability, wear-related issues, periprosthetic fracture, infection, stiffness/arthrofibrosis, or component-related irritation.
• Extrinsic (outside the implant): lumbar spine disorders, pelvic conditions, tendon or bursal problems, vascular issues, or other regional musculoskeletal conditions.

By pain pattern

• Mechanical pattern: worse with weight-bearing or specific movements; may include clicking or feelings of instability.
• Inflammatory pattern: stiffness, swelling, or pain at rest; infection is considered when systemic features or wound concerns are present.
• Focal soft-tissue pattern: tenderness over a specific tendon or bursa region, with pain reproduced by targeted maneuvers.

By location (examples used in hip arthroplasty discussions)

• Groin pain: often prompts evaluation of hip joint mechanics, iliopsoas region, or component position, among other considerations.
• Lateral hip pain: may raise consideration of abductor tendons or trochanteric bursa region, though other causes remain possible.
• Thigh pain: may be discussed in relation to femoral component fixation, bone stress, or referred pain.
• Buttock/back-associated pain: commonly triggers assessment for lumbar spine or sacroiliac contributions.

Pros and cons

Pros:

• Provides a clear, widely understood term for pain related to a joint replacement context
• Encourages a systematic approach (mechanical, infectious, bone, soft tissue, referred pain)
• Helps patients and clinicians communicate about symptoms without assuming a single cause
• Supports appropriate use of imaging and lab testing when clinically indicated
• Useful for documentation, second opinions, and continuity of care across providers
• Helps frame shared decision-making when monitoring versus intervention is being considered

Cons:

• It is broad and can feel vague without further diagnostic clarification
• Similar symptoms can come from very different causes, making evaluation time-consuming
• Anxiety-provoking for patients because it may be associated with implant “failure,” even when that is not the case
• Testing choices can be influenced by implant type and local resources; results are not always definitive
• More than one pain source can exist at the same time (for example, spine plus hip), complicating interpretation
• Some causes are subtle and may not show clearly on initial imaging, requiring follow-up and reassessment

Aftercare & longevity

Because Periprosthetic joint pain describes a symptom rather than a single treatment, “aftercare” focuses on what commonly affects symptom course, evaluation timelines, and longer-term outcomes.

Key factors that can influence how symptoms evolve include:

• Underlying cause and severity: Mechanical instability, infection, fracture, soft-tissue irritation, and referred pain have different typical trajectories.
• Time since surgery: Early recovery tissues can be sensitive, while late-onset pain may prompt closer evaluation for mechanical or biologic changes around the implant.
• Rehabilitation and activity progression: Restoring strength, gait mechanics, and mobility often influences symptoms, especially when soft tissues are a major contributor. Specific plans vary by clinician and case.
• Weight-bearing status and functional demands: Daily load, occupational demands, and sport/recreation levels can influence pain patterns and when symptoms appear.
• Comorbidities: Bone quality, inflammatory disease, diabetes, vascular disease, and spine disorders can affect pain perception, healing, and complication risk.
• Implant and fixation variables: Cemented vs uncemented fixation, bearing surfaces, and implant geometry can shape how forces transmit to bone. Effects vary by material and manufacturer.
• Follow-up and monitoring: Repeat assessment may be important when symptoms change, when initial tests are inconclusive, or when a watchful waiting approach is chosen.

In general, clinicians track trends over time—what worsens, what improves, and what functional limits appear—because pattern recognition is often central to narrowing the cause.

Alternatives / comparisons

Because Periprosthetic joint pain is a clinical descriptor, “alternatives” usually mean other ways of framing the symptom problem or other evaluation pathways.

Observation/monitoring vs active diagnostic workup

• Monitoring: In some situations—especially when symptoms are mild, improving, and not associated with concerning signs—clinicians may choose watchful waiting with reassessment.
• Active workup: When pain is persistent, worsening, function-limiting, or associated with red flags (such as trauma or infection concerns), clinicians often escalate to imaging, lab testing, or specialty consultation.

Physical therapy-focused approach vs procedure-focused approach

• Rehabilitation emphasis: If the suspected drivers are gait changes, weakness, soft-tissue irritation, or deconditioning, clinicians may emphasize physical therapy and gradual functional restoration.
• Procedural testing: In selected cases, targeted injections may be used diagnostically to help localize a pain source (for example, distinguishing intra-articular from extra-articular pain). Whether this is appropriate varies by clinician and case.

Imaging comparisons (high level)

• X-rays: Often the first-line tool to assess component position, alignment, fractures, and some signs that may suggest loosening over time.
• CT, MRI, or nuclear medicine studies: May be considered to evaluate complex bone anatomy, component position, soft tissues, or biologic activity around an implant. The best test depends on the question being asked and the implant’s effect on image quality.

Terminology comparisons

• “Persistent pain after arthroplasty” emphasizes the time course and patient experience.
• “Painful hip replacement” or “painful knee replacement” is common in patient-facing discussions.
• “Failed arthroplasty” is typically reserved for cases where a specific problem is identified (for example, loosening or instability) and may imply a need for revision; clinicians vary in how they use this term.

Periprosthetic joint pain Common questions (FAQ)

Q: Does Periprosthetic joint pain always mean the implant is failing?
No. The term includes many possibilities, including soft-tissue irritation, referred pain from the back, and recovery-related sensitivity. Some causes are mechanical implant problems, but many are not. Determining the cause usually requires a history, exam, and sometimes testing.

Q: What symptoms make clinicians more concerned about infection?
Concern may increase with combinations of worsening pain, swelling, warmth, wound drainage, or systemic symptoms. Not everyone with an infection has all of these signs, and some non-infectious conditions can look similar. Clinicians often use labs and sometimes joint fluid testing when infection is a possibility.

Q: What tests are commonly used to evaluate Periprosthetic joint pain?
X-rays are commonly used first to look at implant position and surrounding bone. Lab tests may be used when inflammation or infection is part of the question. Advanced imaging or aspiration may be considered depending on findings and clinical suspicion.

Q: Can Periprosthetic joint pain improve on its own?
It can, depending on the cause. Some soft-tissue and recovery-related problems may improve over time, while mechanical issues or infection may persist until addressed. The expected course varies by clinician and case.

Q: How long do evaluation and follow-up usually take?
It depends on symptom severity, timing after surgery, and how quickly the likely causes can be narrowed. Some situations are clarified with an exam and X-rays, while others require staged testing over multiple visits. Timing also varies by health system and local resources.

Q: Is it safe to keep walking or exercising with Periprosthetic joint pain?
Safety depends on the suspected cause and the presence of red flags like trauma, inability to bear weight, or infection concern. Clinicians typically tailor activity guidance to the individual situation. General recommendations are not appropriate without an evaluation.

Q: Will I need revision surgery if I have Periprosthetic joint pain?
Not necessarily. Revision is considered when a specific implant-related problem is identified and symptoms are significant. Many patients are managed without revision, especially when pain is due to soft tissues, referred sources, or issues that can be addressed without replacing components.

Q: Can I drive or return to work while this is being evaluated?
Return-to-driving and work decisions depend on pain level, medication use, mobility, reaction time, and job demands. Clinicians often base recommendations on function and safety considerations rather than the label alone. Policies and thresholds vary by clinician and case.

Q: What does it mean if imaging looks “normal” but pain continues?
Some pain sources do not show clearly on initial X-rays, including certain soft-tissue problems, early loosening changes, or referred pain. In those cases, clinicians may reassess the diagnosis, consider additional tests, or monitor changes over time. A normal early test does not automatically rule out every cause.

Q: What does Periprosthetic joint pain evaluation cost?
Costs vary widely based on the setting, insurance coverage, region, and which tests are needed. An evaluation that includes only an office visit and X-rays differs from one requiring advanced imaging, lab work, or procedures. Discussing anticipated steps with the treating clinic is often the most accurate way to understand likely charges.