You had your joint replaced. You walked out of surgery with a plan, a therapist, and the sense that the future looked smoother, less painful. So it can feel confusing and alarming when old pain creeps back in or new symptoms appear months or years later. The good news: not all return-of-pain signals disaster. The better news: when something’s off, MidAmerica Orthopaedics has a clear, stepwise approach to figure out why and to get you moving toward a solution — whether that solution is a course of conservative care, a targeted procedure, or a carefully planned revision.

This piece walks through why replacement pain can return, how to tell the difference between “recovering discomfort” and a problem that needs attention, and what MidAmerica’s Total Joint and adult reconstruction teams actually do to evaluate and treat these situations. We’ll mention a few of the surgeons and specialists on our team so you know who might see you during this process.

Why pain can come back (and why timing matters)

There are several reasons someone might experience pain or dysfunction after a joint replacement. Common causes include:

• Infection: This can happen soon after surgery or even years later. Infection around an implant is serious and requires prompt evaluation.
• Implant loosening or wear: Over time, components may loosen or wear, causing pain and instability.
• Instability or dislocation: Especially with hips, an unstable joint can cause repeated symptoms of giving-way or subluxation.
• Fracture around the implant (periprosthetic fracture): Trauma can cause fractures adjacent to components.
• Soft-tissue problems or referred pain: Tendons, muscles, or even the spine can generate pain that seems like it’s coming from the joint.

Timing matters: immediate postoperative pain that’s progressively improving is usual. New pain weeks to years out — especially if accompanied by swelling, fever, inability to bear weight, or a sudden decline in function — should prompt a specialist evaluation.

What MidAmerica does first: a methodical, evidence-driven approach

When a patient calls describing return of pain, our team follows a stepwise pathway:

• History & physical exam. We take a careful history: when did pain start, was there trauma, any fever, changes in function or gait? Simple details narrow the list quickly.
• Basic labs and imaging. Blood tests (including markers for infection) and X-rays are often first. If infection is suspected, advanced testing and sometimes aspiration of the joint for analysis is ordered.
• Advanced imaging if needed. CT or specialized imaging helps evaluate component position, bone loss, and subtle loosening.
• Multidisciplinary conference. Complex cases may be reviewed by our adult reconstruction surgeons, infectious disease consultants, and rehab team to build a coordinated plan.

This is the kind of coordinated care that surgeons like Sarkis Bedikian, MD (adult reconstruction) and Kevin Lindsay-Rivera, MD (hip & knee replacement) and others on our Total Joint team collaborate on — each bringing fellowship-trained expertise to the evaluation and plan. MidAmerica’s philosophy is to explain options clearly, share risks and expected recovery, and align the plan with each patient’s goals.

Common scenarios and what they usually mean

• Gradual pain months or years after surgery with radiographic loosening: Often related to mechanical loosening or wear. Management might include revision surgery or, in selected cases, targeted nonoperative care if symptoms are mild.
• Sudden pain with fever and wound issues: Suspect infection. This often requires urgent intervention, antibiotic management, and potentially staged revision. Prompt diagnosis matters because infection control is time-sensitive.
• Persistent stiffness but decent radiographs: Sometimes postoperative scar tissue, poor rehab, or referral from the spine is culprit — physical therapy, targeted injections, or spine evaluation can resolve symptoms.
• Acute trauma with inability to bear weight: Evaluate quickly for periprosthetic fracture; surgical fixation or revision may be necessary.

When revision is the right answer

Revision surgery is a bigger, more complex operation than the primary replacement, and it’s chosen after careful deliberation. Reasons for revision include infection that can’t be managed conservatively, mechanical loosening causing pain and loss of function, prosthetic failure, or periprosthetic fracture. Revision procedures can involve removing old components, addressing bone loss with augments or grafting, and placing new, specialized implants. The surgical approach is designed around the cause — there’s no one-size-fits-all.

At MidAmerica, our adult reconstruction surgeons work with imaging specialists and physical therapists to set realistic expectations for recovery and function after revision. If surgery is needed, we coordinate perioperative care through our ambulatory and hospital-based platforms, including the Palos Hills Surgery Center where appropriate.

What you can expect if we recommend surgery

• Detailed preoperative planning with imaging and implant selection.
• Multidisciplinary perioperative care — anesthesia, nursing staff, and therapy are briefed about the unique needs of revision cases.
• Individualized rehab. Recovery can be longer than a primary replacement; our PT and occupational therapy teams design staged plans so you rebuild strength and mobility safely.

Non-surgical options that still help

Not every return-of-pain requires an operation. When appropriate we try:

• Targeted physical therapy to correct strength and gait deficits.
• Image-guided injections for diagnostic and therapeutic relief.
• Activity modification and bracing to stabilize the joint while other treatments work.
• Collaborative care with pain management and PM&R specialists (for example, Dr. Robert Metzler on our team) when needed.

How to make the call

If your replaced joint is suddenly worse, or if you have any of the red flags mentioned earlier (fever, drainage, inability to bear weight, sudden swelling), call us. MidAmerica offers coordinated access to our Total Joint Clinic, imaging, and Immediate Care for acute problems — and our team will help you figure out the next right step.

Final word

Getting a joint replaced is a major step toward a more active life. If the joint starts to return to its old, painful ways, that’s stressful — but it’s not the end of the story. MidAmerica Orthopaedics approaches each case with careful evaluation, thoughtful use of imaging and labs, and a patient-first plan. Whether that plan is conservative recovery, a targeted injection, or a revision operation, our goal is the same: restore your function and get you back to the life you want.

For appointments or urgent concerns, call (708) 237-7200 or request an appointment online. Our Total Joint team and adult reconstruction specialists are available to evaluate and explain your options.