MRI evaluation of the painful hip arthroplasty: focus on circumferential periosteal reaction.

When MRI for painful hip arthroplasty appears normal around the hardware and joint, scrutinize the proximal femoral periosteum. A subtle but key finding is a high-signal rim of circumferential periosteal reaction.

• This is an educational imaging pearl focused on a specific secondary sign of pathology in the setting of painful hip arthroplasty.
• The finding is a high-signal rim of periosteal reaction wrapping completely around the proximal femur, seen on MRI.
• The clinical takeaway is to expand the search pattern beyond the joint and implant-bone interface.

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