The painful total hip arthroplasty requires careful evaluation and investigation. This is usually focused on the prosthesis and adjacent anatomical structures. We present a case report of a 64-year-old man who had a Birmingham hip resurfacing procedure for primary osteoarthritis. His hip pain worsened following the procedure and was under systematic investigation for this. Subsequent investigation for vascular disease revealed a total infrarenal aortic occlusion. An aortobifemoral bypass improved the hip pain and function dramatically, and the patient now has an excellent quality of life.

BACKGROUND Revision of a well fixed cemented acetabular component can lead to significant bone loss. This can be avoided with the in-cement revision technique. We report the use of the Explant ® (Zimmer, Swindon, UK) acetabular cup removal system for revision of an Exeter™ (Stryker, Newbury, UK) metal backed cup with preservation of the original cement mantle, allowing subsequent cement-in-cement revision.