Total hip arthroplasty is a common and effective operation with ahigh success rate. The purpose of this essay is to review the appearance of normal successful hip arthroplasty and accepted post-operative changes as well as the appearance of complications such as osteolysis, infection, aseptic loosening as well as periprosthetic and component fracture. Knowledge of the potential complications and their imaging appearances will help in the diagnostic evaluation of the patient with a total hip arthroplasty. Moreover highlight the accepted post-operative changes will be beneficial not to be overestimated as a complication.