The etiology of pain and dysfunction after total hip arthroplasty remains broad. Radiographic evaluation remains crucial in the examination of painful or failing total hip arthroplasty. A systematic approach to imaging including the use of advanced imaging modalities can identify and classify pathologic processes. Component position, loosening, and implant failure can be reasonably assessed with plain radiographs. Ultrasound, CT scan, and MRI may also be useful when a more specific clinical situation has occurred, including soft tissue problems or instability, or in the surveillance of metal-on-metal components. Revision hip surgeons should be comfortable with the strengths and limitations of specific imaging modalities as they diagnose and treat failing arthroplasties.