Thigh pain following total hip arthroplasty (THA) is frequent in the revision setting due to the use of long, cementless components. The etiology of persistent thigh pain can be divided into intrinsic issues, such as aseptic or septic loosening, and extrinsic, including periarticular and extra-articular conditions. Diagnostic evaluation requires thorough patient history, physical examination, laboratory and radiological techniques to identify underlying causes. Treatment ranges from conservative approach for well-fixed implants to invasive surgical procedures including femoral strut allograft and full revision in cases of persistent severe pain.