Adverse local tissue reactions represent a clear diagnostic and treatment challenge for orthopaedic surgeons in patients who have undergone total hip arthroplasty. Diagnosis and management requires correlation among clinical, laboratory, imaging findings, and determination of hip replacement model to implement the most appropriate treatment strategy. Tribocorrosion processes in metal-on-metal bearings and modular junctions are associated with the release of metal debris, resulting in adverse local tissue reactions (ALTRs), which include an inflammatory reaction termed aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL), tissue necrosis, and osteolysis. Diagnostic evaluation should include metal artifact reduction sequence–magnetic resonance imaging (MARS MRI) and serum metal level testing, in addition to testing to rule out more common etiologies of pain following total hip arthroplasty. Treatment typically requires surgical intervention, with either exchange of modular components or revision of the entire component. It is essential for the orthopaedic surgeon to be aware of the potential for complications secondary to tribocorrosion reactions in patients with a total hip arthroplasty.