Retrieval analyses of orthopedic devices for joint reconstruction often focus on the performance of the implant components and their resistance to fracture, deformation, and wear. Much has been gained in improving implant materials and designs from such an approach. But complex clinical problems in joint arthroplasty require moving beyond retrieval analysis alone to integrate other disciplines, including surgery, imaging, and pathology. We have been using such an integrated approach at our institution to attack the problem of diagnosing adverse local tissue reactions (ALTR) elicited by the generation of particulate and ionic metallic debris. We have been prospectively collecting retrieved components, tissues, and blood from patients undergoing revision hip arthroplasty; to date, we have collected information from 168 hip reconstructions in 162 patients, spanning a broad range of implant types, including metal-on-metal total hips and hip resurfacings, conventional polyethylene on metal or ceramic total hips, and modular neck-stem total hips. We compare outcomes, such as volumetric polyethylene and metallic wear, with factors from magnetic resonance imaging (MRI) of the patients’ hips, including synovial thickness and volume and grade of ALTR. For example, synovial thickness on MRI was significantly greater for metal-on-metal and modular neck-stem hips and significantly associated with extensive necrosis seen on histology. Similarly, the grade of ALTR from MRI was positively correlated with damage to the head-neck taper connection, the neck-stem connection in modular hips, and the volumetric wear of the head and acetabular components for metal on metal articulations. Though we continue to recruit patients to the study, our preliminary findings suggest that MRI can be developed as a biomarker for pending implant failure, serve as a potent surrogate endpoint for clinical trials, and provide important insights into the role of implant performance on clinical success in joint arthroplasty.