Dissatisfaction after total hip arthroplasty (THA) is linked to complications due to comorbitities, radiographic loosening, and poor prosthetic alignment. However, some patients have functional problems without obvious causes. This study elucidated soft tissue abnormalities that may lead to THA dysfunction and assessed the efficacy of customized physical therapeutic modalities. Seventy-eight THA patients complaining of poor functionality capabilities at 3 months after index THA were studied with a detailed physical examination and gait analysis with videotape, 3-dimensional gait studies, and isokinetic strength assessments used when necessary. Patients had muscle weakness (57), muscle tightness (32), limb length differences (11), and/or limb malalignment (10). Treatment protocols included physical therapy, electrical stimulation, shoe lifts, intramuscular botulinum, and corticosteroid injections. At 61-month mean follow-up, 73 (94%) patients had good to excellent clinical outcomes. Patient satisfaction averaged 8.7 of 10 possible points. These results suggest that various assessments and 3-dimensional gait studies are valuable tools in identifying problems after THA and help direct customized rehabilitation modalities.