Evaluation of the Painful Total Hip Replacement:

- See: THR Main Menu and Radiographic evaluation of THR

- Discussion: 
    - normal gait adaptions:
         - trendelenburg limp after THR is a clinical sign of gluteal insufficiency;
               - static trendelenburg sign: drop of the pelvis on the contralateral side while the individual stands on the operative side;
               - many patients will compensate for an isolated drop of the pelvis w/ Duchenne limp;
               - Duchenne limp: bending of the trunk toward the stance side combined with an additional lift of the pelvis on the side of the swinging limb;

    - infection:
    - stress fracture
             - Pubic Ramus Insufficiency Fractures Following Total Hip Arthroplasty. A Report of Six Cases.
             - Acetabular fracture associated with cementless acetabular component insertion: a report of 13 cases.
    - aseptic loosening 
             - examination for loosening
    - osteolysis:
    - thigh pain from press fit stem: 
(press fit stems)
    - trochanteric bursitis:
             - Trochanteric Bursitis After Total Hip Arthroplasty: Incidence and Evaluation of Response to Treatment
             - Lateral trochanteric pain following primary total hip arthroplasty.
             - Distal lengthening of ilio-tibial band by Z-plasty for treating refractory greater trochanteric pain after total hip arthroplasty (Pedersen-Noor operation).
             - A new surgical method for treating patients with refractory external snapping hip: Pedersen-Noor operation.
             - The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band

    - hernia
             - Evaluation of patients with pain following total hip replacement.
             - Strangulated obturator hernia masquerading as pain from a total hip replacement
    - hematoma:
             - Femoral nerve palsy due to iliacus hematoma occurred after primary total hip arthroplasty.
    - component malposition
             - acetabular component malposition
                    - excessive acetabular anteversion
                            - can cause mechanical impingement of  posteroinferior aspect of the neck of the femoral component, with impingement
                                      between the socket and the femoral neck during the maximum extension of the hip
                            - increased posterior tilt of pelvis in the standing position can make anteversion of the acetabular cup more significant, which
                                     will enhanced the cup-neck impingement during the gait;
             - references:
                     - Posterior femoral neck impingement secondary to excess acetabular anteversion in hip resurfacing arthroplasty.
                     - Cup-neck Impingement Due to the Malposition of the Implant as a Possible Mechanism for Metallosis in Metal-on-metal Total Hip Arthroplasty
                     - Notching of the femoral stem neck in metal-on-metal total hip replacement: a case report

    - psoas tendonitis: (see psoas tendon)
           - Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A
           - Oversized cups as a major risk factor of postoperative pain after total hip arthroplasty
    - regional sciatica
           - Painful total hip replacement due to sciatic nerve entrapment in scar tissue and lipoma
           - Sciatic nerve palsy--a complication of posterior approach using enhanced soft tissue repair for total hip arthroplasty
           - Sciatic Nerve Release Following Fracture or Reconstructive Surgery of the Acetabulum
           - Sciatic nerve release following fracture or reconstructive surgery of the acetabulum. Surgical technique
           - Compression of the sciatic nerve by wear debris following total hip replacement: a report of three cases.
    - metal corrosion:
           -
metal on metal prosthesis
           - references:
                  - Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions After Total Hip Arthroplasty
                  - A 68-year-old woman with hip pain 3 years after primary total hip arthroplasty

- Role of Differential Injections: (see hip aspiration)
   - intra-articular injection of marcaine can be used in the diagnosis of component loosening;
   - in the study by Crawford RW, et al (1997), 15 patients with a painful THR received a marcaine injection;
         - 14 patients received relief with the injection and 13 of them were found to have loose components (either femoral and/or acetabular);
                 - it did not seem to matter whether components were cemented or press fit;
         - hip was aspirated and any fluid obtained was sent for culture, and if fluid was not obtained then inject 5 ml of Hartman's syndrome and re-aspirate;
         - after aspiration, 10 cc of marcaine is injected;
         - ref: Intra-articular local anesthesia for pain after hip arthroplasty.  



Orthopedist’s goal in treating unexplained post-total hip arthroplasty hip pain is to clarify and resolve

Evaluation of patients with pain following total hip replacement.

Lateral trochanteric pain following primary total hip arthroplasty.

An Unusual Cause of Groin Pain Following Hip Replacement. A Case Report.

Diagnostic value of intra-articular anaesthetic in primary osteoarthritis of the hip

Evaluation and Treatment of Painful Total Hip Arthroplasties with Modular Metal Taper Junctions



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, August 13, 2015 9:48 am