- Discussion:
    - evaluation of painful THR:
    - when previously pain free hip becomes painful, suspect loosening;
    - where as acetabular loosening tends to cause groin pain, femoral loosening tends to cause thigh pain;
    - increased limp and shortening are signs of subsidence;
    - patient may need to use his hands to lift leg onto exam table;
    - inability to perform straigt leg raises;
    - patient may then complain that his leg has become increasingly externally rotated as the component sinks into retroversion;
    - in a cemented hip, thigh pain of implant origin indicates loosening, however, this is not necessarily the case with uncemented stems;

    - Types of Femoral Component Loosening:
         - cemented femoral component: loosening:
         - bending cantilever
         - calcar pivot: (distal toggle)
         - medial midstem pivot
         - pistoning:

- Radiologic Findings:
    - radiology of press fit stems
    - radiology of cemented stems
    - radiology of the acetabular component

- Differential Injections: (see painful THR)
    - 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

Iliopsoas Bursa Injections Can be Beneficial for Pain after Total Hip Arthroplasty

I Have a Patient With Start-Up Thigh Pain 5 Years After Surgery, and I Think the Femoral Component Is Loose. How Can I Tell for Sure?