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The painful total hip replacement
Kevin J Bozic1, Harry E Rubash
1Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus, MU 320W, San Francisco, CA 94143-0728, USA. bozick@orthosurg.ucsf.edu
Insights
Diagnosing painful total hip replacement requires a detailed patient history and physical exam. This approach helps identify the cause of pain, enabling effective treatment for better outcomes.
Area of Science:
- Orthopaedic Surgery
- Arthroplasty
- Pain Management
Background:
- Total hip replacement (THR) is a highly successful orthopaedic procedure.
- Managing patients with painful THR presents significant diagnostic challenges for surgeons.
- Differential diagnosis for hip pain after THR includes intrinsic and extrinsic causes.
Purpose of the Study:
- To outline a systematic approach for evaluating painful total hip replacement.
- To emphasize the importance of clinical assessment in diagnosing THR complications.
- To guide surgeons in initiating appropriate treatment based on accurate diagnosis.
Main Methods:
- Detailed patient history focusing on pain characteristics (onset, duration, severity, location, quality).
- Targeted physical examination including provocative tests and maneuvers.
- Selective use of laboratory tests and radiographic imaging based on clinical findings.
Main Results:
- A thorough history and physical examination are foundational for a focused workup.
- Pain characteristics and physical exam findings provide crucial diagnostic clues.
- Judicious use of investigations aids in identifying the etiology of pain.
Conclusions:
- Most cases of painful total hip replacement can be diagnosed with a careful and systematic evaluation.
- Accurate diagnosis is essential for initiating effective and appropriate treatment strategies.
- This diagnostic framework aims to improve patient outcomes after hip arthroplasty.
Abstract:
Total hip replacement is one of the most common and successful orthopaedic procedures. However, evaluation and treatment of the painful total hip replacement is one of the most difficult challenges for the arthroplasty surgeon. The differential diagnosis includes causes that are intrinsic and extrinsic to the hip. A thorough history and physical examination provide the basis for a focused, efficient workup of the painful total hip replacement. The temporal onset, duration, severity, site, and character of the pain all provide important clues in determining the cause of the painful total hip replacement. The physical examination should focus on tests and maneuvers that reproduce the patient's symptoms. Laboratory tests and radiographic evaluation are used selectively as indicated by the history and physical examination findings. With a careful and thorough evaluation, the cause of the painful total hip replacement can be determined in most patients, and the appropriate treatment can be initiated.