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Painful hip arthroplasty: definition
Paolo Ferrata1, Serafino Carta, Mattia Fortina
1Orthopaedics and Traumatology Clinic, University Hospital of Siena, Siena, Italy.
Insights
Many patients experience persistent hip pain after total hip arthroplasty (THA). This study identifies factors negatively impacting outcomes and outlines a differential diagnosis for post-THA hip pain.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Rehabilitation
Background:
- Total hip arthroplasty (THA) is a common procedure for improving hip pain and function.
- A subset of patients report persistent hip pain following elective THA.
- Identifying the source of this residual pain is clinically challenging.
Purpose of the Study:
- To investigate prognostic factors associated with poor outcomes after THA.
- To explore the differential diagnosis of hip pain in the context of THA.
- To categorize potential causes of hip pain based on radiographic findings.
Main Methods:
- Systematic review of literature on post-THA hip pain.
- Analysis of clinical case studies.
- Categorization of pain etiologies with and without radiographic evidence.
Main Results:
- Hip pain post-THA can stem from various non-prosthetic sources, including the lumbosacral spine, referred visceral pain, and soft tissue pathologies.
- Soft tissue causes include trochanteric bursitis, tendinitis, hip abductor dysfunction, and inguinal hernia.
- Accurate diagnosis requires a comprehensive differential approach, considering both radiographic and non-radiographic factors.
Conclusions:
- Persistent hip pain after THA necessitates a thorough differential diagnosis beyond prosthetic complications.
- Understanding the diverse origins of hip pain is crucial for effective patient management.
- A structured diagnostic approach aids in identifying treatable causes of post-THA hip pain.
Abstract:
Total hip arthroplasty (THA) has been indicated as the surgical intervention with greatest improvement in pain and physical function. However some patients continue to experience hip pain after elective surgery. We investigate prognostic factors that negatively affect treatment effectiveness and the patient outcome. The "hip region" constitutes the groin, buttock, upper lateral thigh, greater trochanteric area, and the iliac crest. Pain originating from various sources and not directly linked to prosthesis may be perceived here and includes the lumbosacral spine, referred pain from abdominal organs and soft tissue sources such as trochanteric bursitis, tendinitis, hip abductor dysfunction, and inguinal hernia. An accurate assessment of the pain cause is extremely difficult to construct and a complete differential diagnosis is fundamental. We assess all the possible causes of hip pain after THA and we divide them depending on the presence or absence of radiographic signs.
