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The painful hip: diagnosis and deliverance

T P Schmalzried1

  • 1Joint Replacement Institute, St. Vincent Medical Center, 2200 W. Third Street, Suite 400, Los Angeles, California 90057, USA. schmalzried@earthlink.net

The Journal of Bone and Joint Surgery. British Volume
|November 3, 2012
PubMed

Insights

Diagnosing painful total hip arthroplasty requires differentiating between prosthetic and non-prosthetic pain sources. Key considerations include infection, loosening, and adverse local tissue reactions (ALTR), guiding effective treatment strategies.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Diagnostic Imaging

Background:

  • Pain after total hip arthroplasty (THA) presents a diagnostic challenge.
  • Differential diagnoses include infection, loosening, tendinitis, bursitis, synovitis, and adverse local tissue reactions (ALTR).
  • Non-hip sources like spinal disorders or pelvic pain can mimic THA complications.

Purpose of the Study:

  • To outline a systematic approach for diagnosing the source of pain in patients with total hip arthroplasty.
  • To highlight key diagnostic questions for differentiating prosthetic versus non-prosthetic pain generators.
  • To emphasize the importance of identifying and treating the specific pain generator for successful outcomes.

Main Methods:

  • A hierarchical diagnostic framework is proposed, starting with prosthetic vs. non-prosthetic pain.
  • Subsequent diagnostic levels address septic vs. aseptic causes and fixation status (well-fixed vs. loose).
  • Cross-sectional imaging is highlighted as crucial for diagnosing ALTR.

Main Results:

  • Adverse local tissue reaction (ALTR) to cobalt-chromium alloys is a significant consideration.
  • Systematic questioning aids in narrowing down the differential diagnosis of painful THA.
  • Correct identification of the pain generator is essential for successful treatment.

Conclusions:

  • A structured diagnostic pathway is vital for managing painful total hip arthroplasty.
  • Adverse local tissue reactions (ALTR) require specific diagnostic considerations, often involving advanced imaging.
  • Evolving treatment recommendations for ALTR and taper corrosion necessitate ongoing research.

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