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Evaluation of Pain in Patients With Apparently Solidly Fixed Total Hip Arthroplasty Components

Dr. Robbins is Clinical and Research Fellow, Division of Reconstructive Orthopaedics, University of British Columbia, Vancouver, BC, Canada. Dr. Masri is Associate Professor and Head, Division of Reconstructive Orthopaedics, University of British Columbia. Dr. Garbuz is Assistant Professor, Division of Reconstructive Orthopaedics, University of British Columbia. Dr. Duncan is Professor and Chairman, Department of Orthopaedics, University of British Columbia.

Reprint requests: Dr. Masri, Third Floor, 910 West Tenth Avenue, Vancouver, BC V5Z 4E3, Canada.

The cause of pain in a patient with an apparently solidly fixed total hip arthroplasty can be difficult to elucidate. A detailed history, careful examination, and plain radiographs provide the most useful information, especially in excluding causes not primarily related to the hip. Determining whether the pain is related to the implant, to soft tissue, or to bone can require laboratory tests, radiographic and fluoroscopic imaging, and contrast arthrography and local anesthetic injections. Particularly when pain is caused by occult infection, erythrocyte sedimentation rate, C-reactive protein level, hip aspiration, advanced radiologic imaging, and nuclear medicine scans can help determine the diagnosis.

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