The Role of Arthroscopy in Evaluation of Painful Hip Arthroplasty

Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 11/2008; 467(1):174-80. DOI: 10.1007/s11999-008-0525-8
Source: PubMed


Unexplained pain after hip arthroplasty is frustrating for patients and surgeons. We describe the use of hip arthroscopy in management of the painful hip arthroplasty, critically evaluate the outcomes of these patients, and refine indications for hip arthroscopy in this setting. We retrospectively reviewed 14 patients (16 hips) who underwent hip arthroscopy after joint replacement. One patient had suspected septic arthritis despite negative aspiration and one had known septic arthritis but was not a candidate for open arthrotomy; two had intraarticular migration of hardware. The remaining 10 patients (11 hips) had persistent pain despite negative diagnostic studies. The two patients (two hips) with infection were successfully treated with arthroscopic lavage and débridement plus intravenous antibiotics. Intraarticular metal fragments and a loose acetabular screw were successfully removed in two patients (three hips). Findings in the remaining 11 hips included a loose acetabular component (one); corrosion at the head-neck junction of a metal-on-metal articulation (one); soft tissue-scar impingement at the head/cup interface (four); synovitis with associated scar tissue (four); and capsular scarring with adhesions (one). Arthroscopy represented a successful treatment or directly led to a successful treatment in 12 of 16 hips. We observed no complications as a result of the arthroscopy. Arthroscopy may be of value in selected patients undergoing hip arthroplasty with unexplained pain after an inconclusive standard workup.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Download full-text


Available from: Joseph C Mccarthy, Jul 16, 2014
  • Source
    • "The protocol that we routinely use for differential diagnosis includes a detailed medical history and a thorough clinical examination, laboratory tests (FBC, ESR, and CRP), Radiology investigations (X-rays, CT scan, and scintigraphy) and diagnostic nerve blocks. Of all the possible causes of pain (Bozic & Rubash, 2004; Smith & Rorabeck, 1999; Witvoët, 2001), we highlight those which we can be addressed using arthroscopy (Table 1): loosening (diagnostic value), tendon pain (iliopsoas, piriformis and plica syndromes or arthrofibrosis) (Bajwa & Villar, 2011; Beck, 2009; Smith & Rorabeck, 1999), trochanteritis, subluxation and femoroacetabular impingement syndrome (Bajwa & Villar, 2011; Beck, 2009; Bozic & Rubash, 2004; Brown & Callaghan, 2008; Malik et al., 2007; Smith & Rorabeck, 1999), acute and sub-acute infection (Hyman et al., 1999; McCarthy et al., 2009), and pain of unknown origin (Bozic & Rubash, 2004; Witvoët, 2001). 1. Pain associated with the site of surgical approach "

    Modern Arthroscopy, 12/2011; , ISBN: 978-953-307-771-0
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Coulomb force exerted by an electric field on free charges injected into Liquid Dielectrics (LD) may cause motion of that liquids. This motion is named as Electroconvection. The intensive electroconvection may be used to enhance heat transfer. Experiments indicate up to fifteenfold increases in Nusselt number in LD subjected high voltage electric field
    Conduction and Breakdown in Dielectric Liquids, 1996, ICDL '96., 12th International Conference on; 08/1996

  • Arthroskopie 01/2009; 22(4):322-329.
Show more