Department of Orthopedic Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, 5415, boulevard de l'Assomption, Montréal, QC H1T 2M4, Canada.
J Bone Joint Surg Am. 2011 May;93 Suppl 2:93-8. doi: 10.2106/JBJS.J.01711.
Groin pain may persist in up to 4.3% of patients after total hip arthroplasty and up to 18% of patients one year after hip resurfacing. The incidence of this problem after total hip arthroplasty with a large-diameter femoral head is unknown.
We analyzed the natural history of groin pain and its clinical consequences during the first two years after three types of hip arthroplasty. Data were collected prospectively on 279 patients. Eighty-five patients had a polyethylene sandwich metal-on-metal total hip arthroplasty with a 28-mm-diameter femoral head, 105 had hip resurfacing, and eighty-nine had a total hip arthroplasty with a large-diameter femoral head component with three other cup designs (forty-nine in this group had the same monoblock acetabular cup design as those who had hip resurfacing).
At the twenty-four-month follow-up evaluation, seventy-seven patients (28%) reported at least one painful area around the hip and thirty-four patients (12.2%) had pain at more than one location. At three months, the incidence of groin discomfort was significantly increased in those who had hip resurfacing (30.5%) and in those who had total hip arthroplasty with a large-diameter femoral head (30%) compared with those who had total hip arthroplasty with a 28-mm femoral head (18.3%). This incidence decreased at two years (14.9%, 16.9%, and 12.9%, respectively). At twenty-four months postoperatively, eleven (four who had hip resurfacing, six who had total hip arthroplasty with the large-diameter head, and one who had total hip arthroplasty with the 28-mm head) of forty-one patients who had groin pain had not reported groin pain at previous follow-up evaluations. Of the forty-one patients reporting groin pain at the time of the last follow-up, twenty-three patients (56%) did not seek further evaluation or treatment, nine had revision surgery (22%), and the remaining nine patients thought the pain was substantial enough to warrant further evaluation and treatment.
When the exact source of groin pain cannot be found after total hip arthroplasty, careful follow-up should be done as local reactions to metal-on-metal implants and component loosening may take time to become apparent clinically or on imaging studies.
全髋关节置换术后，多达 4.3%的患者会持续出现腹股沟疼痛，髋关节表面置换术后多达 18%的患者会持续出现腹股沟疼痛。目前尚不清楚大直径股骨头全髋关节置换术后出现该问题的发生率。
我们分析了三种髋关节置换术后两年内腹股沟疼痛的自然病程及其临床后果。前瞻性收集了 279 例患者的数据。85 例患者接受了聚乙烯夹层金属对金属全髋关节置换术，股骨头直径为 28mm；105 例患者接受了髋关节表面置换术；89 例患者接受了大直径股骨头组件的全髋关节置换术，其中三个其他杯设计（该组中有 49 例与髋关节表面置换术患者相同的整体式髋臼杯设计）。
在 24 个月的随访评估时，77 例（28%）患者报告至少有一个髋关节周围疼痛区域，34 例（12.2%）患者有一个以上部位疼痛。术后 3 个月，髋关节表面置换术（30.5%）和大直径股骨头全髋关节置换术（30%）患者的腹股沟不适发生率明显高于 28mm 股骨头全髋关节置换术患者（18.3%）。两年后（分别为 14.9%、16.9%和 12.9%），发生率降低。术后 24 个月时，41 例腹股沟疼痛患者中，11 例（髋关节表面置换术 4 例，大直径股骨头全髋关节置换术 6 例，28mm 股骨头全髋关节置换术 1 例）在之前的随访中未报告腹股沟疼痛。在最后一次随访时报告腹股沟疼痛的 41 例患者中，23 例（56%）未寻求进一步评估或治疗，9 例行翻修手术（22%），其余 9 例患者认为疼痛足够严重，需要进一步评估和治疗。
全髋关节置换术后如果无法明确腹股沟疼痛的确切来源，应仔细随访，因为金属对金属植入物的局部反应和组件松动可能需要时间才能在临床上或影像学检查上表现出来。
