Lahner Matthias, von Schulze Pellengahr Christoph, Lichtinger Thomas K, Vetter Gregor, Pesendorfer Stephan Herbert, Hagen Marco, Daniilidis Kiriakos, von Engelhardt Lars Victor, Teske Wolfram
Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
Biomechanics Laboratory Department of Sport and Movement Sciences, University of Duisburg-Essen, Essen, Germany.
Technol Health Care. 2013;21(6):599-606. doi: 10.3233/THC-130761.
Total hip arthroplasty (THA) is a safe and successful procedure for the treatment of osteoarthritis. One of the most common postoperative problems remains persistent hip pain. The arthroscopic evaluation of persistent hip pain following THA can be a valuable diagnostic tool in a select number of patients when carried out by experts in this technique.
Indication for arthroscopy was persistent pain after THA. Inclusion criteria were an absence of radiological loosening and a sterile aspiration 6 weeks before arthroscopy. Hip joint function and pain were evaluated pre- and postoperatively using the visual analogue scale (VAS) and the Hip Outcome Score (HOS), which scored the activities of daily living (ADL), and a sports subscale.
5 patients (3 female, 2 male) with an average age of 60.2 ± 4.27 years (range 51-72 years) were included in the study. Arthroscopy with biopsy, adhesiolysis and psoas tendon release was performed 21.0 ± 21.97 months (range 6-57 months) after primary hip replacement.
Pathological findings were prosthetic joint infection (two cases), impingement between acetabular component and psoas tendon (two cases), adhesions of the periprosthetic tissue (one case). The patients achieved a significant improvement of the Hip Outcome Score (HOS), from an average of 45.6 ± 22.5 (range 14.0-63.1) to 76.5 ± 3.8 (range 41.0-89.4, P=0.016). Evaluation of the VAS showed a significant improvement from a preoperative value of 8.8 ± 0.5 to a postoperative value of 3.4 ± 1.0 (P=0.001).
Hip arthroscopy provides a minimal-invasive tool for diagnosis and therapy. In cases of persistent pain after THA, standard diagnostic procedures should be utilised. Arthroscopy of a hip post-THA would be highly specialised. As a next step, arthroscopy helps the diagnosis and therapy of persistent pain after THA.
全髋关节置换术（THA）是治疗骨关节炎的一种安全且成功的手术。最常见的术后问题之一仍是持续性髋关节疼痛。当由该技术的专家进行时，对THA术后持续性髋关节疼痛进行关节镜评估在部分患者中可成为一种有价值的诊断工具。
关节镜检查的指征是THA术后持续性疼痛。纳入标准为无放射学松动且在关节镜检查前6周无菌抽吸。使用视觉模拟量表（VAS）和髋关节结果评分（HOS）对髋关节功能和疼痛进行术前和术后评估，HOS对日常生活活动（ADL）及一个运动子量表进行评分。
5例患者（3例女性，2例男性）纳入研究，平均年龄60.2±4.27岁（范围51 - 72岁）。在初次髋关节置换术后21.0±21.97个月（范围6 - 57个月）进行关节镜检查并取活检、松解粘连及松解腰大肌腱。
病理结果为人工关节感染（2例）、髋臼部件与腰大肌腱撞击（2例）、假体周围组织粘连（1例）。患者的髋关节结果评分（HOS）有显著改善，从平均45.6±22.5（范围14.0 - 63.1）提高到76.5±3.8（范围41.0 - 89.4，P = 0.016）。VAS评估显示从术前值8.8±0.5显著改善到术后值3.4±1.0（P = 0.001）。
髋关节镜检查为诊断和治疗提供了一种微创工具。在THA术后持续性疼痛的病例中，应采用标准诊断程序。THA术后髋关节镜检查具有高度专业性。下一步，关节镜检查有助于THA术后持续性疼痛的诊断和治疗。
