Forster-Horvath Csaba, Egloff Christian, Valderrabano Victor, Nowakowski Andrej M
Orthopaedic Department, University of Basel, Switzerland.
Swiss Med Wkly. 2014 Oct 8;144:w13974. doi: 10.4414/smw.2014.13974. eCollection 2014.
Total hip replacement is one of the most successful surgical procedures of the 20th century (World Health Organisation). The success rate is dependent on the chosen endpoint. Evaluation of the outcome in joint replacement surgery has shifted from the revision rate toward patient satisfaction and quality of life. Patient satisfaction is reported to be up to 96% 16 years postoperatively, but the prevalence of groin pain after conventional total hip replacement ranges from 0.4% to 18.3% and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1.9% to 40.9% of cases in some series. The aim of our article is to review the aetiology, diagnostic procedures and treatment of the painful primary total hip replacement. We discuss the most relevant intrinsic and extrinsic aetiological factors responsible for chronic pain after total hip arthroplasty focusing on comparative studies and randomised controlled trials including diagnostics and management. Detailed analysis of history, clinical examination, imaging and laboratory tests are required prior to any revision for painful total hip arthroplasty. Revision surgery without knowing the underlying pathology should be avoided.
全髋关节置换术是20世纪最成功的外科手术之一（世界卫生组织）。成功率取决于所选择的终点指标。关节置换手术的结果评估已从翻修率转向患者满意度和生活质量。据报道，术后16年患者满意度高达96%，但传统全髋关节置换术后腹股沟疼痛的发生率在0.4%至18.3%之间，在一些系列病例中，与非骨水泥型髋关节置换股骨部件相关的活动受限性大腿疼痛在1.9%至40.9%的病例中仍然是一个现存问题。我们文章的目的是综述初次全髋关节置换术后疼痛的病因、诊断方法及治疗。我们讨论全髋关节置换术后慢性疼痛最相关的内在和外在病因因素，重点关注比较研究和随机对照试验，包括诊断和管理。在对疼痛性全髋关节置换进行任何翻修之前，需要对病史、临床检查、影像学和实验室检查进行详细分析。应避免在不了解潜在病理的情况下进行翻修手术。
