Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, Clermont-Ferrand, France.
Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute for locomotion, St. Marguerite Hospital, Marseille, France.
J Arthroplasty. 2019 Aug;34(8):1802-1807. doi: 10.1016/j.arth.2019.04.014. Epub 2019 Apr 13.
Identifying the source of pain is paramount for determining appropriate treatment and ensuring successful outcome in terms of management and relief of pain. The difficulty is that each surgeon has his or her own way of seeing the problem, and there is no consensus for the evaluation of these patients. The study hypothesis was that it is possible to find the cause of the pain in most cases.
All patients consulting for unexplained painful hip arthroplasty were included and followed a decision tree to assess the cause of the pain. The primary endpoint was the final diagnosis. Secondary endpoints were subgroup comparison between main causes and assessment of risk factors.
Two hundred one hips of 194 patients were included as unexplained painful hip arthroplasty 6 months postoperatively. Final diagnoses comprised periarticular pain in 53 cases (26.4%): 40 cases of trochanteric bursitis, 5 of iliopsoas tendinitis, 5 of abductor deficiency, 1 of ischial tuberosity tendinitis, and 2 of heterotopic ossification; projected pain in 49 (24.4%): 45 cases of back pain with or without neuropathy, 3 of knee osteoarthritis, and 1 of metabolic neuropathy; wear in 40 (19.9%), in the polyethylene liner; loosening in 20 (10.0%): loosening of the femoral component in 8 and that of the cup in 12; material problems in 17 (8.5%): trunnionosis in 13 and metallosis in metal-on-metal implants in 4; no diagnosis in 7 hips (3.5%); infection in 6 (3.0%), all chronic; instability without real dislocation in 3 (1.5%); misplacement in 3 (1.5%), all for leg-length discrepancy; fracture in 2 (1.0%): 1 of greater trochanter and 1 of ilio-ischiopubic ramus; complex regional pain syndrome in 1 (0.5%).
To our knowledge, this is the first study on the causes of painful hip arthroplasty in clinical practice, whether leading to revision or not. A systematic approach, including physical examination, radiographic assessment and laboratory studies, is needed to find the cause of the pain. It is important to understand the pain so that it can be treated appropriately. Revision surgery can sometimes help-but the worst thing is to make the patient worse.
level 4, retrospective study.
确定疼痛的来源对于确定适当的治疗方法至关重要，这对于管理和缓解疼痛的效果具有重要意义。难点在于，每位外科医生都有自己的看法，而对于这些患者的评估尚无共识。研究假设是，在大多数情况下可以找到疼痛的原因。
所有因不明原因出现髋关节置换术后疼痛的患者均纳入研究，并遵循决策树来评估疼痛的原因。主要终点是最终诊断。次要终点是主要原因之间的亚组比较以及危险因素的评估。
201 髋 194 例患者因髋关节置换术后 6 个月出现不明原因的疼痛而被纳入研究。最终诊断包括：关节周围疼痛 53 例（26.4%）：40 例转子滑囊炎，5 例髂腰肌肌腱炎，5 例外展肌缺陷，1 例坐骨结节肌腱炎，2 例异位骨化；预计疼痛 49 例（24.4%）：45 例背痛伴或不伴神经病，3 例膝关节骨关节炎，1 例代谢神经病；40 例（19.9%）聚乙烯衬垫磨损；20 例（10.0%）松动：8 例股骨组件松动，12 例髋臼杯松动；17 例（8.5%）材料问题：13 例臼杯头无菌性松动，4 例金属对金属植入物的金属过敏；7 髋（3.5%）无诊断；6 髋（3.0%）感染，均为慢性感染；3 髋（1.5%）不稳定但无真性脱位；3 髋（1.5%）位置不当，均为肢体不等长；2 髋（1.0%）骨折：1 例大转子骨折，1 例髂耻坐骨支骨折；1 例复杂性区域疼痛综合征（0.5%）。
据我们所知，这是第一项关于临床实践中髋关节置换术后疼痛原因的研究，无论是否需要翻修。需要系统的方法，包括体格检查、影像学评估和实验室研究，以找到疼痛的原因。了解疼痛非常重要，以便能够进行适当的治疗。翻修手术有时可能会有所帮助-但最糟糕的是让患者病情恶化。
4 级，回顾性研究。
