Orthopaedic Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia.
University of Western Australia, Fremantle Hospital and Health Service, Perth, WA, Australia.
Hip Int. 2024 May;34(3):336-343. doi: 10.1177/11207000231205843. Epub 2023 Oct 20.
Persisting groin pain post total hip arthroplasty (THA) is a common and complex issue that can be difficult to diagnose and manage. Acetabular component positioning is often implicated.
We used a previously well described and validated functional positioning protocol to determine if functional acetabular malpositioning was a factor in groin pain post THA and hence to determine if acetabular revision would be indicated. We compared patient-specific functional acetabular positioning to traditional CT evaluation of cup position and assessment of anterior cup overhang.
39 patients with groin pain post-THA were investigated. Functional acetabular malpositioning was diagnosed in 31% (12/39). Revision THA was performed in those 12 patients, resulting in resolution of functional malpositioning (100%), with an overall accuracy of 5.6° (range 1-12), and resolution of groin pain in 67% (8/12). 33% (4/12) of the revised implants had functional positioning located outside the traditional "40/20 zone". Comparison with CT indicated that 40% (4/10) of implants with anterior overhang were well positioned, however only 50% (6/12) of functionally malpositioned implants had CT evidence of anterior cup prominence. Of the 8/12 revision patients who had resolution of their groin pain, only 1 had cup prominence.
This study suggests that the utilisation of a patient specific functional positioning algorithm in the analysis of persistent groin pain following THA can assist in identifying the underlying cause of pain and help to guide treatment. For a functionally malpositioned acetabulum, revision surgery offers a potential resolution of groin pain.
全髋关节置换术后持续腹股沟疼痛是一个常见且复杂的问题，诊断和处理都颇具难度。髋臼组件的定位往往与此相关。
我们采用了一种先前描述和验证过的功能定位方案，以确定功能性髋臼错位是否是髋关节置换术后腹股沟疼痛的一个因素，从而确定是否需要进行髋臼翻修。我们将患者特定的功能性髋臼定位与传统 CT 评估杯位置和评估前杯突出进行了比较。
我们对 39 例髋关节置换术后出现腹股沟疼痛的患者进行了研究。31%（12/39）的患者被诊断为功能性髋臼错位。对这 12 名患者进行了髋关节翻修手术，结果功能性错位得到纠正（100%），整体准确性为 5.6°（范围 1-12），腹股沟疼痛的总体缓解率为 67%（8/12）。在接受翻修的患者中，有 33%（4/12）的髋臼假体的功能性定位位于传统的“40/20 区”之外。与 CT 比较表明，有 40%（4/10）存在前突的髋臼假体位置良好，但仅有 50%（6/12）的功能性错位髋臼假体有 CT 证据显示前杯突出。在 8 例腹股沟疼痛缓解的翻修患者中，只有 1 例存在杯突出。
本研究表明，在分析全髋关节置换术后持续腹股沟疼痛时，采用患者特异性的功能定位算法可以帮助确定疼痛的根本原因，并有助于指导治疗。对于功能错位的髋臼，翻修手术可能会缓解腹股沟疼痛。
