Hulin Kael, Fearon Angie, Newman Phil
University of Canberra Faculty of Health, Australia.
University of Canberra Research Institute for Sport and Exercise, Australia.
J Clin Orthop Trauma. 2025 May 9;67:103036. doi: 10.1016/j.jcot.2025.103036. eCollection 2025 Aug.
Persistent hip pain after total hip arthroplasty has been reported in up to 23 % of cases. Despite routine clinical tests, the source of pain often remains unclear, and diagnosis requires extensive investigation with imaging or surgical exploration.
This systematic review aimed to identify the diagnoses attributable to the painful hip arthroplasty. The second aim was to identify diagnostic techniques used to identify them.
Three databases (Medline, Scopus and CINAHL) were searched from 2012 to 2024 using keywords and medical subject headings (MeSH) including 'persistent pain AND hip arthroplasty AND diagnoses'. Quality assessment was undertaken with the Joanna Briggs Institute checklist for case-series. Data extraction was performed by one author using Covidence software and crosschecked by another for accuracy. Data included age, sex, arthroplasty type, diagnostic method, and confirmed diagnosis. Data was synthesised to provide a quantitative overview of diagnoses and diagnostic methods. PROSPERO number CRD42022340158.
The search and reference screening returned 285 papers of which seven high quality and two unclear quality case-series met the inclusion criteria. There was a total of 388 painful hip arthroplasties included. Prostheses loosening or infection was present in 28.6 % of cases. Iliopsoas impingement was present in 21 % of cases. Causes outside the hip accounted for 16.4 % of cases with referred pain from the lumbar spine (14.6 %) most common. Greater trochanteric pain syndrome (GTPS) was present in 13 %. The painful etiology remained unknown in 9.2 % of participants. The most common diagnostic imaging technique was x-ray (100 %) followed by magnetic resonance imaging (22 %).
Prosthesis loosening and infection remain a significant cause of pain despite preliminary screening to exclude them. Iliopsoas impingement and causes outside the hip require significant consideration due to high prevalence. Less common differential diagnoses have been identified. X-ray is an important front-line imaging tool while other advanced imaging is used selectively to identify a diagnosis.
据报道，全髋关节置换术后持续性髋关节疼痛的发生率高达23%。尽管进行了常规临床检查，但疼痛来源往往仍不明确，诊断需要通过影像学检查或手术探查进行广泛排查。
本系统评价旨在确定导致髋关节置换术后疼痛的病因诊断。第二个目的是确定用于识别这些病因的诊断技术。
使用关键词和医学主题词（MeSH），在2012年至2024年期间对三个数据库（Medline、Scopus和CINAHL）进行检索，检索词包括“持续性疼痛 且 髋关节置换术 且 诊断”。采用乔安娜·布里格斯研究所病例系列检查表进行质量评估。由一名作者使用Covidence软件进行数据提取，并由另一名作者进行交叉核对以确保准确性。数据包括年龄、性别、关节置换类型、诊断方法和确诊诊断。对数据进行综合分析，以提供诊断和诊断方法的定量概述。国际前瞻性系统评价注册库（PROSPERO）编号：CRD42022340158。
检索和参考文献筛选共返回285篇论文，其中7篇高质量和2篇质量不明确的病例系列符合纳入标准。总共纳入了388例髋关节置换术后疼痛病例。28.6%的病例存在假体松动或感染。21%的病例存在髂腰肌撞击。髋关节外原因占病例的16.4%，其中腰椎牵涉痛最为常见（14.6%）。大转子疼痛综合征（GTPS）占13%。9.2%的参与者疼痛病因仍不明。最常用的诊断成像技术是X线（100%），其次是磁共振成像（22%）。
尽管进行了初步筛查以排除假体松动和感染，但它们仍然是疼痛的重要原因。由于患病率较高，髂腰肌撞击和髋关节外原因需要重点考虑。已确定了较少见的鉴别诊断。X线是重要的一线成像工具，而其他先进成像则有选择地用于明确诊断。
