Simank H G, Brocai D R, Rode S, Lukoschek M
Abteilung I, Stiftung Orthopädische Universitätsklinik Heidelberg.
Z Orthop Ihre Grenzgeb. 1998 Jan-Feb;136(1):39-43. doi: 10.1055/s-2008-1044649.
In order to establish a strategy for early diagnosis of aseptic loosening of total hip arthroplasty (THA) physical examination, patient's assessment and radiographs were analysed.
Pain, self assessment, physical examination and mobility were examined according to a standard examination protocol in 428 hips of 297 patients after cementless total hip arthroplasty (THA). These findings were compared with the radiographic finding of the hip. Sensitivity and specifity of objective and subjective parameters were analysed.
The clinical outcome of THA's is assessed by pain and physical examination. Nearly all hip scores are based on these parameters. In this study sensitivity and specificity of all parameters analysed were unsatisfactory compared with the radiographic finding. Although we found some correlations between clinical and radiological data, clinical data alone are not sufficient for exclusion of THA loosening, especially for loosening of the acetabular component, as there was no clear distinction between the group of radiographically loosened (43 acetabular cups and 4 stems) and intact endoprostheses.
We conclude, that physical examination and pain history are not sufficient to exclude loosening of cementless THA's. Radiographic examination is essential for the assessment of THA's, even in painfree patients.
为制定全髋关节置换术（THA）无菌性松动的早期诊断策略，对体格检查、患者评估及X线片进行分析。
依据标准检查方案，对297例患者428髋非骨水泥型全髋关节置换术后的疼痛、自我评估、体格检查及活动度进行检查。将这些结果与髋关节的X线检查结果进行比较。分析客观和主观参数的敏感性及特异性。
通过疼痛和体格检查评估THA的临床结果。几乎所有髋关节评分均基于这些参数。在本研究中，与X线检查结果相比，所分析的所有参数的敏感性和特异性均不令人满意。尽管我们发现临床和放射学数据之间存在一些相关性，但仅临床数据不足以排除THA松动，尤其是髋臼部件的松动，因为在X线片显示松动的组（43个髋臼杯和4根股骨柄）与假体完整的组之间没有明显区别。
我们得出结论，体格检查和疼痛病史不足以排除非骨水泥型THA的松动。即使对于无疼痛的患者，X线检查对于评估THA也至关重要。
