Iliopsoas cyst causing persistent pain after total hip arthroplasty

Persistent pain after total hip arthroplasty (THA) has many potential causes. The most common are aseptic loosening, infection, and heterotopic ossification. Irritation of the iliopsoas tendon due to the acetabular component is an underestimated cause of persistent groin pain and functional disability after THA with rare incidence. Pain specific to iliopsoas tendonitis includes activities such as hyperextension of the hip, forced flexion, and activities of daily living (eg, ascending stairs). This article presents a case of a 50-year old man with clinical and radiological signs of osteoarthritis of the right hip joint. A THA was performed. After a symptom-free interval of several weeks postoperatively, the patient reported pain projecting from the right groin and radiating ventromedially along the leg. Magnetic resonance imaging of the hip showed a fluid-filled cyst in anatomical proximity to the femoral nerve causing an iliopsoas tendonitis. The patient underwent surgical resection of the cyst was performed by an anterior approach; a conjunction to the hip joint was not present. The implanted components of the prosthesis showed good osseointegration with no signs of loosening. The cyst was removed and the iliopsoas tendon was released. A few weeks after the operation, the patient was pain free. At 17-month follow-up, no problems were reported. In cases such as this, finding the correct diagnosis may be difficult and misleading. Conservative and operative therapeutic options are discussed and compared with divergent findings in the literature.     

Iliopsoas tendinitis after total hip arthroplasty

Determination of the cause of groin pain after total hip arthroplasty can be difficult. The case of a patient with an unusual cause of groin pain after total hip arthroplasty, iliopsoas tendinitis, is presented. The patient failed nonoperative treatment and underwent surgical release of the iliopsoas tendon with complete resolution of symptoms.     

Iliopsoas tendonitis a complication after total hip arthroplasty

The causes of pain after total hip arthroplasty are multiple. We present a series of 15 patients (16 cases) who presented with pain related to the iliopsoas tendon. All patients had previously undergone cementless hip arthroplasty and presented with similar symptoms and clinical signs. Surgery was carried out after failure of conservative measures. Release of the iliopsoas tendon from the lesser trochanter gave good symptomatic relief in all except one patient who required reposition of acetabular prosthesis, with the average Harris Hip Score improving from 58 (range, 44-70) to 91 (range, 78-95) postoperatively. This relatively uncommon condition should be considered in the differential diagnosis of all patients who present with groin pain after total hip arthroplasty. Surgical release of the iliopsoas tendon can give excellent results in these patients.     

Iliopsoas tendinitis--rare cause of pain following implantation of a total hip endoprosthesis

Pain following implantation of a total hip endoprosthesis is described in the literature with an incidence of 1-17.6%, depending on the type of prosthesis. The underlying causes are numerous; the primary reasons for such pain are septic and nonseptic loosening of the prosthesis, periarticular heterotopic ossifications, or trochanteric bursitis. Less common reasons are muscular hernia, squeezing of the joint capsule, distal nerve lesions, stress fractures, compartment syndromes, or neoplasia.One can find only a few reports about tendinitis of the iliopsoas muscle as a cause for pain following implantation of an endoprosthesis in total hip arthroplasty. We now report about a female patient with therapy-resistant pain after total hip replacement, caused by tendinitis of the iliopsoas muscle. We introduce the transpositioning of this tendon from the lesser trochanter to the proximal anterior femur and bony refixation with a PDS cord as a new operative treatment.     

An unusual cause of thigh pain after total hip arthroplasty

The aim of total hip arthroplasty surgery is to relieve pain. There are many postulated causes of thigh pain following total hip arthroplasty, some of which are not easily corrected. Muscle hernia as a result of hip surgery is a cause of thigh pain that is disabling, relatively easy to diagnose, and may be preventable.     

Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty.

In a 58-year-old woman, a cystic mass at the ileocecal region communicated with the loosened hip prosthesis 20 years after total hip arthroplasty (THA). The preoperative arthrogram of the hip and the intraoperative cystogram suggested a one-way communication from the hip to the cystic mass. The mass was diagnosed as an iliopsoas bursitis distended by the influx of the synovial fluid from the loosened THA.     

Retroperitoneal hematoma: an unusual cause of pain after total hip arthroplasty

Pain following total hip arthroplasty due to impingement of the iliopsoas is a recognized complication of the procedure with a reported incidence as high as 4.3%. The pain is most often due to direct mechanical irritation of the iliopsoas due to a malpositioned or oversized acetabular cup. Definitive treatment of iliopsoas impingement often requires surgical revision or iliopsoas tenotomy, although many cases remain undiagnosed or are managed conservatively. We present an unusual case of pain after total hip arthroplasty due to a large retroperitoneal hematoma secondary to acetabular cup irritation of the iliopsoas tendon. This case represents a potentially important complication of undiagnosed or conservatively managed iliopsoas impingement, particularly in patients taking anticoagulants or antiplatelet medications.     

Bisphosphonate fractures as a cause of painful total hip arthroplasty

Osteoporotic fractures pose a significant health concern for postmenopausal women. Bisphosphonate therapy has been shown to decrease the risk of these fractures. The bisphosphonate alendronate was approved by the US Food and Drug Administration for use in the United States in 1995, but questions have recently arisen concerning low-energy subtrochanteric femur fractures sustained by chronic users. Although no definitive association or causality between bisphosphonates and these fractures has been established, numerous cautionary reports exist concerning the duration of use and safety of alendronate in osteoporotic patients. This article reports 3 occurrences of bisphosphonate-associated atypical femur fractures as an etiology of periprosthetic hip pain in the total hip arthroplasty (THA) patient. These fractures are particularly concerning because these patients are often not advised to protect their weight bearing simply due to a painful THA and may sustain a catastrophic failure if not followed closely. Several theories have been suggested concerning the pathophysiology of atypical low-energy subtrochanteric fractures following bisphosphonate use. Each patient described in this article carried a diagnosis of rheumatoid arthritis and underwent chronic medical therapy; each patient experienced a delay in the diagnosis and onset of therapy due to low suspicion for bisphosphonate-associated fracture. This problem may become more common in the clinical setting; therefore, one must be vigilant and aware of this etiology of periprosthetic hip pain.     

初次全髋关节置换术后髋关节疼痛发生影响因素分析

目的探讨初次人工全髋关节置换术后中重度髋关节疼痛发生影响因素分析。 方法选择2015年1月至2017年9月在四川省巴中骨科医院初次接受全髋关节置换术的完整成年患者的病历资料进行回顾性分析。翻修手术、长期慢性疼痛、合并恶性肿瘤、精神疾病等情况的病例排除在外。记录患者的性别、年龄、身体质量指数、合并症、置换类型、术前评估、术中指标和术后并发症发生情况等资料。采用单因素和多因素Logistic分析观察患者术后中重髋关节疼痛的发生率及上述资料与髋关节中重度疼痛发生的相关性。 结果共有476例(476例髋)患者纳入研究,中重度疼痛发生率为9.66%。单因素分析显示,置换部位、疾病类型、高血压、吸烟、饮酒不是影响初次髋关节置换术后中重度疼痛发生的危险因素(P>0.05);性别(χ²＝6.145)、年龄(χ²＝7.847)、身体质量指数(χ²＝14.704)、髋关节活动时间(χ²＝8.043)、糖尿病(χ²＝10.356)、美国麻醉师协会(ASA)分级(χ²＝10.654)、入路方式(χ²＝6.746)、假体类型(χ²＝5.917)、手术时间(χ²＝5.024)、下肢深静脉血栓(χ²＝11.145)、术后C反应蛋白(CRP)值(χ²＝7.494)是影响初次髋关节置换术后中重度疼痛的危险因素(P<0.05)。多因素Logistic分析结果显示,身体质量指数≥28 kg/m²[OR＝3.224,95%CI (2.059,8.159)]、下肢深静脉血栓[OR ＝6.902,95%CI (4.574,13.589)]是影响全髋关节置换术后中重度疼痛的独立危险因素(P<0.05),年龄≥60岁[OR ＝0.718,95%CI (0.611,0.829)]、关节活动时间>2 d [OR ＝0.624,95%CI(0.417,0.852)]是全髋关节置换术后中重度疼痛的保护性因素(P<0.05)。 结论初次人工全髋关节置换术后中重度髋关节发生是多因素综合作用的结果,临床应综合考虑这些因素,以降低全髋关节置换术后中重度疼痛的发生。     

Patients' perception of pain after total hip arthroplasty

A study was undertaken to determine the frequency with which patients had pain that they attributed to their hip after total hip arthroplasty. Pain drawings were used to allow patients to localize the area of their symptoms, and the degree of pain was quantified with visual analog scales. Complete clinical and radiographic data were collected on all patients so that the occurrence of pain could be correlated with a number of parameters previously reported to affect the incidence of pain, including age, sex, activity level, length of follow-up, stem size, bone type (Dorr index), and type of stem fixation (proximally coated, fully coated, or cemented). Results indicated that type of stem fixation was the only parameter statistically correlated with a higher incidence of thigh pain. Patients with proximally coated stems were more than twice as likely to complain of pain than patients with fully coated or cemented hips (P < .01). Although the incidence of thigh pain was significantly higher with proximally coated stems, the severity was not, averaging 3.0 to 3.5 out of 10 on visual analog scale in all 3 groups. The results indicate that patients perceived pain as originating in the hip in a high percentage of cases, particularly when proximally coated stems were used.     

Citrobacter koseri as a cause of early periprosthetic infection after primary total hip arthroplasty

Periprosthetic joint infection in the acute setting is usually caused by gram-positive species and remains a major problem facing total joint surgeons. We report a case of a 53-year-old male who presented with drainage 3 weeks after primary total hip arthroplasty. Citrobacter koseri was cultured from an infected hematoma in his deep tissues. Surgical treatment included irrigation and debridement with femoral head and liner exchange. He received a 6-week course of ertapenem and is currently asymptomatic. We present C. koseri as a rare cause of acute periprosthetic infection and offer an effective treatment protocol.     

Brucellosis as a cause of septic loosening of total hip arthroplasty

Infection after a total hip arthroplasty is a severe complication and is associated with a high incidence of morbidity. We describe a case of late infection, 5 years after the implantation of a cemented hip prosthesis. The infection was caused by gram-negative Brucella melitensis and occurred in a 63-year-old man who owned cattle. As far as we know, such a complication has never been published before.     

Anterior thigh pain after cementless total hip arthroplasty

We compared the incidence of anterior thigh pain retrospectively following primary uncemented total hip replacement in 70 patients (78 hips) with osteoarthritis. In one group (38 hips), an Endoplus porous-coated, canal-filling prosthesis was inserted through an anterolateral approach. In the other group (40 hips), a Furlong hydroxyapatite-coated prosthesis was inserted through a posterior approach. The latter prosthesis has a relatively longer femoral stem and does not achieve diaphyseal press-fit contact. Three patients in the Furlong group had anterior thigh pain, which eventually resolved in two patients. In the Endoplus group, two patients developed anterior thigh pain; in both cases, there was an underlying cause, which had to be treated. Idiopathic anterior thigh pain is more common in non-canal-filling prostheses. When anterior thigh pain is noticed in canal-filling prosthesis, a search for and treatment of the cause will cure the pain. The hydroxyapatite coating did not prevent thigh pain in the Furlong group.

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Résumé Nous avons comparé rétrospectivement la fréquence des douleurs antérieures de la cuisse après prothèse totale non cimentée chez 70 malades (78 hanches) avec coxarthrose Dans un groupe (38 hanches), la prothèse à revêtement poreux Endoplus a été implanté par un abord antérolatéral. Dans lautre groupe (40 hanches), la prothèse enduite dhydroxyapatite Furlong a été implantée par un abord postérieur. Cette deuxiéme prothèse a une tige fémorale relativement plus longue et na pas un contact press-fit diaphysaire Trois malades dans le groupe Furlong avaient des douleurs antérieures de la cuisse, qui ont disparues pour deux dentre eux. Dans le groupe Endoplus, deux malades ont développé ces douleurs, et, dans les deux cas, il y avait une cause sous-jacente qui a dû être traitée La douleur antérieure, idiopathique, de la cuisse est plus fréquente avec la prothèse non remplissante. Quand cette douleur est notée avec une prothèse remplissante , la recherche et le traitement de la cause la feront disparaître. Le revêtement dhydroxyapatite na pas empêché les douleurs de la cuisse dans le groupe Furlong.

     

髂腰肌撞击——全髋关节置换术后并发症的诊治

目的分析全髋关节置换术后髂腰肌撞击假体引起疼痛原因及治疗措施。方法19例人工全髋关节置换术因髂腰肌撞击髋臼假体引起髋部疼痛患者,5例采用保守治疗无效后行髂腰肌肌腱切断术,12例行髂腰肌肌腱切断术,2例髋臼假体翻修。结果术后所有患者疼痛均明显减轻,Harris评分术前47～70（59±5．3）分,术后达83-95（92±1．7）分。双髋对比屈髋力量17例无明显下降,2例部分下降但并不影响髋关节功能。结论人工全髋关节置换术后因髂腰肌撞击髋臼假体引起髋部疼痛的患者,保守治疗常常效果不佳,而髂腰肌肌腱切断术效果较好。     

全髋关节置换术后患者规范化疼痛管理

目的探讨全髋关节置换术后患者规范化疼痛管理的效果。方法将101例初次单侧髋关节置换患者随机分成对照组(51例)和干预组(50例)。对照组采用常规护理,干预组在此基础上由疼痛管理小组给予规范化疼痛管理,比较两组术后72 h疼痛结局。结果两组术后不同时间静息疼痛及活动疼痛评分比较,差异有统计学意义(P<0.05,P<0.01);术后72 h干预组疼痛控制结局显著优于对照组(P<0.05,P<0.01)。结论对初次单侧全髋关节置换患者实施规范化疼痛管理,可以改善疼痛结局,有助于提高患者生活质量。     

人工全髋置换术后疼痛原因分析

目的 探讨人工全髋置换术后疼痛的发生原因、发生情况及其处理。方法 对89例行人工全髋置换术的患者（89髋）进行随访，平均随访时间7年，摄骨盆X线片，并对随访结果作统计学处理。结果 89髋中，31髋存在不同程度疼痛，随术后时间延长，疼痛发生率逐渐升高,其中6髋存在X线松动征象，11髋存在临床松动征象。3例异位骨化患者术后轻中度疼痛，2髋晚期感染，术后严重疼痛。结论 假体移位、下沉是造成人工全髋置换术后疼痛的主要原因；X线松动征象与疼痛关系并不确定，疼痛取决于松动程度；感染及异位骨化是造成术后早期疼痛的重要原因。     

Popliteus tendon dysfunction following total knee arthroplasty

The popliteus tendon can be a potential source of internal derangement after total knee arthroplasty. It can subluxate anteriorly and posteriorly over a retained lateral femoral condylar osteophyte or over the overhanging edge of the metallic posterior femoral condyle. Surgical release of the tendon from its femoral insertion relieves the problem.