Investigating the painful Total Hip Replacement

 

It is important to note there may be more than one reason for pain/problems present. It is important to identify all causes. A careful history and physical examination is therefore especially important.  Investigations are usually performed; these will include x-rays and blood tests.

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The following are some of the tests and scans you may need to undergo:

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• Blood tests can sometimes rule out infection in painful joint replacements.

• X-rays of the hip can help assess bone loss.

• Bone scan, looking for signs of loosening or infection.

• CT scans are useful in assessment of alignment and bone damage.

• MRI scans are useful for assessing muscle damage and for ‘metal on metal disease’.

• Ultrasound scans, when performed by experienced musculoskeletal radiologists, can provide an excellent dynamic assessment of tendon function and bursitis; but are usually used to correctly target diagnostic/therapeutic local anaesthetic +/- steroid injections.

• Examination under anaesthesia is useful for assessing positions of instability.

• Aspiration is useful to test for infection.

• Injecting local anaesthetic into the hip joint is useful to identify if the cause of the pain is inside or outside the hip joint.

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Causes of groin pain after hip replacement:

• Psoas impingement is a relatively common cause of groin pain after hip replacement (4-5%). Mr Ashworth has specialised in arthroscopic treatment of this condition as a day case procedure. He has reported a high success rate in resolving pain caused by psoas tendon impingement over the front of the acetabular component of a hip replacement.

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• Ischio-femoral impingement is a rare cause of pain due to the hip being too narrow/close to the pelvis and the lesser trochanter trapping the quadratus-femoris muscle against the ischium. Once the diagnosis is confirmed it is possible to treat this arthroscopically as a day case.

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