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Case Reports
. 2009 Jan;467(1):174-80.
doi: 10.1007/s11999-008-0525-8. Epub 2008 Oct 2.

The role of arthroscopy in evaluation of painful hip arthroplasty

Joseph C McCarthy  1 , Stefan R Jibodh, Jo-Ann Lee
Affiliations
Case Reports

The role of arthroscopy in evaluation of painful hip arthroplasty

Joseph C McCarthy et al. Clin Orthop Relat Res. 2009 Jan.

Abstract

Unexplained pain after hip arthroplasty is frustrating for patients and surgeons. We describe the use of hip arthroscopy in management of the painful hip arthroplasty, critically evaluate the outcomes of these patients, and refine indications for hip arthroscopy in this setting. We retrospectively reviewed 14 patients (16 hips) who underwent hip arthroscopy after joint replacement. One patient had suspected septic arthritis despite negative aspiration and one had known septic arthritis but was not a candidate for open arthrotomy; two had intraarticular migration of hardware. The remaining 10 patients (11 hips) had persistent pain despite negative diagnostic studies. The two patients (two hips) with infection were successfully treated with arthroscopic lavage and débridement plus intravenous antibiotics. Intraarticular metal fragments and a loose acetabular screw were successfully removed in two patients (three hips). Findings in the remaining 11 hips included a loose acetabular component (one); corrosion at the head-neck junction of a metal-on-metal articulation (one); soft tissue-scar impingement at the head/cup interface (four); synovitis with associated scar tissue (four); and capsular scarring with adhesions (one). Arthroscopy represented a successful treatment or directly led to a successful treatment in 12 of 16 hips. We observed no complications as a result of the arthroscopy. Arthroscopy may be of value in selected patients undergoing hip arthroplasty with unexplained pain after an inconclusive standard workup.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1A–B
Fig. 1A–B
Case 3. (A) A fluoroscopic image shows a migrated trochanteric wire noted 3 years after revision left hip arthroplasty. (B) An intraoperative photograph shows the same hip during arthroscopic wire removal.
Fig. 2A–C
Fig. 2A–C
Case 4. (A) Serial radiographs demonstrate progressive loosening and migration of a peripheral acetabular screw after THA. (B) Shows progression of screw backing out. (C) Shows plain radiograph after screw was removed arthroscopically.
Fig. 3
Fig. 3
Case 6. An intraoperative photograph shows corrosion at the femoral head-neck junction in a patient with diffuse metal synovitis.
Fig. 4
Fig. 4
Case 15. Impinging soft tissue is visible during arthroscopic débridement.
See this image and copyright information in PMC

References

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