cadera / hip - Active Congress.......
cadera / hip - Active Congress.......
cadera / hip - Active Congress.......
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MIÉRCOLES / WEDNESDAY<br />
138<br />
EVALUATION OF THE<br />
PAINFUL THA<br />
D. A. Dennis, M.D.<br />
Adjunct Professor, Dept. of Biomedical<br />
Engineering, University of Tennessee<br />
Assistant Clinical Professor, University<br />
of Colorado Health Sciences Center<br />
Clinical Director, Rocky Mountain Musculoskeletal<br />
Research Laboratory<br />
Denver, Colorado, USA<br />
I. CAUSES OF PAIN AFTER TOTAL HIP<br />
ARTHROPLASTY<br />
A. Articular<br />
1. Prosthetic Loosening<br />
2. Flexural Rigidity Mismatch<br />
a) Femur Vs. Femoral Component Stiffness<br />
3. Infection<br />
4. Instability<br />
5. Component Failure<br />
6. Soft Tissue Impingement<br />
7. Osteolysis<br />
a) Synovitis/ Microfracture<br />
B. Periarticular<br />
1. Trochanteric Bursitis<br />
2. Trochanteric Nonunion<br />
3. Fracture<br />
a) Stress Fracture (Pubic Rami/ Greater<br />
Tuberosity)<br />
b) Avulsion (ASIS/ Ischial Tuberosity)<br />
c) Periprosthetic<br />
4. Iliopsoas Bursitis/ Tendinitis<br />
5. Soft Tissue Contracture<br />
6. Heterotopic Ossifi cation (During Maturation)<br />
7. Piriformis Syndrome<br />
C. Extra-Articular<br />
1. Lumbar Spine Disease<br />
2. Vascular Disease<br />
a) Aortoiliac Stenosis<br />
b) Postoperative Aneurysm/ Pseudoaneurysm<br />
c) Iliofemoral Venous Thrombosis<br />
3. Inguinal/ Femoral Hernia<br />
4. Postoperative Neural Injury<br />
a) Femoral/ Obturator/ Sciatic<br />
5. Psychogenic Factors<br />
II. EVALUATION<br />
A. History<br />
1. Pain Location/ Radiation ??<br />
a) Groin/ Buttock: Acetabular Component<br />
b) Anterior Thigh: Femoral Component<br />
c) Lateral: Greater Trochanteric Bursitis/<br />
Nonunion<br />
d) Buttock/ Posterior Thigh & Calf: Lumbosacral<br />
Spine<br />
2. Pain Onset<br />
a) Initial Painfree Interval Then Late<br />
Pain<br />
• Think Component Loosening/ Failure<br />
or Sepsis<br />
b) Failure To Achieve Any Pain Relief<br />
• Think Periarticular/ Extra-Articular<br />
Source<br />
3. Typical Infection History<br />
a) Night & Rest Pain<br />
b) Fever & Chills<br />
c) Recent Procedures (Dental/ GI/ GU)<br />
4. Typical Aseptic Loosening History<br />
a) ↑ Pain With Activity (Weight-Bearing)<br />
b) ↓ Pain With Rest<br />
B. Physical Exam<br />
1. Abnormal Gait/ + Trendelenberg Test:<br />
Think Articular Source<br />
2. Neurologic Exam<br />
3. FABER TEST (Sacroiliac Disease)<br />
4. Straight Leg Test (L/S Spine Disease)<br />
5. Ober Test (Iliotibial Band Tightness)<br />
6. Range of Motion<br />
7. Extension of Flexed/ Abducted/ Externally<br />
Rotated Hip<br />
a) Iliopsoas Irritation<br />
• Neutral Or Retroverted Cup<br />
• Anterior Cup Edge Exposed<br />
• Trousdale, et al, J Arthroplasty, 1995
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