Comprehensive physical, intake of medical history are key in diagnosis of painful hips
William J. Maloney
WAILEA, Hawaii – Proper assessment of patients with painful hips after total hip arthroplasty should involve a good physical exam, intake of medical history and consideration of extra-articular sources, according to a presenter here at Orthopedics Today Hawaii 2012.
“I start out by doing with asking ‘Is it the hip?’ I think it is like anything else. A good history and a good physical are important in terms of diagnosis,” William J. Maloney, MD, said here.
A basic work-up consists of a history, physical exam, X-rays, complete blood count, erythrocyte sedimentation rate and C-reactive protein measures, he said.To assess the character and location of the pain, Maloney asks patients if the pain has changed since surgery or was there a pain-free interval after surgery.
“Location of the pain is important,” he advised.
Start-up pain indicates loose components, he said, where as constant pain or night pain are signs of infection. Pain in the groin indicates a loose socket or iliopsoas impingement, and pain in the thigh can indicate a loose stem or end-of-stem pain.
“If labs are abnormal or history is suggestive, then an aspiration is indicated to rule out infection,” Maloney said.
He said that osseointegration can be difficult to evaluate with cementless sockets. Nuclear medicine scans should be used in select cases, and negative scans are most helpful.
- Maloney WJ. Evaluation of the painful THR. Presented at Orthopedics Today Hawaii 2012, Jan. 15-18. Wailea, Hawaii.
- Disclosure: Maloney receives royalties from Wright Medical and Zimmer.