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Year |
2001 |
|---|---|
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Question Number |
175. |
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Category |
Select |
Question
In total hip arthroplasty, which of the following characterized the clinical pain pattern seen with a loose femoral component?
1- gluteal
2- night
3- start-up
4- back
5- at rest
Figures
Answer (click for answer)
Preferred response: 3
The location and characteristic of the pain is important in determining its source. Groin pain usually is caused by acetabular component loosening, which can also cause buttock pain. Femoral component loosening usually causes thigh or knee pain. Thigh pain, especially with prolonged activity, can be associated with a stable uncemented femoral component and is usually localized to a specific region of the thigh near the tip of the stem.
Pain caused by component instability usually is activity related. Clinically, a history of "start-up" pain may indicate a loose component. The patient may report that after 5 or 10 steps there is less pain in the groin. Pain with a loose component is triphasic in that the first few steps cause acute sharp pain, the pain lessens with more walking, and then with a moderate amount of walking, pain again increased. A pain caused by subluxation usually occurs when the patient is arising from the seated position. This is a sharp pain, and the patient usually corrects the position before dislocation occurs. Pain that occurs at night should suggest the possibility of infection, a neoplastic process, or spinal stenosis.
Reference: Beaty JH (ed): Orthopedic Knowledge Update 6. Rosemont, IL, AAOS, 1999, pp 455-492.