Hip arthroscopy in patients with painful hip following resurfacing arthroplasty

Abstract

Purpose

Determining the etiology of persistent groin pain after hip resurfacing arthroplasty (HRA) can be very challenging, even for the experienced surgeon. The purpose of the present study was to evaluate the use of hip arthroscopy as a diagnostic and therapeutic tool for the painful hip following resurfacing arthroplasty.

Methods

In the present paper, the indications for arthroscopy and the arthroscopic findings in 15 patients with persistent and incapacitating groin pain following HRA are described. In all patients, nonsurgical diagnostic investigations such as ultrasound and radiography, blood sample analysis, and technetium and leukocyte-labeled scanning were inconclusive so that a definite diagnosis could not be established.

Results

In seven patients, synovial biopsies were taken arthroscopically to rule out metal sensitivity, low-grade infection, or excessive metal wear. A definite diagnosis from histological evaluation could be made in 5 out of the 7 patients. Five patients were clinical suspicious of iliopsoas tendinitis. Diagnostic arthroscopy and histological analysis of the synovial samples provided an alternative diagnosis in 2 out of the 5 patients. Three patients underwent femoral osteoplasty for impingement due to reduced anterior femoral offset with subsequent symptom relief.

Conclusion

Hip arthroscopy after HRA is a valuable diagnostic alternative to open procedures in case of persistent groin pain, when noninvasive investigations fail to explain the symptoms. Multiple tissue samples should always be taken for histological examination and culture, as they are crucial in the final identification of the origin of the complaints.

Level of evidence

IV.

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References

  1. 1.

    Amstutz HC, Le Duff MJ (2008) Eleven years of experience with metal-on-metal hybrid hip resurfacing: a review of 1000 conserve plus. J Arthroplasty 23:36–43

    PubMed  Article  Google Scholar 

  2. 2.

    Beaule PE, Harvey N, Zaragoza E, Le Duff MJ, Dorey FJ (2007) The femoral head/neck offset and hip resurfacing. J Bone Joint Surg Br 89:9–15

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Bin Nasser A, Beaule PE, O’Neill M, Kim PR, Fazekas A (2010) Incidence of groin pain after metal-on-metal hip resurfacing. Clin Orthop Relat Res 468:392–399

    PubMed  Article  Google Scholar 

  4. 4.

    Campbell P, Shimmin A, Walter L, Solomon M (2008) Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplasty 23:1080–1085

    PubMed  Article  Google Scholar 

  5. 5.

    De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K (2008) Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br 90:1291–1297

    PubMed  Article  Google Scholar 

  6. 6.

    De Smet K, De Haan R, Calistri A, Campbell PA, Ebramzadeh E, Pattyn C, Gill HS (2008) Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am 90:202–208

    PubMed  Article  Google Scholar 

  7. 7.

    De Smet K, Pattyn C, Verdonk R (2002) Early results of primary Birmingham hip resurfacing using a hybrid metal-on-metal couple. Hip Int 12:158–162

    Google Scholar 

  8. 8.

    Dienst M, Kohn D (2009) Arthroscopic treatment of femoroacetabular impingement. Technique and results. Orthopade 38:429–443

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Hallab NJ, Caicedo M, Finnegan A, Jacobs JJ (2008) Th1 type lymphocyte reactivity to metals in patients with total hip arthroplasty. J Orthop Surg Res 13:3–6

    Google Scholar 

  10. 10.

    Janssens X, Van Meirhaeghe J, Verdonk R, Verjans P, Cuvelier C, Veys EM (1987) Diagnostic arthroscopy of the hip joint in pigmented villonodular synovitis. Arthroscopy 3:283–287

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Khanduja V, Villar RN (2008) The role of arthroscopy in resurfacing arthroplasty of the hip. Arthroscopy 24:122.e1–3

    Google Scholar 

  12. 12.

    Kluess D, Zietz C, Lindner T, Mittelmeier W, Schmitz KP, Bader R (2008) Limited range of motion of hip resurfacing arthroplasty due to unfavorable ratio of prosthetic head size and femoral neck diameter. Acta Orthop 79:748–754

    PubMed  Article  Google Scholar 

  13. 13.

    Korovessis P, Petsinis G, Repanti M, Repantis T (2006) Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. J Bone Joint Surg Am 88:1183–1191

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Lachiewicz PF (2007) Metal-on-metal hip resurfacing: a skeptic’s view. Clin Orthop Relat Res 465:86–91

    PubMed  Google Scholar 

  15. 15.

    Lachiewicz PF, Kauk JR (2009) Anterior iliopsoas impingement and tendinitis after total hip arthroplasty. J Am Acad Orthop Surg 17:337–344

    PubMed  Google Scholar 

  16. 16.

    Lavigne M, Rama KR, Roy A, Vendittoli PA (2008) Painful impingement of the hip joint after total hip resurfacing: a report of two cases. J Arthroplasty 23:1074–1079

    PubMed  Article  Google Scholar 

  17. 17.

    Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N (2009) Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop 80:653–659

    PubMed  Article  Google Scholar 

  18. 18.

    McCarthy JC, Jibodh SR, Lee JA (2009) The role of arthroscopy in evaluation of painful hip arthroplasty. Clin Orthop Relat Res 467:174–180

    PubMed  Article  Google Scholar 

  19. 19.

    Nikolaou V, Bergeron SG, Huk OL, Zukor DJ, Antoniou J (2009) Evaluation of persistent pain after hip resurfacing. Bull NYU Hosp Jt Dis 67:168–172

    PubMed  Google Scholar 

  20. 20.

    Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, Ostlere S, Athanasou N, Gill HS, Murray DW (2008) Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 90:847–851

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Pattyn C, De Smet KA (2008) Primary ceramic-on-ceramic total hip replacement versus metal-on-metal hip resurfacing in young active patients. Orthopedics 31:1078–1083

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Robertson WJ, Kelly BT (2008) The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement. Arthroscopy 24:1019–1026

    PubMed  Article  Google Scholar 

  23. 23.

    Shimmin AJ, Bare J, Back DL (2005) Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am 36:187–193

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Thomas P, Braathen LR, Dorig M, Aubock J, Nestle F, Werfel T, Willert HG (2009) Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation. Allergy 64:1157–1165

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Vendittoli PA, Ganapathi M, Nuno N, Plamondon D, Lavigne M (2007) Factors affecting hip range of motion in surface replacement arthroplasty. Clin Biomech 22:1004–1012

    Article  Google Scholar 

  26. 26.

    Wettstein M, Jung J, Dienst M (2006) Arthroscopic psoas tenotomy. Arthroscopy 22:907 e1–4

    Google Scholar 

  27. 27.

    Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Koster G, Lohmann CH (2005) Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am 87:28–36

    PubMed  Article  Google Scholar 

  28. 28.

    Zustin J, Amling M, Krause M, Breer S, Hahn M, Morlock MM, Ruther W, Sauter G (2009) Intraosseous lymphocytic infiltrates after hip resurfacing arthroplasty: a histopathological study on 181 retrieved femoral remnants. Virchows Arch 454:581–588

    PubMed  Article  Google Scholar 

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Conflict of interest

No benefits or funds were received in support of the study.

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Correspondence to C. Pattyn.

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C. Pattyn and E. Audenaert contributed equally to the paper.

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Pattyn, C., Verdonk, R. & Audenaert, E. Hip arthroscopy in patients with painful hip following resurfacing arthroplasty. Knee Surg Sports Traumatol Arthrosc 19, 1514–1520 (2011). https://doi.org/10.1007/s00167-011-1463-7

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Keywords

  • Hip arthroscopy
  • Hip resurfacing
  • Metal sensitivity
  • Impingement