ePoster #119 - ISHA Annual Scientific Meeting 2016

Arthroscopy In The Painful Hip Arthroplasty

Jennifer Stefanie Rudolph, Bergisch Gladbach, NRW GERMANY
Jochen Muller-Stromberg, MD, Bonn GERMANY
Holger Haas, MD, Bonn GERMANY
Dirk Schemmann, MD, Bonn GERMANY

Zentrum für Orthopädie, Unfallchirurgie und Sportmedizin, Bonn, Northrhine Westphalia, GERMANY

FDA Status Not Applicable

Summary: Pain after THA is not uncommon. Yet, the role of arthroscopy in differentiating probable diagnoses and treat some of the symptoms has not yet been evaluated.

While arthroscopy often is performed for further insights in cases of painful knee arthroplasty, its use in diagnosis and treatment after THA is yet undetermined. This study tries to outline the role of this procedure as well as its limitations.
Materials and Methods
Within the last 8 years (2007 – 2015), thirty-one patients were treated arthroscopically for remaining complaints after THA. Those cases were reviewed retrospectively looking at microbiological and histological findings, pre- and postoperative radiographs and clinical follow up.
Mean patient age at the time of surgery was 66,8 years. 10 male and 21 female subjects were treated at an average time of 3,8 years after THA. All patients complained of pain. In 75% percent preoperative radiographs were inconspicuous regarding the implant and it’s positioning. All patients had a minimum follow up of 6 months or had a second procedure in our department.
Reasons for arthroscopy were internal impingement (23 cases), suspicion of low-grade infection (5 cases), unresolved pain in (2 cases) and arthrofibrosis (1 case). Intraoperative findings supported the initial diagnosis in 80% for the low grade infection and 74% for the diagnosis of internal impingement. In the cases of unresolved pain the arthroscopy could clearly identify – and to an extent treat - the underlying pathology (1x infection, 1x arthrofibrosis). Histological examination of the synovial specimen revealed particle-induced inflammation in 2 cases, arthrofibrosis in 1 case, indifferent inflammation in 7 cases and infection in 1 case. Microbiological examination remained without bacterial growth in most cases (18), in 5 cases one strain of bacteria could be detected. Since these patients did not show any other signs of infection (inflammatory parameters in blood samples normal, no radiographic signs of implant loosening) the microbiological findings were interpreted as contamination and since clinical follow-up remained unremarkable, no further action was necessary. In 2 cases a mixed colonization of 2 or more bacterial strains was found. These patients received revision arthroplasty with a two-staged strategy. Another 4 patients had a one staged revision with changing of either components or the whole implant due to aseptic loosening after histologic and microbiologic findings from the arthroscopy turned out inconspicous.
The cause for persistent complaints in patients with THA can hardly be detected by standard radiographs. Despite advancements in imaging technology within the last years, the reason for the patient’s complaints were rarely found. In our cohort, arthroscopy proved helpful especially in diagnosing cases of soft tissue impingement and iliopsoas tendon pathologies. Also, in these cases the problem was sufficiently treated within the same procedure. In all cases of a suspected low grade infection the arthroscopy helped identify the bacteria and decide the further treatment.