title: [Diagnosis of hip prosthesis loosening--sensitivity of clinical parameters].
abstract: OBJECTIVE
  In order to establish a strategy for early diagnosis of aseptic loosening of total hip arthroplasty (THA) physical examination, patient's assessment and radiographs were analysed.
  
  
  METHODS
  Pain, self assessment, physical examination and mobility were examined according to a standard examination protocol in 428 hips of 297 patients after cementless total hip arthroplasty (THA). These findings were compared with the radiographic finding of the hip. Sensitivity and specifity of objective and subjective parameters were analysed.
  
  
  RESULTS
  The clinical outcome of THA's is assessed by pain and physical examination. Nearly all hip scores are based on these parameters. In this study sensitivity and specificity of all parameters analysed were unsatisfactory compared with the radiographic finding. Although we found some correlations between clinical and radiological data, clinical data alone are not sufficient for exclusion of THA loosening, especially for loosening of the acetabular component, as there was no clear distinction between the group of radiographically loosened (43 acetabular cups and 4 stems) and intact endoprostheses.
  
  
  CONCLUSIONS
  We conclude, that physical examination and pain history are not sufficient to exclude loosening of cementless THA's. Radiographic examination is essential for the assessment of THA's, even in painfree patients.
authors.affiliation: Abteilung I, Stiftung Orthopädische Universitätsklinik Heidelberg.
authors.forename: H G
authors.initials: HG
authors.lastname: Simank
authors.forename: D R
authors.initials: DR
authors.lastname: Brocai
authors.forename: S
authors.initials: S
authors.lastname: Rode
authors.forename: M
authors.initials: M
authors.lastname: Lukoschek
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012008:Recurrence; D012680:Sensitivity and Specificity