title: The role of arthroscopy in patients with persistent hip pain after total hip arthroplasty.
abstract: BACKGROUND
  Total hip arthroplasty (THA) is a safe and successful procedure for the treatment of osteoarthritis. One of the most common postoperative problems remains persistent hip pain. The arthroscopic evaluation of persistent hip pain following THA can be a valuable diagnostic tool in a select number of patients when carried out by experts in this technique.
  
  
  OBJECTIVE
  Indication for arthroscopy was persistent pain after THA. Inclusion criteria were an absence of radiological loosening and a sterile aspiration 6 weeks before arthroscopy. Hip joint function and pain were evaluated pre- and postoperatively using the visual analogue scale (VAS) and the Hip Outcome Score (HOS), which scored the activities of daily living (ADL), and a sports subscale.
  
  
  METHODS
  5 patients (3 female, 2 male) with an average age of 60.2 ± 4.27 years (range 51-72 years) were included in the study. Arthroscopy with biopsy, adhesiolysis and psoas tendon release was performed 21.0 ± 21.97 months (range 6-57 months) after primary hip replacement.
  
  
  RESULTS
  Pathological findings were prosthetic joint infection (two cases), impingement between acetabular component and psoas tendon (two cases), adhesions of the periprosthetic tissue (one case). The patients achieved a significant improvement of the Hip Outcome Score (HOS), from an average of 45.6 ± 22.5 (range 14.0-63.1) to 76.5 ± 3.8 (range 41.0-89.4, P=0.016). Evaluation of the VAS showed a significant improvement from a preoperative value of 8.8 ± 0.5 to a postoperative value of 3.4 ± 1.0 (P=0.001).
  
  
  CONCLUSIONS
  Hip arthroscopy provides a minimal-invasive tool for diagnosis and therapy. In cases of persistent pain after THA, standard diagnostic procedures should be utilised. Arthroscopy of a hip post-THA would be highly specialised. As a next step, arthroscopy helps the diagnosis and therapy of persistent pain after THA.
authors.affiliation: Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lahner
authors.affiliation: Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: von Schulze Pellengahr
authors.affiliation: Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Lichtinger
authors.affiliation: Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Vetter
authors.affiliation: Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Stephan Herbert
authors.initials: SH
authors.lastname: Pesendorfer
authors.affiliation: Biomechanics Laboratory Department of Sport and Movement Sciences, University of Duisburg-Essen, Essen, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Hagen
authors.affiliation: Department of Orthopaedic Surgery, Annastift Hannover (Medical School Hannover, MHH), Hannover, Germany.
authors.forename: Kiriakos
authors.initials: K
authors.lastname: Daniilidis
authors.affiliation: Faculty of Health Sciences, University of Witten/Herdecke, Witten, Germany.
authors.forename: Lars Victor
authors.initials: LV
authors.lastname: von Engelhardt
authors.affiliation: Department of Orthopaedic Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Teske
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001182:Arthroscopy / Q000379:methods*; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D057925:Femoracetabular Impingement / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000628:therapy
keywords: Hip arthroscopy; periprosthetic hip infection; persistent hip pain; total hip arthroplasty