Painful Prosthetic Joint

Description

Professor Dominic Meek gives his expert insights and discusses the case of a 57-year-old patient who underwent a metal-on-metal hip resurfacing with cobalt-chromium components six years ago and is now presenting with three months of groin and proximal thigh pain. The pain is reported to be constant and worsens with activity, yet the wound appears well-healed and the patient maintains a full range of motion. Radiographs show no abnormalities, prompting a discussion about the appropriate next steps in management.



Professor Meek suggests that while the current imaging does not indicate any issues, it’s advisable to compare with previous imaging to check for subtle signs of complications, especially focusing on the femoral neck for narrowing that could indicate fluid accumulation. The recommended approach includes performing an MRI using a metal artifact reduction sequence to assess for soft tissue fluid or any potential reactions in surrounding muscles.



It is noted that nuclear medicine bone scans are not effective in this scenario, as they do not provide useful information regarding loosening of the components or infection unless an aspiration is performed. In case of suspicion of infection, blood samples for metal ion levels and inflammatory markers (ESR and CRP) are suggested. Professor Meek also covers the considerations for possible conversion to total hip replacement, advocating for the use of ceramic-on-polyethylene components to eliminate the risk of metal hypersensitivity. Ultimately, the decision on management will heavily depend on the findings from the MRI.


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DOI: 10.1302/3114-251266

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