髋关节置换术后持续性髋关节疼痛的诊断是什么？系统回顾

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-09 DOI:10.1016/j.jcot.2025.103036

Kael Hulin , Angie Fearon , Phil Newman

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引用次数: 0

摘要

背景：据报道，23%的病例在全髋关节置换术后出现持续髋关节疼痛。尽管常规的临床检查，疼痛的来源往往仍然不清楚，诊断需要广泛的影像学检查或手术探查。目的本系统综述旨在确定可归因于疼痛髋关节置换术的诊断。第二个目标是确定用于识别它们的诊断技术。方法对2012 - 2024年的Medline、Scopus和CINAHL数据库进行检索，检索关键词为“持续性疼痛和髋关节置换术及诊断”等医学主题词。采用乔安娜布里格斯研究所的病例系列检查表进行质量评估。一名作者使用covid - ence软件进行数据提取，并由另一名作者进行交叉检查以确保准确性。数据包括年龄、性别、关节置换类型、诊断方法和确诊。数据被合成以提供诊断和诊断方法的定量概述。普洛斯彼罗号码CRD42022340158。结果检索和文献筛选共获得285篇文献，其中高质量病例系列7篇，质量不明确病例系列2篇。总共包括388例疼痛性髋关节置换术。28.6%的病例出现假体松动或感染。21%的病例存在髂腰肌撞击。髋关节外原因占16.4%的病例，其中腰椎（14.6%）是最常见的。大转子疼痛综合征（GTPS）出现在13%。9.2%的参与者疼痛的病因不明。最常见的诊断成像技术是x线（100%），其次是磁共振成像（22%）。结论尽管初步筛查排除了假体松动和感染，但它们仍然是引起疼痛的重要原因。髂腰肌撞击和髋关节外的原因需要考虑由于高患病率。不太常见的鉴别诊断已经确定。x射线是一种重要的一线成像工具，而其他高级成像也有选择性地用于诊断。

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What are the diagnoses attributed to persistent hip pain after hip arthroplasty? A systematic review

Background

Persistent hip pain after total hip arthroplasty has been reported in up to 23 % of cases. Despite routine clinical tests, the source of pain often remains unclear, and diagnosis requires extensive investigation with imaging or surgical exploration.

Aims

This systematic review aimed to identify the diagnoses attributable to the painful hip arthroplasty. The second aim was to identify diagnostic techniques used to identify them.

Method

Three databases (Medline, Scopus and CINAHL) were searched from 2012 to 2024 using keywords and medical subject headings (MeSH) including ‘persistent pain AND hip arthroplasty AND diagnoses’. Quality assessment was undertaken with the Joanna Briggs Institute checklist for case-series. Data extraction was performed by one author using Covidence software and crosschecked by another for accuracy. Data included age, sex, arthroplasty type, diagnostic method, and confirmed diagnosis. Data was synthesised to provide a quantitative overview of diagnoses and diagnostic methods. PROSPERO number CRD42022340158.

Results

The search and reference screening returned 285 papers of which seven high quality and two unclear quality case-series met the inclusion criteria. There was a total of 388 painful hip arthroplasties included. Prostheses loosening or infection was present in 28.6 % of cases. Iliopsoas impingement was present in 21 % of cases. Causes outside the hip accounted for 16.4 % of cases with referred pain from the lumbar spine (14.6 %) most common. Greater trochanteric pain syndrome (GTPS) was present in 13 %. The painful etiology remained unknown in 9.2 % of participants. The most common diagnostic imaging technique was x-ray (100 %) followed by magnetic resonance imaging (22 %).

Conclusion

Prosthesis loosening and infection remain a significant cause of pain despite preliminary screening to exclude them. Iliopsoas impingement and causes outside the hip require significant consideration due to high prevalence. Less common differential diagnoses have been identified. X-ray is an important front-line imaging tool while other advanced imaging is used selectively to identify a diagnosis.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.