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ABSTRACT
This study was undertaken to determine the most common referral patterns of hip pain in patients scheduled to undergo primary and revision total hip replacement. The exact location of pain from the hip was recorded prospectively for 323 patients (358 hips) who had primary total hip replacement and for 94 patients who had revision of a loose total hip.
Seventy-three percent of patients with primary hip disease had pain in the grain, and 27% had groin pain that referred to the knee. Eighty-nine percent of 57 patients who had femoral component loosening had thigh or knee pain, and all of the 34 patients who had a loose acetabular component with a well-fixed femoral implant had pain in the hip region without distal radiation of pain.
These results indicate that in patients who have a painful total hip, thigh pain is highly suggestive of femoral component loosening and pain located around the hip region that does not radiate distally is associated with isolated acetabular component loosening.
Hip joint pain classically has been described as presenting in the groin with referral to the anterior thigh and knee. This referral pattern of hip pain to the thigh and knee occurs from radiation to the sensory distribution of the femoral, obturator, and sciatic nerves.1-3 However, hip pain also presents in several other major areas around the hip including the gluteal region or buttock, the greater trochanter, and the medial thigh or adductor region as well as combinations of these locations. Hip joint pain also may be referred to the leg.
A review of data that had been collected prospectively was undertaken to determine the frequency that hip joint pain occurs in each of these different locations in a large series of patients who were scheduled to undergo primary total hip replacement. Severe hip joint space narrowing was present radiologically in all patients.
The referral patterns of hip pain also were studied in another group of patients scheduled to undergo revision total hip replacement for aseptic component loosening to determine whether the location of preoperative pain could indicate the presence of either acetabular or femoral component loosening.
Materials and Methods
Data on the location of hip joint pain in 417 patients who were being evaluated for total...