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The Journal of Bone and Joint Surgery, Vol 76, Issue 10 1464-1470, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Pain in the thigh following total hip replacement with a porous-coated anatomic prosthesis for osteoarthrosis. A five-year follow-up study
RB Bourne, CH Rorabeck, ME Ghazal and MH Lee
Department of Orthopaedic Surgery, University Hospital, London.
We performed a study to determine the prevalence, severity, and natural
history of pain in the thigh in patients who had a total hip replacement
with a porous-coated anatomic prosthesis and to determine if there was an
association between the radiographic findings and the pain in the thigh. We
previously reported the results in these patients two years after the
operation. The present study included ninety-four patients (101 total hip
replacements) who had been followed for a minimum of five years--six of the
original group of patients had died from unrelated causes, two had had a
revision, and one had been lost to follow-up. The patients were assessed
prospectively with use of the Harris hip score and a visual-analog scale
for pain in the thigh. Two of us, who were blinded to the clinical result,
reviewed the radiographs retrospectively for the morphology of the proximal
aspect of the femur; distal fit; metaphyseal fill; alignment of the stem;
shedding of beads; distal cortical hypertrophy; pedestal formation;
cancellous condensations at the distal end of the porous ingrowth surface;
and the presence, extent, and location of radiolucent lines around the
femoral component. At five years, pain in the thigh was found in
association with twenty-seven hips (27 per cent). The pain was new in
fourteen thighs (14 per cent), unchanged (from that at the two-year
follow-up examination) in eight (8 per cent), increased in four (4 per
cent), and decreased in one (1 per cent). Pain in the thigh was most
strongly associated with a poor Harris hip score and the presence of loose
beads.
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