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Hip arthroscopy in patients with painful hip following resurfacing arthroplasty

Christophe Pattyn (UGent) , René Verdonk (UGent) and Emmanuel Audenaert (UGent)
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Abstract
Purpose Determining the etiology of persistent groin pain after hip resurfacing arthroplasty (HRA) can be very challenging, even for the experienced surgeon. The purpose of the present study was to evaluate the use of hip arthroscopy as a diagnostic and therapeutic tool for the painful hip following resurfacing arthroplasty. Methods In the present paper, the indications for arthroscopy and the arthroscopic findings in 15 patients with persistent and incapacitating groin pain following HRA are described. In all patients, nonsurgical diagnostic investigations such as ultrasound and radiography, blood sample analysis, and technetium and leukocyte-labeled scanning were inconclusive so that a definite diagnosis could not be established. Results In seven patients, synovial biopsies were taken arthroscopically to rule out metal sensitivity, low-grade infection, or excessive metal wear. A definite diagnosis from histological evaluation could be made in 5 out of the 7 patients. Five patients were clinical suspicious of iliopsoas tendinitis. Diagnostic arthroscopy and histological analysis of the synovial samples provided an alternative diagnosis in 2 out of the 5 patients. Three patients underwent femoral osteoplasty for impingement due to reduced anterior femoral offset with subsequent symptom relief. Conclusion Hip arthroscopy after HRA is a valuable diagnostic alternative to open procedures in case of persistent groin pain, when noninvasive investigations fail to explain the symptoms. Multiple tissue samples should always be taken for histological examination and culture, as they are crucial in the final identification of the origin of the complaints. Level of evidence IV.
Keywords
MOTION, RANGE, Impingement, Metal sensitivity, Hip resurfacing, Hip arthroscopy, IMPINGEMENT, REPLACEMENT

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Chicago
Pattyn, Christophe, René Verdonk, and Emmanuel Audenaert. 2011. “Hip Arthroscopy in Patients with Painful Hip Following Resurfacing Arthroplasty.” Knee Surgery Sports Traumatology Arthroscopy 19 (9): 1514–1520.
APA
Pattyn, C., Verdonk, R., & Audenaert, E. (2011). Hip arthroscopy in patients with painful hip following resurfacing arthroplasty. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 19(9), 1514–1520.
Vancouver
1.
Pattyn C, Verdonk R, Audenaert E. Hip arthroscopy in patients with painful hip following resurfacing arthroplasty. KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY. 2011;19(9):1514–20.
MLA
Pattyn, Christophe, René Verdonk, and Emmanuel Audenaert. “Hip Arthroscopy in Patients with Painful Hip Following Resurfacing Arthroplasty.” KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 19.9 (2011): 1514–1520. Print.
@article{1900483,
  abstract     = {Purpose Determining the etiology of persistent groin pain after hip resurfacing arthroplasty (HRA) can be very challenging, even for the experienced surgeon. The purpose of the present study was to evaluate the use of hip arthroscopy as a diagnostic and therapeutic tool for the painful hip following resurfacing arthroplasty. 
Methods In the present paper, the indications for arthroscopy and the arthroscopic findings in 15 patients with persistent and incapacitating groin pain following HRA are described. In all patients, nonsurgical diagnostic investigations such as ultrasound and radiography, blood sample analysis, and technetium and leukocyte-labeled scanning were inconclusive so that a definite diagnosis could not be established. 
Results In seven patients, synovial biopsies were taken arthroscopically to rule out metal sensitivity, low-grade infection, or excessive metal wear. A definite diagnosis from histological evaluation could be made in 5 out of the 7 patients. Five patients were clinical suspicious of iliopsoas tendinitis. Diagnostic arthroscopy and histological analysis of the synovial samples provided an alternative diagnosis in 2 out of the 5 patients. Three patients underwent femoral osteoplasty for impingement due to reduced anterior femoral offset with subsequent symptom relief. 
Conclusion Hip arthroscopy after HRA is a valuable diagnostic alternative to open procedures in case of persistent groin pain, when noninvasive investigations fail to explain the symptoms. Multiple tissue samples should always be taken for histological examination and culture, as they are crucial in the final identification of the origin of the complaints. 
Level of evidence IV.},
  author       = {Pattyn, Christophe and Verdonk, Ren{\'e} and Audenaert, Emmanuel},
  issn         = {0942-2056},
  journal      = {KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY},
  keyword      = {MOTION,RANGE,Impingement,Metal sensitivity,Hip resurfacing,Hip arthroscopy,IMPINGEMENT,REPLACEMENT},
  language     = {eng},
  number       = {9},
  pages        = {1514--1520},
  title        = {Hip arthroscopy in patients with painful hip following resurfacing arthroplasty},
  url          = {http://dx.doi.org/10.1007/s00167-011-1463-7},
  volume       = {19},
  year         = {2011},
}

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