Houston Methodist. Leading Medicine



My right hip has been bugging me off and on for two weeks. I have a hip replacement on that side so I'm a little worried. Could this be caused by a problem with the implant?


For anyone with a total hip replacement (THR), hip pain is a red flag. Medical evaluation is important because of the risk of joint infection. Treatment depends on knowing if there is (or isn't) an infection. There are many possible causes for the pain you are having. They may or may not be related to the implant. The first thing the orthopedic surgeon will examine is the hip itself. Your history along with the clinical presentation are very helpful. But then the spine (above) and the knee (below) will be tested as possible sources of referred pain. X-rays and lab tests may be needed to rule out a fracture, implant loosening or infection. Other possible causes include bursitis, ossification (bone formation in the muscle or surrounding soft tissue), or synovitis. Cultures of the joint taken directly from the area during surgery are the most accurate way to confirm (or rule out) joint infection. But this type of testing is not practical for the patient who doesn't have an infection or who doesn't need surgery. And there is a fair amount of false-positive test results with intraoperative cultures due to errors in sampling technique. Instead, the physician may rely on lab tests that are sensitive, reliable, and accurate with a low false-positive and high true-positive results. The following tests may be needed to evaluate for hip infection: erythrocyte sedimentation (SED rate), C-reactive protein (CRP), and synovial fluid white blood cell count (WBC). Don't wait to get tested. See your surgeon now. Early diagnosis can prevent a lot of complications from delayed treatment. Mark F. Schinsky, MD, et al. Perioperative Testing for Joint Infection in Patients Undergoing Revision Total Hip Arthroplasty. In The Journal of Bone and Joint Surgery. September 2008. Vol. 90. No. 9. Pp. 1869-1875.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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