Diagnosis
The diagnosis of pain with a hip prosthesis initially involves a detailed interview (anamnesis). How long has the pain been present, how severe is it, are there triggering factors or does it radiate? The mobility of the hip prosthesis should also be physically examined. The definitive diagnosis of why the hip prosthesis causes pain includes an X-ray and possibly a computer tomography as well as, in case of infectious genesis, some blood tests and a pathogen detection.
Therapy
The therapy depends on the cause of the pain, symptomatically, a suitable pain therapy must be initiated at the beginning. Substances such as diclofenac or paracetamol, but also stronger agents such as oxycodone or tramadol are used. In the case of a hip prosthesis loosening, there is no getting around a revision, i.e. a second operation.
If possible, the hip prosthesis is changed and infectious foci can be cleared out. A better stability for the second hip prosthesis can be ensured by additional anchorages or artificial bone augmentation. An infection that may be the cause of the pain of the hip prosthesis must be treated with high-dose antibiotics, which can also be administered directly into the tissue. Risk factors such as obesity, extreme stress, diabetes or smoking and alcohol must also be well controlled in order to prolong the life of a hip prosthesis without pain.
Prognosis
If a hip prosthesis causes pain, the prognosis depends on many factors. If the cause can be eliminated, there is nothing to prevent a continued good quality of life. A change of prosthesis is often necessary.
It must be said that the prognosis after a revision operation is on average worse than after the first operation, because healthy material is injured and removed again. Infections can also be complicated, which worsens the prognosis, especially if they spread to the bone (osteomyelitis). The risk of infection is significantly increased. However, the chance of a complication-free course after revision is still given as 85-90%.
