Abstract
The painful total hip arthroplasty requires careful evaluation and investigation. This is usually focused on the prosthesis and adjacent anatomical structures. We present a case report of a 64-year-old man who had a Birmingham hip resurfacing procedure for primary osteoarthritis. His hip pain worsened following the procedure and was under systematic investigation for this. Subsequent investigation for vascular disease revealed a total infrarenal aortic occlusion. An aortobifemoral bypass improved the hip pain and function dramatically, and the patient now has an excellent quality of life.
Highlights
Case historyThe pain was a dull ache at most times but much worse on walking for more than around 50 metres
The painful total hip arthroplasty requires careful evaluation and investigation
A 64-year-old man presented with hip pain to our orthopaedic outpatient clinic
Summary
The pain was a dull ache at most times but much worse on walking for more than around 50 metres It was centred on the right hip and radiated to the lateral thigh and buttock. He was independently mobile without walking aids He had been on prednisolone and methotrexate for a number of years previously for inflammatory arthritis. At the six-week review, the patient’s mobility had only improved slightly His wounds had healed well, he could only mobilise with crutches. The quadriceps femoris was noted to be wasted and a provisional diagnosis of femoral nerve neurapraxia was made He was encouraged to fully weight bear and continue mobilising. At eight months, his osteotomy screws were removed owing to continued trochanteric-based pain. The ankle brachial pressure index was measured at 0.42 on the right and 0.44 on e10
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