Hip, groin, anterior thigh pain after THA can result from a multitude of etiologies. In general, when trying to establish the diagnosis, it is helpful to divide the possible causes into two broad categories:
- Those that are directly related to the hip prosthesis
- Those that are not related to the hip replacement
Evaluation must begin with a thorough history and physical examination; afterwards, laboratory tests, plain radiographs, arthrocentesis, and additional imaging can provide more information. Only after the diagnosis has been established should treatment be initiated. Any form of surgical intervention before a definitive diagnosis have been made must be avoided.
Intrinsic Factors
- Loosening
- Infection
- Instability
- Impingement
- Particulate synovitis
- Modulus mismatch
Local Extrinsic Factors
- Bursitis
- Tendinitis
- Heterotopic ossification
- Greater trochanter / abductor avulsion fracture
- Stress fracture
Remote Extrinsic Factors
- Spinal pathology
- Neuropathy / nerve palsy
- Nerve entrapment
- Peripheral vascular disease
- Osteitis pubis
- Hernia
- Fascia lata / quadriceps herniation
- Intra-abdominal pathology
- Tumor
