Review Question - QID 7016

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THA Other Complications QID: 7016 (SAE10HK.28)

QID 7016 (Type "7016" in App Search)

A 62-year-old woman undergoes an uncomplicated primary metal-on-metal cementless hip arthroplasty. Her early postoperative course is unremarkable. She returns at 1 year reporting groin pain. Her symptoms are made worse with stair climbing and getting in and out of her vehicle. Examination reveals minimal discomfort with passive range of motion, but straight leg raising reproduces her symptoms. A radiograph is shown in Figure 28. What is the most appropriate surgical management?

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Revision of the femoral component

21/285

Psoas tendon tenotomy

55%

156/285

Exchange of the bearing to metal-on-polyethylene

23%

66/285

Exchange of the bearing to ceramic-on-ceramic

11/285

Exchange of the bearing to a smaller femoral head and metal liner

27/285

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The radiograph shows a cementless cup that is placed low within the native acetabulum and appears large relative to the patient's native acetabulum. The size and inferior position of the cup place it at risk for causing psoas tendon irritation or impingement. Symptoms are typical for irritation of the psoas tendon and not consistent with either a loose implant (more mechanical activity-related pain) or metal hypersensitivity (more constant pain and not just associated with hip flexion activities). Controversy exists regarding tenotomy versus acetabular revision.

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