DIAGNOSIS OF A SEPTIC LOOSENING IN TOTAL HIP-ARTHROPLASTY - SENSITIVITY OF CLINICAL EXAMINATION

Aim: In order to establish a strategy for early diagnosis of aseptic l oosening of total hip arthroplasty (THA) physical examination, patient 's assessment and radiographs were analysed. Method: Pain, self assess ement, physical examination and mobility were examined according to a standard examination protocol in 428 hips of 297 patients after cement less total hip arthroplasty (THA). These findings were compared with t he radiographic finding of the hip. Sensitivity and specifity of objec tive and subjective parameters were analysed. Results: The clinical ou tcome of THA's is assessed by pain and physical examination. Nearly al l hie scores are based on these parameters. In this study sensitivity and specifity of all parameters analysed were unsatisfactory compared with the radiographic finding. Although we found some correlations bet ween clinical and radiological data, clinical data alone are not suffi cient for exclusion of THA loosening, especially for loosening of the acetabular component, as there was no clear distinction between the gr oup of radiographically loosened (43 acetabular cups and 4 stems) and intact endoprostheses. Conclusion: We conclude, that physical examinat ion and pain history are not sufficient to exclude loosening of cement less THA's. Radiographic examination is essential for the assessement of THA's, even in painfree patients.