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Investigation of a painful joint prosthesis

Authoring team

Pain in a previously painless artificial joint may be symptomatic of infection or loosening.

It is said that:

  • the pain of infection is bad at night
  • the pain of loosening is worst first thing in the morning

The following investigations should be performed:

  • radiographs:
    • infected or loose prostheses are surrounded by a radiolucent rim
    • scalloping of the surrounding cortex may indicate infection or the foreign body response to a loose joint

  • blood tests:
    • blood tests cannot distinguish infection and loosening
    • white cell count is usually normal
    • the ESR may be raised to 30-50 mm/h

  • isotope scans:
    • technetium-99m highlights infection and loosening
    • indium scans may specifically show infection

  • aspiration:
    • sterile aspiration does not exclude infection
    • aspiration should be performed with full aseptic technique in an operating theatre

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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