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首页> 外文期刊>Journal of Medical Case Reports >An unusual case of persistent groin pain after total hip arthroplasty: a case report
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An unusual case of persistent groin pain after total hip arthroplasty: a case report

机译：全髋关节置换术后持续性腹股沟疼痛的不寻常病例：一例报告

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Introduction Arthroplasty is a well-established routine elective surgical procedure in orthopaedics. To a great extent, diagnosis, treatment and post-operative rehabilitation in these patients is standardised. In a busy clinic, surgeons from time to time tend to focus their attention on common causes of joint pain, but it may lead them to overlook sinister but less common pathologies. Here we report a case of a patient with groin pain due to pre-operatively undetected pelvic metastases from a pyeloureteral carcinoma who underwent total hip arthroplasty. There are several case reports which deal with primary or secondary tumours which were either discovered at the time of replacement surgery or developed at the site of prosthesis years after total hip or knee replacement. To the best of our knowledge, this is the first case report in which a metastatic cancer was missed pre-operatively and intra-operatively both by the radiologist and by the orthopaedic surgeon and should be reported so that surgeons are reminded to be careful when dealing with seemingly routine cases. Case presentation A 79-year-old Caucasian woman presented to the arthroplasty clinic with groin pain. Initial radiographs showed subtle bilateral abnormalities in the pelvis. Neither the radiologist nor the orthopaedic surgeon recognized it. A diagnosis of osteoarthritis of the hip was established, and she underwent total hip arthroplasty. Despite initial improvement, the patient came back with worsening hip pain three months later. Further radiological examination revealed multiple metastatic lesions throughout the pelvis due to a pyeloureteral carcinoma. Conclusions This case report emphasizes the importance of meticulous, unbiased pre-operative assessment of patients and their radiographs, even in so-called routine clinical cases. Often subtle radiological changes are classed as normal, especially if they are bilateral. Further radiological imaging should be recommended in all cases where unexplained clinical features or radiological findings are present.
机译：简介关节置换术是骨科中公认的常规选择性外科手术方法。在很大程度上，这些患者的诊断，治疗和术后康复已标准化。在繁忙的诊所中，外科医生会时不时地将注意力集中在关节痛的常见原因上，但这可能会导致他们忽视险恶但不常见的病理。在这里，我们报告一例因接受全髋关节置换术而从术前未发现的肾盂癌骨盆转移引起的腹股沟疼痛患者的病例。有几例病例报道了原发性或继发性肿瘤，这些病例要么在置换手术时发现，要么在全髋关节或膝关节置换术后多年的假体部位发展。据我们所知，这是第一例病例报告，放射科医生和整形外科医生在术前和术中均漏诊了转移性癌症，应予以报告，以便提醒外科医生在处理时要小心看似常规的情况。病例介绍一名79岁的白人妇女因腹股沟疼痛被送至人工关节诊所。最初的X线照片显示骨盆中有细微的双侧异常。放射科医生和整形外科医生都没有意识到这一点。确定了髋骨关节炎的诊断，并对她进行了全髋关节置换术。尽管最初有所改善，但三个月后患者的髋关节疼痛加剧。进一步的放射学检查发现，由于肾盂输尿管癌，整个骨盆有多个转移灶。结论该病例报告强调了对患者及其影像学进行细致，公正的术前评估的重要性，即使在所谓的常规临床病例中也是如此。通常，细微的放射学改变被认为是正常的，特别是如果是双侧的。在存在无法解释的临床特征或影像学发现的所有情况下，均应建议进一步影像学检查。

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