[Painful total hip arthroplasty - operative and conservative therapy]

Removal of protruding screws in a painful total hip arthroplasty: A case report

Persistent pain after total hip arthroplasty can be challenging for the orthopedic surgeon. We present a case of a 56-year-old female with an uncommon cause of persistent pain after total hip replacement, due to protruding screws with the subsequent impingement of surrounding soft tissues. The patient presented persistent groin pain after total hip revision surgery. After ruling out infection and loosening, an infiltration of iliopsoas muscle was performed, with only temporary improvement. The magnetic resonance depicted the conflict of the screws with the surrounding soft tissues, in close relation to the iliopsoas muscle, the external obturator muscle and the sciatic nerve. Revision surgery was performed, removing the screws, and implanting a new liner with complete remission of symptoms. Our case presents an atypical cause of pain due to surrounding tissue lesions by offending screws with complete resolution after only screw removal. In the clinical study of persistent pain following a total hip replacement, screws length, and protrusion should be considered and ruled out as a possible and treatable etiology. Removal of the screws after cup integration can be a conservative and effective strategy to treat the pain.