aspiration
Painful TKR
Differential Diagnosis of the Painful TKA
Surgical Diagnosis
1. Prosthetic loosening and failure
2. Infection
3. Patellofemoral tracking problems
4. Instability
5. Recurrent intra-articular soft-tissue impingement / Component overhang
Nonsurgical Diagnoses
1. Referred pain - Hip / Back
Ganglions
Epidemiology
Most common tumour of hand
F > M
2nd - 4th decade
Aetiology
Unknown
Trauma
Mucoid degeneration of collagen tissue
Synovial herniation
Location
Painful THA
Aetiology
Intrinsic
Infection
Loosening
Thigh pain in uncemented
- micro motion at distal end of stem
- modulus mismatch
Stress fracture / insufficiency fracture
- pubic rami, sacral
Intra-operative fracture
Prosthesis failure
Subtle instability
Extrinsic
Transient synovitis / Septic arthritis
Definition
Transient synovitis of unknown aetiology with complete resolution
Epidemiology
Most common cause of hip pain
- 1 /1000
May occur in 3% of children with majority not seeking medical attention
Wide range of age
- from 9 / 12 to teenagers
- usually 3 - 8 years
- peak 6 years / same as Perthes
More common in
- boys 2:1
- caucasian
Ganglion
Definition
Cystic structure lined by a mature capsule of dense fibrous tissue
- contains thick viscous fluid with a high mucopolysaccharide content
- fluid is a myxoid degeneration of synovial fluid
Epidemiology
Most common in young females
- peak age 15-30
- F:M = 3:1
Most common tumour in hand (2/3)
Aetiology
Unclear
Unicameral Bone Cyst
AKA
Simple Bone Cyst
Definition
A simple bone cyst is a solitary cavity containing clear fluid
- originating in the metaphysis of growing children
- adjacent to the metaphyseal aspect of the growth plate.
Aetiology
Unknown pathological origin
Septic Arthritis
Definition
Joint inflammation secondary pyogenic organism
Epidemiology
All age groups
Usually children
- 50% < age 3
M= F
Any joint
- Infants = Hip
- Children = Knee
- Adults = Large Joints
IVDU - SCJ & SIJ
Pathogenesis
Two Routes