An Unusual Case of Persistent Groin Pain after Total Hip Arthroplasty

A Case Report

Praveen Konala; Thomas K Schaefer; Farhad Iranpour; Niklaus F Friederich; Michael T Hirschmann


J Med Case Reports. 2011;5(1) 

In This Article


Many case reports have been published with regard to tumours developing at the site of arthroplasty.[4–9] It may be assumed that in these cases, the tumour was already present pre-operatively and could have been detected by more extensive clinical and radiological investigation. In our case, even retrospectively it is hard to pick up the pathology on the initial pelvic radiographs, but a closer look reveals an abnormal texture of both pubic bones. This was considered normal, however, as it appeared bilaterally. In addition, the calcified myoma distracted the surgeons' and radiologists' attention. A comparison with a normal pelvic radiograph from another patient could have been helpful and might possibly have resulted in an earlier diagnosis.

Interestingly, the patient's surgery was postponed because of microscopic haematuria, which was interpreted as a lower UTI. However, haematuria is one of the most common findings in urothelial carcinoma, although it is not specific and is also present in cases of UTI.[14] The question whether our patient's preoperative symptoms were caused in total or at least in part by the osteoarthritis is difficult to answer, but the initial clinical presentation as well as the fact that the patient was temporarily pain-free after THA points in that direction. During surgery, no abnormal bone presentation was detected in the hip joint, which further supports this theory, although it is highly likely that the metastases were present at the time of initial presentation. Whether the surgery may have led to a more rapid progression of the metastatic disease because of compromise of the immune system remains unclear. On this issue, no evidence is available in the literature.


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