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  

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

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

AKAUnicameral bone cyst femur

 

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