Research Article| Volume 29, ISSUE 4, P753-756, April 2014

Oversized Cups as a Major Risk Factor of Postoperative Pain After Total Hip Arthroplasty

Published:August 08, 2013DOI:


      After total hip arthroplasty (THA) some patients have persistent postoperative pain (POP). Some of these POP are anterior and are caused by an anterior iliopsoas impingement (AIPI). We have hypothesized that oversized implanted cups could be responsible for POP and especially AIPI. We screened 237 patients who had a primary THA and compared the size difference (ΔS) between the native femoral head and the implanted cup, in patients with and without POP. Median ΔS was 2 mm [−6; 11 mm] and patients with POP had a significantly increased ΔS (P < 0.0001). The threshold above which pain was significantly more frequent was ΔS ≥ 6 mm. Odds ratio was 14.4 for POP and 26 for AIPI pain when ΔS ≥6 mm.


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      1. Hodt-Billington C, Helbostad JL, Vervaat W, et al. Changes in gait symmetry, gait velocity and self-reported function following total hip replacement. J Rehabil Med;43–9:787.

      2. Vissers MM, Bussmann JB, de Groot IB, et al. Walking and chair rising performed in the daily life situation before and after total hip arthroplasty. Osteoarthritis Cartilage;19–9:1102.

        • Brander V.A.
        • Malhotra S.
        • Jet J.
        • et al.
        Outcome of hip and knee arthroplasty in persons aged 80 years and older.
        Clin Orthop Relat Res. 1997; 345: 67
      3. Clement ND, MacDonald D, Howie CR, et al. The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more. J Bone Joint Surg Br;93–9:1265.

        • Barrack R.L.
        • Paprosky W.
        • Butler R.A.
        • et al.
        Patients' perception of pain after total hip arthroplasty.
        J Arthroplasty. 2000; 15–5: 590
      4. Lavigne M, Laffosse JM, Ganapathi M, et al. Residual groin pain at a minimum of two years after metal-on-metal THA with a twenty-eight-millimeter femoral head, THA with a large-diameter femoral head, and hip resurfacing. J Bone Joint Surg Am;93 Suppl 2:93.

        • Ala Eddine T.
        • Remy F.
        • Chantelot C.
        • et al.
        Anterior iliopsoas impingement after total hip arthroplasty: diagnosis and conservative treatment in 9 cases.
        Rev Chir Orthop Reparatrice Appar Mot. 2001; 87–8: 815
        • Bricteux S.
        • Beguin L.
        • Fessy M.H.
        Iliopsoas impingement in 12 patients with a total hip arthroplasty.
        Rev Chir Orthop Reparatrice Appar Mot. 2001; 87–8: 820
      5. Bartelt RB, Yuan BJ, Trousdale RT, et al. The prevalence of groin pain after metal-on-metal total hip arthroplasty and total hip resurfacing. Clin Orthop Relat Res;468–9:2346.

      6. Henderson RA, Lachiewicz PF. Groin pain after replacement of the hip: aetiology, evaluation and treatment. J Bone Joint Surg Br;94–2:145.

      7. Braun KF, Siebenlist S, Sandmann G, et al. [Recurrent hematomas of the iliopsoas muscle after total hip replacement as a differential diagnosis for chronic groin pain: case series report]. Orthopade;41–3:212.

        • Nikolaou V.
        • Bergeron S.G.
        • Huk O.L.
        • et al.
        Evaluation of persistent pain after hip resurfacing.
        Bull NYU Hosp Jt Dis. 2009; 67–2: 168
        • Lachiewicz P.F.
        • Kauk J.R.
        Anterior iliopsoas impingement and tendinitis after total hip arthroplasty.
        J Am Acad Orthop Surg. 2009; 17–6: 337
        • Trousdale R.T.
        • Cabanela M.E.
        • Berry D.J.
        Anterior iliopsoas impingement after total hip arthroplasty.
        J Arthroplasty. 1995; 10–4: 546
      8. Cobb JP, Davda K, Ahmad A, et al. Why large-head metal-on-metal hip replacements are painful: the anatomical basis of psoas impingement on the femoral head-neck junction. J Bone Joint Surg Br;93–7:881.

        • Vresilovic E.J.
        • Hozack W.J.
        • Rothman R.H.
        Incidence of thigh pain after uncemented total hip arthroplasty as a function of femoral stem size.
        J Arthroplasty. 1996; 11–3: 304
      9. Ferrata P, Carta S, Fortina M, et al. Painful hip arthroplasty: definition. Clin Cases Miner Bone Metab;8–2:19.

      10. Mayne IP, Kosashvili Y, White LM, et al. Iliopsoas tendonitis due to the protrusion of an acetabular component fixation screw after total hip arthroplasty. J Arthroplasty;25–4:659 e5-8.

        • Lewinnek G.E.
        • Lewis J.L.
        • Tarr R.
        • et al.
        Dislocations after total hip-replacement arthroplasties.
        J Bone Joint Surg Am. 1978; 60–2: 217
        • Fan C.Y.
        • Chen W.M.
        • Lee O.K.
        • et al.
        Acetabular revision arthroplasty using jumbo cups: an experience in Asia.
        Arch Orthop Trauma Surg. 2008; 128–8: 809
        • Christie M.J.
        • Barrington S.A.
        • Brinson M.F.
        • et al.
        Bridging massive acetabular defects with the triflange cup: 2- to 9-year results.
        Clin Orthop Relat Res. 2001; 393: 216
      11. Hsieh PH, Chang Y, Chen DW, et al. Pain distribution and response to total hip arthroplasty: a prospective observational study in 113 patients with end-stage hip disease. J Orthop Sci;17–3:213.

        • Roder C.
        • Staub L.P.
        • Eggli S.
        • et al.
        Influence of preoperative functional status on outcome after total hip arthroplasty.
        J Bone Joint Surg Am. 2007; 89–1: 11
      12. Lu M, Zhou YX, Du H, et al. Reliability and Validity of Measuring Acetabular Component Orientation by Plain Anteroposterior Radiographs. Clin Orthop Relat Res.

      13. Nho JH, Lee YK, Kim HJ, et al. Reliability and validity of measuring version of the acetabular component. J Bone Joint Surg Br;94–1:32.