Differential Diagnosis for 74-year-old with Hip Pain
Single most likely diagnosis
- Loosening of the prosthetic hip: This is a common complication after hip replacement surgery, especially if the patient has been active. The stabbing pain, worse with walking, suggests mechanical instability or loosening of the prosthetic components.
Other Likely diagnoses
- Infection: Although less common, infection of the prosthetic joint can occur even months after surgery. The pain and worsening symptoms with activity could be indicative of an infectious process.
- Heterotopic ossification: This condition, where bone forms outside the normal skeleton, can occur after hip replacement and cause pain and limited mobility.
- Trochanteric bursitis: Inflammation of the bursa over the trochanter can cause pain on the outer aspect of the hip, which may worsen with walking.
Do Not Miss diagnoses
- Prosthetic hip dislocation: Although less likely, dislocation of the prosthetic hip is a serious complication that requires immediate attention. The patient's symptoms could be indicative of a dislocated hip, especially if there was a recent fall or trauma.
- Deep vein thrombosis (DVT) or pulmonary embolism (PE): These conditions can cause hip pain and are more common in elderly patients, especially after recent surgery. A DVT or PE would be a medical emergency.
- Osteolysis: This condition, where bone around the prosthetic components is resorbed, can lead to loosening and failure of the prosthesis. It may present with pain and worsening symptoms over time.
Rare diagnoses
- Metallosis: A rare condition caused by wear and tear of the prosthetic components, leading to metal debris and inflammation. It can cause pain, swelling, and limited mobility.
- Nerve entrapment or neuropathy: Rarely, the prosthetic components can cause nerve compression or damage, leading to pain, numbness, and weakness in the affected leg.
- Stress fracture: A fracture in the surrounding bone, which can occur due to the altered biomechanics after hip replacement surgery. It may present with pain that worsens with activity.