Differential Diagnosis for 74-year-old Female with L Hip Pain
Single Most Likely Diagnosis
- Loosening of the hip prosthesis: Given that the patient had a hip replacement 7 months ago and is experiencing severe pain with walking, especially on the lateral side, loosening of the prosthesis is a highly plausible cause. The fact that naproxen helped with back pain but not hip pain suggests a mechanical issue rather than an inflammatory one.
Other Likely Diagnoses
- Trochanteric bursitis: This condition, characterized by inflammation of the bursa over the greater trochanter, can cause lateral hip pain, especially with walking. It's a common issue in patients with hip replacements due to altered biomechanics.
- Heterotopic ossification: Although less common, heterotopic ossification (the formation of bone in soft tissues) can occur after hip replacement surgery and cause pain, especially if it involves the soft tissues around the hip.
- Periprosthetic fracture: A fracture around the prosthesis can occur, especially in elderly patients with osteoporosis, and would cause severe pain with weight-bearing activities.
Do Not Miss Diagnoses
- Infection of the prosthetic joint: Although less likely given the time frame since surgery, infection is a critical diagnosis not to miss. It can present with pain, especially with movement, and systemic signs of infection might be subtle in elderly patients.
- Deep vein thrombosis (DVT) or pulmonary embolism (PE): While these conditions might not directly cause hip pain, they are potential complications in patients with recent surgery or immobilization and can be life-threatening if not promptly diagnosed and treated.
Rare Diagnoses
- Nerve entrapment or neuropathy: Direct injury to nerves during the hip replacement surgery or subsequent scar tissue formation could lead to nerve entrapment, causing pain and other neurological symptoms.
- Osteolysis: The dissolution of bone around the prosthesis, which can lead to loosening and pain, is a less common but potential long-term complication of hip replacement surgery.
- Metallosis: If the hip replacement involves metal-on-metal components, there's a rare risk of metallosis, an adverse reaction to metal debris, which can cause pain, swelling, and other systemic symptoms.