A ten-to-15 year follow-up of the Cementless Spotorno stem

Abstract

We welcome letters to the Editor concerning articles which have recently been published. Such letters will be subject to the usual stages of selection and editing; where appropriate the authors of the original article will be offered the opportunity to reply. Letters should normally be under 300 words in length, doublespaced throughout, signed by all authors and fully referenced. The edited version will be returned for approval before publication. Pain related to the psoas muscle after total hip replacement Sir, I read with interest the article in the September 2002 issue by Jasani, Richards and Wynn-Jones 1 entitled 'Pain related to the psoas muscle after total hip replacement'. I entirely agree with the authors that when investigating a painful hip following total hip replacement (THR), causes other than infection and loosening of the prosthesis have to be considered. However, I would like to highlight psoas haematoma as another cause of groin pain, particularly in patients on anticoagulant medication. Although this complication of anticoagulant therapy is well recognised, its importance in relation to THR has only been recently reported. 2 Early clinical diagnosis can be established by looking for weakness of the hip flexors and a sluggish quadriceps reflex following compression of the femoral nerve by the haematoma inside the psoas sheath. The diagnosis may be confirmed by a CT scan. Prompt intervention by stopping the anticoagulation may lead to a good outcome. If not, surgical decompression will be required.