OBJECTIVE: To explore the difference in level of pain experienced by patients with total hip arthroplasty between aseptic loosening and periprosthetic infection, and to examine the correlation between C-reactive protein (CRP) and pain. METHODS: Fifty-one patients (recruited from our hospital between March 2010 and November 2011) suffering aseptic loosening or periprosthetic infection after total hip arthroplasty were included in this study: 24 males and 27 females, with mean age 68.13 years. The patients were divided into an aseptic loosening group (n=31) and a periprosthetic infection group (n=20). Both the visual analog scale (VAS) and Harris pain score were used to estimate the level of pain experienced by the patients. CRP levels in serum were measured. The difference in assessment of pain by VAS and Harris pain score was compared between the two groups, and the correlation between pain and CRP was analyzed. RESULTS: The mean VAS in the aseptic loosening group was 5.39 (2.10-8.13) compared with 5.48 (2.09-8.30) in the periprosthetic infection group; however, the difference was not statistically significant (P=0.85). The mean rank of Harris pain score was 26.23 in the aseptic loosening group and 25.65 in the periprosthetic infection group, but again there was no significant difference (P=0.88). The CRP level in the periprosthetic infection group (36.20-101.40 mg/L, mean 72.86 mg/L) was obvious higher than that in the aseptic loosening group (1.37-13.70 mg/L, mean 6.53 mg/L), and the difference was statistically significant (P<0.01). The VAS was related with the CRP level in the periprosthetic infection group (r=0.87, P<0.01), and the correlation between Harris pain score and CRP level was conspicuous (r=0.92, P<0.01) in this group. However, those correlations were not evident in the aseptic loosening group (r=0.25, P=0.17; r=0.19, P=0.65). CONCLUSION There is no difference in perception of pain in patients after total hip arthroplasty between those with aseptic loosening and those with periprosthetic infection. It is therefore unreliable to make a initial diagnosis only according to the level of pain. However, the level of CRP is a sensitive and effective way of differentiating the two conditions. The positive correlation between CRP and pian exists in patients with periprosthetic infection but not with aseptic loosening.
Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; C-Reactive Protein ; analysis ; Female ; Humans ; Male ; Middle Aged ; Pain Measurement ; Prosthesis Failure ; etiology ; Prosthesis-Related Infections ; blood ; physiopathology

Objective To study the feasibility and value of magnetic resonance diffusion tensor imaging (DTI) to monitor non?arteritic anterior ischemic optic neuropathy (NAION). Methods Thirty eight NAION patients (56 eyes) were divided into acute period in 17 eyes, progressive period in 16 eyes and chronic period in 23 eyes at the base of onset time. According to matching principle, 56 eyes in 38 normal controls (NCs) were enrolled. All the patients and NCs underwent MR and DTI scan. The raw data were processed by two experienced radiologists, mean diffusivity (MD), axial diffusivities (λ//), radial diffusivities (λ┴), fractional anisotropy (FA) and Length value were got. The independent sample t test was used for the parameter values between the NAION group and the NCs group. A single factor variance analysis was used to compare the parameters among different stages of NAION group. Results Compared to the NCs group, the values of FA and Length in NAION group were reduced [0.20±0.11 vs 0.31±0.12, (5.85±0.92) vs (65.11± 6.89) mm], and the differences were statistically significant (t=-4.28,-5.25;P<0.05). The values of MD andλ┴were increased [(0.16±0.04)×10-3 vs (0.10±0.04)×10-3 mm2/s, (0.16±0.05)×10-3 vs (0.09±0.03)×10-3 mm2/s] in NAION group and the differences were statistically significant (t=6.83, 7.10;P<0.05). The value of FA and Length in acute period, progressive period and chronic period of the NAION group decreased differently compared to the NCs group. At the same time, the value of MD value and λ┴in the three periods of the NAION group increased compared to the NCs groupand the differences were statistically significant (P<0.05). The value of FA between the acute period, the progressive period, and the chronic period of NAION group were statistically signficant (F=10.88, P<0.05). However, no significant differences were found in the values of MD, λ┴and Length of the NAION group (F=0.23, 0.64, 0.33, 1.38;P=0.79, 0.54, 0.72, 0.27). Conclusion The parameters of DTI can be used to monitor the damage of optic nerve and development in NAION.