TY - CHAP M1 - Book, Section TI - Chapter 13. Approach to the Patient with a Painful Prosthetic Hip or Knee A1 - Marchie, Anthony A1 - Freiberg, Andrew A. A1 - Kwon, Young-Min A2 - Imboden, John B. A2 - Hellmann, David B. A2 - Stone, John H. PY - 2013 T2 - CURRENT Diagnosis & Treatment: Rheumatology, 3e AB - A thorough clinical history and a detailed physical examination are essential to delineate various intrinsic and extrinsic causes of pain in patients with hip and knee total joint replacements.Radiographs with orthogonal and weight-bearing views should be ordered to assess signs of implant-related complications.Laboratory investigations should include both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as screening serologic markers for joint infection.A high index of suspicion for infection must always be maintained, especially in patients with comorbidities such as diabetes, inflammatory arthritis, and compromised immunity.Awareness of adverse soft-tissue reaction to metal wear debris in patients with painful metal-on-metal total hip replacements is important in light of its increasing use in young and active patients. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=57271534 ER -