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.%目的:探讨髋关节置换术后无菌性松动与假体周围感染患者疼痛程度的差异及疼痛程度与C-反应蛋白(C-reactive protein,CRP)水平的相关性.方法:分析2010年3月至2011年11月收治的髋关节置换术后无菌性松动、假体周围感染患者51例,男性24例,女性27例,平均年龄68.13岁.分为无菌性松动组(n=31)及假体周围感染组n=20),翻修术前行视觉模拟评分(visual analogue scale,VAS)及Harris评分评估患者的疼痛程度,测定血清CRP含量,比较两组间疼痛程度、CRP水平的差异,并分析疼痛程度与CRP的相关性.结果无菌性松动组VAS平均为5.39 (2.10～8.13),假体周围感染组为5.48(2.09～8.30),两组间差异无统计学意义(P=0.85)；Harris疼痛评分两组的平均秩次分别为26.23和25.65,差异亦无统计学意义(P=0.88).假体周围感染组CRP为72.86 (36.20～101.40) mg/L,明显高于无菌性松动组6.53(1.37-13.7) mg/L,两者间差异具有统计学意义(P＜0.01).假体周围感染组CRP水平与其VAS及Harris疼痛评分均呈正相关(r=0.87,P＜0.01；r=0.92,P＜0.01),而无菌性松动组CRP与两种疼痛程度评分均无相关性(r=0.25,P=0.17;r=0.19,P=0.65).结论:无菌性松动与假体周围感染在疼痛程度上无差异,根据疼痛的程度做出初步判断并不可靠,而CRP测定是两者鉴别诊断的敏感而有效的指标.假体周围感染患者CRP水平与其疼痛程度呈正相关,而这种相关性在无菌性松动患者中并不存在.
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