End-of-stem pain in hip and knee arthroplasty

End-of-stem pain after knee and hip arthroplasty with diaphyseal supportive stems is a frequently overlooked and potentially underestimated complication. A commonly recurring clinical phenome is the symptom-free interval after surgery of weeks to months, with new onset of symptoms under stress only later. The patient is often again reliant on walking sticks. End-of-stem pain is a diagnosis of exclusion. Pain is projected into the tip of the stem, and if differential diagnoses such as loosening are excluded, then the patient might be treated with a bending-plate. Since bone cement has a similar elastic modulus to human cortical bone, a change of method to a cemented implant can also be expedient. In the primary situation, in addition to cemented stems, the use of split-stems could be useful. After revision surgery of any kind, a timely cessation of pain confirms the diagnosis.

Automated summary

End-of-stem pain after knee and hip arthroplasty with diaphyseal supportive stems is a frequently overlooked complication, with symptoms often only appearing weeks to months after surgery. Treatment options include using a bending-plate or switching to a cemented implant after excluding differential diagnoses.