A review of the clinical approach to persistent pain following total hip replacement

Lam, Yuk-Fai; Chan, PK; Fu, Henry; Cheng, Yan; Chiu, K. Y.

doi:10.12809/hkmj164969

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…One had a radiograph taken due to a subjective feeling of subluxation which showed a congruent hip joint. Computed tomogram (CT) is a well-recognized tool in assessment of polyethylene wear and component alignment in hip arthroplasty [21]. We are unaware of any cases where a CT has been used to detect polyethylene dissociation; however, a thin-slice metal suppression CT may detect subtle changes not evident on plain radiographs.…”

Section: Discussionmentioning

confidence: 99%

Polyethylene liner dissociation with the Pinnacle acetabular component: should we be concerned?

Memon

Gwynne‐Jones

2020

Arthroplasty Today

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Between 2007 and 2018, 535 total hip arthroplasties using the uncemented Pinnacle acetabular component (DePuy Synthes, Warsaw, IN) and polyethylene liner were implanted in our unit. Of these, 6 patients presented acutely with liner polyethylene dissociation, giving a rate of liner dissociation of 1.11%. All dissociations were atraumatic. Failure occurred at mean 37 months (range 4.5 to 130 months). Radiologically, all acetabular components were within safe zone of abduction and mean anteversion was 10 degrees (range 2-20). In one case, there was posterior impingement against the femoral neck due to femoral malalignment. All patients underwent head and liner exchange with no repeat failures. Despite excellent long-term results, the frequency of dissociated polyethylene liners is a cause of concern with the Pinnacle acetabular component.

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Section: Discussionmentioning

confidence: 99%

Polyethylene liner dissociation with the Pinnacle acetabular component: should we be concerned?

Memon

Gwynne‐Jones

2020

Arthroplasty Today

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“…Imaging in THA patients has several purposes: normal follow-up (to detect complications without clinical symptoms), patients’ complaints (to determine or help to determine the cause of the patients’ symptoms), biopsy or fluid collection guidance, and planning for the treatment of complications (i.e., implants positioning, bone stock evaluation). Therefore, clinicians must be aware of these factors to comprehensively evaluate patients with HA [ 7 ] and order prompt imaging workup for an optimal diagnosis. Radiographs are the first imaging modality used for routine follow-up in asymptomatic and painful cases [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, clinicians must be aware of these factors to comprehensively evaluate patients with HA [ 7 ] and order prompt imaging workup for an optimal diagnosis. Radiographs are the first imaging modality used for routine follow-up in asymptomatic and painful cases [ 7 ]. CT and MRI used to suffer from metallic artifacts, but are nowadays central in HA complications diagnosis [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy

Lombard¹,

Gillet

Germain³

et al. 2022

JCM

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Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.

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“…For patients who have hip joint disease, total hip arthroplasty (THA) is one of the most successful treatments for end-stage osteoarthritis and other hip diseases [1]. Generally, THA is an effective approach to relieve pain and improve function and quality of life for various hip diseases [2, 3]. Over the past decade, the incidence of THA has increased both in elderly and young individuals, and this number is estimated to reach 572,000 cases by 2030 [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Perioperative Auricular Therapy on Postoperative Pain after Total Hip Arthroplasty: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Gao

et al. 2019

Evidence-Based Complementary and Alternative Medicine

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Auricular therapy (AT) is a conventional therapy in traditional Chinese medicine. However, the effectiveness of perioperative AT in pain treatment after total hip arthroplasty (THA) is still controversial. Nine randomised controlled trials (RCTs) involving 605 patients who have undergone THA with or without AT from inception to March 2018 were collected and included in this study by searching more than 12 databases (e.g., PubMed, Excerpta Medica Database, and Cochrane Library). A random-effects model that pooled seven articles showed that the visual analogue scale (VAS) in the AT group was lower than that of the control group at each postoperative time point in patients after THA, except at the time points of 6 and 36 h. The intraoperative body mass-adjusted fentanyl amount in the AT group was also lower than that of the control group in two trials. The other outcomes (time to first analgesic request and incidence of postoperative nausea and vomiting, perioperative bradycardia, and transitory hypotension) showed insignificant difference. Then, subgroup analysis showed similar results to those of the total articles with the term “VAS”. Regression analysis found that the prolonged time after the operation decreased the difference in VAS between the two groups. Although all the outcomes were assessed as very low to low in the GRADE system, evidence on the effectiveness of perioperative AT in pain treatment after total hip replacement was positive.

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A review of the clinical approach to persistent pain following total hip replacement

Cited by 6 publications

References 34 publications

Polyethylene liner dissociation with the Pinnacle acetabular component: should we be concerned?

Polyethylene liner dissociation with the Pinnacle acetabular component: should we be concerned?

Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy

Effectiveness of Perioperative Auricular Therapy on Postoperative Pain after Total Hip Arthroplasty: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

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