Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach (original) (raw)
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Anaesthesia, 2021
The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include preoperative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal antiinflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intraoperative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.
Orthopedic Reviews
The main objective of this study was to evaluate the difference in pain levels during postoperative physical therapy pathways in patients who underwent a cement less total hip replacement either through a muscle sparing direct anterior approach (DAA), or the classic trans-gluteal lateral approach (LA). One hundred and twelve (112) patients were randomized into two equal groups. Baseline values of myoglobin levels were acquired prior to surgery and repeated at 6 hours postoperatively as a biomarker for muscle damage. Pain levels during the first passive and consecutive 3 active physical therapy sessions were noted using a visual analogue-numeric scale (VAS). Pain levels were also acquired at 6 weeks, 3 months, 6 months and 1 year, following a 20-meter (65.6 feet) walking test. Postoperative myoglobin (ng/mL) levels were significantly higher (p< 0.05) in the LA group (335.05±83.54) then the DAA group (237.71±57.54). Pain levels were significantly lower (p<0.001) in the DAA group...
2019
Background: Patients experiencing high levels of pain after surgery remains a considerable clinical problem. Often, no consensus about the best analgesic treatment is present. The majority of clinical trials regarding postoperative pain, generally, target the average analgesic efficacy. In terms to step forward, a focus on the individual patients´ pain levels is needed and an identification of the patients in risk of developing higher postoperative pain levels.Aim: The overall aim was to explore the pain management for total hip arthroplasty (THA) patients by investigating the evidence in the literature, and the manifestation in clinical practice, including a focus on the individual patient and possible predictive tools.Methods: A systematic review was conducted investigating the different analgesic treatments in randomised clinical trials (RCT) regarding THA patients (Study I). To investigate the analgesic efficacy at the individual patient level, in terms of obtaining, ‘no worse t...
A Prospective Evaluation of 2 Different Pain Management Protocols for Total Hip Arthroplasty
The Journal of Arthroplasty, 2010
Pain management after total hip arthroplasty has improved dramatically in the past decade. However, most protocols use opioid medications for pain control. In the current study, 100 patients were prospectively selected to receive a traditional narcotic-based patient-controlled analgesia protocol or a nonnarcotic oral protocol for pain management after primary total hip arthroplasty. Therapy programs were similar for both groups. Postoperatively, patients were followed daily for opioid use, medication adverse effects, pain control, and overall satisfaction. The nonnarcotic oral group showed lower mean pain scores during the first 24 hours after surgery. The satisfaction rate was high in both groups. Both protocols provided adequate pain control after total hip arthroplasty; the nonnarcotic pain management protocol resulted in significantly decreased opioid consumption and fewer adverse effects.
Chronic pain following total hip arthroplasty: a nationwide questionnaire study
Acta Anaesthesiologica Scandinavica, 2006
Background: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence of chronic pain after THA in relation to pre-operative pain and early post-operative pain. Methods: A questionnaire was sent to 1231 consecutive patients who had undergone THA 12-18 months previously, and whose operations had been reported to the Danish Hip Arthroplasty Registry. Results: The response rate was 93.6%. Two hundred and ninetyfour patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post-operative pain [95% confidence interval (CI), 20.4-33.4%] and pain complaints from other sites of the body (95% CI, 20.7-32.1%), but not to the pre-operative intensity of pain. Conclusion: Chronic pain after THA seems to be a significant problem in at least 12.1% of patients. Our results suggest that genetic and psychosocial factors are important for the development of chronic post-THA pain.
Factors associated with severe postoperative pain in patients with total hip arthroplasty
Acta orthopaedica et traumatologica turcica, 2014
The aim of this study was to determine the risk factors for the development of postoperative pain following total hip arthroplasty, particularly those connected with psychological distress and personality traits. The study included 90 patients with complaints of postoperative pain following cemented total hip replacement divided into two groups based on the intensity of postoperative pain as measured using the numerical rating scale (NRS). Patients with NRS scores of 5 or higher were included in the study group and those with NRS of less than 5 were included in the control group. The Hamilton scales for anxiety and depression and the DS14 test for the identification of Type D personality were used for psychological evaluation. In the study group, more patients were female (29 vs. 13) and had more anxiety (13 vs. 3), depression symptoms (11 vs. 2), and Type D personality (18 vs. 9) than the control group. Mean preoperative NRS was 7.2 ± 1.7 in the study and 6.0 ± 1.2 in the control g...
BMJ open, 2013
To identify patient characteristics and surgical factors associated with patient-reported outcomes over 5 years following primary total hip replacement (THR). Prospective cohort study. Seven hospitals across England and Scotland. 1431 primary hip replacements for osteoarthritis. The Oxford Hip Score (OHS) was collected preoperatively and each year up to 5 years postoperatively. Repeated measures such as linear regression modelling are used to identify patient and surgical predictors of outcome and describe trends over time. The majority of patients demonstrated substantial improvement in pain/function in the first year after surgery-between 1 and 5 years follow-up, there was neither further improvement nor decline. The strongest determinant of attained postoperative OHS was the preoperative OHS-those with worse preoperative pain/function had worse postoperative pain/function. Other predictors with small but significant effects included: femoral component offset-women with an offset ...
The Experince with Anterior Minimally Invasive Hip Surgery
Medical Archives, 2011
and Herzegovina 3 i introduction. When total hip arthroplasty (THA) is performed, the surgeon has to make a decision about the correct approach. Goals. In this research we will show our first experince with the implantation of endoprothesis for hip, using the method of anterior minimally invasive surgery. Methods. At the Traumatology clinic in Banja Luka, General hospital in Travnik, General hospital "Medicus" in Jelaha during the period between March 30th 2005 and June 1st 2009 53 hip prosthesis were implanted using minimally invasive Hueter approach, with the average length of incision of 7.3 cm. Subjects were 28 females and 25 males, with an average age of 56.8 years old. The reason for the surgery was hip arthrosis III i IV degree with 48 patients, while two patients had displastic arthrosis. One patient had arthritic changes following non-dislocated fracture of the acetabulum. One patient had arthritic changes of the femur. We implanted 50 non-cemented prosthesis, and tri comined (hybrid) prosthesis. Results. The orthopedic surgery was done with the use of two assistents and operating nurse, within 68 minutes on average while using on average 436 mL of transfused blood. Movements in an upright position with full weight bearing was done on post operative day one with 50 patients. Acute rehabilitation lasted 8.9 days on average. Full recovery was at 50 days on average, with achieved full range of motion and no use of assistive devices. The average Harris Hip Score (HHS) preoperativelly was 56, and three months postoperativelly it was 93. Five patients had complications: two with anterior displocation of the hip, one sealing of the shaft of the femur, and two infections; one superficial and the other deep. Superficial infection was treated with conservative therapy and the other patient had a removal of the prosthesis. Conslusion. Anterior minimally invasive surgery with THA is a method which gives a number of advantages for the patients, such as: lesser extent of operative trauma, shorter hospital stay, and quicker return to activities of daily living.