Painful Total Hip Arthroplasty: A Systematic Review and Proposal for an Algorithmic Management Approach
Daniela Yucuma1, Irene Riquelme2, Martin Avellanal2
1Pain Clinic, University Hospital Sanitas La Moraleja, Madrid, Spain.
Pain Physician
|May 14, 2021
Summary
Painful total hip arthroplasty is common. This review suggests referring extrinsic pain causes, like myofascial pain, to pain clinics after ruling out intrinsic orthopedic issues.
Area of Science:
- Orthopedics
- Pain Medicine
- Clinical Research
Background:
- Painful total hip arthroplasty presents a complex diagnostic and management challenge.
- Identifying the source of pain is crucial for effective treatment, with ongoing debate regarding the role of clinical pain units.
Purpose of the Study:
- To conduct a systematic literature review on the etiologies of painful primary total hip arthroplasty.
- To propose an evidence-based algorithmic approach for managing hip arthroplasty pain.
Main Methods:
- Systematic literature review with qualitative data synthesis.
- Searched Medline/PubMed, Embase, Clinical Trials, and Cochrane databases up to August 2019.
- Included studies on etiologies, management, and imaging of painful hip arthroplasty.
Main Results:
- Twenty-four studies were synthesized, revealing a wide range of pain etiologies.
- Two-thirds of pain causes are intrinsic (orthopedic); one-third are extrinsic, potentially treatable by pain clinics.
- Myofascial etiology was the most frequent extrinsic cause of pain.
Conclusions:
- Painful hip arthroplasty is a significant clinical issue.
- An algorithmic approach integrating etiology, diagnosis, and management of chronic pain is proposed.
- The review emphasizes differentiating intrinsic and extrinsic pain sources for appropriate referral and treatment.
