Original Articles
Patients' perception of pain after total hip arthroplasty*,**

https://doi.org/10.1054/arth.2000.6634Get rights and content

Abstract

A study was undertaken to determine the frequency with which patients had pain that they attributed to their hip after total hip arthroplasty. Pain drawings were used to allow patients to localize the area of their symptoms, and the degree of pain was quantified with visual analog scales. Complete clinical and radiographic data were collected on all patients so that the occurrence of pain could be correlated with a number of parameters previously reported to affect the incidence of pain, including age, sex, activity level, length of follow-up, stem size, bone type (Dorr index), and type of stem fixation (proximally coated, fully coated, or cemented). Results indicated that type of stem fixation was the only parameter statistically correlated with a higher incidence of thigh pain. Patients with proximally coated stems were more than twice as likely to complain of pain than patients with fully coated or cemented hips (P <.01). Although the incidence of thigh pain was significantly higher with proximally coated stems, the severity was not, averaging 3.0 to 3.5 out of 10 on visual analog scale in all 3 groups. The results indicate that patients perceived pain as originating in the hip in a high percentage of cases, particularly when proximally coated stems were used.

Section snippets

Materials and methods

Two separate consecutive series of uncomplicated primary THAs performed by 2 different surgeons at 2 university-affiliated teaching hospitals were studied. At 1 center, cemented stems were used in patients older than age 60 years, and proximally coated cementless stems were used in younger patients. At the other center, fully coated stems were implanted in >98% of patients regardless of age.

All procedures were performed through a posterolateral surgical approach, and the same cementless

Results

The average Harris Hip Score for the overall group was 90. The average hip score for proximally coated hips was 86; for fully coated hips, 93; and for cemented hips, 87. No patient underwent revision for persistent pain during the course of this study, and there were no patients considering revision for pain. There were also no cases of probable or definite radiographic loosening in any of the 3 groups.

Thigh pain was present to some degree in 23% of the entire group of 320 hips based on the

Discussion

To clarify the issue of the incidence, location, and severity of pain after THA, we administered a number of qualitative and quantitative ratings of pain to a large group of patients who had undergone primary THA with cemented and cementless stems that were evaluated with the same degree of detail. The same cementless acetabular component was used in all cases to neutralize the potential effect of that parameter. Pain drawings were used to allow patients to specify their perception of the

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    *

    Funds were received from DePuy, Inc, in support of the research material described in this article.

    **

    Reprint requests: Robert L. Barrack, MD, Tulane University School of Medicine, Department of Orthopaedic Surgery, 1430 Tulane Avenue, SL32, New Orleans, LA 70112.

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