PAIN LOCALISATION IN HIP ARTHROPLASTY

Abstract

Patients are increasingly demanding more (and better quality) information regarding the likely outcomes of THA surgery. Hip joint pain may be referred variably and widely in anatomical location and it has been unclear how reliably these pains can be relieved by arthroplasty.

193 patients undergoing primary unilateral Charnley THA were studied. Each patient was asked to indicate on a diagram where they were experiencing pain both preoperatively and at six months postoperatively. A scoring grid was superimposed for assessment. These two scores were compared with the Harris Hip Score, SF36 and satisfaction scores obtained at the same intervals. Comparisons were made between pre-operative and postoperative pain location and severity.

Preoperative pain is most often experienced in the groin (74% of patients), thigh (64%), knee (56%) and buttock (62%). Over 80% of pain in all zones is relieved by THA. However, the accepted assumption that groin and anterior thigh pains are the most reliably relieved is not borne out: pain is relieved in the leg and posterior thigh more reliably (in 97%, 93% and 100% cases respectively) than that in the groin (88%) or thigh (91%). Pain in the lower back is relieved in 81% of cases. Postoperative pain correlates closely with the postoperative SF36 and Harris Hip Score pain scores.

Postoperative dissatisfaction was most closely correlated with postoperative pain in the groin and buttock (p< 0.0001) and the anterior thigh (p< 0.05). 84% of patients would have the procedure again in the same circumstances, although 91% would recommend it to a friend or relative in the same situation.

THA is effective in relieving most pain around the hip. This is the case not only in the groin and anterior thigh which are often regarded as being highly specific for hip pain, but also in the lower back and leg. Postoperative dissatisfaction is highly significantly correlated with persisting pain in the groin, thigh and buttock.