
Painful Total Hip Arthroplasty: A Systematic Review and Proposal for an Algorithmic Management Approach
Author(s) -
Martı́n Avellanal
Publication year - 2021
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2021/24/193
Subject(s) - medicine , etiology , observational study , systematic review , medline , arthroplasty , physical therapy , orthopedic surgery , clinical trial , evidence based medicine , surgery , alternative medicine , pathology , political science , law
Background: The etiological diagnosis of painful primary total hip arthroplasty and itsmanagement is a complex clinical challenge for pain physicians. Extrinsic sources of pain in the hipjoint might be efficiently treated by clinical pain units, although the topic remains controversial.Objectives: To conduct a literature review and suggest an evidence-based algorithmic approachto managing painful hip arthroplasty.Study Design: Systematic literature review with qualitative data synthesis.Methods: We conducted an online search of Medline/Pubmed, Embase, Clinical Trials, andCochrane database using the Medical Subject Heading (MeSH) and free terms on all biomedicalliterature published up to August 2019. Articles that described either the etiologies and managementof painful primary total hip arthroplasty or the imaging techniques to specifically assess any of itscauses were included. We collected the demographic data (gender, age, body mass index), mainetiologies, diagnostic tests, and specific treatments applied in each study. Based on the reviewedevidence, we propose an algorithmic approach, with a special emphasis on etiologies that shouldbe referred to pain clinics.Results: Twenty-four studies were included for the synthesis, 16 of which were observationalstudies and 8 of which were non-systematic literature reviews that described a wide range ofetiologies of painful primary total hip arthroplasty. The results showed that 2/3 of the causes ofpain were intrinsic and need to be managed by orthopedic surgeons. One third of the etiologieswere extrinsic and should be referred to pain clinics once intrinsic causes have been ruled out.Among extrinsic sources of pain, the most frequent was myofascial etiology.Limitations: A publication bias might have been present due to the inclusion of studies publishedonly in English, Spanish, and German. The included studies also had heterogeneous methodologies.Conclusions: The current review suggests that painful hip arthroplasty is not a rare conditionin clinical practice. We systematically reviewed etiologies and various treatments published inthe literature and we suggest an algorithmic approach to management based on the availableevidence. This approach incorporates the evidence regarding our knowledge of the etiologies,diagnosis, and management of chronic pain after total hip arthroplasty.Systematic review registration: The protocol was registered in PROSPERO the internationalprospective register of systematic reviews, ID CRD42020185663.Key words: Chronic pain, review, pain management, arthroplasty, hip replacement