Painful prosthesis: Approaching the patient with persistent pain following total hip and knee arthroplasty

Prisco Piscitelli, Giovanni Iolascon, Massimo Innocenti, Roberto Civinini, Alessandro Rubinacci, Maurizio Muratore, Michele D'Arienzo, Paolo Tranquilli Leali, Anna Maria Carossino, Maria Luisa Brandi

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Symptomatic severe osteoarthritis and hip osteoporotic fractures are the main conditions requiring total hip arthroplasty (THA), whereas total knee arthroplasty (TKA) is mainly performed for pain, disability or deformity due to osteoarthritis. After surgery, some patients suffer from "painful prosthesis", which currently represents a clinical problem. Methods. A systematic review of scientific literature has been performed. A panel of experts has examined the issue of persistent pain following total hip or knee arthroplasty, in order to characterize etiopathological mechanisms and define how to cope with this condition. Results. Four major categories (non infective, septic, other and idiopathic causes) have been identified as possible origin of persistent pain after total joint arthroplasty (TJA). Time to surgery, pain level and function impairment before surgical intervention, mechanical stress following prosthesis implant, osseointegration deficiency, and post-traumatic or allergic inflammatory response are all factors playing an important role in causing persistent pain after joint arthroplasty. Diagnosis of persistent pain should be made in case of post-operative pain (self-reported as VAS ≥3) persisting for at least 4 months after surgery, or new onset of pain (VAS ≥3) after the first 4 months, lasting ≥2 months. Acute pain reported as VAS score ≥7 in patients who underwent TJA should be always immediately investigated. Conclusions. The cause of pain needs always to be indentified and removed whenever possible. Implant revision is indicated only when septic or aseptic loosening is diagnosed. Current evidence has shown that peri-and/or post-operative administration of bisphosphonates may have a role in pain management and periprosthetic bone loss prevention.

Original languageEnglish
Pages (from-to)97-110
Number of pages14
JournalClinical Cases in Mineral and Bone Metabolism
Volume10
Issue number2
DOIs
Publication statusPublished - May 2013

Keywords

  • Hip arthroplasty
  • Knee arthroplasty
  • Painful prosthesis
  • Persistent pain

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

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