Cic edizioni internazionali
Clinical Cases in mineral and bone metabolism

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

Mini-review, 97 - 110
doi: 10.11138/ccmbm/2013.10.2.097
Tag this article
Abstract
Enhanced HTML Full text PDF
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.

Vol. XV (No. 3) 2018 September - December

  1. From the Editor-in-Chief
    Brandi M.L.
  2. Effect on Trabecular Bone Score (TBS) of Tissue-Selective Estrogen Complex (TSEC) in early post-menopausal women: case report
    Lello S., Capozzi A., Scambia G.
  3. Sport and physical activity in patients with hereditary multiple exostoses
    D'Ambrosi R., Caldarini C., Massari G., Facchini R.M., Ragone V.
  4. Underdiagnosis of osteoporosis in different ethnic groups when bone mineral density is measured in a single area
    Mastaglia S.R., Bagur A., Mautalen C.A.
  5. Approach in aromatase inhibitors - induced osteoporosis: results from an Italian multicenter observational study
    Migliaccio S., de Sire A., Marocci C., Fornari R., Paoletta M., Greco E.A., Amar I.D., Moretti A., Ronzoni S., Gimigliano F., Vinicola V., Chiacchiararelli F., Guadalascara F., Pastore R., Falaschi P., Minisola G., Falla O., Castellitto D., Lenzi A., Villa P., Iolascon G.
  6. The clinical safety and possibility of immediate implant placement in aggressive periodontitis patients in maxillary esthetic zone: an empty systematic review
    Yussif N.M., Rahman A.R.A., Darhous M.
  7. Bilateral atypical femoral fractures in macroprolactinoma with hypopituitarism: a case report
    Charoensri S., Pongchaiyakul C.
  8. Spinal deformities in neurofibromatosis type 1
    Lykissas M.G., Mavrogenis A.F., Megaloikonomos P.D., Gelalis I.D., Lykomitros V.
  9. Treatment of osteoarthritis: focus on glucosamine
    Rovati L.C.
  10. Refractory hypercalcemia after idiopathic rhabdomyolysis
    Rodríguez-Quintero J.H., Ramos-Pineda A., Salas-Villela R., Gotés-Palazuelos J.
  11. Severe scoliosis in a Colombian patient with childhood hypophosphatasia
    Zarante Bahamón A.M.
  12. Teriparatide in cervical fracture consolidation
    Cordeiro Albino C., Porcelli Savarani C., Aguiar Moreira C.
  13. Incidental finding of osteopetrosis complicated with osteomyelitis
    Ibrahim A.K., Sansare K., Karjodkar F.R:
  14. Hungry bone syndrome presenting as pathological fracture in a young boy
    Chandra A., Hussain Z., Prasad Assat R., Chandra Meena R.
  15. Rare multifocal eosinophilic granuloma involving maxilla and mandible. A case report
    Shawky Shaker I., Salah Mohamed N.
  16. Teriparatide treatment for an atypical femoral fracture in a patient with calcinosis cutis associated with juvenile dermatomyositis: a case report
    Yoshitani J., Kabata T., Yamamoto N., Shimizu M., Kajino Y, Takagi T., Ohmori T., Ueno T., Tsuchiya H.
  17. Surgical approach to rare case of recurrent pheochromocytoma and bones metastatic paraganglioma
    Cosseddu F., Sacchetti F., Shytaj S., Grossi S., Citarelli C., De Gori M., D'Arienzo A., Capanna R.
  18. Mazabraud’s syndrome: a case report
    Ramírez Stieben R. S., Lifton S.
  19. A case of hypercalcemic parathyroid crisis in a patient with normocalcemic hyperparathyroidism
    Lithgow K., Pasieka J., Kline G.
  20. A Platelet Rich Plasma (PRP) and bovine xenograft combination placed in a jaw bone defect after surgical removal of a compound odontoma associated with an impacted lower canine using piezoelectric surgery: a case report
    Ayoub Al-Delayme R.M.
  21. Pharmacological therapy of sarcopenia: past, present and future
    Iolascon G., Moretti A., de Sire A., Liguori S., Toro G., Gimigliano F.
  22. Revision surgery for acetabular nonunion: role and challenges to preservation of hip joint
    Rollò G., Meccariello L., Bisaccia M., Pichierri P., Filipponi M., Giaracuni M., Di Giacomo L.M., Zinghì G.
  23. Reliability and value of external modular fixation (Hoffmann II®) in the management of humeral shaft fracture
    Bisaccia M., Meccariello L., Rinonapoli G., Ibáñez-Vicente C., Ribes-Iborra J., Gomez-Garrido D., Rollo G., Falzarano G., Shahid Khan M., Grubor P., Caraffa A.
Last Viewed articles: la lista degli ultimi x visitati.
  1. Painful prosthesis: approaching the patient with persistent pain following total hip and knee arthroplasty
    Piscitelli P., Iolascon G., Innocenti M., Civinini R., Rubinacci A., Muratore M., D’Arienzo M., Tranquilli Leali P., Carossino A.M., Brandi M.L.
    doi: 10.11138/ccmbm/2013.10.2.097
credits