Background & Aims

In recent years, femoral neck fractures have been on the rise as Japan’s population ages. At our hospital, a high proportion of femoral neck fractures undergo bipolar hip arthroplasty. Postoperative pain can have detrimental effects on individuals, both psychologically and physically. In addition, we believe it is important to understand local hip pain near the fracture site and changes in physical function and psychological aspects during the acute period after bipolar hip arthroplasty for femoral neck fractures. The purpose of this study was to evaluate the changes in the pressure pain threshold near the fracture site after surgery and to understand the relationship between pain and psychological and physical aspects.

Methods

The subjects were 11 patients with femoral neck fractures for whom bipolar hip arthroplasty was performed. Postoperative pain when walking was measured using Numerical Rating Scale (NRS), psychological aspects were evaluated using Tampa Scale for Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS), and physical function was evaluated using Time Up and Go test (TUG).
To measure the pressure pain threshold, a digital hand algometer (SBMEDIC Electronics, Sweden) was used to press the skin on the center of the femoral head and the gluteus medius muscle attachment of the greater trochanter (trochanteric part) on the affected and healthy sides, respectively. The pressure force was measured when the patient began to feel pain. The measurement site was identified by echo and measured from early postoperative period to before discharge.

Results

The NRS decreased significantly from 6.1±1.9 (mean ± standard deviation) postoperatively to 2.5±1.4 before discharge. The pressure pain threshold was significantly lower in the trochanteric part than in the healthy side, and it increased significantly from 143±77 kPa postoperatively to 238±103 kPa before discharge. In addition, the femoral head also showed an increase after a downward trend on the affected side than on the healthy side.
On the healthy side, both the trochanteric part and the femoral head tended to rise after a transient drop in the threshold early postoperatively. There was no significant difference of TSK and PCS between postoperation and before discharge. TUG decreased significantly until discharge.

Conclusions

The change in tenderness threshold suggested an increase in local sensitization at the gluteus medius muscle attachment site rather than the femoral head on the affected side.
On the healthy side, the transient tendency to decline after surgery was considered to be the effect of the load on the healthy side due to functional training. In addition, although physical function showed improvement with the progress of pain reduction, it seems that there was no effect on psychological aspects.

References

Martin F. Bjurström, Michael R. Irwin, Mikael Bodelsson, Michael T. Smith, Niklas Mattsson-Carlgren ,”Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty,” Volume 25, Issue 7 Pages: 1482-1492,August 2021.

B. W. Kuiper, S. Graybill, J. M. Tate, N. Kaufman, and D. Bersabe, “After the fall: improving osteoporosis treatment following hip fracture,” Osteoporosis International, vol. 29, no. 6, pp. 1295–1301, 2018.

J. Katz and Z. e. Seltzer, “Transition from acute to chronic postsurgical pain: risk factors and protective factors,” Expert Review of Neurotherapeutics, vol. 9, no. 5, pp. 723–744, 2009.

Presenting Author

Atsushi Imayama

Poster Authors

Atsushi Imayama

B.D.

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Lead Author

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Motohiro Kawasaki

NHO Shikoku Medical Center for Children and Adults

Lead Author

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Takamitu Fujii B.D.

Department of Rehabilitation, NHO Shikoku Children's and Adult Medical Center, National Hospital Or

Lead Author

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Kaito Ise

NHO Shikoku Medical Center for Children and Adults

Lead Author

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Topics

  • Specific Pain Conditions/Pain in Specific Populations: Post-surgical/Post-traumatic Chronic Pain