Three cases of type-1 complex regional pain syndrome after elective total hip replacement

Background. The incidence of sciatic nerve (SN) damage after a total hip replacement (THR) is 10 percent. The underdiagnosis of paucisymptomatic sciatic neuropathy may lead to the unsatisfactory outcome of the treatment in these patients featured by frequent chronic pain syndrome. This research was aimed at the evaluation of the dynamics of clinical and electrophysiological patterns in SN after THR. Material and methods. The research involved 16 individuals 45 to 68 years old with primary idiopathic coxarthrosis who underwent THR in the Scientific Research Institute of Traumatology, Orthopedics and Neurosurgery, Federal State Budgetary Educational Institution of Higher Education V.I. Razumovsky Saratov State Medical University, the Russian Federation Ministry of Healthcare. We compared the findings of clinical and neurologic examinations (VAS, muscle strength, and sensitivity evaluation) as well as ENMG before surgeries and 14 days after them. Results. In the evaluation of the clinical score in 9 patients, we observed some negative changes featured by paresthesia around the area of the SN innervation. The analysis of changes in ENMG findings revealed the decrease in M-response amplitudes of both peroneal and tibial nerves by more than 10 percent of the age-appropriate normal value; this was more prominent in patients who had undergone the lengthening of extremities in more than 3 cm. Conclusion. THR is associated with a higher risk of traction and entrapment changes in SN that lead to the progress of their neuropathies in the post-operative period.

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Surgery for greater trochanteric pain syndrome after total hip replacement confers a poor outcome

International Orthopaedics ◽

10.1007/s00264-017-3546-7 ◽

2017 ◽

Vol 42 (1) ◽

pp. 77-85 ◽

Cited By ~ 3

Author(s):

Eve Robertson-Waters ◽

James R. Berstock ◽

Michael R. Whitehouse ◽

Ashley W. Blom

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Pain Syndrome ◽

Greater Trochanteric Pain Syndrome ◽

Total Hip ◽

Poor Outcome

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Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2006.marapr01 ◽

2006 ◽

Vol 11 (2) ◽

pp. 1-3, 9-12

Author(s):

Robert J. Barth ◽

Tom W. Bohr

Keyword(s):

Clinical Practice ◽

Complex Regional Pain Syndrome ◽

Somatoform Disorders ◽

International Association ◽

Pain Syndrome ◽

Somatoform Disorder ◽

Syndrome Type ◽

Previous Issue

Abstract From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).

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Postoperative functioning, age, obesity, and social support influence where patients go after total hip replacement

PsycEXTRA Dataset ◽

10.1037/e556262006-011 ◽

2005 ◽

Keyword(s):

Social Support ◽

Total Hip Replacement ◽

Hip Replacement ◽

Total Hip

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The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646293 ◽

1992 ◽

Vol 68 (04) ◽

pp. 436-441 ◽

Cited By ~ 23

Author(s):

Nigel E Sharrock ◽

George Go ◽

Robert Mineo ◽

Peter C Harpel

Keyword(s):

Heart Rate ◽

Deep Vein Thrombosis ◽

Cardiac Index ◽

Total Hip Replacement ◽

Epidural Anesthesia ◽

Hip Replacement ◽

Low Dose ◽

Total Hip ◽

Vein Thrombosis ◽

Deep Vein

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

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Effects on Coagulation and Fibrinolysis of Desmopressin in Patients Undergoing Total Hip Replacement

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646480 ◽

1991 ◽

Vol 66 (06) ◽

pp. 652-656 ◽

Cited By ~ 7

Author(s):

Per Anders Flordal ◽

Karl-Gösta Ljungström ◽

Jan Svensson ◽

Brenda Ekman ◽

Gustaf Neander

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Bleeding Time ◽

Antithrombin Iii ◽

Postoperative Bleeding ◽

Double Blind ◽

Total Hip ◽

Von Willebrand ◽

Willebrand Factor ◽

Coagulation And Fibrinolysis

SummaryTwelve patients undergoing total hip replacement, with regional anaesthesia and with dextran infusion for plasma expansion and thromboprophylaxis, were given the vasopressin analogue desmopressin (DDAVP) or placebo in a randomized, double-blind prospective study. In controls (n = 6) we found a prolongation of the bleeding time, low factor VIII (FVIII) and von Willebrand factor (vWF) and a decrease in antithrombin III to levels known to be at risk for venous thrombosis. Desmopressin shortened postoperative bleeding time, gave an early FVIII/vWF complex increase, prevented antithrombin III from falling to critically low values and appeared to activate the fibrinolytic system, both by tPA increase and PAI-1 decrease.Thus in the controls we found changes in both coagulation and fibrinolysis indicating a haemorrhagic diathesis as well as a risk for thromboembolism. Desmopressin induced factor changes that possibly reduce both risks.

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Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648020 ◽

1976 ◽

Vol 36 (01) ◽

pp. 157-164 ◽

Cited By ~ 34

Author(s):

P. M Mannucci ◽

Luisa E. Citterio ◽

N Panajotopoulos

Keyword(s):

Deep Vein Thrombosis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Low Dose ◽

Control Group ◽

Total Hip ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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