Prevention of postoperative pain after total hip arthroplasty in patients with proximal femur fractures

Abstract

Introduction Proximal femur fractures can be associated with nailing and total hip arthroplasty (THA). Treatment of elderly inpatients necessitates adequate postoperative pain relief. Obese patients require specific inpatient and outpatient treatments.The objective was to evaluate the effectiveness of pain relief in obese patients at the stages of rehabilitation after primary THA performed for a proximal femur fracture.Material and methods VAS score was compared in two groups of 60 clinical cases to evaluate the effectiveness of postoperative multimodal pain relief using the author's method.Results Comparable results of an effective and stable pain relief were obtained in the two groups by the time the patient was discharged from the hospital 5-6 days after THA. Multimodal analgesia with a glucocorticosteroid injected in the projection of the sacroiliac joint provided an effect being greater by 29 % than with use of opioids after two postoperative days and by 11 % after five postoperative days.Discussion Old age, comorbidities are associated with optimal surgical strategy. THA in patients with extra-articular proximal femur fractures can improve the rehabilitation potential early after surgery and general clinical and functional results providing high quality of life in the late rehabilitation period.Conclusion THA demonstrated a stable positive effect of pain relief in the study group of patients with proximal femur fractures, regardless of the weight and the height. Positive dynamics in pain relief was seen in patients with elevated BMI of any gradation, including those with BMI ≥ 40.