title: Postoperative pain after hip fracture is procedure specific.
abstract: BACKGROUND
  Hip fracture patients experience high pain levels during postoperative rehabilitation. The role of surgical technique on postoperative pain has not been evaluated previously.
  
  
  METHODS
  One hundred and seventeen hip fracture patients were included in a descriptive prospective study. All patients received continuous epidural analgesia and were treated according to a standardized perioperative rehabilitation programme. Resting pain, pain on hip flexion, and walking were measured during daily physiotherapy sessions on a verbal five-point rating scale during the first four postoperative days. Patients were stratified into four groups according to surgical procedure: screws or pins, arthroplasty, dynamic hip screw (DHS), and intra-medullary hip screw (IMHS).
  
  
  RESULTS
  Cumulated pain levels were significantly different between surgical procedures both for hip flexion (P=0.002) and for walking (P=0.02) with highest dynamic pain levels for patients who had either DHSs or IMHSs compared with arthroplasty or parallel implants. There were significant negative correlations between ambulatory capacity assessed by the cumulated ambulation score and both the dynamic cumulated pain scores on hip flexion (r=-0.43, P<0.001) and walking (r=-0.36, P=0.004).
  
  
  CONCLUSIONS
  Postoperative pain levels after surgery for hip fracture are dependent on the surgical procedure, which should be taken into account in future studies of analgesia and rehabilitation.
authors.affiliation: Department of Anesthesiology, Rigshospitalet Copenhagen University, Copenhagen DK-2100, Denmark. nbf@comxnet.dk
authors.forename: N B
authors.initials: NB
authors.lastname: Foss
authors.forename: M T
authors.initials: MT
authors.lastname: Kristensen
authors.forename: H
authors.initials: H
authors.lastname: Palm
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods* / Q000534:rehabilitation; D005594:Fracture Fixation, Intramedullary / Q000534:rehabilitation; D006620:Hip Fractures / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology*; D026741:Physical Therapy Modalities / Q000009:adverse effects; D011446:Prospective Studies; D016138:Walking