Treatment of intractable hip pain after THA and GTB using peripheral nerve field stimulation: a case series.
OBJECTIVE
It has been estimated that 10%-35% of patients who undergo total hip arthroplasty (THA) have chronic postoperative pain, most often located at the greater trochanter. After greater trochanteric bursectomy (GTB), patients also may continue to experience chronic surgical site pain. Chronic pain has a neuropathic component, which often responds poorly to opioids. In an attempt to provide increased pain relief for patients with intractable chronic pain, unconventional agents and interventional management approaches have received considerable attention. Peripheral nerve field stimulation (PNFS) has been used with increased frequency as a minimally invasive and safe intervention for the management of intractable neuropathic postoperative pain. The objective of this retrospective study was to evaluate the efficacy of PNFS for treatment of chronic hip pain after THA and GTB.


METHODS
Twelve patients with chronic post-operative pain after THA and GTB underwent an uneventful PNFS trial with percutaneous placement of 2 temporary 8-electrode leads (Medtronic Inc, Minneapolis, Minn) positioned in the subcutaneous tissue in the area of greatest pain, parallel to postoperative scar over the affected upper lateral thigh.


RESULTS
After experiencing excellent pain relief over the next 2 days, the patients were implanted with permanent leads and rechargeable or non-rechargeable generator 2-4 weeks later. They reported sustained pain relief at 12-month follow-up visits.


CONCLUSIONS
PNFS provides an effective alternative treatment option for select patients with chronic postoperative pain after THA and GTB who have failed conservative treatment.
Yakovlev
Alexander E
AE
Comprehensive Pain Management of the Fox Valley, SC, Appleton, WI 54911, USA. aeyakovlev@yahoo.com
Resch
Beth E
BE
Karasev
Sergey A
SA
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006615:Hip; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy*; D010149:Postoperative Pain / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome