title: The distribution of nociceptive innervation in the painful hip: a histological investigation.
abstract: Our understanding of the origin of hip pain in degenerative disorders of the hip, including primary osteoarthritis, avascular necrosis and femoroacetabular impingement (FAI), is limited. We undertook a histological investigation of the nociceptive innervation of the acetabular labrum, ligamentum teres and capsule of the hip, in order to prove pain- and proprioceptive-associated marker expression. These structures were isolated from 57 patients who had undergone elective hip surgery (44 labral samples, 33 ligamentum teres specimens, 34 capsular samples; in 19 patients all three structures were harvested). A total of 15,000 histological sections were prepared that were investigated immunohistochemically for the presence of protein S-100, 68 kDa neurofilament, neuropeptide Y, nociceptin and substance P. The tissues were evaluated in six representative areas. Within the labrum, pain-associated free nerve ending expression was located predominantly at its base, decreasing in the periphery. In contrast, the distribution within the ligamentum teres showed a high local concentration in the centre. The hip capsule had an almost homogeneous marker expression in all investigated areas. This study showed characteristic distribution profiles of nociceptive and pain-related nerve fibres, which may help in understanding the origin of hip pain.
authors.affiliation: Department of Orthopaedics, University Hospital of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Haversath
authors.forename: J
authors.initials: J
authors.lastname: Hanke
authors.forename: S
authors.initials: S
authors.lastname: Landgraeber
authors.forename: M
authors.initials: M
authors.lastname: Herten
authors.forename: C
authors.initials: C
authors.lastname: Zilkens
authors.forename: R
authors.initials: R
authors.lastname: Krauspe
authors.forename: M
authors.initials: M
authors.lastname: Jäger
mesh_terms: D000077:Acetabulum / Q000294:innervation / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D005260:Female; D006621:Hip Joint / Q000294:innervation*; D006801:Humans; D008023:Ligaments, Articular / Q000294:innervation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D059225:Nociception; D059226:Nociceptive Pain / Q000175:diagnosis* / Q000503:physiopathology; D009619:Nociceptors / Q000473:pathology*; D010147:Pain Measurement; D055815:Young Adult
keywords: Capsule; Hip; Innervation; Labrum; Ligamentum teres; Pain