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Annotation: S. E. Gwilym, T. C. B. Pollard, and A. J. Carr Understanding pain in osteoarthritis J Bone Joint Surg Br 2008; 90-B: 280-287 [Abstract] [Full text] [PDF]

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Understanding pain in osteoarthritis

Michael Wroblewski   (9 May 2008)

Understanding pain in osteoarthritis 9 May 2008
Michael Wroblewski, Professor of Orthopaedic Biomechanics, Consultant Orthopaedic Surgeon John Charnley Research Institute, Wrightington Hospital, Wigan UK Send letter to journal: Re: Understanding pain in osteoarthritis bmwhipdr{at}hotmail.com Michael Wroblewski	Sir, This annotation by Gwilym et al is timely indeed. It focuses the attention on the complexity of pain pathways of arthritic joints at the stage when the demand for total joint replacement continues unabated, while efforts are made to abandon follow-up. Attempts at characterising both the quality and localisation of pain from arthritic hips offered some information but this could not be claimed to be entirely source-specific.1 In clinical practice it is the sequence - history, examination of the patient, and lastly of the radiograph - that is most valuable. Total hip arthroplasty is so successful that failure to relieve pain must call into question patient selection, indication for the operation, or possibility of complications. Pain relief is assumed to be primarily due to the replacement of the articular and subarticular symptomatic structures with a neuropathic spacer which functions within a foreign body bursa. Excision of the capsule2 or synovium is not an integral part of the procedure. Phantom pain of internal amputation is yet to be described. The authors’ suggestion may be valid if the source of pain, close to the replaced articulation, remains and gains prominence after surgery. Since understanding pain in osteoarthritis is such a complex subject, would it be correct to suggest that understanding symptoms, if any, of a failing total hip arthroplasty is even more complex? Since clinical results do not reflect the mechanical state of the arthroplasty3, what patterns of clinical presentation could be expected from a particular mode of failure in the long term? If follow-up after total hip arthroplasty is abandoned who should bear the continuing burden of clinical, moral, legal and financial responsibility? Further comments from Gwilym et al would be most welcome. B.M. Wroblewski FRCS, Professor of Orthopaedic Biomechanics, Consultant Orthopaedic Surgeon, John Charnley Research Institute, Wrightington Hospital, Wigan, UK. 1. Wroblewski BM. Pain in osteoarthrosis of the hip. Practitioner 1978;220:140-1. 2. Charnley J. Low Friction Arthroplasty of the Hip: Theory and Practice. Berlin: Springer-Verlag, 1979:317. 3. Wroblewski BM, Fleming PA, Siney PD. Charnley low-frictional torque arthroplasty of the hip. 20- to 30-year results. J Bone Joint Surg [Br] 1999;81-B:427-30.