Pressure-pain threshold algometric measurement in patients with greater trochanteric pain after total hip arthroplasty.
ABSTRACT The evaluation of tenderness associated with greater trochanteric pain (GTP) syndrome is amenable to bias and depends on the examiner's experience. In this study, we tested whether the use of an electronic pressure algometer enhanced the reliability of this evaluation.
Pressure-pain threshold (PPT) was measured with an electronic algometer in 18 patients who developed GTP after total hip arthroplasty and in matched controls. Both groups were evaluated with visual analog scale.
The PPT measurements showed large interindividual variability across patients. The correspondence of the PPT measurements in asymptomatic patients was good. We found good validity for the algometer used. The PPT ratio of 0.8 (affected vs. unaffected side) can be used as a cut-off ratio. The PPT measurements at the greater trochanter (local pain) were significantly lower than at the ilio-tibial band (radiated pain). There was no correlation between PPT measurements and visual analog scales. Despite the acceptable sensitivity and specificity of pressure algometer, because of low positive predictive value and large interindividual variability, pressure algometer has a limited value as a screening test.
The examination of tenderness associated with GTP is facilitated by the used algometer. It is the intraindividual body-side PPT differences that yield the most sensitive measurement for the assessment of deep pain. A cut-off value of 0.8 can be used for diagnostic purposes. Interindividual differences might be considerable and could mask pathologic diagnostic findings.
- SourceAvailable from: Tamara E LacourtScandinavian Journal of Pain 01/2012; 3(1):31-37. DOI:10.1016/j.sjpain.2011.10.003
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ABSTRACT: The development of greater trochanteric pain (GTP) after total hip arthroplasty (THA) represents a special category. Despite that treatment is mainly conservative, some patients show poor response and surgical intervention should be considered. We propose a new method consisting of distal lengthening of ilio-tibial band (ITB) by Z-plasty. Between March 2004 and June 2006, 12 women with refractory GTP after THA were operated on using distal ITB lengthening. The procedure was done under local anaesthesia on an outpatient basis. The patients were followed up 3-4 months postoperatively by phone interview and at 1-3 years by EQ-5D questionnaire and clinical examination including tenderness evaluation with algometer. All patients improved significantly (EQ-5D = 0.26 preoperatively vs. 0.67 postoperatively; P < 0.005) except one patient who experienced no change in GTP symptoms. No postoperative complications were reported. We believe that treating patients with GTP after THA by the technique described offers a simple, safe and reliable method.Archives of Orthopaedic and Trauma Surgery 07/2008; 129(5):597-602. DOI:10.1007/s00402-008-0693-8 · 1.36 Impact Factor
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ABSTRACT: With the advent of cell-based therapies, biologics, and pharmaceuticals for the potential treatment of osteonecrosis, it is important to conduct evaluations using scientifically accepted outcomes measures. For the treatment of osteonecrosis, most studies have focused on pain relief, surgery, or the need for surgery, disease progression (advancing stage), and change in lesion size. Quantification of imaging techniques continue to gain in sophistication but have not yet been validated for use in clinical trials. Despite recent interest in using biomarkers or genetic markers in the diagnosis and analysis of disease progression, more research is needed to determine the sensitivity and specificity of these techniques with respect to osteonecrosis.Orthopedic Clinics of North America 05/2009; 40(2):179-91. DOI:10.1016/j.ocl.2008.10.005 · 1.70 Impact Factor