Persistent Pain After Total Hip Arthroplasty: Standard Rehab Protocol with Pain Education and Orthotics Assessment Supplementation

Introduction: Arthritic hip pain is one condition that often leads people to seek physical therapy and surgical management. Most have good outcomes, however there are some who are plagued with persistent pain even after surgical intervention. Case Description: This case describes a 52-year old female who underwent a left total hip arthroplasty (THA) due to osteoarthritis yet had persistent pain months after surgery. This pain was not localized to the hip, however it presented in the low back. Intervention: Without relief from low back pain with the typical THA protocol, other interventions were used as supplements to help manage the pain from all angles. Therefore, an orthotics assessment and usage were utilized to correct biomechanical deficits, and chronic pain education was given to avoid development or further development of chronic pain. Outcomes: This patient demonstrated improvements in functional mobility, gait, and reported daily functions per her LEFS score following supplemental treatments. Discussion: Osteoarthritis is a big player into chronic pain and is one of the leading reasons for individuals getting a THA. While the root of the persistent pain was unknown, studies have shown that if an individual has higher pre-operative pain levels then they have a greater risk of developing persistent pain after the surgery. On the other hand, if the pain was from a biomechanical standpoint it could be targeted by an assessment of the kinetic chain and the use of an orthotic to correct it, yet it is unknown how the hip replacement approach really affects gait. These are just two more options to target treatment for persistent pain in individuals post-surgical to improve their quality of life.