Effectiveness of intraoperative periarticular infiltration in Total Hip Arthroplasty (THA): A clinical audit

S Kavin1, S Chockalingam2, P Ramasamy3

1Registrar – Department of Orthopaedics, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Senior Consultant, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3HOD Ortho, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Background

Pain control after THA is pivotal in rehabilitation. Analgesics play an important role in pain control. The selection of those analgesics also a significant area in the treatment. This article will discuss about one of the analgesia in the pain management.

Analgesia modalities after THA

  • Epidural analgesia
  • Opioid Administration
  • Peripheral nerve blocks

Per articular infiltration

TypesAdvantagesDisadvantages
Epidural analgesiaProlongation of analgesia
Good pain relief and relaxation
Pruritis, Urinary retention
Opioid administrationGood pain reliefNausea, sedation, Respiratory depression drowsiness
Peripheral nerve blockGood pain reliefNeurovascular injury
Periarticular infiltration analgesiaExcellent pain reliefChances of infection

Periartciular cocktail injection will work on sensory innervation of hip joints they are, Sensory receptors: mechanoreceptors and nociceptors

Anterior capsule having higher density of receptors they are the primary pain generators of hip joint by Pericapsular nerve group block (PENG)

Aim

To Assess the Efficacy of intraoperative Anterior capsular periarticular cocktail injection after THA

Parameters

  • Pain on the day of operation (VAS score) Time taken for mobilization
  • Hospital stay duration Complication

Materials

Study Type: Observational outcome study

Place: Kauvery Hospitals, Trichy, Tamil Nadu

Duration: 2019-2024

Sample Size: 87 patients

Inclusion criteria: Primary THA

Exclusion criteria: Revision THA

Results and Discussion

Diagnosis

Anesthesia

Cocktail Injection

Technique of THA

  • Spinal anasthesia
  • Lateral position
  • Posterior approach
  • Bleeding control – Trenexemic acid
  • Antibiotic prophylaxis – cefotaxime +sulbactum
  • DVT – mechanical prophylaxis
  • POD-0 >> physio rehab exercises

Technique of Cocktail Injection

Content – 70m

  • 38ml – Normal Saline
  • 25ml – Ropivacaine
  • 4ml – Dexamethazone
  • 2ml – Ketorolac
  • 1ml – Clonidine

Anatomical Zones

  • Anterior capsule –outside
  • Anterior femur
  • Anterior acetabulum
  • Subcutaneous tissue

Standard Post Op Protocol

  • Medicines (Paracetamol, Tramadol, NSAIDS in selected patients)
  • Physio on the day of surgery
  • No catheterization (except with epidural)
  • Early discharge

Methods

  • Pain score with VAS & faces scale
  • Length of stay post-surgery
  • Mobilization delay (or absence)
  • Complication related to surgery and PAI

Pain on POD-0

Hospital Stay

POD 1POD 1POD 1POD 1 and More
OA HIP (28)07138
ICNF Fracture (59)71239

Mobilization

Complication

  • Foot drop in one patient –Approach related
  • Quadriceps weakness – PAI addition to PENG Block
  • infection -NIL
  • DVT –NIL
  • Bed sore-NIL

Summary of Results

  • Least possible post operative pain
  • Hospital stay
  • Patient satisfaction
  • Postoperative complication
  • Better rehabilitation

Review of Literature

  • Laumonerie P, Dalmas Y, Tibbo Me, Robert S, Durant T, Caste T, Vialla T, Tiercelin J, Gracia G, Chaynes P. Sensory Innervation Of The Hip Joint And Referred Pain: A Systematic Review Of The Literature. Pain Medicine. 2021 May 1;22(5):1149-57.
  • Chang Rw, Nunes Jc, Batista Bb, Borborema Tc. The Effectiveness Of Periarticular Anesthetic Infiltration In Postoperative Analgesia Of Total Hip Arthroplasty. Revista Brasileira De Ortopedia. 2023 Aug 11;58(2):252-6.
  • Hannon Cp, Fillingham Ya, Spangehl Mj, Karas V, Kamath Af, Casambre Fd, Verity Tj, Nelson N, Hamilton Wg, Della Valle Cj. The Efficacy And Safety Of Periarticular Injection In Total Joint Arthroplasty: A Direct Meta-analysis. The Journal Of Arthroplasty. 2022 Oct 1;37(10):1928-38.
  • Ross Ja, Greenwood Ac, Sasser Iii P, Jiranek Wa. Periarticular Injections In Knee And Hip Arthroplasty: Where And What To Inject. The Journal Of Arthroplasty. 2017 Sep 1;32(9):s77-80.

Conclusion

This Study of PAI in THA has not been widely studied in Indian literature, Nor Reported in Published literature

The study showed that PAI in THA

  • Is Safe and Effective
  • Anterior Capsular infiltration is sufficient and Safe
  • Early Mobilization is not impeded
  • Has no complication

Kauverian Bookshelf

Applied Medical Statistics

Journals

Kauvery Hospital
Find Doctor
Book Appointment