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Hip arthroplasty also relieves ipsilateral knee pain
Wang W. Clin Orthop Relat Res. 2011. doi:10.1007/s11999-011-2116-3
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The results of a retrospective study of 255 patients who underwent hip arthroplasty during a 2-year period links intra-articular hip disease with ipsilateral knee pain and indicates that the procedure may also relieve knee pain.
To determine the connection between hip disease and preoperative ipsilateral knee pain and to evaluate whether knee pain is relieved after hip disease is treated, Wenbao Wang, MD, and colleagues obtained the WOMAC pain scores of the patients’ joints preoperatively, and at 3 months and 1 year after hip arthroplasty. Of the 255 patients included in the study, 3-month or 1-year follow-up measures were available for 245 patients.
The investigators found that 55% of patients reported preoperative pain in the ipsilateral knee, while 18% reported contralateral knee pain. In addition, those with preoperative ipsilateral pain had worse WOMAC scores.While the investigators discovered that the ipsilateral knee pain improved at both time points, they found no significant differences between the scores of patients with either ipsilateral or contralateral knee pain at 3 months and 1 year.
“Our observations suggest hip disease is associated with ipsilateral knee pain, and that it improves after hip arthroplasty,” the authors wrote in their abstract. “This should be considered during preoperative evaluation for patients with hip and knee pain.”
The article entitled “Does ipsilateral knee pain improve after hip arthroplasty?” by Wang, Geller, Nyce, Choi and Macaulay is a well done retrospective study that clearly documents a percentage of patients that undergo hip replacement surgery will have resolution of some of their ipsilateral knee pain. They took a group of 225 patients who underwent primary hip arthroplasty over a 2-year period, and preoperatively documented the WOMAC pain score of both the hip and knee. They then documented what happened at 3 months and 1 year to that WOMAC score.
They showed very nicely, and not surprisingly, that ipsilateral knee pain was more frequently observed than contralateral knee pain (55% vs. 18%) and preoperative ipsilateral knee pain scores were worse than the contralateral knee pain scores (80 vs 95). Furthermore, they also documented that ipsilateral knee pain improved at both 3 months and 1 year intervals when compared with the contralateral knee.
One of the weaknesses of the study is they do not have imaging studies documenting the severity of disease in both knees. Their primary outcome measure was the WOMAC pain score of each joint.
This study nicely documents what I think is commonly known that hip arthritis can refer pain to the knee. The strength of this article is that they have put relatively hard numbers to this commonly assumed condition. It further emphasizes the fact that if someone presents with both hip and knee pain, it is reasonable to proceed with hip replacement before the knee replacement as some of the knee pain may improve.
– Robert T. Trousdale, MD
Orthopedics Today Editorial Board member
Mayo Clinic
Rochester, N.Y.
Disclosures: Trousdale recieves royalties from Depuy, Wright Medical Group and Mako Surgical Corp.