Modificación de la percepción del dolor y la función física tras artroplastia total de cadera

Abstract

INTRODUCTION: Osteoarthrosis (OA) is a disease that affects an increasing number of people, being more prevalent at older ages and in the female sex, which implies a growing socioeconomic impact and one of the main factors that contribute to global disability. Pain is the predominant symptom in OA, being the result of sensitization of peripheral nociceptors and / or changes in the central nervous system as a consequence of the repetitive painful stimulus. Total hip arthroplasty (THA) is a cost-effective surgical technique in the treatment of pain and functionality of the hip joint, however, studies related to changes in central sensitization in patients submitted to this technique are scarce. For the evaluation of patients, there are specific pain assessment instruments, the most commonly used being the Harris Hip Score (HHS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Visual Analogue Pain Scale (VAS-pain) and Oxford Hip Score (OHS); For the assessment of general quality of life the most widely used questionnaires are the Short-Form 36 (SF-36) and its variant Short- Form 12 (SF-12) and EuroQol-5D and for the measurement of generalized hyperalgesia it is commonly used pressure algometry. HYPOTHESIS: Inflammation and joint damage can be the initial pain points in hip OA. However, sustained exposure to nociceptive stimuli can induce neuronal plasticity with widespread pain sensitization that can be modified after total hip arthroplasty. OBJECTIVES: The general objective of this thesis has been to evaluate the modification of pain, functional capacity and quality of life, as well as the relationship between them, in patients undergoing THA. The specific objectives were: 1) to determine which variables are associated with improvement in the physical component of general health, 2) to compare hypersensitivity to pressure in patients with symptomatic hip OA before and after total hip arthroplasty, 3) establish the association between painful sensitivity to pressure and the intensity of clinical pain in patients with hip OA. CONCLUSIONS: Central sensitization in patients with OA can be normalized after elimination of the peripheral nociceptive stimulus through total hip arthroplasty, being a technique that improves not only pain, but also functional capacity and quality of life of patients subjected to it. The evaluation of PPTs measured by pressure algometry to assess generalized hyperalgesia is a method that could be used in routine clinical practice in patients with hip OA undergoing THA, which would mean a better diagnosis of these patients and, therefore, a better treatment.