Therapeutics
Simon Chen, MD
Resident Physician, Physical Medicine & Rehabilitation
University of Calgary
Calgary, Alberta, Canada
Chris Beavington, MD
Physician, Sports Medicine
University of Calgary
Calgary, Alberta, Canada
George Deng, MD
Physician, Physical Medicine and Rehabilitation
University of Calgary
Calgary, Alberta, Canada
A 73 year-old male with left greater than right hip joint osteoarthritis with previous left acetabular and hip open reduction and internal fixation (ORIF) in 2013 and 2022, respectively, presented with left lateral hip pain. Associated co-morbidities include Chrohn’s, colitis, diabetes, hypothyroidism, and left inguinal hernia surgery. Pain was localized just distal to the greater trochanter and was provoked by activity and lateral decubitus positioning. Point of care ultrasound identified the point of maximal tenderness corresponding to a screw visibly protruding and tenting the ITB, fluid collection/adventitious bursa formation around the screw and chronic synovial thickening. His pain persisted despite physical therapy, home exercise program, oral acetaminophen, and topical diclofenac cream. Two soft tissue adapted biocompatible hyaluronic acid (Sportvis) injections 3 weeks apart were performed targeting the area superficial to the ITB tented by hardware with a reported 60-70% improvement in pain thereafter.
Discussions:
Persistent pain after hip ORIF is associated with significant disability. The pathological etiology is heterogenous and there are limited studies on precise anatomical etiologies. Management options outside of conservative and pharmacologic options are limited. Hyaluronic acid (HA) is typically used intraarticular for the management of chronic osteoarthritis. However, there is recent evidence for its use for management of soft tissue injuries, with Health Canada approvals for lateral epicondylosis and acute lateral ankle sprains. This case takes advantage of the HA’s viscoelastic and lubricating properties as well as anti-inflammatory effects to successfully manage a patient with persistent pain after hip ORIF.
Conclusions:
This case report represents the first instance, that we are aware, of persistent post-hip ORIF pain arising from the ITB and hardware and successful treatment of such with HA. Use of Sportvis for the treatment of ITB syndrome would be an off-label indication as a soft tissue injection.
