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Comparative Study
. 2025 May 20;145(1):304.
doi: 10.1007/s00402-025-05916-7.

Differences in acute phase pain characteristics between patients undergoing bipolar hip arthroplasty versus open reduction internal fixation for hip fracture

Tomohiro Oka  1   2 , Tomonori Kawamura  3   4 , Wataru Shirasaka  5
Affiliations
Comparative Study

Differences in acute phase pain characteristics between patients undergoing bipolar hip arthroplasty versus open reduction internal fixation for hip fracture

Tomohiro Oka et al. Arch Orthop Trauma Surg. .

Abstract

Introduction/objectives: Patients who experience hip fractures often undergo bipolar hip arthroplasty (BHA) or open reduction and internal fixation (ORIF); however, acute postoperative pain remains a significant concern, often delaying rehabilitation and impairing recovery. This study compared acute phase pain characteristics (intensity and trajectory, and duration of analgesic use) between BHA and ORIF. Previous studies have suggested that patients undergoing ORIF may experience higher pain levels than those undergoing BHA, although most assessments have been limited to single time points, which may not capture the full scope of postoperative pain.

Materials and methods: This prospective cohort study was conducted between February and August 2024. Pain intensity was evaluated on postoperative day (POD) 1, 3, 5, 7, and 14 using a numerical rating scale. Pain trajectories (slope and intercept) were calculated based on pain intensity assessed on POD 1, 3, 5, and 7. The duration of analgesia was assessed from the time of surgery until discontinuation. Multiple linear regression analysis was performed to examine the effect of surgical type (0, BHA; 1, ORIF) on pain-related outcomes, adjusting for confounders including age, sex, preoperative C-reactive protein level, and operative duration.

Results: Data from 48 patients who underwent BHA and 32 who underwent ORIF were analyzed. There were no significant differences in pain intensity between the groups on POD 1 and 3. However, pain was significantly greater in the ORIF group on POD 5 (p < 0.01), 7 (p < 0.01), and 14 (p < 0.01). Regression analysis revealed that surgery type significantly influenced pain intensity on POD 14 (β = 1.27, p = 0.01) and pain trajectory slope (β = 0.52, p = 0.03). The intercept and analgesic duration were not significantly different between the groups.

Conclusions: Acute phase postoperative pain characteristics differed between BHA and ORIF, highlighting the need for targeted pain management during recovery in patients undergoing ORIF.

Keywords: Acute phase; Analgesic use; Bipolar hip arthroplasty; Open reduction and internal fixation; Pain trajectory.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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