Capsular neuronal elements and their relation to pain reduction and functional improvement following total hip replacement


We studied changes of pain intensity and functional impairment in 22 patients with osteoarthrosis undergoing total hip replacement. Using a visual analogue scale, the mean scores for pain and disability before surgery were 71.7 and 70.9 respectively. Both scores showed gradual improvement during a 1-year follow-up period, with more than 90% of the total improvement occurring within the first 3 months. After 1 year, the scores for pain and disability were 11.9 and 4.1 respectively. The hip joint capsule was studied using immunohistochemistry to detect neurofilaments. Neurofilament immunoreactivity was observed in 16/22 cases and was correlated with pain and disability scores. However, there were no correlations between pre- and postoperative pain scores, the score changes, and the quantity of capsular neurofilaments. Thus, other factors than capsular neurofilaments influence the scores of pain and disability in osteoarthritis.


Nous avons étudié les changements d’intensité de la douleur et les modifications fonctionnelles chez 22 malades ayant subit une prothèse totale de la hanche pour arthrose. Avec une échelle analogue visuelle, les scores moyens pour la douleur et l’invalidité avant la chirurgie étaient de 71.7 et 70.9 respectivement. Les deux scores ont montré l’amélioration graduelle pendant une année après l’opération, avec plus de 90% de l’amélioration totale dans les trois premiers mois. Après une année les scores pour douleur et invalidité étaient de 11.9 et 4.1 respectivement. La capsule articulaire a été étudiée par immunohistochimie pour détecter les neurofilaments. L’immunoréactivité des neurofilaments a été observé dans 16/22 cas et était corrèlée avec la douleur et le score de l’invalidité. Cependant, il n’y avait pas de corrélations entre les scores de la douleur pré- et postopératoire, la modification du score fonctionnel et la quantité de neurofilaments capsulaires. Il y a donc d’autres facteurs que les neurofilaments capsulaires qui influencent la douleur et l’invalidité dans l’arthrose.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Arnoldi CC, Djurhuus JC, Heerfordt J, Karle A (1980) Intraosseous phlebography, intraosseous pressure measurements and 99mTC-polyphosphate scintigraphy in patients with various painful conditions in the hip and knee. Acta Orthop Scand. 51:19–28

    Google Scholar 

  2. 2.

    Bajaj P, Bajaj P, Graven-Nielsen T, Arendt-Nielsen L (2001) Osteoarthritis and its association with muscle hyperalgesia: an experimental controlled study. Pain. 93:107–114

    Google Scholar 

  3. 3.

    Berend ME, Thong AE, Faris GW, Newbern G, Pierson JL, Ritter MA (2003) Total joint arthroplasty in the extremely elderly: hip and knee arthroplasty after entering the 89th year of life. J Arthroplasty 18:817–821

    Article  PubMed  Google Scholar 

  4. 4.

    Birrell F, Croft P, Cooper C, Hosie G, Macfarlane G, Silman A (2000) Health impact of pain in the hip region with and without radiographic evidence of osteoarthritis: a study of new attenders to primary care. The PCR Hip Study Group. Ann Rheum Dis. 59:857–863

    Google Scholar 

  5. 5.

    Denk H (2002) Drug-induced liver injury. Verh Dtsch Ges Pathol 86:120–125

    CAS  PubMed  Google Scholar 

  6. 6.

    Goddard NJ, Gosling PT (1988) Intra-articular fluid pressure and pain in osteoarthritis of the hip. J Bone Joint Surg Br. 70:52–55

    Google Scholar 

  7. 7.

    Hernanz A, De Miguel E, Romera N, Perez-Ayala C, Gijon J, Arnalich F (1993) Calcitonin gene-related peptide II, substance P and vasoactive intestinal peptide in plasma and synovial fluid from patients with inflammatory joint disease. Br J Rheumatol. 32:31–35

    Google Scholar 

  8. 8.

    Knutsson S, Engberg IB (1999) An evaluation of patients’ quality of life before, 6 weeks and 6 months after total hip replacement surgery. J Adv Nurs. 30:1349–1359

    Google Scholar 

  9. 9.

    Laine L (2003) Gastrointestinal effects of NSAIDs and coxibs. J Pain Symptom Manage. 25(Suppl 2):32–40

    Google Scholar 

  10. 10.

    Mao BY (1993) The change of intraosseous pressure in the femur and tibia near knee and knee pain. Zhonghua Wai Ke Za Zhi 31:593–595

    CAS  PubMed  Google Scholar 

  11. 11.

    Nilsdotter AK, Aurell Y, Siosteen AK, Lohmander LS, Roos HP (2001) Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty. Ann Rheum Dis. 60:228–232

    Google Scholar 

  12. 12.

    Nilsdotter AK, Petersson IF, Roos EM, Lohmander LS (2003) Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study. Ann Rheum Dis. 62:923–930

    Google Scholar 

  13. 13.

    Perrot S, Guilbaud G (1996) Pathophysiology of joint pain. Rev Rhum Engl Ed. 63:485–492

    Google Scholar 

  14. 14.

    Rabinowicz T, Jacqueline F (1980) Lesions of the nerves of the hip involving chronic rheumatic infections (ankylosing spondylitis, rheumatoid arthritis, arthrosis). Anatomopathologic study. Rev Rhum Mal Osteoartic. 47:37–44

    Google Scholar 

  15. 15.

    Rabinowicz T, Jacqueline F (1990) Pathology of the capsular and synovial hip nerves in chronic hip diseases. Pathol Res Pract. 186:283–292

    Google Scholar 

  16. 16.

    Safieh-Garabedian B, Poole S, Allchorne A, Winter J, Woolf CJ (1995) Contribution of interleukin-1 beta to the inflammation-induced increase in nerve growth factor levels and inflammatory hyperalgesia. Br J Pharmacol 115:1265–1275

    PubMed  Google Scholar 

  17. 17.

    Schaible HG, Ebersberger A, Von Banchet GS (2002) Mechanisms of pain in arthritis. Ann N Y Acad Sci. 966:343–354

    Google Scholar 

  18. 18.

    Sherry E, Egan M, Warnke PH, Henderson A, Eslick GD (2003) Minimal invasive surgery for hip replacement: a new technique using the NILNAV hip system. ANZ J Surg. 73:157–161

    Google Scholar 

  19. 19.

    Skaper SD (2001) Nerve growth factor: a neurokine orchestrating neuroimmune-endocrine functions. Mol Neurobiol. 24:183–199

    Google Scholar 

  20. 20.

    Sluka KA, Milton MA, Willis WD, Westlund KN (1997) Differential roles of neurokinin 1 and neurokinin 2 receptors in the development and maintenance of heat hyperalgesia induced by acute inflammation. Br J Pharmacol. 120:1263–1267

    Google Scholar 

Download references


This study was supported by a grant from the Hungarian Medical Research Council (60/2000). We express special thanks to Katalin Hodosi, Béláné Szanitter Magdolna Hajdú and László Kiss for their kind assistance.

Author information



Corresponding author

Correspondence to Levente Gáspár.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gáspár, L., Dezső, B., Csernátony, Z. et al. Capsular neuronal elements and their relation to pain reduction and functional improvement following total hip replacement. International Orthopaedics (SICOT) 28, 142–145 (2004).

Download citation


  • Mast Cell
  • Visual Analogue Scale Score
  • Joint Capsule
  • Loose Connective Tissue
  • Neuronal Element