Post-Operative Hip Replacement: When to Seek Further Medical Evaluation

Q: Post-Operative Hip Replacement: When to Seek Further Medical Evaluation

There are two types of artificial hip joints： total hip replacement and hemiarthroplasty (artificial femoral head). <br>It is common to experience pain within the first three months after surgery; however, if pain persists after six months, it may indicate a problem that needs to

Postoperative hip joint care

Hello, doctor.
My grandmother had a hip replacement surgery on her left leg about seven months ago, just before the Lunar New Year.
Normally, she should be able to walk independently without using a cane within two to three months, but she still needs to use a cane to walk.
Additionally, she is experiencing persistent pain in the operated leg, particularly severe pain in the groin area.
She has been receiving traditional Chinese medicine treatments and physical therapy, but the results have been unsatisfactory.
She has had multiple follow-up visits, and X-rays have been taken repeatedly.
The attending physician has consistently stated that there are no issues with the surgical site.
The medications prescribed have mainly focused on calcium supplements and anti-inflammatory drugs.
I would like to ask whether she should be referred to another specialty or if a comprehensive examination is necessary to determine if there are issues elsewhere.
She is eager to recover quickly, but the doctors keep giving the same responses, which has made her very frustrated and even consider amputation.

Hsin, 20~29 year old female. Ask Date: 2016/08/15

Dr. Shi Guozheng reply Orthopedics

There are two types of artificial hip joints: total hip replacement and hemiarthroplasty (artificial femoral head).
It is common to experience pain within the first three months after surgery; however, if pain persists after six months, it may indicate a problem that needs to be investigated.
Possible causes include infection, inflammation, loosening, improper positioning, or wear of the artificial femoral head against the acetabular cartilage.
It is advisable to consult another orthopedic specialist for further evaluation.

Reply Date: 2016/08/15

More Info

Post-operative recovery from hip replacement surgery can be a complex process, especially for elderly patients. It is not uncommon for patients to experience pain and mobility issues several months after surgery. In your grandmother's case, having undergone hip replacement surgery seven months ago, it is concerning that she is still experiencing significant pain and requires a cane for ambulation. Here are some considerations and recommendations based on her situation.

Understanding Post-Operative Pain
1. Normal Recovery Timeline: Generally, patients can expect to regain a significant level of mobility and independence within two to three months post-surgery. However, recovery can vary widely based on individual factors such as age, overall health, and the presence of comorbid conditions. For elderly patients, it may take longer to recover fully.

2. Pain Location and Nature: The severe pain in the groin area could be indicative of several issues. While it is reassuring that X-rays show no apparent problems with the surgical site, pain can still arise from other sources, including muscle strain, tendonitis, or referred pain from other joints or structures.

3. Potential Complications: Although the surgical site appears intact, complications such as implant loosening, infection, or even issues related to the surrounding soft tissues can occur. These may not always be visible on X-rays, especially in the early stages.

When to Seek Further Evaluation
Given your grandmother's ongoing pain and mobility issues, it may be prudent to consider the following steps:
1. Consult a Specialist: If her current orthopedic surgeon has not provided satisfactory answers or solutions, it may be beneficial to seek a second opinion from another orthopedic specialist. They may offer new insights or alternative treatment options.

2. Physical Therapy Evaluation: A thorough evaluation by a physical therapist can help identify specific weaknesses or imbalances in her hip and surrounding musculature. Tailored rehabilitation exercises may improve her strength and mobility.

3. Consider Other Medical Evaluations: If orthopedic evaluations continue to yield no results, it may be worthwhile to explore other medical conditions that could contribute to her pain. Conditions such as arthritis in adjacent joints, vascular issues, or even neurological concerns could be factors.

4. Pain Management Consultation: A pain management specialist can provide additional strategies for managing chronic pain, which may include medications, injections, or alternative therapies.

5. Psychological Support: Chronic pain can lead to frustration and emotional distress. Counseling or support groups may help her cope with the psychological aspects of her recovery.

Importance of Communication
It is crucial for your grandmother to communicate her concerns clearly with her healthcare providers. If she feels her needs are not being met, advocating for herself or having a family member assist in this process can be beneficial.

Conclusion
In summary, while some pain and mobility issues can be expected after hip replacement surgery, the persistence of severe pain and reliance on a cane seven months post-operation warrants further investigation. Seeking a second opinion, engaging with physical therapy, and considering a multidisciplinary approach involving pain management and psychological support may provide her with the relief and recovery she desires. It is essential to remain proactive in her care and ensure that her concerns are addressed comprehensively.

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