Hip Joint Pain After Surgery: Is It the Hardware?

Femoral intramedullary nail

Hello Dr.
Li,
My son is currently 30 years old and underwent surgery three years ago for a fracture of the left hip joint, where a steel plate and screws were used for fixation.
Recently, he has been experiencing pain on the inner side of his left thigh near the pubic area, which radiates down to his lower leg.
The imaging studies show no issues.
The physical therapist mentioned that it is possible the screws may have shifted, is that true? What should we do about this? I sincerely request your guidance! Thank you very much!

A Fu, 60~69 year old female. Ask Date: 2019/11/27

Dr. Li Yongheng reply Orthopedics

Hello, if the physical therapist says there is a possibility that the metal pin is misaligned, an X-ray can reveal this.
It could be due to avascular necrosis of the femoral head or post-traumatic arthritis.
Further examination is recommended.

Reply Date: 2019/11/27

More Info

Understanding hip joint pain after surgery can be complex, especially when hardware such as plates and screws are involved. In your son's case, it is essential to consider several factors that could contribute to his pain, including the position of the hardware, the healing process, and any underlying conditions.

Firstly, it is important to understand that after a surgical procedure involving the hip joint, such as the fixation of a fracture with plates and screws, patients may experience pain for various reasons. While the hardware itself is designed to stabilize the bone and facilitate healing, it can sometimes lead to discomfort or pain if it is not positioned correctly or if there is irritation to surrounding tissues.

1. Hardware Positioning: If the screws or plates are misaligned or if they have shifted from their original position, they could potentially cause pain. This is especially true if they are pressing against nerves or soft tissues. However, imaging studies such as X-rays or MRIs are typically used to assess the positioning of the hardware. If the images show that everything is in place, then the pain may not be directly related to the hardware.

2. Soft Tissue Involvement: Pain in the groin or thigh area can also be attributed to soft tissue issues rather than the hardware itself. This includes muscle strains, tendonitis, or bursitis, which can occur as a result of compensatory movements during the recovery phase. Rehabilitation exercises may have inadvertently stressed these areas, leading to pain.

3. Nerve Irritation: The hip joint is in close proximity to several important nerves, including the femoral nerve and the sciatic nerve. If the hardware is causing irritation or if there is swelling in the area, it could lead to nerve pain that radiates down the leg.

4. Healing Process: The body’s healing process can also contribute to pain. After surgery, it is common for patients to experience discomfort as the body repairs itself. This can include inflammation around the surgical site, which may take time to resolve.

5. Rehabilitation: Engaging in physical therapy is crucial after hip surgery. A rehabilitation specialist can help assess the pain and develop a tailored exercise program that strengthens the hip and surrounding muscles while minimizing discomfort. If the pain persists despite rehabilitation, it may be necessary to revisit the surgical team for further evaluation.

6. Consultation with Specialists: If the pain continues or worsens, it is advisable to consult with the orthopedic surgeon who performed the procedure. They can provide insights into whether the hardware may be the source of the pain and if any further imaging or intervention is necessary.

In conclusion, while it is possible that the hardware could be contributing to your son's pain, it is essential to conduct a thorough evaluation to determine the exact cause. This may involve imaging studies, a review of his rehabilitation progress, and possibly a referral to a pain management specialist if necessary. Addressing the pain promptly and effectively is crucial for a successful recovery and return to normal activities.

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