Lumbar Pain: When to Consider Surgery for Hip Issues

Lumbar pain

Hello, Dr.
Wang! Over the past year, I initially experienced soreness and pain on the outer side of my knee after walking for a long time.
Six months later, I started to feel pain in my right lumbar region (specifically from the right side of my lower back, through my hip, down to the outer side of my right knee).
Sitting down provides some relief, but my lower back still hurts.
I have consulted multiple orthopedic specialists, and most have indicated that it is due to joint degeneration, asking if I would like to take pain medication.
However, I am still at a tolerable stage, so I declined.
I have a daily exercise routine, but I find it increasingly difficult to walk due to the soreness and pain.
Because this has been a long-standing issue, I recently visited an orthopedic specialist who focuses on hip joints.
He performed X-rays and an MRI, which showed no signs of joint degeneration.
However, he discovered a mass in the deep area of my right groin and recommended a surgical biopsy to determine if this is affecting my knee pain.
I am a bit scared!
Doctor, given this situation, do I really need to undergo surgery for the biopsy? What recommendations do you have? (I am currently abroad, and it seems that local doctors often suggest surgery without hesitation), which has left me quite troubled, especially since I have seen several doctors, each with different opinions.
Thank you!

Janice, 50~59 year old female. Ask Date: 2020/06/28

Dr. Wang Jiacheng reply Orthopedics

It is recommended that you refer to the information provided by the Ministry of Health and Welfare, as follows: Shared Decision Making (SDM) encourages patients to bravely express their questions and thoughts, helping healthcare providers understand the patients' needs.
It also assists patients in fully understanding various options, ensuring that they have the right to choose the treatment method that is most suitable for them.
This process involves healthcare providers presenting evidence-based information about different options, including the benefits and drawbacks of each.
Patients then express the significance of these pros and cons to themselves, and together with healthcare providers, they engage in a discussion to make a decision.
(https://sdm.patientsafety.mohw.gov.tw/PeopleZone/Detail?sn=1087&id=1401) Related example videos can be found here: https://sdm.patientsafety.mohw.gov.tw/Public/MediaInfo?sn=11&id=1157 Wishing you good health!

Reply Date: 2020/06/28

More Info

When it comes to understanding lumbar pain and deciding whether surgery is necessary for hip issues, it’s essential to consider several factors, including the nature of the pain, diagnostic findings, and the potential benefits and risks of surgical intervention.

Firstly, lumbar pain can often be a complex issue, especially when it radiates down to the hips and knees. In your case, the pain you experience in the right lumbar region, which extends down to the right knee, could be indicative of several underlying conditions. While you have been advised that there is no joint degeneration based on X-rays and MRI, the presence of a mass in the right groin area raises concerns that should not be overlooked.
The recommendation for a biopsy to investigate the mass is a prudent step. While the idea of surgery can be daunting, it is crucial to determine the nature of the mass. If it is a benign growth, it may not pose a significant risk, but if it is malignant, early intervention could be critical. The pain you are experiencing could potentially be related to this mass, especially if it is pressing on surrounding structures or nerves.

In terms of managing your lumbar pain, there are several non-surgical options you can explore. Physical therapy is often beneficial for strengthening the muscles around the lumbar spine and hips, improving flexibility, and reducing pain. Additionally, engaging in low-impact exercises, such as swimming or cycling, can help maintain your fitness without exacerbating your pain.
Pain management strategies, including over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can provide temporary relief. However, since you mentioned that you are currently able to tolerate the pain, it may be wise to monitor your symptoms closely while considering the biopsy.

If the biopsy results indicate that the mass is benign and not contributing to your pain, you may continue with conservative management. However, if it is found to be malignant or if your pain worsens, surgical intervention may become necessary.
It is also important to communicate openly with your healthcare providers. If you feel that the local doctors are too quick to recommend surgery, seek a second opinion from a specialist who can provide a comprehensive evaluation of your condition. This could include a thorough review of your imaging studies, a physical examination, and a discussion of your symptoms and concerns.

In summary, while surgery may be a consideration depending on the biopsy results, it is essential to weigh the benefits and risks carefully. Non-surgical options should be explored and utilized as much as possible to manage your symptoms. Ultimately, the decision should be made collaboratively with your healthcare team, ensuring that you feel comfortable and informed about your treatment plan.

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