Post-Surgery Hip Joint Pain: Seeking Answers for Ongoing Discomfort

After decompression surgery for the left hip joint, there is an inability to walk normally?

Hello, Doctor.
I underwent left hip joint decompression surgery and artificial bone grafting under general anesthesia at the end of July this year.
During a follow-up appointment in mid-October, the doctor suggested that I could stop using crutches if I wasn't experiencing significant pain, so I put them away.
However, by late October, my pain has intensified daily and continues to this day! Multiple consultations with the surgeon have concluded that the X-rays appear normal.
When I asked if it could be nerve compression, nerve adhesion, or other issues, he said it was unlikely.
He mentioned that the only major nerve near the hip joint is the sciatic nerve, which is not likely to be affected.
However, I experience pain when lying down, sitting, and especially standing, which leaves me feeling weak and in severe pain! I have to take painkillers and endure the pain to walk slowly for about 30 minutes before I can recover a little.
But I can't walk for too long, otherwise, I experience pain in my knee, left hip, and groin.
He referred me to a spine specialist, citing that my previous lumbar spine slippage might be pressing on a nerve.
However, the MRI results from the spine specialist showed that my lumbar spine is not severely compressing any nerves.
Still, he advised me to undergo a nerve block procedure at the spine clinic first.
If that doesn't help, I should return to him to check for synovitis or other issues.
Doctor, I would like to ask you...
is it possible that during the hip joint decompression surgery, the nerve could have been accidentally affected, or could there be nerve adhesion or compression? If it is synovitis as he suggested, isn't it something that shouldn't be delayed? I have been in pain since mid-October, and he cannot determine where the problem lies...
What should I do? I am unable to work or live normally.
I'm almost going crazy!

Ama, 40~49 year old female. Ask Date: 2020/12/10

Dr. Shi Guozheng reply Orthopedics

Hip joint decompression is performed from the lateral side of the femur, and the nerves are located behind the bone at a certain distance, typically avoiding contact with the nerves.
However, it is possible that avascular necrosis of the femoral head may continue to progress, rendering decompression ineffective.

Reply Date: 2020/12/10

More Info

Post-surgery hip joint pain can be a complex issue, especially after procedures like hip joint decompression and artificial bone augmentation. Your experience of ongoing pain and discomfort, despite the initial optimism from your surgeon, raises several important considerations.

Firstly, it’s essential to understand that pain after hip surgery can stem from various sources. While the X-rays may not show any immediate problems, pain can still arise from soft tissue issues, nerve irritation, or even referred pain from other areas, such as the lumbar spine. The fact that you are experiencing pain while lying down, sitting, and standing suggests that there may be more than just a straightforward surgical recovery issue at play.

1. Nerve Involvement: Although your surgeon mentioned that significant nerve compression is unlikely, it is still possible for nerves to be irritated or entrapped post-surgery. The sciatic nerve, which runs close to the hip joint, can be affected by swelling or scar tissue formation. Nerve entrapment can lead to symptoms such as pain, tingling, or weakness in the affected areas. If you are experiencing pain that radiates down the leg or into the foot, this could indicate nerve involvement.

2. Soft Tissue Healing: After any surgical procedure, the surrounding soft tissues, including muscles, tendons, and ligaments, need time to heal. In some cases, scar tissue can form, leading to adhesions that may cause pain and limit mobility. This is particularly relevant if you have a history of surgeries in the same area. Rehabilitation and physical therapy can be crucial in managing these issues, as they can help improve flexibility and strength, potentially alleviating some of the discomfort.

3. Inflammation and Synovitis: The mention of potential synovitis (inflammation of the synovial membrane) is also significant. This condition can occur after surgery and may lead to joint pain and swelling. If your surgeon suspects this, it may be worth exploring anti-inflammatory treatments or corticosteroid injections to reduce inflammation and pain.

4. Psychological Factors: Chronic pain can also have psychological components. Anxiety and stress about your condition can exacerbate the perception of pain. Engaging in supportive therapies, such as counseling or pain management programs, may help address these aspects.

5. Further Evaluation: Given that your symptoms have persisted and are affecting your quality of life, it may be prudent to seek a second opinion from another orthopedic specialist or a pain management specialist. They may recommend further imaging studies, such as an MRI, to assess soft tissue structures and any potential nerve involvement more thoroughly.

6. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can tailor exercises to improve strength, flexibility, and function while addressing any specific pain issues you are experiencing. They can also provide modalities such as ultrasound or electrical stimulation that may help alleviate pain.

In conclusion, while it’s understandable that your surgeon may not see any immediate surgical complications, your ongoing pain warrants further investigation. It’s crucial to advocate for your health and seek additional opinions or therapies that can help you manage your symptoms effectively. Remember, recovery from hip surgery can take time, and addressing all potential sources of pain is essential for a successful outcome.

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