Managing Post-Surgery Pain: Hip Replacement Complications and Solutions

Pain in the lower back, a specific point in the buttocks, and thigh pain?

Hello Doctor, my mother underwent a left hip joint replacement surgery in early November.
Initially, she did not experience much pain during her hospital stay or upon discharge, but by December, she started to feel significant pain.
It escalated from a few episodes of pain per day to constant pain that left her in agony and unable to sleep.
We returned to the original hospital for a follow-up, where the doctor prescribed pain medication, but it has been ineffective.
She has sought treatment from traditional Chinese medicine, acupuncture, and physical therapy, all without relief.
She is still in so much pain that she cannot sleep, and she has started to lose her appetite, experiencing tinnitus and hearing loss.
Due to the surgery, she is unable to perform rehabilitation exercises.
In January, an X-ray revealed that her pelvic alignment is off, and there is some scoliosis, whereas her spine was straight before the surgery.
I truly do not know what to do anymore; please help us, Doctor...

Xie, 60~69 year old female. Ask Date: 2021/02/08

Dr. Wang Shouji reply Orthopedics

Hello, after hip joint surgery, if you experience severe pain again, it is important to be aware of potential issues such as infection or dislocation.
It is advisable to reassess your condition.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2021/02/08

More Info

Managing post-surgery pain, especially after a hip replacement, can be a complex and challenging process. Your mother's experience, which includes severe pain that has escalated after the surgery, is concerning and warrants a thorough evaluation. Here’s a comprehensive approach to understanding and managing her situation.

Understanding Post-Surgery Pain
1. Normal Recovery Process: After a hip replacement surgery, it is common for patients to experience some level of pain and discomfort as they recover. However, this pain should gradually decrease over time. If the pain worsens or persists beyond the expected recovery period, it may indicate complications.

2. Potential Complications: Several factors could contribute to your mother's pain:
- Infection: Post-surgical infections can lead to significant pain and discomfort. Symptoms may include swelling, redness, and warmth around the surgical site.

- Implant Issues: Sometimes, the implant may not be positioned correctly, or there could be issues with the implant itself, leading to pain.

- Nerve Damage: Surgical procedures can sometimes inadvertently affect nearby nerves, leading to chronic pain or neuropathic symptoms.

- Muscle and Joint Imbalances: If the pelvis is misaligned or if there are changes in muscle strength and flexibility post-surgery, this can lead to pain in the hip, lower back, or even the knees.

Steps to Manage Pain
1. Consulting Specialists: Since your mother has already seen various practitioners without relief, it may be beneficial to consult a pain management specialist. They can offer targeted therapies, including nerve blocks or other interventions that may provide relief.

2. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can tailor exercises to strengthen the muscles around the hip and improve flexibility, which may alleviate some of the pain. If she is unable to perform traditional exercises due to pain, a therapist can provide alternative methods, such as aquatic therapy, which is often easier on the joints.

3. Medication Review: If the prescribed pain medications are ineffective, it may be necessary to revisit this with her healthcare provider. There are various classes of pain medications, including non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant medications like gabapentin or duloxetine, which can help with nerve pain.

4. Alternative Therapies: While acupuncture and traditional Chinese medicine may not have provided relief, other modalities such as chiropractic care, massage therapy, or even mindfulness and relaxation techniques may help manage pain.

5. Imaging and Further Evaluation: Given the new findings of pelvic misalignment and spinal curvature, it may be necessary to conduct further imaging studies, such as MRI or CT scans, to assess the underlying structures and determine if there are any additional issues contributing to her pain.

6. Lifestyle Modifications: Encourage your mother to maintain a healthy diet and stay hydrated, as these can impact overall health and recovery. Gentle activities, such as walking or stretching, can also promote circulation and healing.

Conclusion
Your mother's situation is understandably distressing, and it is crucial to take a comprehensive approach to her pain management. Continuous communication with her healthcare team is essential to ensure that all aspects of her recovery are addressed. If her current providers are not meeting her needs, seeking a second opinion or a multidisciplinary approach may provide new insights and treatment options. Remember, recovery from hip replacement surgery can take time, and persistence in seeking the right care is key to improving her quality of life.

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