Managing Post-Surgery Pain: Insights on Hip Replacement Complications

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 at the beginning of November.
Initially, she did not experience much pain during her hospital stay and upon discharge.
However, in December, she began to experience significant pain.
It escalated from a few episodes of pain each day to constant pain that causes her to cry out and prevents her from sleeping.
We returned to the original hospital for a follow-up, where the doctor prescribed pain medication, but it has been ineffective.
She has also sought treatment from traditional Chinese medicine, acupuncture, and physical therapy, but none have provided 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: 2021/02/10

Dr. Wang Shouji reply Orthopedics

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

Reply Date: 2021/02/10

More Info

Managing post-surgery pain, especially after a hip replacement, can be a complex issue that involves understanding the underlying causes of pain, the healing process, and the potential complications that may arise. Your mother's experience of increased pain after initially tolerable discomfort is not uncommon, and several factors could contribute to her current situation.

Firstly, it’s important to recognize that pain following hip replacement surgery can stem from various sources. While the surgery aims to alleviate pain caused by conditions like osteoarthritis or avascular necrosis, the body undergoes significant changes during and after the procedure. These changes can lead to pain due to inflammation, nerve irritation, or even muscle strain as the body adjusts to the new joint.

In your mother's case, the fact that she experienced pain that escalated over time could indicate several possibilities. One common issue is the development of scar tissue around the joint, which can lead to stiffness and pain. Additionally, if there was any nerve damage during the surgery, it could result in neuropathic pain, which is often described as sharp, shooting, or burning sensations.

The mention of her pelvis being misaligned and the development of scoliosis post-surgery raises concerns about her overall biomechanics. If the hip joint is not functioning correctly or if there is an imbalance in the muscles surrounding the hip, it can lead to compensatory movements that strain other parts of the body, including the spine. This could explain the increased pain and discomfort she is experiencing.

Moreover, the fact that traditional pain management strategies, including medications and alternative therapies like acupuncture, have not provided relief suggests that her pain may not be solely due to the surgical site. It may be beneficial to explore a multidisciplinary approach to her care. This could include physical therapy focused on gentle range-of-motion exercises, strengthening the muscles around the hip, and improving overall mobility. A physical therapist can also assess her gait and posture to identify any compensatory patterns that may be contributing to her pain.

In some cases, imaging studies such as X-rays or MRIs may be necessary to evaluate the integrity of the hip implant and surrounding structures. If there are concerns about the alignment of the pelvis or any other complications, a referral to an orthopedic specialist for further evaluation may be warranted.

It’s also essential to consider the psychological aspect of pain management. Chronic pain can lead to anxiety and depression, which can exacerbate the perception of pain. Engaging with a mental health professional who specializes in chronic pain management could provide additional support for your mother.

In summary, managing post-surgery pain after a hip replacement requires a comprehensive approach that addresses both physical and psychological factors. It’s crucial to maintain open communication with her healthcare providers, ensuring that all aspects of her pain are thoroughly evaluated and addressed. If her current treatment plan is not effective, advocating for a second opinion or a referral to a pain management specialist may be necessary to explore further options.

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