Post-Operative Hip Replacement: Addressing Nerve Pain and Recovery Concerns

Post-hip replacement surgery

After the mother underwent left total hip arthroplasty, she experienced numbness and pain on the outer side of her lower leg, and she is unable to dorsiflex her foot, although she can plantarflex and move her toes.
The attending physician indicated that this might be due to a blood clot compressing the nerve, and recovery could take two weeks to three months.
Have you encountered similar cases in clinical practice? Is there a chance for recovery? My mother is concerned about her ability to walk in the future, and there is also a discrepancy in leg length.
The physician mentioned that they intentionally lengthened one leg slightly during the surgery, stating that it would not have an impact.
I would like to understand the purpose of this approach.
The attending physician did not provide a specific response.
Thank you.

Xiao Zhu, 30~39 year old female. Ask Date: 2022/11/30

Dr. Shi Guozheng reply Orthopedics

1.
It is possible that the sciatic nerve is being compressed, which can lead to an inability to dorsiflex the ankle joint.
If the compression is not severe, recovery is possible.
Currently, one option is to use a splint to maintain the ankle joint at a 90-degree angle.

2.
After total hip replacement surgery, there may be issues with leg length discrepancy.
Sometimes, this is done intentionally to ensure joint stability and prevent dislocation, resulting in a slight difference in leg length.

Reply Date: 2022/11/30

More Info

Post-operative complications following hip replacement surgery can be concerning, especially when they involve nerve pain and mobility issues. In your mother's case, experiencing numbness and tingling in the outer side of her calf, along with difficulty in dorsiflexion (lifting the foot upwards), is not uncommon. These symptoms can arise from nerve compression or irritation, often due to swelling or hematoma (blood clot) formation in the surgical area.
It is indeed possible for nerve function to recover after such incidents, but the timeline can vary significantly among individuals. In clinical practice, many patients do experience gradual improvement in nerve-related symptoms, with some recovering within a few weeks, while others may take several months. The recovery process can be influenced by various factors, including the extent of nerve injury, the presence of swelling, and the overall health of the patient.
Regarding your mother's concern about her ability to walk in the future, it is important to understand that while nerve injuries can be serious, many patients regain full or near-full function over time. Physical therapy plays a crucial role in this recovery process. Engaging in rehabilitation exercises can help strengthen the muscles around the hip and improve overall mobility. It is essential to follow the rehabilitation plan provided by the healthcare team, as they can tailor it to her specific needs and monitor her progress.

As for the issue of leg length discrepancy, it is not uncommon for surgeons to intentionally adjust the length of the femur during hip replacement surgery. This can be done for several reasons, including achieving better alignment of the hip joint, improving stability, and accommodating for any pre-existing discrepancies. The surgeon may have determined that a slight lengthening would enhance the overall function of the hip joint and reduce the risk of dislocation.
In cases where there is a noticeable difference in leg length post-surgery, patients may be advised to use orthotic devices or shoe lifts to help balance their gait and improve comfort while walking. It is crucial to communicate any concerns about leg length to the surgeon, as they can provide further insights and recommendations based on your mother's specific situation.

In summary, while your mother's symptoms are concerning, they are not uncommon following hip replacement surgery. Recovery from nerve-related issues can take time, and physical therapy is vital for regaining strength and mobility. The intentional adjustment of leg length during surgery is a common practice aimed at optimizing hip function. Continuous communication with the healthcare team is essential to address any concerns and ensure the best possible recovery trajectory.

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