Post-Hip Replacement Surgery: Leg Weakness and Nerve Issues

Inability to lift the leg after total hip replacement surgery?

After undergoing right total hip arthroplasty, there is a sensation of numbness extending from the front of the thigh to the front of the calf on the right leg.
When walking without straightening the leg, the knee feels weak.
While lying flat, raising the right leg is difficult, and maintaining the raised position is challenging, with the foot also feeling weak.
However, the dorsiflexion and ankle movements are normal (both upward and downward movements are functioning properly).
The surgeon postoperatively assessed that the nerves have not yet recovered and will gradually improve.
However, after an electromyography (EMG) examination by a neurosurgeon, it was determined that there is no nerve damage (if there were damage, it might take about a month post-surgery to detect).
It is suspected that the issue may be related to cervical spine problems.
I would like to know which specialty should primarily manage this condition.
Thank you.

Xiu, 30~39 year old female. Ask Date: 2023/11/20

Dr. Shi Guozheng reply Orthopedics

Rehabilitation or neurology departments can conduct strength training to improve muscle function.
Additionally, taking active vitamin B12 may provide some benefits.

Reply Date: 2023/11/20

More Info

Post-hip replacement surgery, experiencing leg weakness and nerve issues can be quite concerning and frustrating for patients. It’s important to understand that while hip replacement surgery is generally successful, complications can arise, particularly related to nerve function and muscle strength.

Firstly, the symptoms you describe—numbness from the thigh to the front of the calf, knee instability when walking, and difficulty lifting your leg—can be attributed to several factors. After surgery, it is not uncommon for patients to experience temporary nerve dysfunction or weakness in the affected leg. This can be due to direct trauma to the nerves during surgery, swelling, or even positioning during the operation. The fact that your surgeon mentioned that the nerves may not have "woken up" yet suggests that there might be some temporary nerve irritation or compression that could resolve over time.

The electromyography (EMG) results indicating that there is no nerve damage are reassuring. However, the presence of weakness and numbness can still occur due to other reasons, such as muscle atrophy from disuse, post-surgical inflammation, or even referred pain from other areas, such as the cervical spine, as suggested by your follow-up with the neurosurgeon.

Given your symptoms, it would be prudent to consult with a physical medicine and rehabilitation (PM&R) specialist, also known as a physiatrist. These specialists focus on restoring function and improving quality of life through non-surgical means. They can provide a comprehensive rehabilitation program tailored to your needs, which may include physical therapy to strengthen the muscles around the hip and improve overall mobility.
Physical therapy will likely focus on exercises that enhance strength, flexibility, and coordination. This can help address the weakness and instability you are experiencing. Additionally, if there is a concern about cervical spine issues contributing to your symptoms, a referral to a neurologist or an orthopedic spine specialist may also be warranted. They can evaluate your neck and determine if there are any underlying issues that need to be addressed.

In the meantime, it is essential to engage in gentle movements and exercises as tolerated. Avoiding prolonged bed rest is crucial, as it can lead to further muscle atrophy and weakness. If you experience significant pain or discomfort during exercises, it’s important to communicate this with your healthcare provider to adjust your rehabilitation plan accordingly.

Lastly, staying proactive about your recovery is vital. Regular follow-ups with your orthopedic surgeon and any other specialists involved in your care will help monitor your progress and make necessary adjustments to your treatment plan. Recovery from hip replacement surgery can take time, and while it may be frustrating, many patients see significant improvements in their strength and function with appropriate rehabilitation and care.

In summary, your symptoms post-hip replacement surgery warrant a multidisciplinary approach. Engaging with a physical medicine and rehabilitation specialist, alongside your orthopedic surgeon, will provide you with the best chance for recovery and improvement in your leg strength and function.

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