Post-Surgery Pain in Femoral Osteonecrosis: What to Expect

Avascular necrosis of the femur

Hello Doctor: I underwent femoral decompression last month! The doctor used two types of bone grafts, one is bone allograft and the other is osteoconductive bone graft.
It should be better to use these two together, right? On the 20th, it has been exactly four weeks post-surgery.
I had a right hip arthroplasty, but my left leg had a total joint replacement two years ago.
My current issue is that on the 17th, 18th, and 19th, especially on the 17th and 18th, I felt a mild aching sensation in my right femur, but it was slight and only occurred at certain angles.
Even though my left leg was operated on two years ago, I felt unexplained soreness on the 17th, and I could distinctly feel discomfort in the area of the prosthesis, particularly in the femoral region, where I could sense a dull pain in the femur.
By today, the 19th, it has eased somewhat, but there is still mild soreness.
What could this situation be? Additionally, I just discovered today, the 19th, that when bending and standing up, there seems to be a dull ache extending from the femur up to my lower back, but it disappears quickly! This only occurs with certain fixed movements, and it is just soreness, not pain.
I would appreciate it if the doctor could provide a clear explanation of the possible causes! I understand medical ethics, but doctors should also be aware that even if there is a problem, my attending physician would only say it's normal and not a big deal, and they rarely directly mention the possibility of something being wrong, as that would imply a failure of their surgery! I understand the protective barrier between doctor and patient.
The left leg issue might also be due to the physician's lack of experience; in their 30s, they used a metal block due to insufficient bone graft, resulting in half of the femur being removed, which led to the need for a joint replacement, and I was transferred to the current surgeon.
Both legs were operated on by them.
I just want to know what is happening with my surgery.
The doctor can use pronouns and interrogative words to explain.
I just want to understand the situation and how to protect myself.
Please provide me with possible, maybe, or perhaps clearer uncertain answers.
Thank you.
😓😓😓

ei hai, 40~49 year old female. Ask Date: 2024/05/19

Dr. Chen Yongxue reply Orthopedics

Hello, avascular necrosis of the femoral head can be treated with decompression surgery in the early stages, a hemiarthroplasty in the mid-stages, and a total hip arthroplasty in the late stages.
Each individual's condition is different, so please trust your attending physician, as they understand your situation best.
If you seek another physician's opinion without X-rays or physical examination, relying solely on your symptoms would not be reliable.
If I had to "guess," I would say that the soreness after the right-side surgery is quite normal.
As for the left side, it may be experiencing more load because the right side is currently unable to bear weight, which could cause temporary discomfort.
I still advise you to trust your attending physician since you have chosen them.
Thank you.

Reply Date: 2024/05/19

More Info

Understanding post-surgery pain, especially after procedures like femoral decompression, can be complex and multifaceted. It's important to recognize that some degree of discomfort is common following surgery, particularly in the early stages of recovery. Given your recent surgery and the symptoms you're experiencing, let's delve into what you might expect and how to manage your pain effectively.

Post-Surgery Pain: What to Expect
1. Normal Recovery Process: After any surgical procedure, including femoral decompression, it is typical to experience pain and discomfort as your body heals. This pain can vary in intensity and may be influenced by factors such as the type of surgery, your overall health, and your body's healing response. In your case, experiencing mild pain or discomfort in your right femur and even in your left leg (which had a previous total hip replacement) can be part of the normal healing process.

2. Pain Characteristics: The pain you describe as "acid pain" that occurs at certain angles or positions may indicate that your body is adjusting to the changes made during surgery. It’s not uncommon for patients to feel discomfort in the area surrounding the surgical site as the tissues heal and adapt. The sensation of pain radiating from the femur to the lower back could also be related to muscle strain or tension as you adjust your movements post-surgery.

3. Potential Causes of Pain:
- Surgical Trauma: The surgical procedure itself can cause inflammation and irritation in the surrounding tissues, leading to pain.

- Muscle Weakness or Imbalance: After surgery, especially if you had a previous hip replacement, muscle imbalances can develop, leading to discomfort as your body compensates for weakness.

- Nerve Sensitivity: Sometimes, nerves can become sensitive after surgery, leading to sensations of pain or discomfort that may not necessarily indicate a problem with the surgical site itself.

Managing Post-Surgery Pain
1. Follow-Up Care: It’s crucial to maintain regular follow-ups with your orthopedic surgeon. They can assess your recovery and determine if your pain is within the expected range or if further investigation is needed.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can help you strengthen the muscles around your hip and improve your range of motion, which may alleviate some of the discomfort you’re experiencing.

3. Pain Management Strategies:
- Medications: Over-the-counter pain relievers like acetaminophen or NSAIDs (e.g., ibuprofen) can help manage pain. Always consult your doctor before taking any medication.

- Ice and Heat Therapy: Applying ice packs to the affected area can reduce swelling and numb the pain, while heat can help relax and soothe tight muscles.

- Gentle Stretching and Movement: While it’s important to avoid overexertion, gentle stretching and movement can help maintain flexibility and reduce stiffness.

4. Monitoring Symptoms: Keep a close eye on your symptoms. If you notice any significant changes, such as increased pain, swelling, or changes in mobility, it’s essential to contact your healthcare provider promptly.

When to Seek Further Evaluation
If your pain persists or worsens despite conservative management, or if you experience new symptoms such as fever, significant swelling, or inability to bear weight, it may warrant further evaluation. Your concerns about the possibility of surgical failure are understandable, but it’s essential to approach this with a balanced perspective. Many factors can contribute to post-surgical pain, and not all indicate a failure of the procedure.

In conclusion, while some discomfort is expected after femoral decompression surgery, it’s important to communicate openly with your healthcare team about your symptoms and concerns. They can provide tailored advice and interventions to help you navigate your recovery effectively. Remember, healing takes time, and with the right support, you can work towards regaining your strength and mobility.

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