Post Hip Replacement: Persistent Pain and Mobility Issues Explained

One month after total hip replacement surgery, the patient is still unable to walk?

My mother underwent left hip joint replacement surgery last month, and she has been experiencing severe pain in her left calf.
The calf and its sides are very painful when pressed, and she is still unable to walk.
She cannot lift her toes upward, but she can point them downward.
The surgeon mentioned that my mother has a significant leg length discrepancy that has led to tendonitis, and that there is no nerve damage, as nerve injury would result in complete immobility of the leg rather than just pain in the left calf.
Doctor, could you please advise if it is possible that she has sustained nerve damage? If nerve damage has occurred, is recovery possible? What treatment options are available?

A-Pang, 40~49 year old female. Ask Date: 2006/07/06

Dr. Shi Guozheng reply Orthopedics

After hip replacement surgery, if there is a phenomenon of foot drop (where the toes or ankle cannot be lifted), it is important to consider whether there is an impairment of the sciatic nerve or common peroneal nerve.
If the nerve is damaged, there will typically be sensations of numbness and pain, and sometimes it may manifest as weakness in the foot or toes.
Based on your description alone, it is difficult to make a definitive assessment; it would be best to consult another physician or undergo nerve conduction studies.
Some nerve impairments may recover, while others may not fully heal, but medications or rehabilitation therapy may provide some benefit.

Reply Date: 2006/07/06

More Info

Post-operative pain and mobility issues following a hip replacement surgery can be concerning and frustrating for both patients and their families. In your mother's case, the persistent pain in her left calf and the inability to move her toes upward (dorsiflexion) are significant symptoms that warrant further exploration.
Firstly, it is important to understand that hip replacement surgery, while generally successful, can sometimes lead to complications or residual pain. The fact that your mother is experiencing pain in her calf after surgery could be attributed to several factors, including muscle strain, tendon inflammation, or even issues related to her gait and biomechanics post-surgery. The surgeon's assessment that her leg length discrepancy is causing tendonitis is plausible, as such discrepancies can lead to altered walking patterns, which may strain the muscles and tendons around the hip and knee.

1. Nerve Injury Consideration: While the surgeon indicated that the surgery did not involve the calf area and that nerve damage is unlikely, it is still essential to consider the possibility of nerve irritation or entrapment. The sciatic nerve, which runs down the back of the leg, can sometimes be affected by swelling or inflammation in the hip area. If the nerve is compressed or irritated, it can lead to pain, weakness, or numbness in the leg. However, if the pain is localized to the calf and there is no significant weakness or sensory loss in the entire leg, it may suggest that nerve injury is less likely.

2. Recovery and Rehabilitation: If nerve damage were to occur, recovery could vary widely depending on the extent of the injury. Many patients experience improvement over time, especially with appropriate rehabilitation. Physical therapy is crucial in this context. A tailored rehabilitation program focusing on strengthening the muscles around the hip and improving flexibility can help alleviate pain and restore function.
3. Treatment Options: For your mother's current symptoms, it may be beneficial to consult a physical therapist who specializes in post-operative rehabilitation. They can assess her gait, muscle strength, and flexibility, and develop a personalized exercise program. Additionally, modalities such as ultrasound therapy, electrical stimulation, or even gentle stretching may provide relief.
4. Pain Management: Pain management strategies, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) or other pain relief medications, may also be considered under the guidance of her healthcare provider. If inflammation is a significant issue, corticosteroid injections may be an option, but this should be discussed with her doctor.

5. Follow-Up with the Surgeon: It is crucial for your mother to have a follow-up appointment with her orthopedic surgeon to discuss her ongoing symptoms. The surgeon may recommend imaging studies, such as an X-ray or MRI, to rule out any complications like hardware issues or other structural problems that could be contributing to her pain.

In summary, while your mother's symptoms are concerning, they may not necessarily indicate nerve damage. A comprehensive approach involving physical therapy, pain management, and close follow-up with her healthcare team will be essential in addressing her pain and mobility issues. Encouraging her to engage in rehabilitation exercises, even if they are gentle at first, can significantly improve her outcomes and quality of life post-surgery.

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