Post-Operative Hip Pain After Total Hip Replacement

Persistent pain one month after hip replacement surgery?

Hello Doctor, I have systemic lupus erythematosus (SLE) and underwent a left hip total hip arthroplasty in August of this year.
It has been one month post-surgery, and I am still experiencing pain, which differs from the "ease" described in general literature.
I have organized my questions as follows:
1.
I can now perform external rotation movements post-surgery, which I was unable to do before.
Does this mean that the pain caused by the bone (cartilage) has completely resolved?
2.
During rehabilitation exercises: a.
Lying supine with the affected limb extended upward.
b.
Tightening the gluteal muscles.
c.
Lying supine with the affected limb moving laterally outward.
I experience hip joint pain (unable to distinguish if it is from bone or tendon).
Is this considered part of normal postoperative pain? Could it be due to poor implant positioning or tendon damage?
3.
The pain described in point 2 is similar to what I experienced before the surgery.
Is it possible that the surgery was unsuccessful? What could be the potential reasons?
4.
There was a three-year delay from the discovery of necrosis to surgery.
Could this have contributed to the postoperative outcomes being less than expected?
5.
I have experienced atrophy in the major muscles of my thigh.
Is there a possibility for recovery through exercise?
I look forward to your response.
Thank you!

Ye Xiansheng, 30~39 year old female. Ask Date: 2015/09/22

Dr. Shi Guozheng reply Orthopedics

It is normal to still experience pain one month after surgery; the pain typically subsides around three months.
One month post-surgery is still within the recovery period.
The condition after surgery can be assessed through X-rays; pain does not necessarily indicate failure.
Muscle atrophy can be improved with exercise, but it may take more than six months to see some recovery.

Reply Date: 2015/09/22

More Info

Post-operative hip pain after total hip replacement (THR) can be a complex issue, particularly in elderly patients or those with pre-existing conditions such as systemic lupus erythematosus (SLE). Your concerns are valid, and it’s essential to address them comprehensively.

1. Pain and Range of Motion: The ability to perform external rotation post-surgery, which you couldn't do before, is a positive sign that the surgical intervention has alleviated some of the pain caused by the damaged cartilage or bone. However, the presence of pain during certain movements does not necessarily indicate that the underlying issue has been completely resolved. It is common for patients to experience discomfort as they begin to use their hip in ways they haven't for some time, especially if they are engaging in rehabilitation exercises.

2. Rehabilitation and Pain: Experiencing pain during rehabilitation exercises is not uncommon. The movements you described—lying flat with the affected leg straight, tightening the glutes, and moving the leg outward—can stress the muscles and tendons around the hip joint. This discomfort may be part of the normal healing process, but it could also indicate issues such as improper alignment of the implant or muscle strain. If the pain is sharp or persists, it is crucial to consult your orthopedic surgeon or physical therapist to assess your technique and the implant's positioning.

3. Concerns About Surgical Failure: If the pain you are experiencing during rehabilitation is similar to what you felt before the surgery, it raises concerns about the effectiveness of the procedure. However, it does not automatically mean that the surgery was a failure. Factors such as scar tissue formation, muscle weakness, or even referred pain from other areas can contribute to ongoing discomfort. A thorough evaluation by your surgeon can help determine if there are any complications or if the pain is part of the normal recovery process.

4. Impact of Delayed Surgery: The three-year delay from the diagnosis of avascular necrosis to surgery could indeed impact your recovery. Chronic pain and disuse of the hip joint can lead to muscle atrophy and decreased range of motion, which may prolong recovery and complicate rehabilitation. The body needs time to adapt to the changes after surgery, and previous conditions can influence healing.

5. Muscle Atrophy and Recovery: Muscle atrophy in the thigh is a common issue after hip surgery, especially if the joint was not used effectively for an extended period. Rehabilitation exercises are crucial for regaining strength and function. A physical therapist can design a tailored program to help rebuild muscle strength and improve mobility. Consistency in rehabilitation is key, and while recovery may take time, many patients can regain significant function with appropriate exercises.

In conclusion, while some discomfort after total hip replacement is expected, persistent or severe pain should not be ignored. Regular follow-ups with your orthopedic surgeon and physical therapist are essential to monitor your recovery and adjust your rehabilitation program as needed. They can provide guidance on pain management strategies and ensure that your recovery stays on track. Remember, each patient's recovery journey is unique, and patience is vital as your body heals and adapts to the new hip joint.

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