Post-Operative Concerns After Hip Replacement Surgery: A Patient's Inquiry

Postoperative Consultation for Hip Joint Replacement Surgery

Hello Doctor, due to my SLE condition, I underwent a left hip "total hip replacement" in August of this year.
It has been one month post-surgery, and I still experience pain, which differs significantly from the "ease" described in general literature.
I have organized my questions as follows:
1.
I can now clearly perform external rotation movements post-surgery (which I could not do pre-surgery).
Does this mean that the pain caused by the bone (cartilage) has completely resolved?
2.
During rehabilitation exercises: a.
Lying on my back with the affected limb straight up.
b.
Tightening the gluteal muscles.
c.
Lying on my back and moving the affected limb outward.
I feel pain in the hip joint (unable to distinguish if it is from bone or tendon).
The surgeon mentioned that this is due to not fully recovering and a lack of confidence, advising me to relax.
However, any movement involving angles causes pain, which is quite different from my expectations post-surgery.
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.
It took three years from the discovery of necrosis to the surgery.
Could this delay be a reason for the post-operative outcomes not meeting expectations? Should I consult a rehabilitation specialist?
5.
The major muscles in my thigh have atrophied.
Is there a possibility for recovery through exercise?
I look forward to your response and appreciate your help!

Ye Xiansheng, 30~39 year old female. Ask Date: 2015/09/25

Dr. Zhou Jianwen reply Rehabilitation

The above statement cannot provide a comprehensive diagnosis; please discuss further with your surgeon.

Reply Date: 2015/09/25

More Info

Post-operative concerns after hip replacement surgery can be quite common, especially in patients with underlying conditions such as Systemic Lupus Erythematosus (SLE). It is essential to address your concerns comprehensively and provide insights based on medical knowledge.

1. Pain and Range of Motion: The ability to perform external rotation post-surgery, which you were unable to do before, is a positive sign indicating that the mechanical obstruction caused by the damaged cartilage or bone has been alleviated. However, the presence of pain suggests that while the source of pain from the joint may have been addressed, other factors could be contributing to your discomfort. This could include soft tissue irritation, inflammation, or even nerve-related issues that can arise post-operatively.

2. Rehabilitation Exercises: Experiencing pain during rehabilitation exercises is not uncommon, especially in the early stages of recovery. The pain you describe during specific movements could be due to several factors, including muscle weakness, tightness in the surrounding muscles, or even psychological factors such as fear of movement. It is crucial to communicate with your physical therapist about the pain you are experiencing. They can modify your rehabilitation program to accommodate your current level of comfort and gradually increase the intensity as you progress.

3. Concerns About Surgical Failure: While it is natural to worry about the possibility of surgical failure, it is important to consider that pain can be a part of the healing process. The similarity of pain to pre-operative symptoms could be due to residual issues that were not fully addressed during surgery, such as muscle imbalances or nerve irritation. It is advisable to follow up with your surgeon to discuss your symptoms in detail. They may recommend imaging studies or further evaluations to rule out complications such as infection or implant issues.

4. Impact of Delayed Surgery: The three-year delay from the diagnosis of avascular necrosis to surgery could potentially impact your recovery. Chronic pain and disuse of the affected limb can lead to muscle atrophy and joint stiffness, which may contribute to a longer recovery period. Consulting with a rehabilitation specialist could provide you with tailored strategies to enhance your recovery and address any lingering issues.

5. Muscle Atrophy and Recovery: Muscle atrophy in the thigh is a common consequence of disuse and can be addressed through targeted rehabilitation. Engaging in a structured physical therapy program focusing on strength training, flexibility, and functional movements can help restore muscle mass and improve overall function. It is crucial to start gradually and ensure that exercises are performed correctly to avoid exacerbating any pain.

In summary, while it is concerning to experience pain one month post-surgery, it is not uncommon, especially in complex cases like yours. Continuous communication with your healthcare team, including your surgeon and physical therapist, is vital to ensure a successful recovery. They can provide you with the necessary support and adjustments to your rehabilitation plan to help alleviate pain and improve function. Remember, recovery from hip replacement surgery can take time, and patience is key.

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