Sunday, October 26, 2014

Physical Therapy

Pain After Hip Replacement Surgery

By Christina Lasich, MD, Health Pro Monday, November 19, 2012

In the time leading up to hip replacement surgery, you were looking forward to living pain free. But now months after the surgery, you are disappointed with your reality of living with ongoing pain or even worse pain than you had before.  What went wrong? Why aren’t you experiencing the pain-free life that you dreamed of? A few things can be going wrong and preventing you from the best possible results after the replacement of your hip.

 

First and foremost, you might be caught in a painful triad of arthritis involving both the hips and the spine. Replacing one or both hips does not solve the back pain. And fusing the back does not solve the hip pain. The hip-spine connection is frequently encountered in the elderly because all of these parts have deteriorated over time.1 Sometimes hip arthritis is misdiagnosed as low back pain. Sometimes low back pain is misdiagnosed as hip arthritis. And many times both are seen together in the same person. Even someone who has had the spine fused and both hips replaced can still experience pain.

 

In the case of ongoing pain after hip replacement surgery, the pain could be caused by irritation to the sciatic nerve, either from the lumbar spine or as a result of the hip replacement surgery. Those with spinal stenosis are at higher risk of nerve injury to the sciatic nerve during the hip replacement surgery because the nerve is already irritated and the surgery methods can physically stress the nerve.2 The sciatic nerve can be monitored for stress during the hip replacement surgery in order to prevent damage.3 Those who have had the sciatic nerve injured during hip replacement surgery might be experiencing burning pain, shooting pain, foot drop or other signs of nerve damage affecting the leg.  

 

At other times, nerve damage is not the reason why someone is still experiencing pain after hip replacement surgery. From the early beginnings of joint replacement surgery, complications involving the prosthetic implant have been the known to cause pain. For example, hardware loosening can lead to joint instability and pain. Infections of the surgery site are always a possibility. And lately, the metal-on-metal prosthesis has come under scrutiny for causing chronic pain after hip replacement surgery because of metallic debris. Each of these hardware problems might require a revision surgery in order to fix the problem that is causing pain after hip replacement surgery.4

 

No matter what the reason for the pain, the biggest question is: how can you relieve the pain? In the case of nerve injury or irritation, medications used to treat nerve pain can help as the nerve takes time to heal. But sometimes surgery is required if, for example, there is cement actually putting pressure on the nerve. Surgery may also be needed to revise a failed prosthesis or remove an infected prosthesis. If the low back is the source of pain, then physical therapy, medications and/or surgery may be needed to address any joint, muscle, ligament or nerve problem is coming from the spine.

By Christina Lasich, MD, Health Pro— Last Modified: 08/31/14, First Published: 11/19/12