Hip Replacement Pain: A Frustrated Patient
I’ve blogged before on hip replacement pain, or when patients still have pain after hip replacement. Likely the most detailed study to date showed continued pain in patients who had hip replacement surgery-for example, on average 53% of hip replacement patients reported pins and needles 6 months after the surgery. Yesterday a new patient came in who exemplifies this problem. She was one and a half years post hip replacement surgery at the ripe old age of 31, but still had significant disabling pain. Suffice it to say she was frustrated and worried.
This patient had hip and back pain going back to her 20s. She had tried chiropractic, physical therapy, massage, acupuncture, etc… None of this worked well. Around 3-4 years ago her right hip pain got worse and subsequent x-rays showed a rapid advancement of hip arthritis. So 1.5 years ago she bit the bullet and had a surgeon replace her hip. The good news was that some of the disabling pain in the hip area went away, the bad news was that she still had pretty significant pain even after the hip replacement surgery. The question was, why?
Her pain diagram that she drew for us is above and it tells a story that frankly should have been paid attention to by her surgeon. Note the pain in the back of the hip and down the leg into the knee and calf. Pain from the hip joint commonly refers to the front groin area. However, these other pain sites like the back of the hip are more commonly from the SI joint. Pain radiating down into the knee and calf are more commonly from pinched nerves in the low back. Sure enough, her exam is most consistent with an unstable SI joint and an irritated S1 low back nerve. What came first, the back issues or the hip arthritis? Good question. However, I can say that this back issue should have been identified earlier as an overlapping problem with her hip. Regrettably, too often in our modern orthopedic care system, stuff like this gets over looked. For this woman, it’s been a year and a half of distress as she didn’t get the results from the hip replacement she thought she would attain.
The upshot? Someone once said that if you listen to the patient, they will tell you what’s wrong with them. In this case, the patient laid out exactly what was wrong in her pain diagram. Regrettably, nobody was paying close attention! The next steps will be a low back MRI and then likely the Regenexx-PL-Disc procedure.