Medical Edge Newspaper Column

Hip Replacement That Doesn't Relive Pain Should Be Evaluated by Surgeon

May 22, 2009
Dear Mayo Clinic:
I had a hip replacement in October 2008. I now have significant pain when I walk. This really limits my activities. The pain is deep in my left buttock (the site of surgery). I also feel pain in my groin and all around the top of my thigh. Is there anything I can do to get some relief?

Answer:
The pain you're experiencing isn't common following hip replacement, and it needs to be evaluated. I recommend you make an appointment to see your orthopedic surgeon to investigate the cause of your discomfort.

For most people who undergo the surgery, hip replacement successfully relieves hip pain and restores hip function. Pain management in the first days after hip replacement surgery has improved a great deal over the last 10 years. And once healed after surgery, more than 95 percent of people who have a hip replaced can go back to a reasonable level of activity with little discomfort.

When, as in your situation, people have pain after the surgery, there's often an underlying problem that can be diagnosed and effectively resolved if treated promptly. Sometimes the pain may be from another source, such as your back, or it may come from irritation of the soft tissues around the hip joint. In other cases, there may be a problem directly related to the hip prosthesis, such as an infection.

Another possible cause of your pain could be a loose implant. Pain when putting weight on the leg or when walking is common in people whose implants have loosened. Most often this happens over a long period of time, though — sometimes decades. And, today's technology makes a loose implant less likely than in the past, since many of the implants used today are designed to grow into the bone.

The surface of a hip implant can wear and cause pain over time. But again, that would not be as likely in your situation because you had your hip replacement recently.

X-rays and a physical exam typically are the most important initial tests needed to uncover the cause of pain following hip replacement. Even people who don't have pain should see their orthopedic surgeon periodically to have a hip replacement checked. Most surgeons recommend having X-rays of the hip done once every one to five years — depending on your age and activity — to make sure there's not a problem with the implant developing internally that's not obvious externally. Some problems, such as wear of the implant, may not cause any symptoms.

If you delay in seeking care for the pain you're having, it's possible that additional damage could develop. For example, as an implant loosens, it tends to rub against the bone and cause bone loss, making the hip more difficult to repair. The same thing goes for excess wear of the implant. As it wears down, small plastic particles may form, which can cause inflammation and lead to bone loss. As the bone loss gets worse, reconstruction of the hip becomes more difficult. Eventually, if the bone loss is severe, it limits reconstruction options and, in some cases, makes reconstruction more complex and extensive.

I recommend that people in your situation return for an evaluation with the surgeon who originally performed the hip replacement. If that isn't an option, ask your primary care doctor to refer you to another orthopedic surgeon, preferably one who has experience working with failed hip replacements.

— Daniel Berry, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.