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Medical Edge Newspaper Column from Mayo Clinic
PAIN PERSISTS AFTER HIP-REPLACEMENT SURGERY
DEAR MAYO CLINIC: My father, age 71, had his hip replaced last year. The day after surgery, he felt something slip in his hip and now he is always in pain. X-rays don’t show any problems. Now doctors are saying it might be bursitis. My father says he can’t live with the pain. What do you suggest? — Missouri
ANSWER: While some pain is expected after hip replacement surgery, your father should be pain-free or nearly so by this time. Your father and his doctor should be able to determine what is causing the pain and develop a treatment plan to minimize it. Possible causes for his pain include:
— Hip subluxation: In this condition, the hip joint slips in and out of place. When your father sits, he might experience a slipping feeling. The condition is painful and would not show up on routine X-rays. If the subluxation is recurrent, reoperation with revision of the joint replacement may be needed.
— Hip dislocation: The replacement ball and socket are smaller than normal joints, and certain positions can cause the ball to move out of the socket. X-rays should help in diagnosis, and surgery is not usually needed to relocate the hip joint. Recurring hip dislocation may require another operation with revision of the replaced joint.
— Bursitis: Bursae are small, fluid-filled sacs that lubricate and cushion pressure points between your bones and tendons and muscles near your joints. Bursitis occurs when bursae become inflamed due to arthritis, infection, overuse or other, sometimes unknown, reasons. In bursitis of the hip, the pain would be centered over the greater trochanter, the part of the femur (thigh bone) that juts out on the outside of the thigh just below where the thigh bone joins the hip.
— Infection: Rarely, infection can be deep at the site of the hip replacement. Diagnosis is aided by X-rays and other imaging techniques and cultures. The usual treatment is antibiotics, coupled with removal of the implanted, infected joint, followed by delayed reconstruction with repeat hip replacement surgery.
Home treatment includes rest, applying heat and taking nonsteroidal anti-inflammatory drugs (NSAIDS) to relieve pain. Bursitis usually disappears in a week or two, but flare-ups are common, and some patients develop chronic bursitis.
If these measures don’t help, other options exist. Your doctor could inject a corticosteroid drug into the bursa to relieve inflammation. This treatment can be repeated, if needed. If bursitis is caused by an infection, your father would need antibiotics. Occasionally, the bursa must be surgically drained. More rarely, the affected bursa can be surgically removed.
Other musculoskeletal problems: Some individuals will develop degenerative arthritis at numerous joints. Your father may be experiencing pain referred from a spine or knee condition. Overlap in symptoms with these conditions is considerable, and a doctor should carefully examine these areas to exclude another cause for his trouble.
Encourage your father to persist in finding the reason for the pain. With a careful evaluation and logical treatment plan, most likely, he can find some relief.
— Paul Huddleston, M.D., Orthopedics, Mayo Clinic, Rochester, Minn.
Additional Resources:
Hip-Replacement Surgery
Appointment Information
More Information on Hip-Replacement Surgery
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Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2005 TRIBUNE MEDIA SERVICES, INC.
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