Painful Hip after Replacement

Total hip replacement is a highly successful procedure with more than 90% people having good or excellent results. Current evidence shows the hip replacement lasting 15 to 20 years in more than 90% of people. However there can be pain and other problems which may need attention in a small proportion of patients. Soft tissue related pain is the common reason for pain around the hip after total hip replacement. The reason for pain coming from the hip joint replacement itself are loosening, infection, instability, fractures, failure of bearing surfaces etc. Our surgeons are highly trained and are high volume revision surgeons with excellent outcome.

Soft tissue problems: Common reason for pain around the hip is soft tissue related problem. These can be due trochanteric bursitis/ Gluteus medius muscle tendonitis, Iliopsoas muscle tendonitis etc. Doing the hip exercises will usually ease the pain. Physiotherapy is commonly helpful. Rarely steroid injections are considered. If there is persistent pain in spite of adequate exercises then hip replacement will need to assessed with examination and investigations to identify the problem.

Occasionally  the pain around the hip could be radiating pain secondary to low back problems.

Loosening of prostheses: This is the commonest reason for revision of the hip replacement. The loosening of the prostheses from the bone results in micromovement. This can further wear out the bone. This commonly presents as discomfort or ache or pain on walking or occasionally at rest. There can be limp and occasionally change in leg length. This needs to be fully investigated and the surgeon will discuss the treatment options which could range from regular monitoring to planned or urgent revision depending on the findings.

Infection: Infection in the hip can present as acute (few days), subacute (few weeks to month) or chroninc (few month to years) in duration. They can be associated with loosening of hip prostheses. Sinus discharging from the hip joint is not necessarily seen. Infection needs urgent or semiurgent intervention after thorough assessment and investigations. Aim of the treatment is to eradicate the infection and restore the hip function. Depending on the onset of infection, extent, type of infection, time to intervention, and bone changes  the extent of surgery will change. Eradication of infection involves thorough debridement of the wound and period of treatment with appropriate antibiotics. The bearing surfaces alone might be changed or the prostheses would be revised in total depending on various factors mentioned above.

Recurrent instability or dislocation: Late instability or dislocation is very rare. Often this needs revision surgery. Instability presents as sharp pain with certain movements like forward bending and sometimes a feeling like hip coming out. Dislocation is acutely painful and needs urgent reduction with pain relief +/- anaesthesia in the hospital set up. Definitive treatment would be planned after thorough assessment, further investigation and informed decision making process keeping patient’s symptoms, expectations and health in the centre of focus.

Periprosthetic fracture: Periprosthetic fracture happens as a result of injury such as falls. These are acutely painful. If the fracture is stable and prostheses are well fixed they are treated non operatively with rest, analgesics and monitoring. If the fracture is unstable without loosening of prostheses then it needs fixation alone. If there is loosening of prostheses as well then it will need revision of the hip.

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