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Femoral Stem Pain After Hip Replacement

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How Long Do Hip Implants Last

Top 3 Mistakes After Total Hip Replacement

Generally speaking, a hip replacement prosthesis should remain effective for between 10 and 20 years, and some can last even longer.

Results vary according to the type of implant and the age of the patient. In a 2008 study of more than 50,000 patients who had THR surgery at age 55 or older, between 71% and 94% still had well-working implants after 15 years.

When a hip implant does need to be replaced because it has loosened or worn out over time, this requires what is called .

What Causes Stabbing Pain In The Thigh After Hip Replacement

Hip replacement surgery involves two parts, one piece inserted into your femur bone and the other piece the socket in your pelvis. Generally both parts are easily fitted by the surgeon and should allow you to put weight through it immediately after surgery.

Stabbing mid thigh pain after hip replacement is something you can expect to feel in the first few weeks after surgery. This area of your leg has major muscle, blood supply and nerve supply running through it. Because of this involvement, effects from the hip surgery can cause it to be very sensitive and cause pain.

Because the replacement post is inserted lengthwise into your femur bone, there is a good chance that you will have some femoral stem pain in your thigh for 4-6 weeks after surgery. Dont forget, bone takes 6 weeks to heal. By placing the post into the bone you are doing some minor injury to the area which takes time to heal.

If this stabbing pain in the thigh continues beyond a year after surgery you will want to get reevaluated. This type of pain can last up to 6 months however when continued beyond a year after surgery would be abnormal.

If you feel any excess movement in the mid thigh along with your stabbing pain please contact your surgeon. Excess movement or any movement of any kind can be signs of non-healing of the femoral stem and need to be x-rayed.

How Should I Prepare For Hip Replacement Surgery

There are certain steps patients can take both before and after surgery to improve recovery time and results. It is important to follow the instructions and guidance provided by your orthopedic surgeon, medical team and rehabilitation therapist. Visit to get information on preoperative hip replacement classes and patient education materials about joint replacement surgery.

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How Do I Safely Rest And Sleep After A Hip Replacement

Elevate both of your legs when sitting to minimize swelling. When resting or sleeping in bed, lie on your non-operative side for the first four to six weeks following surgery. Make sure you have a pillow between your legs and a second pillow to support your foot and ankle. When you lie on your back, you must have a pillow between your legs. If you get up in the middle of the night, sit at the side of the bed for a few seconds to avoid dizziness.

How Can I Manage At Home During Recovery From Hip Replacement Surgery What Are Hip Replacement Precautions And Restrictions


There are some general safety tips to keep in mind. For example, simplify your surroundings:

  • Remove clutter.
  • Keep stairs free of objects.
  • Keep supplies in the same place.
  • Remove small rugs throughout the house.

Keep walking areas safe:

  • Watch out for your pets when walking.
  • Keep hallways/stairways well lit.
  • Purchase night lights for bedrooms and bathrooms.
  • Stairs should have securely fastened handrails. Non-skid threads on stairs add to safety. If you have problems with your vision, add a contrasting color to mark stair edges.

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Discussing The Best Approach With Your Doctor

The surgical approach your doctor will recommend depends on several factors, including how the surgeon will gain access to the hip, the type and style of the implant and how it will be attached, and your age and activity level, and the shape and health of the hip bones. The likelihood of future surgery also figures into the decision, because some surgical approaches and types of implant attachment can make a revision surgery easier or more challenging.

As part of the evaluation for surgery, your orthopaedic surgeon will discuss the options of minimally invasive surgery or traditional hip replacement, as well as how he plans to perform the surgery and what type of implant will be used.

Fracture After Total Hip Replacement

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A periprosthetic hip fracture is a broken bone that occurs around the implants of a total hip replacement. It is a serious complication that most often requires surgery.

Although a fracture may occur during a hip replacement procedure, the majority of periprosthetic fractures occur after a patient has spent years functioning well with a hip replacement. Fortunately, these fractures are rare.

The treatment of these fractures is often challenging because patients are older and may have thinning bone or other medical conditions.

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I Have Groin And/or Thigh Pain At Rest And It Is Worse At Night I Feel Weak And Lethargic The Pain Is Constant Achy And Sometimes Burning Or Throbbing

This is more concerning because it could indicate a joint infection or bodily reaction to metal or plastic debris. Blood work and aspirations of the joint are helpful to rule these conditions out as long as the patient is not on antibiotics for some other reason. Advanced imaging like MRI and bone scans can also be helpful. Recent dental work, an immune system depressing virus, or certain medications can make this problem much worse because the immune system may not be functioning, as it should.

Overall, hip replacements are very successful and help most patients. The risk of complications like dislocation and infection are about 1-2% for total hip replacements, and not all complications require revision surgery. Some will heal with time while others may just need conservative treatment.

Studies show the most common causes for hip revision after a total hip replacement are instability , aseptic loosening of the implants from wear, and infection.

A recent article found the number one cause for hip revisions was from aseptic loosening in 45% of their recorded hip revision cases , followed by wear , instability , infection , and fracture.

They are also seeing a rise in revisions of metal on metal hip replacements secondary to metal debris causing local tissue reactions and destruction of the hip tissues.

It is important to see your total joint surgeon if you are experiencing any pain after replacement. Its also important to understand why your hip might hurt.

Lateral Femoral Cutaneous Nerve

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During the anterior approach to a hip replacement, the lateral femoral cutaneous nerve travels near the incision. The nerve can be stretched or cut during surgery. Injury to the nerve can cause numbness to the thigh region. Sometimes the damage can create a neuroma, which can become painful.

Some surgeons routinely cut the nerve during an extensive surgical approach to the hip. Dr. Morton is a fellowship-trained hip specialist and is careful to minimize this risk as much as possible by performing a minimally invasive procedure.

Suppose you are having pain or numbness to your anterior thigh. In that case, a physical examination will help determine if this is the cause.

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What Is A Hip Replacement

Hip replacement, also called hip arthroplasty, is a surgical procedure to address hip pain. The surgery replaces parts of the hip joint with artificial implants. The hip joint consists of a ball and a socket . Hip replacement surgery includes replacement of one or both parts. The goal of the procedure is to allow you to resume daily activities and exercise with less pain.

After A Hip Replacement

Hip replacement recovery starts right away. You will be encouraged to get up and move around as soon as possible after surgery. Patients who dont have other health conditions can go home as soon as they demonstrate that they can walk, climb stairs, and get in and out of a car.

Some patients might spend time in an inpatient rehabilitation unit to prepare for independent living at home. Whether you go home or to a rehabilitation unit after surgery, you will need physical therapy for several weeks until you regain muscle strength and good range of motion.

The surgeon, physical therapist or occupational therapist can advise you on when you are ready to walk with or without assistance, and how to manage your pain. The provider will discuss your rehabilitation needs, what to expect in the days and weeks ahead, and how to make the most of your recovery. Your motivation and cooperation in completing the physical therapy is critical for an effective recovery process and overall success of the surgery.

While you recover, be sure to:

  • Keep the surgical area clean and dry. Your doctor will give you specific bathing instructions.
  • Take all medications as directed.
  • Keep all the follow-up appointments with your surgeon.
  • Attend physical therapy and complete home exercises.
  • Resume your normal diet unless otherwise instructed.
  • Elevate the leg and use ice to control swelling.
  • Do not drive until your doctor says it is safe to do so.

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What Should I Look For In A Hip Replacement Surgeon

When looking for an orthopedic surgeon to perform your hip replacement surgeon, its important to do your research and check the surgeons credentials, experience and reputation. It is also important to research the hospital or facility where you will have your operation, as well as its supporting staff, such as the anesthesiologists.

The success rate for hip replacement surgery at HSS is very high. In a study, HSS interviewed patients to learn about their progress. Two years after their surgeries, 99.4% of patients said they had relief from pain, 98.8% said their ability to move was improved, and 97.8% said their quality of life was better because of their surgery.

Below, explore detailed articles and other content on this topic, or find the best hip replacement surgeon at HSS to suit your specific condition, location and insurance.

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Thigh pain 5 years after a total hip replacement can be caused by a variety of conditions. Although aseptic loosening is always a possibility, extrinsic and other intrinsic causes of pain must always be ruled out.

I first like to rule out the extrinsic causes of pain. Thigh pain with tenderness over the greater trochanter may be caused by trochanteric bursitis. Local anesthetic injection into the trochanteric bursa administered with a form of steroid is both diagnostic and therapeutic. Spine disease, such as thoracolumbar discogenic pain, L3-4 posterior-lateral disc herniations or L4-5 foraminal disc herniations, may also cause groin and thigh pain, with or without associated low back pain. As such, I like to do a thorough back examination to rule out such conditions.

Figure 19-1. Preoperative roentgenogram of a symptomatic patient 3 years after total hip replacement. Note endosteal scalloping, generalized osteolysis, and cortical hypertrophy. Intraoperative cultures confirmed prosthetic joint infection.

Figure 19-2. Preoperative roentgenogram of a symptomatic patient 15 years after total hip replacement and 3 years after revision of the acetabular component. Note circumferential radiolucencies, cortical discontinuity, and cement fracture. Gross loosening was confirmed intraoperatively.


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How Long Will I Be In The Hospital

You may be in the hospital up to two days after surgery. If it is unsafe for you to return directly home from the hospital, you might have to go to a rehabilitation center prior to discharge home. Talk to your healthcare provider about the best recovery plan.

How long that ends up being in the hospital depends on three things:

  • If your pain is under control: You wont go home if your pain is unbearable.
  • How well you safely move around: You wont go home if it looks like you might be unsafe there.
  • How stable you are, medically: You wont go home if, for example, your blood pressure is too high.

What Medications Will I Receive Right Before During And Right After The Hip Replacement

  • Antibiotics: Medication to help prevent infection.
  • Anesthesia: An anesthesiologist will meet with you before your surgery. They will explain the various types of anesthesia available to you and the risks and benefits of each with your health history. The spinal, or regional anesthetic block, is the most common method used for orthopaedic joint replacement procedures. Youll also be asked to complete a health questionnaire from the anesthesia department for surgery clearance to ensure your safety.
  • Thromboprophylaxis: Medication to help prevent blood clots .
  • Pain control: Various medications can help control pain, including NSAIDs, narcotic pain medications and peripheral nerve block.

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Loosening Of The Joint

This happens in up to 5 in 100 hip replacements. It can cause pain and a feeling that the joint is unstable.

Joint loosening can be caused by the shaft of the implant becoming loose in the hollow of the thigh bone , or due to thinning of the bone around the implant.

It can happen at any time, but it usually happens 10 to 15 years after the original surgery was done.

Another operation may be necessary, although this cannot be done in all patients.

What Does Recovery Look Like Whats The Rehabilitation After Hip Replacement Surgery

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Rehabilitation and physical therapy are started immediately following surgery and continue throughout hospitalization and at home for one year after surgery. Your physical therapist will monitor the strength and flexibility in your leg and hip, as well as your ability to stand and sit. In addition, a physical therapist will provide goals and instructions for you to complete while in the hospital and at home.

Although discharge home is the goal for the majority of patients, your healthcare provider may determine that its best for your recovery if you go to a rehabilitation center or nursing home after discharge from the hospital. At the rehabilitation center, you will have concentrated time with a physical therapist and occupational therapist and will regain your strength, learn about all your exercises and the precautions that youll need to follow. Your length of stay at this facility is approximately five to 14 days, depending on your recovery progress. Your healthcare providers assistant or nurse will discuss facilities available for your needs, and a case manager specializing in discharge planning will meet with you during your admission. The case manager handles all of the planning for your rehabilitation.

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What Are The Different Types Of Hip Replacement Surgery

The three major types of hip replacement are:

  • total hip replacement
  • partial hip replacement
  • hip resurfacing

The most common type of hip replacement surgery is called a total hip replacement . In this surgery, worn-out or damaged sections of your hip are replaced with artificial implants. The socket is replaced with a durable plastic cup, which may or may not also include a titanium metal shell. Your femoral head will be removed and replaced with a ball made from ceramic or a metal alloy. The new ball is attached to a metal stem that is inserted into the top of your femur.

Healthy hip

Arthritic hip

Replaced hip

Two other types of hip replacement surgeries are each generally appropriate for patients of specific age groups and activity levels:

  • Partial hip replacement involves replacing only one side of the hip joint the femoral head instead of both sides as in total hip replacement. This procedure is most commonly done in older patients who have .
  • of the femoral head and socket is most commonly done in younger, active patients.

X-ray of a total hip replacement showing the ball, socket and stem implants

Hip replacement surgical methods

There are two major surgical approach methods for performing a total hip replacement:

  • the posterior approach

To begin the operation, the hip replacement surgeon will make incisions on either the back or front of the hip. Both approaches offer pain relief and improvement in walking and movement within weeks of surgery.

How Do You Know If You Need A Hip Replacement

When your quality of life suffers due to hip pain, it may be time for hip replacement. Signs of declining quality of life include:

  • Inability to get restful sleep because of pain
  • Difficulty doing simple tasks such as getting dressed or climbing stairs
  • Inability to fully participate in the activities you enjoy

At first, your doctor may recommend other treatments such as medicine for pain or inflammation, walking aids, joint injections and physical therapy. If these measures do not relieve pain and stiffness, hip replacement surgery may be necessary to restore function and improve quality of life.

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Greater Trochanteric Pain After Hip Replacement

Many surgeons consider trochanteric pain a relatively minor complication following arthroplasty, however the impact can be substantial, with significant reductions in post-operative satisfaction, quality-of-life and functional outcomes.1,2,3 Those with greater trochanteric pain have been reported to have quality-of-life and levels of disability similar to those with advanced hip osteoarthritis.4 Therefore, the benefits of alleviation of joint pain by arthroplasty may not be realised by many patients who experience abductor pain and dysfunction after hip replacement surgery.

Abductor dysfunction in the form of weakness and functional deficits such as a Trendelenburg gait may also persist or worsen after hip arthroplasty. This may be related to trochanteric pain or to neurological injury or mechanical impairment associated with the surgical technique. Even in the absence of hip pain, a significant gait disturbance associated with iatrogenic hip abductor muscle impairments may result in a longer-term reliance on walking aides. Pain may also develop in adjacent regions, most commonly the lumbar spine or knee, due to the hip abductor muscle dysfunction, altered kinematics and loads transferred to these regions.

If a patient presents to your clinic with abductor pain and dysfunction after hip replacement surgery, there are usually 3 main scenarios:

  • They had co-morbid gluteal tendinopathy prior to hip arthroplasty recognised or unrecognised.
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