Thigh pain after cementless total hip replacement (Page 1)

Yes, I have similar issues. I also had a hip replacement in Oct. 2008. I am 59 yrs. old I seemed to recover very fast but then 4 mos. after surgery started having thigh and knee pain of which my Dr. said was bursitis. I got a cortizone shot and have done lots of IT band stretching as well as exercises to strenghten my core. The pain doesn't seem to be as bad now but it's different...a definite burning (as in nerve pain) in my mid thigh. I hesitate to go back to my Dr. because he'll just want to give me another injection. Jut trying to work it out but I would like to know if it is just residule nerve pain that will decrease with time??? I really expected to be back to almost normal after a year and a half following surgery! I exercise quite often and ride horses so the pain doesn't occur with any regularity but enough to be really bothersome. Any advise as o what to expect or do about it would be great.
Thanks, Fran

I am a 36 year old female that had a total hip replacement, using porclein. I am experiencing the same stuff. My thigh is in pain, well achey most of the day. I am functioning but it is unnerving trading hip pain for thigh pain. I am not sure what to do.
Any thoughts or help?
Thanks
Jamee

Jamee27,

It depends upon how long ago the arthroplasty was done.

If it has only been a few months, then it is best to wait as see if the micromotion at the tip of the femoral stem subsides. This can sometimes take as long as a year or more.

But, if it has already been several months, and the pain is such that you have to have something done, then about the only thing that can be done is to try a femoral stem revision.

This is of course, that an indolent infection has been ruled out. The most common cause of thigh pain after a THR is the femoral stem micromotion, but continued pain does have to be worked-up. And infection has to be ruled out.



But, at age 36, you do not want to start having revision surgeries already, unless the pain is just so bad that you can't stand it. Because, having a joint put in at such a young age, you are looking at having at least one, if not more, revisions in your lifetime.

A total joint prosethesis will usually only last about 10-15 years, if taken care of. So, you are sort in that rock and a hard place position. If the discomfort can be dealt with, that is probably the best route to go (once infection has been rule out).

But, that is something you will have to discuss with your surgeon. Good luck.

My wife who is 32 just had a total hip replacement 3 weeks ago (titanium). She also had previous hardware removed from a procedure her Dr. did to her when she was five. For about 1 1/2 week she has been experiencing very bad thigh and knee pain but more thigh pain then anything. Her hip itself does not hurt at all anymore. Two days ago I had to rush her to the ER because the pain was unbearable and she was later admitted to the hospital. The first Dr. who examined her said he was sure she had ruptured a tendon connecting her quad and knee and would need surgery to re attach. Then her surgeon looked at it and said he did not agree with the previous diagnosis and ordered an MRI. The MRI came back good and he stated to me that he has no idea as to what could be wrong and he had never encountered such a problem. He sent her to a special Dr. who deals with nerves and sensations something like a physiologist. Tomorrow is her appointment where we hope to find out what is going on and how to fix it. I replied to you because I was surprised to find other people out there experiencing this mystery problem and especially another young female with a total hip replacement. Can you write back and tell me more of what any specialist has informed you of as to what your problem is/was and how to deal with it as well as your confidence in his/her diagnosis. Thanks Craig

CraigWal,

The physician you are speaking about is a physiatrist. This is a physician who is a PM&R specialist (physical medicine and rehabilitation).

With pain, this close out from surgery, an infection must be ruled out. The patient may not exhibit overt systemic symptoms (fever, chills, malaise), but continued pain around a total joint is always worrisome.

Once infection has been ruled out, then the history and exam should guide the attending physician.

Pain at rest is different than pain only with activity. Start up pain tells the physician something else. Try to have your wife determine when the pain is the worst and what makes is worse and what makes it better.

Note any associated symptoms, such as electrical shock type of pain, burning pain, and numbness or tingling in the thigh, leg, or foot. These point to a neurological etiology, either with the peripheral nerves or the spine.

In some patients, the total hip replacement lengthens the limb some. This lengthening can sometimes put stress on the sciatic nerve, causing pain. It can also stretch the muscles, causing them to function a little differently.

Even though the hip doesn't hurt right now, it is known that hip problems can sometimes cause referred pain to the distal thigh and knee.

The MRI of the thigh should have ruled out any muscle tears or if there were any post-op hematomas within the thigh.


Though micromotion of the femoral stem causes pain in the thigh, it should not be severe enough to cause a patient to go to the ER. Bothersome, yes, but not excruciating.



As you can see, so many things can cause problems, and they can be located in other places other than the thigh. It is going to take some work to figure this out.


Good luck. Hope the physicians figure out what is going on and your wife feels better soon.

Im a 31 year old female i was diagnosed with avascular necrosis and osteo arthritus wich the pain started in 2005 but do to only having indian benefits i was only able to see the same doctor and i had to pay for xrays wich showed nothing and the doctor had no clue what i have couse nothing had shown up in the xray and that's becouse in the early stages it dont show up it sometimes is visible with mri wich a mom & Dad of 2 and young we could barely afford the xray wich i still owe on.Anyways i didn't get a diognoses till 2010 and that was becouse i got preganant with my 3rd son and was able to get better insurance & my pregnancy was really harsh when i gained weight my hip was hurting so bad i was in tears my sleep was interupted my daily life was interupted. And after he was born i got busy finding doctors to get me checked out and i finally got a name to my pain then i moved from the Oregon coast to Florida and had to start all over finding doctors and ortho doctors to give me surgery i went on for 3yrs in tremendouse pain i lost interest in things couse i couldn't do them couse of pain i endured, and when i got my mri here in florida i had no cartlidg and not much muscle and i had a seriouse limp waddle going on for 3yrs and my femur had came down and crushed the ball joint and being preggo and bearing that extra weight 2yrs earlier didn't help but at the same time the baby was a little miracle with out him i would have never found out what was wrong with with. But anyways i just had a total hip replacment almost 4weeks ago he did ceramic and plastic i really llike the doctor he was one of the best i dont think he did anything wrong my body just isn't taking the THR very well or somthing! The first 3days in the hospital was hell i got zero pain relief from 1500mgs of oxy and morphine at the same time so i suffered 3days and i couldn't get pain relief couse i was on hydrocodone for 3yrs before my sugery couse of my AVN and Arthritus. I was hurting so bad after the THR i'd rather give natural child birth again even to twins or triplet! than go through that pain again! On the 4th day i was able to control the pain with meds. When i got home i felt like the pain was going down i was walking bearing full weight and was able to do some things on my own around the house im doin my exercises but assisted with the ones well lying down couse i lost so much muscle with the Avn and i was bone on bone so i had no cartlidge left so doin some of the exercises are tough but im doing them i cant find any PT do to my cruddy florida insurance so that's not an option right now But it's been 4weeks and i still hurt i cant pull my leg up and touch my toes i cant bend down and touch my toes wich makes shaving and washing my feet difficult i have a lufah on a stick to reach my toes. I can only bend so far before i get pain like i had with my AVN and the area that was cut is still very tender sitting for awhile hurts i get pain down my leg like i did before surgery like a deep both throb and somtimes shooting pain, i cant get comfy for sleep unless i take a valume to relax my muscles and i wake up crying in pain in the morning as early as 5:30 at times i wake myslef up yelling and crying from the pain wich was also a problem before my surgery and when i awake with pain i have to get out of bed and get into my easy chair and im so sore and stiff just like before the surgery i dont know what is goin on. I see your post is old but im looking around to see if their was anybody close to my age with the same ceramic hip replacment that is still having pain. I was wondering if you have gotten better or if you still struggle with your pain? Any info would be helpfull Thank you Brenda!

Brenda,

Sorry about all of your problems.

You state that you are only four weeks out from your surgeon. You are still very much in the immediate post-op period.

Also, you were not in the best of shape when your total joint was placed. It sounds like you were pretty well hobbled for several years before the surgery.

So, your total joint replacement procedure is much different than that of someone who is in his/her 60’s or 70’s, and who is still basically walking around, maybe using a cane. These patients have very low physical demand and as such their expectations are not quite as much.


Thus, it is always a concern when total joints are placed in very young patients, that their expectations are sometime too high. A total joint will never give a patient a “normal” joint. It is a replacement, designed to make the patient better, again, not “normal”.


So, you were probably significantly “out of shape” before the surgery was done, thus you not only have to recover from the surgery, but also try to get back “into shape”.

Recovery does not “just happen”, it really has to be worked at. It takes a lot of sweat, time, effort, and diligence.

Again, you are only four weeks out from a major orthopedic surgery. Even if you had been in the best of condition before the surgery, you would still not yet be recovered from the procedure.

Continue to work with your physical therapist, and see how things progress.


Good luck. Wishing you the best.

Thank you so much for the fast reply your information has helped me feel better about my situation. I know im still into the early recovery period but i had a couple girlfriends who had THR at a young age and they said they had no pain after words they pretty much jumped out of bed the same day and was doing PT & walking around and doing great they told me i will feel better right away and it's a walk in the park. So when i came out of surgery and a couple days past i didn't feel like jumping out of bed i could barely move without screaming in pain and i got really bad muscle spasms they had to give me valume for and the pain was unbeleivable! And with what my friends told me and how i was feeling i was worried if the surgery went wrong i asked the doctor why im having such a hard time and so much pain he said everybody is different and you were in really bad shape yrs before surgery so it will take you longer to recover. Thank you again for your helpfull information and appinion im continuing to walk and do my exercises and work hard on gettin back into shape and hopfully i will get better soon =) Brenda

Brenda,

As you have found out, everyone IS different. Having patients compare their results to someone they know is one of an orthopedic surgeon's worst nightmares.

Everyone has his/her own pain tolerance level, each patient (even if the underlying condition is the same) reacts to the pathology in a unique way, every patient’s conditioning is at a different level, and so forth. You just cannot compare your experience to that of someone else’s.

And remember, a total joint will never give you a “normal” joint. One well regarded total joint surgeon once stated, that a total joint will, at best, give a patient a Grade B joint, on a scale where a young normal joint is considered a Grade A and a totally degenerated joint with bone and bone would be a Grade D. This is why total joint surgeons would like for their patients to be at least a Grade C or C- before have a total joint placed. If a patient is only a B- or C+, they are not going to see a big difference in their result.


So, as a young patient you are going to have to really work on your rehab and conditioning, so that you can get into a condition where you will be able to protect your implant. Currently, prostheses only last about 15 years, give or take. So, you are looking to at least one (probably more) revision surgeries. Revisions are much more difficult to perform and carry higher risks/complications. With every revision, more scar tissue is formed and more bone stock is lost. This is why total joint surgeons want to limit the number of procedures that are done. It is conceivable that if too many revisions are done, the patient runs out of bone stock in which to place the prosthesis. When this occurs, no more total joints can be placed, the patient ends up with a Girdlestone (flail hip), and is in a wheelchair from then on out. This is why total joint surgeons are so hesitant to place total joints in the very young patient.


So, really work hard in your rehab and conditioning and really protect that implant. Try to not do any physical activities that put a lot of stress on the prosthesis (impact exercises, twisting and pivoting, etc). But, do be as active as possible, so that you maintain your conditioning, balance, agility, and proprioception (being able to chew gum and walk as the same time), and also your weight in the proper range.


Good luck. Have a great time in rehab (lol).

Yes I had the same symptoms a Ceramic Cementless Finsbury hip in Oct 2009.
I had sharp pain and could not stand on one leg.My quads wasted despite continual reps of quad exercises. Many reasons were cited. Nerve damage L3 - lumbar spine, muscle imbalance, need more restorative exercise. As luck would have it the head came away from the neck and as emergency surgery I had hip revision. The new cemented hip March 2012 after two weeks I was walking without pain and after 10 weeks the muscles that wouldn't respond to exercise now have increased in muscle mass by 2cm(5cm above the patella).It is unbelievable the difference. Don't put up with pain as it is not normal. I found out the hard way but the comparison with a cement hip is unbelievable. I biked 15 kms on two consectutive days at 8 weeks, and I am no longer limping as I did post my hip replacement nor do I have any pain. I believed the issues I was having with pain, limp and lack of entheusiasm as normal after a repalcement. It not and 10 weeks after surgery I am nearly back to where I was in 2007.

My husband had this surgery two years ago this July....For many of us, things are never the same even they say as good as new ...What they say is really not what happens...However, he was 71 when this happened...I believe the younger that you are, the more your body adjusts to it...I have a son who is 47 years old, who had this same surgery a few months before my husband and is now playing some of the best golf of his life...I mean make the papers good...I would pass on the cortisone treatment...But this is just my veiw on it...I have had these before and it is just a temporary relief... Good luck to both of you...Take care...

Caroline

thigh pain is common after uncemented total hip replacement ,it does usualy diminish with time , if you still have it after two years then i beleave the implant is most likley undersized the impland in the thigh , being undersized ies loose and needs changeing this is most likley the cause of your thigh pain . i had it with my uncemented hip but it went away after a efr say 6 months and never came bace .

just to let evreyone knoe there is a new tech hip replacement around its called s CERAMIC ON METAL YES I MENT THAT A CERAMIC ON METAL ARTICULATION , these hips are new only been aound for wider use for 2 years but so far so good , they produce 100% less wear debries than metal on metal hips and almost as little wear as ceramic on ceramic options , another benifit is that these CERAMIC ON METAL HIPS produce just half the metal ions into the bloodstream as metal on metal hips . i know about these hips becouse i have one . feels awesome , no pain full range of movement unlimited pain free walking .

No body knows what happens in the long term with these hips and there is very little clinical evidence to support the use of ceramic on metal hips.

i am a 43 yr old active female that had total hip replacement feb 2010... titanium and chrome... i still experience some thigh pain and still walk with a limp unassisted. i have full range of motion - putting socks and shoes on are no problem- and i do physical therapist recommended exercises. my question is, this far out from surgery, is my pain and limp typical? am i expecting too much too soon?

Hi there, my hip is 13 years old, due for a revision any day now...
I suggest you try massage therapy for your thigh pain. I have similar pain and much of it is relieved by deep tissue massage. From what my RMT tells me, muscles in your glutes can impinge or press on the sciatic nerve which can cause pain to radiate down your thigh.
It can''t hurt to try it anyway!

I''m 45 and had my THR in feb 2010 and just the last month I''ve got this horriable thigh pain and radiates around my incise& hip. It''s crazy. I wake up in this pain every night and I''m on so much medication and that not helping must. I''m ready to crack!!! I have a cementless thr. Why is this happening. Is there anything? Is it going to get better?

So glad I read your note! I had THR April 2010 and everything was great till the last couple months. Then in the last couple weeks, much more pain to the point where the last couple days I cannot raise my leg any more than a couple inches, cannot put shoes or socks on... Almost worse than BEFORE surgery. Hope you get some answers soon.

I had the same symptoms before my THR. Ended up being sciatica. Spine DR gave me Neurontin (blocks the nerve signals) to take at night. Pain went away in 2 nights. Been on it for 3 mos. w/ good result. Had TRH 6 weeks ago.

to coco 196445

You need to have this looked at by your surgeon ASAP to rule out infection....also you components may be loose and unstable...thigh pain with cementless components is not uncommon and generally settles, although there can be episodes of recurrence with certain activity....most often it is due to a mis match of implant stiffness to bone stiffness...most of the modern day implants are designed to avoid this complication which was common with first generation devices in the early 90's.

Bottom line....get it looked at ASAP

Hello, it's comforting to hear so many similar stories. I am a 46 year old woman born with congenital hip disorder so by the time I had the op the deterioration of my hip was significant. My uncemented total hip replacement was on 20th May this year. Light weight bearing on crutches for 6 weeks which will be up when I have my revision on 30th June, after which all going well I'm assuming I wean off the crutches (?) While I can certainly notice definite and ongoing gradual improvement during the day, the general discomfort and thigh pain (esp spasms) at night are getting me down and making it difficult to get to and stay asleep for more than a couple of hours at a time. I'm trying to go to bed as late as possible to limit the number of times I wake during the night. I'm taking over the counter Mersyndol for the muscle relaxant but doesn't seem to work. I'm reluctant to get prescription from my GP as have a history of bad reactions or the drugs being ineffectual, so thought I'd hang in there to discuss with surgeon at revision on the 30th. I've tried heat, massage, gentle exercise, elevating my leg, humour "does my hip look fat in these crutches?"
Any other suggestions most welcome ... sorry for the ramble but this kind of public forum is a bit out of my comfort zone ...

I thought i was the only person experiencing this thigh pain. I had my total hip replacement at 34 years old. I am now 39 and I still have thigh pain, expecially at night, every night. It is a burning, raidiating pain on the outside of my thigh, near the incision, down my thigh to my knee. I'd love a painfree night. I can't sleep because of this.

me to i was the same age now i am 39 and having tests cos i have a metal on metal hip replacment and in pain

your symptoms could be due to lateral cutaneous nerve damage

I thought i was the only person experiencing this thigh pain. I had my total hip replacement at 34 years old. I am now 39 and I still have thigh pain, expecially at night, every night. It is a burning, raidiating pain on the outside of my thigh, near the incision, down my thigh to my knee. I'd love a painfree night. I can't sleep because of this.

thigh pain is caused bye the natural turnover of bone cells , during this time the bone around the impland re models its self and this can cause what is called micro motion of the thigh implant . this goes away in time it can last up to two years im sorry to say . i have had this problem with an uncemented hip my self , my surgeon kept an eye on the hip over this time to make sure the stem wasent sinking or subsideing as they call it . any way i dont get the thigh pain anymore and hip looks good on x ray . so if you can grin and bare it dont change an implant just for thigh pain i assure it does resolve in 99% of cases . keep that first hip replacement as long as you can . revisions are not quite as good usualy .another thing to ask your surgeon to cheeck for is late infection bye doing a C R P work up its just a simple blood test , as infection can be more common a cause my surgeon beleaves in long term thigh pain , he is a prof of orthopeadics so he knows somthing i guess. good luck .

I believe that I have the solution for your pain. I had the same pain before and after my hip replacement. VERY PAINFULL !! It's actually hip bursitis caused by IT band irritation. Mr physical therapist used an ultrasound gel which was a mixture of dexamethasone and lidocaine. They apply a liberal amount to the affected area and then use a sonogram device w/heat to disburse the medication deep down into the affected area. Very effective treatment, should end your suffering. Good luck

I can see this post is old, but this is a great thread. I had my right THR in 2009 and it is nothing but wonderful, way better than ever in my life (I have bilateral shallow hip sockets). Then had the right THR in 2010 and it hurt before and and after the surgery. Hurts every day. Still using a cane. Doctor says it looks ok on X-ray. It does feel like bursitis, and I am about to re-start physical therapy so I will see if they will do the ultrasounds. Had that before and loved it. The only time I am not in pain is when I sit in my recliner. I am spending my life there and I hate that! Hoping the therapy will help. I also have very limited mobility in the joint and burning of my groin and thigh. It is hard to stand for any length of time. I am glad I found this forum! Good insight is out there. Hope I like my therapist, he was snotty on the phone but the only one at the company medical clinic. Thank you everyone for all this information!

after hip operation 3 months later had a fall landed standing on operated leg. Now 4 months later i have a pain in my bottom, i can hardly walk. Has anyone eles had this and will it go. I has total hip operation.

My right hip was replaced in September, 2009. Later I learned the surgeon used the Depuy ASR system, I don't know if the problems stem from that but I have experienced burning around the hip joint that radiates down the inside of the leg to my foot. It goes away with rest but returns first thing every morning and really burns late in the day. Any ideas!

hi had hip replacement 2 years this may, been back to doc 3 times said its my back, some days i can walk real good then other days got this limp and pain, just had MRI done on my back , and its not my back the back doc said its my hip i have soft tissues and said to go get second opion from another hip doc, i have a titanium hip, cant sleep good got to keep going from one side to the other, then my hip doc says see you in 5 years what a lod of crap
cheers 59 year old female (aussie)

I had metal THR april 2010 MY pain and life is worse than before. I have really bad bad thigh pain and lower left back pain. Ortho doc said it was fine had second opinion also said looked fine.Then why can I not move me leg in or outwards without alot of pain and why does my lower left back scream with pain always? Did physical therpy several times injections no relief. Now I live planning my life around pain management and prcedures to releive pain. I am a 52 yr old female who was active now my life is so much worse than before replacement I wish I would never have done it!!

hi had hip replacement 2 years this may, been back to doc 3 times said its my back, some days i can walk real good then other days got this limp and pain, just had MRI done on my back , and its not my back the back doc said its my hip i have soft tissues and said to go get second opion from another hip doc, i have a titanium hip, cant sleep good got to keep going from one side to the other, then my hip doc says see you in 5 years what a lod of crap
cheers 59 year old female (aussie)

I saw someone on here hypothesize that younger patients do not have the difficulty with thigh pain as much as older patients. I will admit that it seems to be a logical theory; however, in my situation, it have not held true. I had a total hip replacement at 24 following a major car wreck at 18. I have had severe thigh pain off and on since that time. I am now 36. I have been tolerating this as much as possible for 12 years! The pain seems to be becoming more frequent. I went to my doctor when it first started, but he told me that it was just my imagination and that he had never heard of such a thing. I can promise you it certainly is NOT! Also, I have never been able to walk without a limp since the THR. I'm frustrated because I want to be active. I still work a full time job and ignore the pain as much as I can, but sometimes I just can't go anymore. Does anyone know of a top-notch surgeon who can look at my situation and give me an honest answer? If so,message me.

Very belated response, but are you by chance in Toronto area? Had my first THR at 16, went along okay for a while, never ever remotely pain free however. Then a few years ago the pain got significantly worse until I couldn't weight bare. The Ortho that did the surgery dismissed the pain and I ended up seeing 8 Ortho surgeons who all said my implant looked fine. 9th one was Dr. Davy at Toronto Western and he finally figured it out, did a revision and my life is 100x better. Turned out the lining of the tabular component had been shedding and building up in tissues, something not seen on an xray. This doctor solved what 9 others couldn't and has a passion for unique cases.

What diagnostic tests were done for doc to determine this tabular component issue
before you had surgery again? I need to find a doc. with passion for unique cases in Philadelphia, Pa
Any input is greatly appreciated. I had THR almost a year-seemed like I was doing real good- but increasingly having issues. Significant start-up pain now too. Have had X-rays, ct scan blood work, EEG... Nothing speaking to a specific issue...Doc from Rothman wants to go in there and see what's going on.
more surgery scares me.
I'm 48 , real good health (despite having m.s)

philadelphiaweaver,

What ferbs is referring to is an inflammatory condition caused by particulate debris which has come from the lining of the acetabular component. The polyethylene which is used for the lining of the cup can degenerate and break down. Then the tiny pieces get absorbed by the soft tissues around the joint. These can set up an inflammatory response or a foreign body reaction.

Sometimes, the particulate matter can get into the bone/prosthesis interface of the femoral component. In some cases this can cause loosening of the component.

However, this breakdown usually takes several years to occur. And, not all patients actually react to the particulate matter.

This is routinely checked for in patients with problems around a total joint. Labs would show elevated inflammatory markers and usually the bone scan will show increased uptake. Loosening of the components will usually show up on x-rays.


Sorry that you are having problems. Hope that you will be able to find the etiology of your discomfort. Good luck.

shirid,

You don't say where your pain is located. Thigh pain (mid-thigh, where the stem ends) is not uncommon in uncemented hips, but with a titanium prothesis, at two years, that shouldn't be a problem. Titanium ingrows very well, so you shouldn't have thigh pain, unless the stem is loose.

If it is groin pain, then it can be a couple of things. A loose cup can cause continued groin pain. Unfortunately, scar tissue around the acetabulum can also be a problem. The loose cup can be addressed, but the scar tissue is very difficult to treat.

Another cause of continued pain about a total joint is an indolent infection. You don't have to have systemic symptoms (ie fever, malasie, warmth, redness, etc) to have a subclinical infection, especially if the organism is Staph epi.

I would see another total joint surgeon. The only reason to do a total joint is to alleviate pain. So, if you are still in pain, it's not right. With a thorough exam and some studies (labs, x-rays, CT, MRI, bone scan, hip aspiration, etc) the cause of your pain should be able to be identified. It should not just be blown off. If you do have an indolent infection or loose components, they are just going to get worse.

See another total joint surgeon. Good luck.