Chronic pain following total hip replacement

Hi,

I'm Sue and I had both hips replaced in Feb and Sept 2011. Prior to this I had many years of pain and a great deal of difficulty with medical fields trying to determine what was causing my pain. Anyway once it was decided to replace both hips I was happy they had at last found a cause and what I thought was a solution. My first his replaced was my right and this seemed to go okay, it was a total different story with my left. I have been in excruciating back and leg pain since, I cannot walk any distance or stand for any more than five minutes. I need to use a wheelchair if I go out and crutches also, I am stuck at home all day while my family go out to work - I am frustrated and feel useless.

My pain is across my lower back and generates down my legs, my last three toes on my right foot go numb constantly. The pain is tingling, numbness, sharp, deep pulsating pain and electric shock type pain. The more I try to do the worse the pain gets. I spend most of my time with my legs raised as this helps, the pain never goes away but does ease when resting. I have painkillers and muscle relaxants but they do not really help. My hip surgeon like most of the forums I have read told me my hips are fine according to the MRI scan. He then referred me to the Spinal consultant, after nearly a year of seeing the spinal people they have now turned round and said the pain is not coming from my back and there is nothing they can do to help. I asked them what I was supposed to do and they said they had no answers!! I have attended all the physio appointments and even did a three week intensive course along with hydrotherapy - nothing has made a difference.

I lost my job due to all this pain and I am now registered disabled. I had more mobility (although painful) prior to my surgery than I do now. It was nice to read that other people are going through what I am experiencing (although I would not wish this on anyone) it somehow makes me feel better.

I have had numerous cortisone injections in the hips, nerve block of the L4/5 nothing has worked for me post surgery. I had cortisone injection prior to my surgery and guess what it helped - work that one out. I am now being referred to the Pain Clinic (again) and Rheumatology as it was noticed on one visit to the hospital that I had a butterfly like redness on my face and they queried Lupus (still waiting for those appointments - surprise, surprise).

Thank you for taking the time to read this and if anyone would like to respond I would be very grateful.

Hi sue. So sorry to hear you're last op has caused you so much trouble and pain. At my consultation the surgeon explained that there was a chance of damage to the sciatic nerve during surgery. I'm sure they will have looked into that. It's so frustrating that no one seems able to identify the problem. I do hope you get this resolved soon and get some relief from the pain.

Hi Delina,

Thank you for your comments. The spinal consultants looked at me having a stenosis of the lumbar but have since decided I do not even though my hip consultants have put in reports that I have a slight stenosis of the lumbar spine and that my pelvis is tilted. You just can't seen to win with these people.

Hi sue, you sound pretty similar to me, they can't make up there mind if it's

My hip or my spine , I have arthritis of the spine and stenosis also arthritis of the right hip and left knee

And stenosis in the top of my spine with arthritis, I went and had a nerve test

Done on my legs and don't appear to have lost any nerves, they sent me on Monday

For a nuclear scan which showed up the pain in my back and hot spits of arthritis , maybe you could ask

For those doing, it might help, hope you get it sorted , I just want to be able to go out for walks again , I don't have any pain on resting just standing and walking

Hi Lynn,

Thank you for responding and sorry to hear you are in a similar position to me.

I had a nuclear bone scan along time ago and that also showed nothing. Just like you I want to be able to go out again without being dependent on everyone else.

I hope you get sorted soon, any other ideas please let me know.

Sue I was going to suggest that you ask to see a nerve specialist. You have similar pains and sensations to me. I have read a lot about nerve damage and you sound as though you could have damage to your sciatic nerve. I have femoral nerve damage. Both are rare complications but can happen due to overstretched nerves orS pressure during surgery. I have been told that I may get back feeling and function 9 months or longer if the damage is not too severe.If you read some subjects on this site many surgeons will not acknowledg that they have damaged the nerve. Luckily my surgeon has acknowledged ny danage but cant tell me how it would have happened as he did not need to go near femoral nerve. As I had previous surgery of a fracture repair with plates and screws it is more likely. Extra care should have been given in my op according to my research since. Not many surgeons have dealt with a replacement like mine. My surgeon had done over 1000 normal replacement but only 3 like me.. only one other patient of his had nerve damage which repaired after 9 months.You describe your symptoms very clearly. One significant feeling of electric shock type pains is just ad I describd it. I do hope you dont have Lupus my sister has this. This can also affect joint s nerve and organs. You may have more pain because of this.I have just got a leg brace as one consequence of femoral nerve is instability of the leg. I have literally falken on the floor twice as my leg has given way. After 3 months being in the house with crutches I now have freedom to move about without being scared of falling.

Hi Debbie, thank you for that. I have seen a spinal surgeon and they have told me my pain is not being caused by my back/spine and have now washed their hands of me. I now have to go back to my GP again. Is the nerve specialist totally different to the spinal specialists? If so I will speak to my GP about this, something else to hang on to.

Its good to hear that you can now walk around without the fear of falling and I hope you continue to progress further.

I had a test that could tell if any nerves on your legs have died and not working any more, ask for that doing.

Hope you get somewhere.

Hi Lynn,

Thank you for that.

At this stage I will try anything, this has been going on for so many years now. Its unbelievable in this day and age that they cannot get to the bottom of my pain.

Sue a nerve specialist conducts tests on your nerves. I had aneedle inserted into my muscle which is not working to test if there was any electrical activity. I don't think they are the same. There are several tests they do to co nfirm thst nerves are damaged. At least if your doctor refers you for tests it should confirm if it id sciatic nerve damage. I am almost sure that is what you have and the reason for your continued pain after hip replacement. Has there been any improvement at all with the sensation and pain over the years since your op? I wish you luck and hope you get dome answer.

I will definitely speak to my GP about that then, I don't get to see her until 4 March. I have had no improvement at all since my last hip operation in fact if anything it has got worse.

I am still questioning the fact that they put different size hip implants in my hips and I now have one leg longer than the other. The surgeon says the MFI looks fine and that is not the cause but that is not what my body is telling me. I am lobsided and walk awkwardly and also have a tilted pelvis. I did not have any of these problems prior to surgery. I just wish they would say they know I have a problem and try to help me but all they have done in the last three years is say everything looks fine.

Thanks for all your help and good luck with everything getting sorted for you.

I am writing to update you on my hospital visit today to the Pain Clinic.  The consultant I saw was extremely nice, did not rush the appointment and asked lots of questions and examined me.  He has said that I can have an injection into my nerve root which will numb the nerve, the numbing will last for between 4 and 6 hours if it is successful.  In this time hopefully my pain will not be there, if this is the case I can then have a further procedure where they can permanently kill off the nerve roots which are causing my pain (if that turns out to be the cause).  I have at last got some hope and I will keep you all updated on the outcome but I now have to wait for the appointment which I was told could take some time.

I am also at the hospital next Monday to see the Rheumatologist to check for other causes to my pain (mainly to rule out Lupus which they say I may have).  Again I will update everyone with my results once I have them.

 

I have read of your situation and initially thought that it referred to my condition. Just to state that I have both back and hip problems and have had great difficulty in deciding which is causig the different pains from which I suffer.I consider that I might be of some help in suggesting courses of action following my lifelong experience with living with back problems - I am aged 78 and decay sets in everywhere.

In yourdiscertation you have not mentionned any form of contact with other than the medical profession. Have you explored Physiotherapists, osteopaths or chiropractors. These have been far more successful for me in ameliorating pain than the medical profession who only seem to come into play when surgery is the last resort. From your description of the nature and location of the pain it repeats those I encountered for 2 years of what was  identified as a prolapsed disc. Eventually was directed to an American osteopath (35 years ago) who after 3 - 4 manipulations alllowed the pain to dissipate and for me to start to live a normal life.

Have you had a MRI scan of the lumbar spine - L3/4 down to L5/S1? This will show any prolapse + wear and tear of the spine  i.e.  Prolapsed discs, stenosis bulging discs etc. Normally hip surgeons go by X - Rays and not MRI scans.

If I can be of any further help please contact. There must be few people with my experience of back/leg pain from the receiving end.

Hi Brian, I have had numerous physiotherapy sessions even did an intensive three week course.  This did nothing to help with my pain even made it worse at times.  I have had hydrotherapy sessions too.  The spinal surgeons say I have degeneration of the L4/L5 and possible impingement of the nerve.  My hip surgeon even mentioned trochanteric bursitis, he goes by what he sees on the MRI rather than x-rays.  I have thought all along that my pain was associated with the nerves and I cannot wait to have the nerve root injections.  I will update everyone when I do finally get the appointment but will probably be a long wait.  Osteopaths are very expensive and I have lost my job due to my situation so at present that is not an option.  Thank you for your suggestions.

Have you had a senior therapist check if your pelvis is tilted?  Have you had your sacroiliac iliac joint checked?

My hip consultant told me I had a tilted pelvis (MRI).  The spine consultants did not mention the sacroiliac iliac joint (S1 region) only that I had degeneration in the L4/L5.

Sorry for delay in response to your comments.

It appears that both the location and nature of your back injury is the same as mine.

L4/5 is the main problem + those either side. The full MRI scan 2 years ago showed severe degeneration of the disc etc which resulted in bilateral recess stenosis and trapped nerves at the exit from the joint at the foramen. The pain/discomfort from this is different to sciatica which is caused by disc bulge onto the spinal canal. One has both pain and  a tingling sensation around the foot which can be numb and after injudicious use of the back, spreads from the little toe across to the big toe. The original outside of the foot numbness first occurred after the original prolapsed disc. When walking a few hundred metres or standing for a few minutes the pain mounts and bending forwards on a chair or standing helps alleviate the pain. This condition has changed over the last year, perhaps due to daily back exercises and the tingling etc., has reduced leading to greater low back pain.

I have suffered 2 - 3 times from tilted pelvis/ sacro - iliac joint injury which is incredibly painful, but does not involve trapped nerves. A good manipulator to straighten the pelvis and SIJ  is the only solution for this. Once stenosis has been confirmed, no osteopath or physio will entertain manipulation and the normal treatment is referred to  as decompression which means chopping away the build - up around the nerve exits. I will not consider conventional back surgery so your approach of attacking the nerves to deaden them sounds feasible. However, my trapped nerves syndrome has noticeably changed  although I do not know why.

I must have the other hip replaced and try and walk again rather than hobble everywhere first before reconsidering the back.

I am sorry that since you cannot work or pay for treatment, that does limit your options.

Brian

There was a period of time between my labral repair and hip replacement when the muscles in my lower back and hip trapped a nerve in my SI joint and I started having similar but less severe problems. I had a steroid injection in the SI joint and it helped a lot. 

I don't have any joint deterioration in my back so it was all caused by muscles. My husband, however, had stenosis in his back which also caused similar pain more severe like yours. It was more straightforward though and surgery to carve away the bone and "patch" the hole in the disc made his pain go away. 

Sue, I read through all of your posts and responses tonight and wish I had an answer for you. I can tell how frustrated you are, rightfully so, and can only imagine what you deal with on a daily basis. Not much is worse than being in severe pain and everyone telling you everything is fine. My heart goes out to you.

I have nerve damage to my lateral femoral cutaneous nerve that causes burning, tingling and extreme sensitivity in almost my entire thigh. That nerve is a sensory nerve that enervates the skin rather than motor nerves (sciatic and femoral) that control muscles and movement in general. You definitely sound like you have motor nerve damage but a sensory nerve may be involved too.

I also have tendonitis in my foot on my "good" leg and it has made it very difficult to walk and do exercises to heal my new left hip. I know how frustrated I've been dealing with something interfering with my recovery for 3 weeks. I can only imagine dealing with it as long as you have.

I sincerely hope the nerve block gives you some relief. Mine was just short of a miracle. I didn't have the nerve disabled afterward but I had a procedure called radio frequency ablation that burns the nerve enough to basically deaden it for about 6 months at a time. The doctors are still hoping mine will eventually heal so they don't want to do anything permanent yet. 

Good luck and please keep us posted. 

Thank you for your kind words Cindy.  I will certainly keep everyone posted as to the outcome of my nerve root injections.  Just waiting for the appointment now........... rolleyes