No Relief From Other Treatments
Most hip problems can be resolved without a full hip replacement. There is a range of treatments available, including physiotherapy, medication and hip resurfacing that may better address your symptoms.
If your hip pain is not severely limiting your daily life, or you have found ongoing relief from these less invasive treatments, then it indicates a hip replacement is likely not the right option for you yet.
Identify The Structure Causing The Pain
In the clinic, the first thing I would do as the evaluating physical therapist is to determine the structure I believe is causing the pain.
I would try active and passive movements to determine if I thought it was muscle or ligament.
I would vary the position of the hip during movements like hip flexion, extension, abduction, and adduction.
If I was able to eliminate the pain with positional changes I would feel more confident that it is a mechanical problem.
* Note: If the pain didnt change with positioning I would have to ask myself if it could be a chemical problem.
Getting Help What Is The Usual Treatment
- Gaining an understanding of what the problem is and how to stop provoking it, is the first important step. This is often called load management. Your Hip Pain Professional can identify specific aggravating factors and provide individualised advice. Things you do regularly may be making the situation worse. For example, stretching into hip extension is usually not recommended for hip flexor or iliopsoas related groin pain. A formal assessment of your hip flexor length is necessary to determine if lengthening is required and the safest way to improve flexibility of the hip flexors. A Hip Pain Professional will also discuss other things that may be aggravating your condition and specific strategies that will be beneficial in alleviating pain in your situation.
A specific, graduated and individualised exercise program is the other main aspect of treatment. Improvements can occur quickly, particularly if you have caught the problem early. If you have had the condition for a long time, progress may be slower.
An exercise program can have many benefits such as:
Cortisone injections usually only provide short¬ term relief. Cortisone may also reduce health of the tendons, particularly with repeated injections. So, it is usually best to commit to an education and exercise approach first.
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Symptoms Of Hip Problems
People with hip pain or aching hips may have one or more of the following symptoms:
- Popping or crunching noise when bending, walking, running, sitting down, or returning to a standing position
- Persistent ache inside the hip joint, usually felt in the groin area
- Aching or shooting pain around the hip joint or in adjacent areas, such as the buttocks, thighs, or groin
- Stiffness, swelling, or redness around the hip joint
Assess Progress And Track Improvement
The final step is to assess progress and track improvement. If we were able to determine the pain is not causing tissue harm or damage, then we would test painful movements after each session and between sessions to determine improvement.
Often, patients will stop an activity because it hurts, but how something feels during the activity might not be as important as how it feels after the activity.
If something hurts at the time of exercise, but then feels better later that day or the next morning then it is usually a good thing to keep performing those exercises.
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How Should Surgeons Manage Symptoms Of Psoas Tendinitis After Tha
Dr. Michael Taunton answers ICJRs questions about the diagnosis, causes, and treatment options for patients who present with groin pain following total hip arthroplasty.
ICJR: How do you diagnose psoas tendinitis after total hip arthroplasty ? Whatare the key history, physical exam, and radiographic findings that suggest psoas tendinitis?
Michael J. Taunton, MD: The iliopsoas muscle originates from the transverse processes of the 12th thoracic vertebrae through the 5th lumbar vertebrae. The musculotendinous portion crosses the anterior acetabulum over the anterior column. The tendon inserts on the lesser trochanter. The muscle is innervated by branches of the femoral nerve and serves in hip flexion.
Patients experiencing psoas tendinitis after THA typically present with groin pain with activity. The onset of this pain may occur immediately after surgery or in a delayed fashion. The symptoms typically develop with resisted hip flexion activities, such as ascending stairs, getting up out of a chair, and getting in and out of automobiles. Patients who exercise excessively after THA, especially soon after surgery, may also experience groin pain.
ICJR: What are the acetabular and femoral causes of psoas tendinitis?
ICJR: What are the treatment options for psoas tendinitis, and how do you determine which patients are candidates for which treatments?
ICJR: What outcomes are typically seen with non-operative versus operative treatment?
References
Osteonecrosis Of The Femoral Head
This issue, known as ONFH, causes the hip bone to deteriorate and collapse due to a lack of blood to the area. The cartilage that covers the hip bones also deteriorates, resulting in arthritis.
Hip pain is typically the first symptom, and it may accompany a throbbing pain or dull ache in the buttocks and groin. As the condition progresses, it may be difficult to put weight on the hip and any movement may be painful.
This may progression can take several months to a year, and getting an early diagnosis leads to a better outlook.
Treatment
Internal causes of hip and groin pain may stem from underlying conditions or growths in other regions of the body. The issue may be:
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Is It The Size Of The Implant Possibly But May That Is Not It All
Doctors at the Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, the University of Toronto and the Adult Reconstruction and Joint Replacement Division, at the Hospital for Special Surgery in New York combined to assess the causes of chronic groin pain after hip replacement with a focus on possibly the oversized femoral implant head size characteristic of implants used in dual mobility total hip replacement. Dual mobility hip replacement adds an addition polyethylene component which is seen as superior in younger patients who are more active and this type of device reduces or even eliminates the risk of dislocation of the implant. What this research stuyd found was that Overall, 8.7% of hip replacement patients reported groin pain at one year. Patients with groin pain were younger and had lower body mass index .
Why Does My Hip Hurt
If the cartilage in the hip joint degenerates and the hip joint develops arthritis, then many normal activities such as walking, standing, or sitting may result in hip or groin pain. Groin pain is a symptom commonly associated with hip arthritis.
Our team of orthopedic hip specialists begin by diagnosing the cause of your hip pain, and reviewing treatment options with you to get you back to your normal activities.
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Additional Challenges For Men
Recent studies show that women often have better outcomes than men following hip replacement surgery. Researchers looked at 97,000 cases of hip and knee replacements at an Ontario hospital and found that men:
- Were more likely to make a trip to the emergency room within 30 days
- Suffered from more heart attacks
- Needed revision surgery more often
- Were more likely to suffer a serious infection after surgery
If youre at a higher risk for complications, make sure to talk to your doctor about all of your concerns.
Success Of Endoscopic Iliopsoas Tenotomy For Treatment Of Iliopsoas Impingement After Total Hip Arthroplasty
A July 2019 paper in The Journal of arthroplasty wrote: Iliopsoas impingement after total hip arthroplasty occurs in up to 4.3% of patients resulting in functional groin pain. Operative treatment historically has included open iliopsoas tenotomy or acetabulum revision. In this paper the researchers wanted to demonstrate effectiveness and risks in patients treated with endoscopic iliopsoas tenotomy for iliopsoas impingement after total hip replacement.
- 60 patients with iliopsoas impingement after total hip arthroplasty treated with endoscopic iliopsoas tenotomy was retrospectively evaluated.
- Outcomes assessed were resolution of pain, function, and complications.
Results:
- At last follow-up , 93.3% of patients had resolution of pain. Clinically important improvements in function, and low rate of complications. According top the paper: Endoscopic tenotomy should be considered as a treatment option in patients with iliopsoas impingement after total hip arthroplasty.
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What Are Normal Amounts Of Pain After Hip Replacement Surgery
During a hip replacement, your surgeon will remove damaged sections of your hip joint and replace them with artificial parts made of metal, ceramic, or plastic. In the long run, these parts should improve your range of motion and reduce any pain you currently experience. However, like any surgical procedure, a hip replacement can cause short-term pain.
It is difficult to determine how much discomfort you will experience after surgery because every person and case is unique. Always talk with your doctor about the type and severity of pain youre experiencing during your recovery and follow their directions for pain management.
Typically, many patients may find relief from over-the-counter medications, such as Tylenol . The Food and Drug Administration considers 2,000-3,000 milligrams per day to be safe, but you should consult with your doctor regarding an appropriate regimen for your specific needs. For example, if you are elderly or have a history of liver problems, you will need a smaller dose.
Many patients wont find relief from over-the-counter medications and will need a prescription for something stronger. Your doctor will determine if a prescription pain killer is appropriate for your pain management and will provide a schedule of how much you should take and how often.
Signs It May Be Time For A Hip Replacement
When is it time to consider a hip replacement? The orthopedic hip specialists at University of Maryland Medical Center may recommend hip replacement to patients who, after non-surgical treatments for hip arthritis, continue to suffer and have the following symptoms.
You can make an appointment with one of our hip specialists by calling or request an appointment online.
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Groin Pain After Total Hip Replacement
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I Had A Total Hip Replacement And My Hip Hurts
Posted on:Dr. Frank Bohnenkamp
Its not common for me to hear a lot of complaints about pain after hip replacement surgery because a total hip replacement is one of the best surgeries a patient can undergo to get relief from a painful arthritic joint. 95% of the time, patients have wonderful outcomes, but sometimes, problems arise after a total hip replacement, and thats where my joint reconstruction experience can help .
A lot of hip replacements are being done, and they are increasing exponentially as the population ages, especially the baby boomers.
We also have better implants now and are doing them in younger and younger patients because the prostheses are going to last longer. With more hip replacements being done, we are expecting a rise in revision procedures too, it is predicted to go up 137% in the next two decades, which will have a significant impact on healthcare.
Before I delve into hip pain possibilities after total hip replacement, lets look at the causes of hip pain prior to surgery. Possibly, some if not all the pain a patient has before surgery is not a result of arthritis of the hip.
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Iliopsoas Impingement After Total Hip Replacement
What do your patients most look forward to once they have finally made the decision to take the leap into a surgical solution for end stage hip osteoarthritis? PAIN RELIEF! Of course, there are many functional and quality of life ambitions, but these are usually inextricably linked with relieving the pain of advanced arthritis. Failure to achieve adequate pain relief, particularly when a completely new pain scenario develops post operatively, can be devastating. The knock-on effect is usually an inability to restore function and quality-of-life, with expectations and goals much higher in the rising numbers of younger people who are now undergoing total hip arthroplasty each year. There is a wide range of reasons why pain may persist but, in this blog, we are going to discuss one of the most common reasons for persistent groin pain following total hip replacement – iliopsoas impingement.
While overall, total hip replacement is a highly successful procedure in appropriate candidates, the incidence of persistent pain following surgery has been reported to be as high as 40%1. Most causes of postoperative pain following joint arthroplasty can be encompassed within Brown et als four Is:
- wrong Indication,
- Instability and
- soft tissue Impingement 2.
Persistent Groin Pain Following Total Hip Replacement Treated With Physical Therapy
A March 2022 paper in the journal Physiotherapy theory and practice wrote that hip impingement syndrome can occur after total hip replacement and that nonoperative treatment is inconsistently recommended and surgical options include iliopsoas tenotomy. In this case, a patient with persistent groin pain after total hip replacement and iliopsoas tenotomy is presented:
- The patient was a 72-year-old male who had a 4-year history of persistent groin pain following total hip replacement and an unsuccessful iliopsoas tenotomy. He had pain and limited right hip range of motion during active and passive hip flexion, abduction, and external rotation.
- This patient was treated with high-grade joint mobilization to improve the range of motion of the right hip and an exercise program.
- The patient was treated for six visits over 3 weeks. Clinically important improvements were noted in pain, function, and perceived level of improvement. Pain during hip flexion improved on the Numeric Pain Rating Scale, and function improved on the Lower Extremity Functional Scale. Improvements in the range of motion and strength were also observed. At 6-month follow-up, he reported maintenance of improvements .Discussion: Joint mobilization and exercise were effective for improving range of motion, groin pain, and function in a patient with a 4-year history of persistent groin pain after THA and subsequent iliopsoas tenotomy.
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Tests For Groin And Hip Pain
At the appointment with your doctor, they will probably:
- feel your abdomen, leg, or hip to determine the exact location of your pain
- move your leg or hip in various positions
- test your strength by having you resist as they try to move your leg
Your doctor may order imaging tests to get further information. These might include:
- X-ray. Fractures or worn-down cartilage can be seen with X-rays.
- MRI.Magnetic resonance imaging shows soft tissue injuries, such as ligament, muscle, or tendon tears.
- Ultrasound.Ultrasound uses high-frequency sound waves to create images of your bodys organs, such as your ovaries. There is also a therapeutic form of ultrasound that is used to increase blood flow, relax muscles, and speed healing.
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.
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Home Remedies For Groin Pain
Home remedies for groin pain after hip replacements involve taking supplements and eating foods rich in omega fatty acids. Omega fatty acids are essential fats that play a role in maintaining good health.
Eating fish regularly is a great way to get enough omega fatty acids. Fish contains high levels of omega fatty acids.
Other foods containing omega fatty acids include flaxseed oil, walnuts, and almonds. Flaxseed oil is particularly helpful for reducing scar tissue formation.
Walnuts and almonds are also effective natural remedies for groin pain after surgery. Both nuts contain high amounts of omega fatty acids.
Pain After Hip Replacement: Causes And Tips To Help
It is natural to think that you will have no pain after your hip replacement surgery, but things may not work that smooth for some people. Pain after hip replacement is more common than you think. In fact, sometimes, the pain you experience is even worse than what you were experiencing before undergoing the surgery. A number of factors may be preventing you from getting the best results after your surgery.
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