Signs and Symptoms
Most people have soreness, swelling and some stiffness for several weeks to a few months after a hip replacement. Pain is worth a closer look when:
- Pain has not steadily improved by about 3 to 6 months after surgery, or it comes back
- You have groin or thigh pain, especially when you first stand up or start walking
- You have pain on the outside of the hip that is worse when lying on that side or climbing stairs
- The hip feels loose, clunks, or has slipped out of place (dislocated), even once
- You notice a new limp, or one leg seems shorter or turned differently than before
- Swelling, warmth or drainage near the incision keeps coming back, with or without fever
What Causes It?
There are several possible reasons a hip replacement stays painful, and more than one can be present:
- Loosening, where the bond between the implant and the bone breaks down over time
- Infection around the implant, which can appear soon after surgery or years later
- Instability or dislocation, when the ball of the implant slips partly or fully out of the socket
- Wear of the plastic or other bearing surface, which can lead to bone loss around the implant (called osteolysis)
- A fracture of the bone around the implant (a periprosthetic fracture), often after a fall
- Tendon irritation or bursitis, meaning inflammation of the tendons or of the small fluid-filled sacs (bursae) on the outside or front of the hip
- Pain referred from somewhere else, most often a pinched nerve or arthritis in the lower back
How We Diagnose It at POPB
Finding the cause is the most important step. Your evaluation includes a history of your surgery and recovery, an exam of your walking, leg lengths, strength and hip motion, and a check of your lower back. X-rays are taken on site and compared with earlier films when available.
Depending on what the exam shows, next steps may include blood tests for infection, drawing fluid from the hip (aspiration) to test it, or further imaging. Because the hip is deep, aspiration is often guided by diagnostic ultrasound or fluoroscopy (live X-ray), both available in our office. A numbing injection into one spot can help show whether pain comes from the joint, a bursa or a tendon.
Painful hip replacements are evaluated by Dr. Kerr, who is fellowship-trained in adult hip and knee reconstruction at Cleveland Clinic Florida and specializes in direct anterior hip replacement, robotic-assisted joint replacement and revision joint replacement, and by Dr. Martin, who has special expertise in complex revision of failed hip and knee replacements.
Non-Surgical Treatment Options
When there is no loose implant, infection or fracture, many causes of ongoing pain can be treated without another operation:
- Targeted physical therapy in our office to strengthen the hip muscles and improve walking, with your therapist and physician sharing the same chart
- Ultrasound-guided injections for bursitis or tendon irritation around the hip, performed in our office
- Treatment of the true source when pain is coming from the lower back
- Medication adjustments, activity changes, or a cane or walker for a period of time
Surgical Options
Revision hip replacement means replacing some or all of the original implant parts. It may be recommended for loosening, infection, repeated dislocation, worn parts with bone loss, or a fracture around the implant. Revision is more complex than a first hip replacement and often requires special implants and planning.
Dr. Martin has special expertise in complex revision of failed hip replacements, and Dr. Kerr also performs revision joint replacement. Some revisions replace only the worn liner or ball, while others replace the stem or socket. Infections sometimes require more than one operation.
Recovery
Recovery depends on the cause and the treatment. Physical therapy for weakness or a limp usually takes several weeks to a few months. Recovery after revision surgery is often longer than after the first replacement and may include limits on weight-bearing or hip precautions for a time. Full improvement can take up to a year or more. Timelines vary.
Therapy after revision is usually done in our office, so your therapist and surgeon can adjust your plan together.
Insurance and Cost
Medicare and most commercial PPO plans generally cover the evaluation, X-rays, lab tests, physical therapy, medically necessary injections and medically necessary revision surgery, subject to your co-pay, co-insurance and deductible. Some procedures require prior authorization.
HMO and managed-care plans require a referral from your primary care physician before your visit. Our staff verify your benefits when you call. You do not need to have had your first surgery at POPB to be evaluated.
When to Be Seen
Call our office if your hip replacement is still painful or unstable several months after surgery, or if pain returns after the hip had been doing well.
Go to the emergency room or call 911 if you have fever, spreading redness or drainage from the incision, which can be signs of infection, or if your hip suddenly gives way, looks out of place or you suddenly cannot bear weight on the leg, which can be signs of a dislocation or fracture.
