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PATIENT HIP RELATED QUESTIONS

Join Dr Liew in answering your questions. Post a comment on the Facebook Post specific for this page, and Dr Liew will read, and answer most questions on here. The current segment is focussing on Hip Pain and Hip Arthritis and Sports injuries of the Hip. Please note that sensitive medical information will not be disclosed on this page. This area will be used for general questions that can be used to help others that may have the same questions as you.

Social Tennis post Total Hip Replacement

I considering THR procedure and have read your comments on suitable exercise – I play social doubles tennis and presume this would still be possible to do?

Yes, absolutely – doubles tennis is played by a lot of our patients, and this is absolutely not a problem. With a total hip replacement, or any lower limb joint replacement, constant hard impact running is not suitable, but things like tennis, golf, snow skiing etc are all fine after a total hip replacement performed via the direct anterior approach.

Hip disintegrated - what is the recovery time of a total hip replacement?

The hip has disintegrated and they don’t know how he is walking .
what the recovery time please

Thankyou for your question. Recovery time can be variable, and highly dependent on factors such as how fit and healthy a person is, what the state of their muscles are, whether or not they are walking still, and how long their disease has been going on for.

In general terms, I have found that the direct anterior approach for total hip replacement surgery has a faster recovery. This has been proven in many papers. The long term outcomes are roughly the same for any approach, but it is undeniable that the anterior approach exhibits a quicker recovery. For our own patients, we like them to be walking on the same day of surgery, or first thing the next morning (if they are done later in the day). We don’t let our patients drive for the first 2-3 weeks until they come back to see us. At that time, about 80% of our patients are off their heavy pain medications during the day, and are just taking Panadol at the most.

Of course, there are many factors, and with careful consideration, a surgeon should be able to estimate what your recovery would be like. I have found that hip replacement recovery to be surprisingly rapid for almost all of our patients, but as stated above, this is highly dependent on many factors.

I hope this helps.

Hip Bursa - is there an operation for this after failed non operative treatment?

I have a right hip bursa. I have had shock wave therapy x2 , cortisone injections and physio with a little help. Is there a operation as I am in pain.

Many thanks for your enquiry – Trochanteric Bursitis can be a big issue when it cannot be controlled. The first step is to certain what the cause of the trochanteric bursitis is. There are many causes, but some of the main ones includes: A torn abductor muscle (gluteus medium or minimum), disease in other joints resulting in a severe limp (also may occur if you have a very bad back), excessive hills/stairs training, or even just direct trauma to the area. Sometimes, having an arthritic hip can cause you to walk awkwardly to avoids causing pain, and this can result in an imbalance resulting in trochanteric bursitis.

The first step is to try conservative management – which includes physiotherapy, and all of the things you have attempted, such as extracorporeal shock was therapy, and injections. Most trochanteric bursitis can be managed by these methods. When this fails, the last resort is surgery.

The reason why surgery is not offered immediately, is because most cases can be successfully treated without an operation, and because operations are not as successful as we like – probably ranging somewhere around the 50-70% mark for success.

When you have trialed non operative management without success, obtaining an Xray, and Ultrasound is the first step. Depending on the pathology, an MRI may then be ordered, to quantify how bad the surrounding muscles might be. In some cases, when the Ultrasound suggests that there is a tear to the gluteal muscles, then they need to be fixed in conjunction with the bursectomy (removal of the bursa).

The operation to fix the bursa is either arthroscopic (key hole) or open. I prefer the arthroscopic method unless the gluteal muscles need to be reattached.

I hope this helps to answer your question.

Severe pain in many areas, Had cortisone. Is there anything that can help?

I have severe pain particularly in left hip, both knees,lumbar spine, sacral area and both shoulders….a lot of bone on bone. Is there anything to help? Had cortisone to r,hip which had reasonable result, cortisone into lumbar back which slightly relieved pain but after that had severe pain in coccyx across both buttocks which created strong spasms. Is your clinic private? Have private cover but can’t afford the gaps

Hello, and thankyou for your enquiry. It sounds like that you have many areas affected. Potentially this is from osteoarthritis in many areas, or you may have another condition. Sometimes rheumatoid arthritis can cause you to have pain in many joints which is more a disease of the coating in the joint (synovium) rather than the cartilage or it can even be both.

If you have some pain in your lumbar spine, and you find that you had some relief in all of your areas after being injected into that area with cortisone, you may find that your lumbar spine is the one that is affected, and potentially the nerve roots are being irritated. This may be the best starting point.

I would suggest that you have your GP examine you and take some plain Xrays. This will give you the first indication of whether or not you may have arthritis. Depending on this, they will decide if you need to see an Orthopaedic Surgeon, or if something else is going on, and if you need to see perhaps a Rheumatologist or Spinal surgeon.

Thankyou for your enquiry.

Treatment for nerve damage after a hip operation

Is there any treatment for nerve damage after a hip operation?

The first thing to determine is what type of nerve damage there is. Nerves can be broadly broken down into two kinds of nerves – they can be sensory (ie only supplying skin) or motor (powering the muscles). In general, the most important ones are the motor ones, as they control movements of your joints. Sensory ones can be very important in certain areas, such as on the soles of your feet, and palms of your hand. In other areas, losing some sensation can be a minor nuisance.

If your hip operation was a total hip replacement, then broadly, the nerves that can be damaged are as follows:

  • Posterior Approach: Sciatic nerve (Damage may result in foot drop, and loss of sensation in the foot).
  • Lateral Approach: Superior gluteal nerve (Damage results in gluteal muscle degeneration)
  • Anterior Approach: Lateral femoral cutaneous nerve (Damage results in decreased sensation on the upper side of your thigh).

From my perspective, the worst nerve damage occurs when a motor nerve is damaged as this limits function. This is the reason I prefer the direct anterior approach for all total hip replacements. The nerve that is at risk is the lateral femoral cutaneous nerve of the thigh. Post operatively, research suggests a 20% rate of nerve injury, but a very high level of recovery. In general, about 1-2 our of 100 seem to have longer term decreased sensation. Given that this is only a sensory nerve, function is not limited, and it is of minor significance.

As you can see, there is a wide range of nerve injuries out there. When a nerve is injured, the treatment is based on whether the nerve is cut, or just stretched, or even just affected by swelling. The only thing to be done if it is damaged, is to firstly determine its long term significance, and if it is of major concern, then a Neve conduction study and ultrasound are done to determine what might be happening with the nerve.

I hope this answers your question.

Tilted pelvis. What treatment options do I have?

I was told recently that I have a tilted pelvis. While I have some idea of what that is, I don’t know what has caused it and what treatment options do I have? Thank you, Marion.

Thankyou for your question, Marion. It is an important one, as a tilted pelvis can mean a lot of things, and it is often discussed as the cause for different kinds of hip/back, and even knee pain.

When we look at a pelvis, it can be tilted in 2 main planes, or rotated. A pelvis that is tilted when looking from the front (as in when you stand in front of a mirror) can be due to your hips, or your spine. In general, these two are the most common causes of a tilted pelvis from that aspect. When your hip has arthritis and loses the cartilage, you can lose leg length due to this. This can be up to 1cm at times, and this leg length inequality results in your pelvis having to tilt to accomodate for that shorted leg. Any cause that will shorten a leg in relation to the other may result in a tilted pelvis. This can often be the reason why one leg feels longer than the other for a few weeks after surgery, as your pelvis becomes used to being stuck in that tilted abnormal position. A scoliosis of your spine can also cause your pelvis to tilt, as it pushes your pelvis into a compensatory position.

The other type of tilt, is when your pelvis is tilted forwards or backwards when looking at it from the side. Again, this can be due to the hip or spine. When you hip has a lot of osteoarthritis, the structures that degenerate cause your hip to flex up slightly. You may see your surgeon testing for this during a hip examination. If your hip contracts on the front, then your spine tilts to accomodate for this. Again, if your spine has an abnormal tilt to it, then this will in turn cause your pelvis to tilt.

The last kind of tilting is actually a twisting of your spine. This can be due to combined abnormalities in your spine and/or hips. Same idea as the above.

When your pelvis is tilted, it is important to determine what the cause is. If you just have back pain, and a tilted pelvis, then addressing your spine is the correct treatment. If your pelvis is tilted and you have hip pain (ie groin, thigh, buttock pain), then treatment targeted to your hip is the most beneficial. Often, this means a total hip replacement.

I hope this helps to answers your query.

Unable to sleep on side, severe pain. Do I need hip replacements?

I am unable to sleep on either side due to pain in both hips. Pain so severe it wakes me up. The pressure on my hips on laying either side in bed is unbearable. Does this mean I need hip joint replacements?

Thankyou for your question. There are many causes of hip pain, and within the hip, the usual causes are hip osteoarthritis or trochanteric bursitis. Lying on your side often makes trochanteric bursitis worse, however hip osteoarthritis can also be the cause. Generally, the first step would be for your surgeon to assess your history, and perform an examination. Someone with good range of movement of their hip joints, but tenderness on the sides of the hip, and no groin pain, usually suggests that its trochanteric bursitis or something outside of the hips. If the pain is felt in the groin or buttocks as well as the sides, and you have stiff hips, then this could certainly be from hip osteoarthritis.

Once this is done, your X-rays are reviewed. This will be able to tell if you have severe hip osteoarthritis. Trochanteric bursitis cannot be seen on an Xray, so either an ultrasound or an MRI are performed to check for this. An MRI can be useful if we are considering if you’ve torn your gluteal muscles, as this can be something that requires surgery to reattach the muscles.

A total hip replacement is required if the source of your pain is from osteoarthritis. I think the best first step would be to obtain some X-rays of your hip, and determine if you have hip osteoarthritis, or if further investigations are necessary.

I hope this helps you.

Hip feels alien, numb, and uncomfortable. Is this normal?

After two years my hip still feel an “alien“ to me. Not pain but a sort of numb. Sleeping on my side still feels uncomfortable. Is this normal for hip surgery?

Hello, and thankyou for your question. I am going to make a few assumptions, and that is you’ve had a total hip replacement, and that everything went well. One of the most important things to determine is whether you had exactly that type of side (lateral) discomfort prior to the surgery. Hip pain that originates from the hip area, come from 2 main areas: the hip joint itself (Osteoarthritis); or the side of the hip from Trochanteric Bursitis. You can have one of either, or both at the same time.

Trochanteric bursitis often causes pain on the side of your hip, and this makes lying on your side uncomfortable. Walking up and down stairs and hills cause a lot of issues. One of the reasons for trochanteric bursitis is due to damage of the underlying muscles (gluteal muscles). If there are major tears, then you would have a very abnormal gait pattern. This is called a Trendelenburg gait, and results in the inability for your gluteal muscles to support your pelvis as you walk. If this is the case, then surgery is often required if your muscles have become detached from the bone. This is far more common in patients who have had hip replacements performed via the lateral approach, and not common in those who have had a direct anterior approach for their total hip replacement surgery.

An alien feeling hip is not a common sensation. Our end goal after a total hip replacement is to achieve what is called a “Forgotten hip”. This means a hip that you do not think about on a daily basis, and one that allows you to do almost anything (With the exception of prolonged running or impact activities). I tell all my patients to expect this to occur somewhere between 3-12 months.

Some patients can get numbness in different areas around the incision site. With our approach, this can sometimes affect a small patch of skin on the side of the thigh, where your skin sensation of less than what it was. This is usually due to stretch of the lateral femoral cutaneous nerve of the thigh. It is purely sensory. One of the other advantages of the direct anterior approach for total hip replacement surgery is that the surgery is not performed close to the 2 main nerves of the leg (Femoral and Sciatic), so complications like muscle weakness and foot drops are highly unlikely.

I hope this answers your question.

Salter Osteotomy leading to a Total Hip Replacement

My daughter had to have a salter Inominate osteteotomy at 2 years old…. is she more likely to require a THR when she’s older ?

Thankyou for your question, which is a great one. A Salter osteotomy is performed to help with young children (usually the age of your daughter at 2yo) who have hip dysplasia. If left untreated, the acetabulum in a patient with hip dysplasia fails to develop properly, and may result in a hip that does not have enough socket depth to house the ball (femoral head) portion of the hip joint. This can lead to a lot of hip dysfunction later in life.

A Salter osteotomy has good results. Whilst it is something that I personally do not perform, the long term outcomes of having a Salter osteotomy would be better than those of patients who have hip dysplasia who do NOT have the osteotomy. ie: the osteotomy would IMPROVE their long term outcome.

However, your question relates to whether or not it increases the chances of hip osteoarthritis. Whilst having a Salter Osteotomy certainly improves a patients long term outcome if they have hip dysplasia, there is a higher chance that something would need to be done to your daughters hip later in life. This could be another realignment surgery, surgery to correct for the new placement of the hip once her hips are fully developed, or osteoarthritis. I am not 100% certain of the current statistics with respect to requirement for total hip replacement surgery, but certainly, the chances of hip surgery later in life is increased with people who have hip dysplasia, as well as those who have had a Salter Osteotomy.

A Salter Osteotomy is usually performed via an anterior approach to the hip, which is a similar approach to how my patients receive their total hip replacements (The incision site, size and method is slightly modified).

I hope this helps to answer your question.

Bone on bone in knees and ankles

Is there such a thing as bone on bone of knees and ankles?

Thankyou for getting in touch. Yes, absolutely – like any joint in the body, there is cartilage which coats the bone, and then a thin fluid film between the cartilage. Once you have advancing osteoarthritis, you lose the cartilage that is normally protecting the bone, and you become bone on bone. Every joint in the body has be arthritic, and you can be bone on bone in virtually any joint. Some joints are more susceptible than others because they are very mobile joints, or because they take a lot of load and forces. These joints are the ones that often cause pain if they become bone on bone. Knee osteoarthritis is more common than hip osteoarthritis in Australia, when considering the numbers of total hip replacements vs total knee replacements. Both can be quite debilitating until a replacement is performed.

Similarly, ankle osteoarthritis can occur in any joint of the foot. Whilst the feet are not my specialty, my colleague, Dr Mike Smith is a dedicated foot/ankle/knee specialist who deals with ankle and feet osteoarthritis daily. If you have a query specific to foot/ankle issues, please feel free to post it on our facebook page for him to take a look at.

Have a great day, and thanks for your question.

Bone on Bone osteoarthritis

Hi, I have been told via an X-ray that I have bone on bone on both hips. What can be done or taken to help this. Will this affect me down the track.

Thankyou for your enquiry. Bone on bone means that there is no cartilage left in your helps. All joints have cartilage, which helps to protect the joint and prevent them from causing pain and osteoarthritis. When you have lost cartilage in your joint, and there is inflammation, then this is called “osteoarthritis”. There are other types of arthritis, where cartilage may be present, but you may still have pain, such as Rheumatoid Arthritis, which is a disease of the synovium (Lining of a joint).

If you have bone on bone, this usually means that your arthritis is severe. A classification often used is out of 4, where 0 is no arthritis, and 4 is bone on bone. Once you are bone on bone, then generally you are in a lot of pain, with restricted range of movement. An article about hip osteoarthritis can be found here.

When you have developed bone on bone osteoarthritis, the next step is to manage it with simple analgesia first, such as regular Panadol Osteoarthritis, Glucosamine and Fish oil, and the occasional or intermittent anti-inflammatory (ie: Nurofen/Naprosyn). Once these are ineffective, and your quality of life is impaired, then a total hip replacement is considered. There are many types of hip replacements that can be performed, along with different methods for how the hip joint is accessed. Personally, I use the direct anterior approach for all my total hip replacement surgery, as I have found it to be a fantastic operation for my patients with hip arthritis.

I hope this answers your queries.

Rehab Exercises after THR

Is there specific rehab exercises to do after a total hip replacement? Do you suggest hydrotherapy

Thankyou for your enquiry – physiotherapy plays a very important role in the recovery after any joint replacement, be that a total hip or total knee replacement. It is more crucial to participate in regular and dedicated physiotherapy after a total knee replacement.

From a total hip perspective, I do want my patients to do rehabilitation regularly for the first few days after their operation, as this enables our patients to realise that they can move, and put full weight through their leg immediately post operatively. We like to see our patients up and walking the same day of surgery, with the help of our dedicated physiotherapists.

There are no specific rehabilitation exercises which will be most beneficial for every patient, as everyone comes into a hip replacement with different deficiencies, and requirements. Our philosophy is to tailor everything to each patient that comes to us, as it allows us to get the best we can from each patients unique anatomy, disease state, medical background, and more. She patients require a lot more physiotherapy than others, and some, require none.

As a bare minimum, rehab exercises should be focussed on gait retraining. Hydrotherapy is a great way to do this. For my own patients, we do not allow them into the pool for 4 weeks post operatively, to decrease the risk of infection. After this 4 week period, I do find that patients enjoy hydrotherapy, and the ones who do this find it very useful. Not all patients require hydrotherapy and I do not force it on them.

Because the direct anterior approach for total hip replacements does not violate or damage any muscle, patients generally need less physiotherapy, and for my patients, I find that 2-3 sessions post operatively once they leave hospital is all they will require.

I hope this answers your question.

Running after a Total Hip Replacement

Hi I used to enjoy running and would love to run again. I had LTHR anterior approach. I’m 46 years old.
What are your thoughts about running after thr?

Thankyou for your enquiry. Generally speaking, any impact activities after a total hip replacement are not advisable. The reason behind this is that the repetitive impact can cause damage to the prosthesis. Whilst a body can normally heal itself when minor damage is sustained, ie from impact damage from running, an implant cannot.

The best exercises are those that do not involve impact – this includes cycling, swimming, walking, hiking, and even snow skiing. I advise my patients not to run for pleasure, but can do so for short spurts. I allow my patients to jog around on grass, such as with the little ones, but not to pound the pavement for exercise.

You are at the younger end of the scale for having a total hip replacement so the goal is to keep your hip functioning well for the long term. The rate of revision surgery for patients under 55yo is about 15% at 15 years (Data from the Australian Joint Replacement Registry). This is slightly increased as compared to the general population which is 8%. Given this fact, I would advise you not to run if you can find other activities that can interest you.

I hope this answers your question.

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Dr Chien-Wen Liew

Dr Chien-Wen Liew

Orthopaedic Surgeon

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