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You did it.  You were tired of the debilitating pain and you had a hip replacement.  Unfortunately,  you still have severe pain and limited function.  Unbelievable.  What is hip replacement surgery?  What are the symptoms of Hip Replacement Failure?  What causes hip replacement failure?  What is revision surgery?   Let’s dig in.

 

What Is Hip Replacement Surgery?

Hip replacement,  also called total hip arthroplasty is surgery to replace a worn-out or damaged hip joint with an artificial joint called a prosthesis.  Once the injured joint is surgically removed the prosthesis is cemented into the thigh bone and pelvis.  Prosthesis composites include metal, ceramic and hard plastic.  Hip replacement is an increasingly common surgery.  A recent Blue Cross Blue Shield report revealed that hip replacements between 2010 and 2017 increased by 33% (1).  Often times viewed as a safe and long-lasting, hip replacement is not foolproof.

 

What Are the Symptoms of Hip Replacement Failure?

Pain in the hip, groin and anterior thigh with restriction in range of motion are the most common symptoms of hip replacement failure.

 

Why Does my Hip Still Hurt After Hip Replacement?

There are many causes of hip pain after hip replacement.  The most common causes include:

 

1. Infection

Infection is a serious complication.  The incidence in urban non-teaching hospital is 1.18% (2)

 

2. Loose Prosthesis

Hip replacement surgery involves gluing the prosthesis into the thigh and pelvis bones to ensure a tight fit.  Unfortunately, the prosthesis can become loose causing pain.  Risk factors for prosthesis loosening include the male gender, patients over 60 years of age and increased body weight (3).  The main mechanism for loosening is thought to be wear particles from the prosthesis itself which in turn triggers an inflammatory reaction.  Wear particles are microscopic fragments from the prosthesis.  Over time the inflammatory response eats away the bone surrounding the prosthesis causing loosening (4).  Pain is the prominent symptom and prompt evaluation is important since a loose prosthesis can rub on the hip socket potentially causing additional bone loss and making future surgical repairs more difficult.

 

3. Tendonitis

Tendons are the thick bands of connective tissue that connect muscle to bones.  Inflammation and injury of the tendon is called tendonitis.  In the hip, there are multiple muscles and tendons including the psoas, abductor, and adductor tendons all of which can cause pain.

 

 

4. Failure Due to Wear and Tear

Hip replacements don’t last forever.  Longevity is dependent upon many factors including the level of activity and type of prosthesis.  The younger the patient the more likely they will require a second hip replacement.  A large review study demonstrated that hip replacements last 25 years in approximately only 58% of patients. (5).

 

5. Dislocation

A dislocation is an injury where the ball portion of the prosthesis is forced out of the socket.  The result is pain and limited function. The true incidence ranges from 0.3 – 3% and is dependent upon surgical, patient and implant factors (6).

 

6. Metal on Metal with Ions

When a metal-on-metal artificial hip cup and ball grind together, tiny shavings can be released into the blood-stream and body causing pain and restriction.  Newer prostheses designed to improve this problem have not been successful. 

 

7. Prosthesis Fracture

The prosthesis itself can fracture resulting in pain. The most common causes for prosthesis fracture include increasing patient longevity and increased levels of activity.  Fractures are associated with poor clinical outcomes and high mortality rate (7).

 

8. The Wrong Diagnosis

Not all hip pain arises from the hip itself.  There are other structures that can cause significant hip pain and restriction in activity. These structures should always be evaluated in patients with ongoing pain and restriction.  The most common sources include:

  • Spinal Disorder – Disc injuries, disc herniations, disc slippage and narrowing of the canal (stenosis) can all cause hip pain.
  • Nerve Disorders – Nerve irritation or compression can be a source of hip pain and should always be evaluated.
  • SI Joint Dysfunction – The Sacroiliac Joint is an important joint that is made by the waist bone (ilium) and the sacrum.  It is important as it transfers the weight from the torso to the lower extremities.  It is susceptible to injury and can cause hip pain.

 

 

What Is Revision Surgery?

Revision surgery is the procedure that comes after the initial hip replacement has failed.  Yes, it is another surgery.  Compared with the initial hip replacement, revision hip replacements are associated with increased risk of complications including infection and dislocation (7).  The longevity of the implant also decreases with each revision, due to increased wear on the bone site.

 

Recommendations

If you have ongoing hip pain after hip replacement, the list above can assist you in identifying the cause.  If you have ongoing hip pain and your surgery has been canceled as a result of COVID-19, now is a great opportunity to learn more about your condition and non-surgical treatment options.  Other sources of hip pain such as the lumbar spine should be evaluated.  At the Centeno-Schultz Clinic, we are experts in the management and treatment of hip, spine, and sacroiliac joint injuries.  A board-certified, fellowship-trained physician we review your history, prior treatments, current imaging and treatment options.  Telemedicine allows you to have this performed from the comfort of your own home or office.  Treatment options include precisely guided PRP, bone marrow concentrate or both.  To see our results from bone marrow please click here.

 

In Conclusion

Hip replacement surgery replaces a worn out or damaged hip joint with an artificial joint called a prosthesis.  The symptoms of hip replacement failure are pain, and limited mobility.  There are many causes of hip pain after replacement.  The most common include infection, loose prosthesis, tendonitis, hip replacement failure, dislocation, metal ions, prosthesis fracture, and the wrong diagnosis.  Other causes of hip pain include spinal disorders, nerve disorders, and sacroiliac joint dysfunction.  If your hip replacement surgery has been canceled due to COVID-19 please take this time to better understand your hip pain, its sources and possible treatment options that are not complicated by infection, toxic metal ions, fracture, dislocation, and limited longevity requiring additional surgery.  PRP and bone marrow concentrate injections are effective, non-surgical treatment options for your ongoing hip pain.  Don’t be sidelined by your hip pain.  Call us to better understand your options.

 

References ————————————————————————————————————————————————-

1.https://www.bcbs.com/the-health-of-america/reports/planned-knee-and-hip-replacement-surgeries-are-the-rise-the-us

2.Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23(7):984-91.

3.Melloh, M., Eggli, S., Busato, A., & Roder, C. (2011). Predictors of Early Stem Loosening after Total Hip Arthroplasty: A Case-Control Study. Journal of Orthopaedic Surgery, 269–273. https://doi.org/10.1177/230949901101900301

4.Karachalios T, Komnos G, Koutalos A. Total hip arthroplasty: Survival and modes of failure. EFORT Open Rev. 2018;3(5):232-9.

5. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):647-54.

6.Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg [Am] 2009;91-A:128-133

7.An analysis of the risk of hip dislocation with a contemporary total joint registry. Khatod M, Barber T, Paxton E, Namba R, Fithian D. Clin Orthop Relat Res. 2006 Jun; 447():19-23.

8.Kenney C, Dick S, Lea J, Liu J, Ebraheim N. A systematic review of the causes of failure of revision total hip arthroplasty. J Orthop. 2019;16(5):393-395. doi:10.1016/j.jor.2019.04.011