Every day, our hips are built to work hard. They support us, carry our weight, and allow us to run, kick, and jump. You can walk and bend. If you are stiff or sore, it is difficult to move and more difficult if there is severe pain. Pain can be felt above the hip near the spine, at the back of your hip, in the lower back, below the knee, along the side of the joint, and in the groin.
Because it is a ball-and-socket joint, like the shoulder, we have great movement. It is much more stable than the shoulder, and it has the most powerful muscles to operate.
Many structures can cause pain in the hip and groin, including ligaments, muscles and joints. Hip and groin pain can be caused by imbalances in the pelvis. A proper evaluation is necessary to determine if knee problems are also related to hip pain.
You still have pain six months after your hip replacement surgery. Is it normal for groin pain to persist after total hip replacement? Is there a reason for groin pain following total hip replacement? What are the symptoms of a failing hip? What are the treatment options? Let’s dig in.
Is it normal to have groin pain after total hip replacement?
It is common to experience pain after surgery. Usually, it improves over several days. Although persistent groin pain after hip replacement surgery is rare, it can happen. The incidence of groin discomfort after hip replacement surgery is between 0.4 and 18.3%. This can be distressing as many patients choose hip surgery to relieve their groin pain and limit their hip range of motion.
It is iliopsoas impingement?
After total hip arthroplasty, persistent groin pain can be caused by iliopsoas impingement on the Acetabular Rim. There is much debate about whether revision or tenotomy is a better surgical option. The doctors shared their limited experience with combined revision of the acetabular and partial iliopsoas, tenotomy after other conservative treatments failed.
Eight patients were diagnosed with iliopsoas impedement after hip replacement. The patients all had groin pain that had been present for at least six month and had had no relief from their treatment.
All patients had acetabular revision and partial psoas tendon removal. There were no stems (hardware), that were changed. This study reports on dislocations, complications, as well as clinical outcomes.
- Seven of the eight patients had a positive diagnosis with an image-guided inject (a painkiller was administered to the groin to determine if it relieved the pain).
- The cup hardware was adjusted during the revision surgery.
- There were no significant complications post-op.
- The average follow-up was 3.3 years. The mean Hip disability score and Osteoarthritis Outcome Score (Joint Replacement) were 75 points.
- Combining acetabular revision with tenotomy may be a good option for managing conclusion iliopsoas impedement. Intraoperative imaging may help with the challenges of implant positioning and placement.
It could be the implant’s size.
Experts gathered to evaluate the causes of chronic groin discomfort after hip replacement. They also focused on the possible oversized femoral implants head sizes that are common in dual mobility total hip. Dual mobility hip replacement includes an additional polyethylene component that is preferred by younger patients who are more active.
This type of device reduces, or even eliminates, the risk of implant dislocation. This research found that 8.7% of hip replacement patients experienced groin pain within a year. Patients suffering from groin pain were typically younger and had lower body masses.
What Causes Groin Pain After Total Hip Replacement?
After a total hip replacement, there are many reasons for groin pain. These are the most common causes:
Inguinal Hernia; Inguinal hernia refers to a weakness in the abdominal muscles, which can lead to groin pain.
Infection; Patients who have undergone surgery are always at risk of infection. A recent study found that 22% of patients experiencing pain following hip replacement had an infection.
Removal of Artificial Hip Implant; An implant can become loose, causing pain. Brown et. al. found that 22% of patients suffering from pain after surgery had loose implants.
Low Back Nerve Injuries; Herniations, disc bulges at the low back, slippage, and small joint overgrowth can all lead to nerve root irritation, which can result in groin pain.
Iliopsoas Tendonitis; Tendons are a thick band of connective tissue that connects muscles and bones. The Iliopsoas tendon begins in the lower lumbar spine. It then descends to the hip joint and groin, where it attaches to the thighbone. There are a few things that can cause irritation, including retained cement, long screws or a poorly sized hip implant. Groin pain is becoming more common due to Iliopsoas tendonitis. The groin is the most common location for pain.
Pelvic Fracture; The hip implant is forcefully hammered into place during surgery. This can lead to a pelvic fracture. Patients with low bone density are more at risk of a pelvic fracture.
What are the signs of a failing hip replacement?
Hip pain in the hips, groin, and anterior thigh is the most common sign of hip replacement success. Hip replacement failure can be caused by infection, wear and tear, dislocation, or fracture.
What are the Treatment Options?
Avoiding hip replacement surgery is the best way to prevent groin pain. There have been significant complications associated with hip replacement surgery, including pseudotumors and hip dislocations, strokes and metal toxicity from wear particles. Also, there has been an increase in the incidence of falls. A recent study of 51 hip replacement patients found that activity and sleep levels did not improve after 6 months.
The underlying cause of groin pain following hip replacement is important. A loose or infected implant, infection, or a pelvic fracture may all require immediate surgical evaluation. Additional surgeries may be required. Iliopsoas tendonitis can be treated with conservative care, which includes rest, safe NSAIDs and stretching. Steroid injections may be recommended if treatment fails.
Steroids can be toxic to the orthopedic tissues and are therefore best avoided. Steroids can also decrease local stem cell counts and impair immune system activity. If the pain continues, surgery is an option. Sometimes, the Iliopsoas tendon can be cut to relieve the pressure. This can also affect the biomechanics in the hip and lower extremities, as the Iliopsoas Tendon is a significant stabilizer.
Hip pain can be controlled with medication
Your doctor will recommend pain medication for you. Remember:
- You may feel more pain as you leave the hospital. During this time, you may need to take prescription pain medication or opioids.
- You will notice a decrease in the frequency and/or lower doses of prescription pain medication over time.
- Gradually you will stop using over-the-counter pain relief. This can take anywhere from 2-8 weeks to occur after surgery. Everybody is different.
- Most people eventually stop using over-the-counter pain relief drugs. This transition can take place in a variety of ways.
- Without permission from your doctor, pharmacist, do not mix prescription pain medication with any other medication, including sleep aids.
Talk to your doctor if you are worried about using opioids if you have a history or addiction. Seek medical attention if you feel pain that is not due to infection, deep vein bleeding (blood clot), and nerve damage. These conditions can be life-threatening.
Participating in physical therapy
Before being discharged from the hospital, all patients will have undergone supervised physical therapy. Physical therapy can be continued after discharge:
- In a rehabilitation centre
- Outpatient physical therapy clinic
- A visiting physical therapist can visit you at home.
- Follow the written instructions and illustrations of your surgeon or physical therapist at home
Patients who are discharged from the hospital can expect to perform some physical therapy unsupervised, with rare exceptions. Expect to do about 20-30 minutes of exercises multiple times per day.
Resuming a daily routine
You may require help with basic chores such as cleaning and meal prep after you are discharged from the hospital. You can enlist the help of a spouse, a friend, or a hired helper.
This stage is usually short-lived. You’ll likely be able to walk again within one or two weeks of surgery.
- You can move around your house more easily
- You can walk a short distance to get to your mailbox, around your block, or even further.
- You can prepare your own meals. You may be able stand on your own within a few weeks of surgery. Follow the instructions of your surgeon.
- Shower. To protect the surgical incision, some people are advised not to shower for several days. You should follow the instructions of your surgeon regarding when you can shower.
People who have been discharged from rehabilitation centers are often sent home within a week.
After hip replacement surgery, driving
Several factors influence the time it takes to return to driving.
- Any medication that can cause drowsiness, or errors in judgement, must be stopped.
- You’ll need to have the stamina and reflexes to drive.
- It is possible to delay driving if you have had surgery on your right side. This is to ensure that you are able to control the brake and gas pedals with enough strength and coordination.
- You may be able drive your car in two weeks if you have had surgery on your left side hip.
It is important to listen to your body, and to seek out the advice of your doctor.
Stem Cell Treatments and PRP
PRP is high in growth factors, which can increase blood flow and reduce inflammation. Your stem cells can recruit other cells to speed up healing. During an ultrasound exam, the Iliopsoas tendon can be easily seen and evaluated. To ensure the correct placement of stem cells and PRP, all injections are done under ultrasound or x-ray guidance.
Although it is rare, persistent groin pain following hip replacement can occur. Inguinal hernias and low back nerve irritation are all possible causes of persistent groin pain following surgery. A surgical evaluation is required for any complications such as infection, loose implants, or pelvic fracture
Given the serious complications, it is best to avoid having hip surgery. Iliopsoas Tendonitis can be treated with conservative care. Avoid steroids as they can be toxic. The structure and function the hip and lower extremities are affected by surgically cutting the tendon.
Stem cells and PRP are non-surgical options that provide effective treatment. They increase blood flow and speed up natural healing. Telemedicine consultations with board-certified and fellowship-trained physicians can help you evaluate your nonsurgical options if groin pain from hip replacement is keeping you from your passion and activities.