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Doctors' Advice for Back and Leg Symptoms after Total Hip Replacement

Posted on: 07/30/2003
Are you 55 years old or older and still pain free? Chances are you have osteoarthritis and don't know it. X-rays show arthritic changes in eight out of every 10 adults age 55 and older.

Knees, hips, and spines are affected most, in that order. Older adults with leg pain may have arthritic changes in both the hip and spine. They sometimes have a total hip replacement (THR) only to develop groin and buttock pain next. Or suddenly they have muscle weakness that isn't related to the THR.

In these cases, lumbar spinal stenosis (LSS) may be the problem. LSS occurs when age-related changes narrow the canal where the spinal cord and nerves travel. Bone spurs, thickened ligaments, and worn-down joints are just some of the changes leading to LSS.

These doctors from Baylor College of Medicine offer other orthopedic surgeons some guidance. They say that when a patient with a recent THR has severe pain after the operation, look for infection, an unstable implant, or LSS. Location of the pain is a key to diagnosing the cause of the problem.

Groin pain is likely caused by loosening of the implant socket. Muscle inflammation or LSS are two other possibilities. Thigh or knee pain often comes from loosening of the implant at the top of the thighbone. Any sign of nerve injury should suggest LSS. The patient may need a second operation to take the pressure off the spinal nerves. This is called lumbar stenosis decompression.

In older adults considering a THR, the doctor should look for lumbar stenosis. If testing shows both hip arthritis and LSS, the authors advise doing a THR first. Decompression surgery is only done if the patient has symptoms or problems related to the stenosis.

Guy R. Fogel, MD, and Stephen I. Esses, MD. Hip Spine Syndrome: Management of Coexisting Radiculopathy and Arthritis of the Lower Extremity. In The Spine Journal. May/June 2003. Vol. 3. No. 3. Pp. 238-241.

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