THR Nerve pain with thigh muscle atrophy after THR

Kingster23

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I had my right hip replaced with the anterior method September 16. I believe I had an epidural nerve block. Subsequently I have had (mainly lateral) nerve pain down my thigh from the surgical site. It's largely what I would call cutaneous nerve pain in that it hurts to touch the thigh. Initially it was very painful to have clothing or bedsheets touch my thigh. I'm happy to say that things seem to be (very) slowly improving. However, the other strange complication is the loss of muscle mass in my right thigh. This was apparent soon after the surgery (within a week or so) and it hasn't improved much since. Interestingly, with physical therapy three times a week, I seem to have gotten pretty good strength in the thigh. But it is nevertheless disconcerting. My thighs were thin to begin with, but now I feel like Big Bird on the right side. Does anyone have any similar experience?
 
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I have had a similar experience. I had my left hip replaced five years ago and experienced a great deal of sensitivity on the outside of my thigh. I couldn’t bear for fabric to brush against it. I took to wearing first aid tape over that area to protect it from my skirt or nightgown. I also experienced a pins and needles feeling several times per day. The hypersensitivity gradually cleared up over several months—maybe a year—and the pins and needles sensation also waned over the years. It is no longer a daily occurrence, but sometimes still happens. The area is still tender to the touch.

I’ve also experienced the muscle atrophy you mentioned. I have a bit of a divot in my thigh. My leg feels like it has concrete inside it and has not recovered full strength. I did several years of physical therapy, including massage and taping. The fact that you are improving is a really good sign that your nerves and muscles are recovering from the trauma of the surgery.

I count the stairs where I work, and that is how I tell I am still making progress with strength. Two years ago the muscle fatigue kicked on at step 4; last year it was around step 9; now I get to step 14. There are 19 steps and I hope someday to bound up them without having to provide extra “umph” at the top.

I hesitate to share my experience because I don’t want to cause anyone anxiety or discouragement. My surgery was complicated, my congenital anatomy was rearranged, and in the process, my femoral nerve was aggravated. My surgeon used the anterior approach. No one really told me what had happened until I consulted several other surgeons regarding replacing my right hip—which is scheduled for a few days from now. Apparently, femoral nerve damage is a rare but known complication of the anterior approach. I will have the minimally invasive posterior approach this time and am hoping for a positive outcome.

Be patient with the process and I am sure you will feel much better soon.
 
@Kingster23 Welcome to BoneSmart! It's not unusual to have muscle atrophy pre-op. Limping around pre-op impacts many areas as you are trying to stay off a sore hip. The good news is PT seems to be working for you.

I'll leave your recovery guidelines here for you:
Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Thank you for the encouragement. I'll try to be patient. I had been playing tennis and table tennis 3 times each per week before my hip got bad and Covid. I'm hoping I can return to that. National and World Senior Games may resume next year and I enjoy competing in them. The therapist is going to try to get me back to a condition where I can compete. I know I tend to push too hard (too many 2+ mile walks early on). The PT is trying to slow me down! Anyway, it's reassuring to hear that atrophy does sometimes occur. I'm seeing the surgeon's PA next week so they can have a look-see. The surgeon is quite good. He's #3 in the country in anterior THR operations performed and his patients adore him. So I'm hoping things will turn out well.
 
Happy Monday and a Happy Two Month Anniversary!
Patience is key, slowly but surely you’ll get there.
It’s great to have faith in your surgeon. I hope you have a good visit with his PA next week.
Be safe, stay well and in touch. :wave:
@Kingster23
 
Thank you. Progress is really slow. I feel quite good one day and have lots of pain the next. I don’t know why. I should mention that I’ve found straight leg raises to be extremely difficult. Painful in the groin area. So I’m not going to try them anymore for a while. PT today and tomorrow and then none for 12 days as I am flying to tropical Minnesota. No, not for the weather. . Family. I understand covid has increased there so will be diligent. I need to get suggestions from PT for exercising while at an Airbnb with no gym or equipment. I did see the surgeon’s PA a couple weeks ago. He urges patience and, if no relief, he’d consider a cortisone shot. So, that’s brief update. Thanks for listening!
 
@Kingster23, we have much in common. My family is in Minnesota, too. I decided long ago to not travel there for the holidays this year, and that was a factor in my choosing to undergo a second hip replacement two weeks ago. I did, however, fly to Michigan and Minnesota about two months after my previous hip replacement (April 2015). I brought my cane on board and everyone was very nice to me and gave me room to maneuver. I think our seats were upgraded on at least one flight. I made sure to elevate the operated leg on my tote bag. It wasn’t a problem. I’m sure your PT will have exercise suggestions using walls, furniture, chairs, etc. in your Airbnb. Enjoy your visit whilst avoiding COVID. And be very careful to avoid slipping on the ice!

If I may offer more advice, its about those straight leg lifts. I drove myself crazy trying so hard to do them after my first hip replacement. Every physical therapist would urge me on, shouting “harder, harder, harder.” I just plain couldn’t do it and that made me cry. I don’t like to fail. It took eight weeks before I got that little 1/2” liftoff. I told myself this time around to just do what I can do with normal effort. No straining, no inducing groin pain, and no tears if I can’t do something. It just means my body is not ready yet. It will come. Please be patient. Your anatomy got reoriented and its quite likely a nerve is irritated and not ready to fire up those quads.

This surgery, I did a little tiny straight leg lift in the recovery room. You can only imagine my joy! At two weeks out, I do 10 gentle lifts every day, stopping right when I feel the least little bit of pain. I’ve found it really helps to start the effort with my core muscles, not my leg muscles.

Finally, as I’ve read so often on this forum, the goal is to walk without a limp and to be able to enjoy your chosen activities, such as tennis. If you never do the leg lift, you’ll still be fine.

Say hi to the frozen northland for me!
 
Wow, if your PT wants you to to slow down that's saying something! Obviously, you need to slow down. It might feel excruciatingly slow, but it will feel worse if you injure yourself and it sets you back. Speaking from experience here, when too many straight leg lifts injured me and I had to back off completely for almost 3 weeks.

Did your surgeon diagnose the femoral nerve damage? Your nerves can be angry adter surgery but not be technically damaged. It's common to have angry muscles and nerves. Sigh.

I'm almost at 6 months and it seems pains come and go for sometimes no apparent reason. My husband says it's like a balloon-- squeeze it somewhere and it pops out somewhere else. Hang in there!
 
No PT for 12 days sounds like a good vacation! Might be interesting to see if you have more good days in a row without PT.
 
Well, things have shifted to a different concern. The nerve pain issue slowly improves but I’ve got a new issue. For the last week or so I’ve gotten increasing “groin” pain. If I didn’t know better I’d think it is an inguinal hernia, but I had mesh put in there about 6 years ago so that shouldn’t be the cause. It hurts when I bend forward and straighten out. I can reduce the pain with ibuprofen, but can’t get rid of it. Before, I’d occasionally have pain in that area but it’s now always there when I bend. It’s quite frustrating in that it makes me wonder if something’s up with the hip.
 
I had groin pain off and on through my first months of recovery, more often after extra activity or too much too soon PT exercises. It can be a common plaint with new hippys but because if referred pain in this area may be difficult to isolate the actual reason.
Hope you are still abstaining from the straight leg lifts as you don't want to deal with chronic tendonitis.
The Iliopsoas could be the culprit?

The iliopsoas muscle joins to the femur at the lesser trochanter.
Here is the article in our library about Iliopsoas syndrome
 
Thanks for the iliopsoas information. I’ll try some of the exercises.
 
Hello,
It‘s good to read the nerve pain is easing, I hope the groin pain is also. It’s a special day...
Happy Three Month Anniversary!
I hope things settle for you soon and you enjoy a Merry Christmas and a joy filled, healthy New Year!
@Kingster23
 
Thank you Layla. I have scheduled a CT scan for the 30th to see what’s going on. I’m hoping I’ll be canceling due to improvements by then. My body has always been a mystery to me.
 
Happy Four Month Anniversary!
Wondering if you had the CT scan a couple weeks ago?
I hope your New Year is going well so far and it wasn’t necessary after all.
Wishing you peace, healing and all things good in 2021! :)
@Kingster23
 
So I've reached my five month anniversary. On a positive note, the nerve pain issue has pretty much resolved. There's numbness south of the incision, but that's a lot better than pain! I also started playing doubles tennis a couple of weeks ago. I don't have the quickness I had previously, but maybe that will come back with time. My chief complaint is still the groin pain. It's there when I lift my leg, straight or bent. It seems to go down my inner thigh a few inches. I'm guessing it's probably tendon-related. I still can't do straight leg raising without pain, so I avoid it for the large part. The good news is that the pain is tolerable. It hasn't stopped my tennis although it makes me reluctant to push things too far. I just have to let some of those balls go. I'm hopeful that, with time, the pain will diminish. I played doubles today with a fellow who had his replacement two months earlier than mine, and he has pain on the outside of his hip. So, it's always something. I think we'll both get better with time. Thank you for your support!
P.S. I canceled the CT scan because the pain had become less severe.
 
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@Kingster23 Give it a year! Full recovery from THR takes at least 12 months. You are not even half way there yet and already playing tennis. Well done - but there is more healing to come. Patience prescribed.
 
Glad that your nerve pain has improved.
I also play tennis and am excited to return, but I’m just four weeks from the hip replacement.
My doctor told me that I should play doubles from now on, but not singles. I honestly love playing singles. Has your doctor told you the same?
 

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