From the Guidelines
Managing hip pain and gait disturbance after hip replacement requires a comprehensive approach combining medication, physical therapy, and lifestyle modifications, with the most recent evidence from 1 suggesting the use of scheduled acetaminophen and NSAIDs as the foundation of pain management. The initial management should include scheduled acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) and NSAIDs like ibuprofen (400-600mg every 6 hours with food) or celecoxib (200mg daily) if tolerated, as recommended by 1 and supported by the findings of 1 and 1. For severe pain, short-term opioids such as hydrocodone/acetaminophen may be prescribed for 1-2 weeks, but their use should be cautious and monitored due to potential side effects and the risk of dependency, as noted in 1 and 1. Physical therapy is crucial and should begin within 24 hours after surgery, focusing on:
- Progressive weight-bearing exercises
- Gait training with appropriate assistive devices (walker initially, transitioning to cane)
- Specific strengthening exercises for hip abductors and extensors Patients should adhere to hip precautions for 6-12 weeks, including:
- Avoiding hip flexion beyond 90 degrees
- Internal rotation
- Crossing legs Regular ice application (20 minutes every 2-3 hours) helps reduce inflammation, while maintaining proper posture and using elevated toilet seats and shower chairs prevents strain, as suggested by the general principles of postoperative care. If pain worsens, is accompanied by fever, wound drainage, or significant leg length discrepancy persists, immediate medical attention is necessary as these could indicate infection or implant complications, highlighting the importance of close monitoring and follow-up, as implied by the guidelines in 1. Most patients see significant improvement in gait and pain within 6-12 weeks as tissues heal and muscles strengthen around the new joint, emphasizing the need for patience and adherence to the rehabilitation plan, as supported by the evidence from 1 and the principles outlined in 1, 1, and 1.
From the Research
Managing Hip Pain and Gait Disturbance after Hip Replacement
- Hip pain and gait disturbance are common complications after hip replacement surgery 2, 3
- The causes of hip pain after total hip arthroplasty can be varied, including failure of fixation, infection, instability, and mechanical dysfunction 3
- A systematic approach to evaluation and diagnostic investigations is necessary to identify the underlying pathology of a painful hip 2
Diagnostic Investigations
- Evaluation of the painful hip should start with a careful history and review of preoperative radiographs 3
- Serologic tests, such as sedimentation rate and C-reactive protein, can be useful in diagnosing infection or loosening 3
- Imaging studies, such as radiographs, bone scans, and computed tomography scans, can help identify loosening, wear reactions, or mechanical dysfunction 3
Risk Factors for Complications
- Certain patient factors, such as male sex, younger age, elevated body-mass index, diabetes, and dementia, can increase the risk of revision for prosthetic joint infection after hip replacement 4
- Surgical factors, such as the use of the lateral surgical approach, can also increase the risk of revision for prosthetic joint infection 4
- The use of ceramic rather than metal bearings may be associated with a decreased risk of revision for prosthetic joint infection 4