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    How can persistent pain in the hip be treated?

Posted on Tue, 11 Jul 2017 in Back Pain
Question: I had a left hip replacement in 1997. In 2005, I contracted a bacterial infection due to strep entering through deep wound in my foot. A regular hip revision was done, the tissue area treated with antimicrobial beads, followed by 8 weeks of antibiotics via picc line. In 2012, the hip device loosened. I had another revision, where tissue biopsy revealed presence of strep. Again, the tissue was treated, surgery was followed by 6 wks of picc line antibiotics. Since then, I have been on a suppressant dose of Keflex. In April, I developed acute pain in the left hip region. Blood tests show sharply elevated CPR & Sed rate.However, white cell count is within normal range. Fluid aspiration shows no strep. X-rays, MRI and bone scan show no loosening of the hip prosthesis. Bone scan report summary reads: "Increased perfusion with increased activity on immediate blood pool phase images in the soft tissues of the left lateral thigh/hip region around the arthroplasty. This may reflect hyperemia in the setting of inflammation, granulation tissue, or soft tissue infection. No significant periarticular uptake is seen within the osseous structures on the delayed phase images, or significant asymmetric periarticular uptake." I am waiting for my orthopedic surgeon to comment, but his office is very slow to follow-up on testing. To date, his view is that there is no specific evidence of infection and no loosening of the hip device. I have an infectious disease specialist who defers to the hip surgeon as the lead doctor. Meanwhile, after 8 weeks of anti-inflammatory meds including prednisone, I am still in continuing acute pain that is constant when sitting or standing, any position. As a result, I have no appetite and cannot sleep for more than 2-3 hours at a time. Can you advise if I should be following up with a specialist other than the orthopedic surgeon for diagnosing the cause of the pain. Or, should I find an orthopedic person who specializes in complicated hip revision situations. I am at a loss. I live in Williamsburg, XXXXXXX
Answered by Dr. Praveen Tayal 3 hours later
Brief Answer:
Pain is due to inflammation around the joint.

Detailed Answer:
Thanks for posting your query.
The persistent pain in the hip is due to an inflammation in the region as suggested by the bone scan. The antibiotics and prednisolone have not been able to control the inflammation. Local steroid injections at the hip joint can help for some time. it is best to consult another orthopedician who specialises in complicated hip revisions.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Praveen Tayal 40 hours later
We are getting a second orthopedic specialist to review the case. Based on test results to date, it appears that the inflammation is not being caused by 1) failure of the hip prothesis which is intact; 2) infection, since both test results and physical evidence show none; and 3) muscle/tissue irritation, since anti-inflammatory drugs have not reduced the pain. What are the possible other causes of acute pain and inflammation in the hip region, not necessarily related to the hip revision? Bursitis? Nerve damage? Blood clot? Blockage in an artery? Any others? We want to be as informed as possible in our discussion with other specialists.
Answered by Dr. Praveen Tayal 7 hours later
Brief Answer:
Can be an allergic reaction.

Detailed Answer:
Thanks for writing again.
The inflammation can be due to muscle or tissue irritation caused by the implant itself or bursitis. An allergic reaction to the implant can be there. Any blood clot or nerve damage or blocked artery is not likely.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12074 Questions


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