Richard Haynes PTA/CPT - 5/19/2009

Question
Richard,
My father-in-law broke his hip and had a partial replacement (new ball only).  He is 80 years old and after 10-12 weeks of PT he is barely walking with a walker because he complains of pain in his front thigh just above his knee when he puts weight on the leg.  He has had a very slow recovery and only at 8 weeks post-op did they begin walking PT.  He has never had a broken bone in his life so he may not realize the amount of pain that would be "normal" in this situation.  Xrays taken at 8-weeks post-opt showed everything OK with the replacement.  Could you advise on how long moderate-to-severe pain may be felt due to the prosthesis?  Would it be pain in the bone or muscle pain?  Thanks in advance.

Answer
Hi Paul,

These types of injuries can take up to 10-12 months to heal completely. The speed also in which he gets back to walking correctly and the pain lessens will depend on how active and strong he was before the surgery.

The fact that he started walking eight weeks into the recovery assures me that it will take longer then the average partial replacement takes.

The pain just above the knee is generally from compensation in his gait pattern not walking correctly using a good heel-toe gait. Muscle weakness in the thigh will cause some of that and  possibly some referred pain from the injured site.

The pain should be getting less each day. he has to be sure he is getting his exercise in daily, walking every hour or so, and use heat on the area as well to keep the pain down if needed.

the pain is not coming from the prosthesis itself it's surgical pain only and it should be much less then it was at four weeks.
Give it another two weeks and see where he is at.

The pain is strictly muscle pain only form my experience.

Some patients also get apprehensive with these injuries become anxious when they walk tighten up etc...which causes the increased pain and the overall delay in the healing process.

If everything checks out according to the surgeon then its a matter of time everything should be fine providing he does not slow down his rehab efforts and stop walking. That would be the worse thing he could do.

Also if he is able and cleared by the doctor a pool would be beneficial at this time for recovery.

Strengthening  the thigh, hamstrings and abductor muscles which are on the side of the hip are extremely important. The therapy he was getting however always includes these exercises and they should still be done on a daily basis at this time.