Question
QUESTION: Hi. I am 4 months post hip replacement and 55 year old female. I have still been dealing with severe swelling in my right buttocks and around the incision and severe pain in those areas as well as my inner groin area and leg. I have had an ultrasound of my buttocks, x-rays of my hip, and a CT scan of my buttocks and hip. The only answer I have received from my hip surgeon is that I have built up scar tissue in both my incision area and my buttocks. He said he peels the buttocks back from the hip to do the surgery and I have already been building excessive scar tissue and this is causing my severe pain on use and also the swelling. Also when I bend down and then up I feel a popping sound in my hip. I told my surgeon about this too. My answer from him was, massage the area 2-3 times a day for 15 mins at a time to try and break up the scar tissue but I may have to live with a swollen butt. Can you tell me what is going on with me and why this is happening. I talked to others who had the same surgery as me around the same time and they all are doing fine. Also I have the full metal replacement, Titanium. I have Titanium in other parts of my body and have never had a reaction to it. Please can you help me? Is there someone out there that I should be seeing to fix this or is there no fix? Thannks so much. I'm suppose to be pain free and I'm very depressed over this.

ANSWER: Hi Raye

I'm so sorry for all you are going through and I truly hope things get better for you soon.

I have a few thoughts for you. First of all, swelling is not uncommon up to six months post op, especially if the surgery was very hard on a person, so you might want to give it a few months more for the swelling to go down.  

The thing that concerns me most is your level of pain.  You should not be having severe pain at four months out of surgery.  You need to have your surgeon look at that more closely.  Especially with your complaint of popping of the hip.  

Popping can come about if a tendon or ligament is slipping over the prosthesis when you move. It's not dangerous, if that is the case, but it can be frightening to you.  

You can have massage on scar tissue, and if you can find a massage school in your area that offers student massage at a lower price, please look into that.  Do not let the students or even a professional therapist do any range of motion on your hip. You should only let them do massage on you.  If they do range of motion, that can lead to dislocation.

I would also suggest that you get a second opinion.  I personally have never heard of a surgeon having to peel away the buttocks to insert a prosthesis.  I'm not saying it's not possible, but I have never heard of it.  They do need to cut a large muscle to insert the replacement, but not peel away the gluteus to do it.  so please get a second opinion.

Sharon Davis

---------- FOLLOW-UP ----------

QUESTION: Hi again, by me doing this soft tissue massage will the scar tissue ever get smaller? And what you said about the popping is exactly what the surgeon told me. I may have been mistaken with his words about peeling back the muscle. But originally they thought it was fluid in there and then ruled that out with tests, then they thought it was a herniation of the buttocks muscle and the CT ruled that out saying it was scar tissue. I have also been very active as soon as I was permitted to walk and drive, which was about 8 weeks. Do you think that perhaps I'm over doing things? I walk every day and I also work outside around the house, which includes bending and such. The surgeon also told me that the swelling was from the scar tissue and most likely post surgical as you said, but it's this swelling that is causeing me so much pain. Also I have read that groin pain can be from the leg being longer then the other. The surgeon told me mine was only slightly longer and I wouldn't need anything in my left shoe. Do you think I should have him measure my legs on my next visit and suggest a lift in my left shoe to help relieve this? Thanks again so much for everything and I will keep you posted on what I find out.

ANSWER: Hi again Raye

I think what the surgeon meant was that he worked with the periformus.  That is a large muscle that must be moved or cut when the replacement goes in and that muscle takes a long time to heal, and can swell.  I had swelling in that area for over 8 months.  The periformus stretches over the backside and then twists near the hip.  It is a huge muscle.

I have not really heard of groin pain due to one leg being longer than the other, but it may be part of your problem. I have one leg that is almost one longer and I get pain in my back and thigh.  If your leg is less than 1/2 inch longer, then you will eventually adjust to the difference.  If the length is MORE than 1/2 inch difference, then I would suggest getting a lift made and you can insert the lift into your shoe.  A shoe repair shop will take an outline of the shoe you wish to put the lift in and then make one for you.   You slip the lift into and out of the shoe when needed.  I paid about thirty dollars for the lift.  Another option would be, if you have heels that you wear, the shoemaker can cut one heel a bit so the legs are even.  It the leg difference is the problem, once you use the lift, you should feel immediate relief.  I don't think insurance covers the lift, so if your doctor measures your legs and tells you how much of a difference there is in the legs, you can just go to the shoemaker and ask for whatever height the lift needs to be.

I used to run the administrative end of a massage school, so I was able to get student massages for a very low price and I got one massage a week.  I think student massages in general, run about $20.00.  A GOOD massage school will offer student massages, and I highly suggest that you do that.  It will help with stress, and definitely help with the swelling.  You must be sure to let ANYONE who touches you know that you have a replacement and they are not to manipulate the leg at all.  All they should do is something called "efflurage and petrisagge" which is basically rubbing your legs.  It will feel wonderful and some insurance companies cover massage therapy.  Massage is more than just rubbing, and unless you know what you are doing, self massage probably won't help much.  I could never do self massage and I was well versed in the different massage techniques.  There are areas you cannot reach on your own.  One student even gave me a bare butt gluteal massage which is basically working on the buttocks.  After I got over the initial shock of it all, I loved it.  Just make sure you go to a school and that you go to a reputable massage therapist who is NATIONALLY CERTIFIED.  If the therapist is not nationally certified, do not, under any circumstances use that person.

If you find a reputable massage therapist, ask for a type of massage called "Manual Lymph Drainage", or MLD.  That is a very specific massage technique that would be fabulous for you because it is designed specifically to reduce swelling, but it you will have to have it done on a regular basis until the swelling goes down.  

I'm thinking that your surgery was a hard one to experience so much swelling.  It will go down, but please give it time.  I truly know your frustration, as one of my revision surgeries had me in a body cast for a few weeks and my swelling lasted almost 8 months.

Please do keep me posted and let me know what you find out and if you go for the massage.

---------- FOLLOW-UP ----------

QUESTION: Hi Sharon, do you think the massages on my buttocks which is what the doctor said had to be done, will reduce the scar tissue that has built up in there? I do have a tendency to build more scar tissue since it's shown up with all of my other surgeries. Thank you again for everything.

Answer
Hi again Raye

I can't say for sure if the gluteal massage will help.  If you are going to look into massage therapy, ask about manual lymph drainage.  (MLD)  That will be more effective to reduce swelling.

Efflurage and Petrissage will help with the scar tissue.

Sharon