Adam Rufa - 9/24/2006

Question
Hi Adam,
I am ten weeks post-op with a total hip replacement.I have done everything by the book and have been meticulous in obeying my hip restrictions. I have the Big Femoral Head,metal on metal. And it is clunking. It isn't audible, but that is the sensation. It started with the hip flexion and extension excercise at approx 2 weeks post-op and now happens constantly,not just in physio but even with small shifts in my body weight while standing or sitting. It happens when I stand up, when i sit down,moving in bed, and in almost all of the physio excercises.

The phsyiotherapist is concerned "the head may be moving" and I am now waiting for an appointment to visit my surgeon again.In the meantime I am a bit anxious.If the head - or any other part - is moving, what does that mean? How can it move? What is the risk and how much should I dare to move around?

By the way the operated leg now has an additional 1 centimetre(real, not functional). Could that have anything to do with the clunking?

Many thanks for your help.This forum is invaluable.

Elizabeth

Answer
Congrats on the new hip.  

I often have pts complain of clicking after their THA however, an actual clunk is not a normal complaint. A clunk can be indicative of excessive motion at the prosthesis. This can occur for different reasons including improperly sized hip, failure of the prosthetic device, failure of the cement/bone fixation or the ball is not seated properly in the socket. All of these problems almost always require a revision of the surgery.

Now don't get too upset. What I stated above is the worse case scenario and chances are everything is ok. The above problems happen in very few cases.  The clunk could be coming from your back, knee, ankle or maybe even your imagination. Talk to your PT about how much you should move around. As long as you are not getting unusual amounts of pain you should be ok.  Your PT can let you know if your pain levels are within the norm.

Let me know what the surgeon says!


Adam

PS: the head of the hip has to move, the question is does it move too much.