A Common Surgery, a Rare Outcome
Total hip replacements are one of the most common orthopedic surgeries in the US, and will soon be approaching 500,000 performed every year. Unlike other common orthopedic surgeries, which aren’t always as successful, total hip replacement is actually one of the most successful orthopedic surgeries. Just like any surgery, however, complications can occur. After surgery, about 4% of people report having continued pain in the front of the hip. Although it’s different from your run-of-the-mill hip impingement, it’s usually referred to as hip impingement. After a total hip, the causes of your continued hip pain could be due to surgical components being more prominent and irritating your tendon as it rolls over the surface of your hip joint.
One of the most commonly recommended ways to treat hip impingement after total hip replacement is called an iliopsoas tenotomy. The word “tenotomy” literally means “cutting the tendon.” Because you have multiple muscles that move the hip into flexion, you can release the iliopsoas tendon and still be able to flex your hip, albeit with less strength. To see the procedure being performed, you can watch it here. The surgery is somewhat successful in terms of removing the pain associated with hip impingement, but keep in mind that now you will have greater difficulty moving your hip. For this reason, conservative treatment is usually recommended first – but what does that consist of?
Treatment methods for impingement after total hip replacement can be “conservative treatment.” Unfortunately, the research appears to place a cortisone injection as the main conservative treatment for this condition, and physical therapy is inconsistently recommended. The problem with cortisone injections are that they don’t appear to be very effective for tendon pathology in the long-term, and can even be somewhat harmful on the tendon structure. For example, you can read our blog post on an article describing worse outcomes in gluteal tendon problems when a cortisone injection is given. Secondly, some of the research still recommends stretching the tendon. While this might feel good at the time, most physical therapy researchers now don’t recommend stretching tendons when compression could occur, as it could aggravate the tendon. As part of the reason for this condition may be irritation against the hip surface, it doesn’t make a ton of sense to continue to pull it against the surface during a prolonged stretch.
A case study I wrote was recently published by that describes the outcome of one of our patients who had continued groin pain after total hip replacement and ended up having a positive outcome with physical therapy – even after the iliopsoas tenotomy was performed. You can read the full case report here. The physical therapy treatment primarily consisted of improving gluteal strength (which serves to restrain movement of the head of the femur forward and inward) and to improve mobility of the hip into external rotation and flexion. We did do this through stretching, just not stretching of the hip flexor tendons in the front. Joint mobilization and patient stretches were key to improving mobility and allowing this gentleman to regain the ability to move his hip better again.
Send us an email or message through the website with any questions specific to your condition. We are doing free consultations, where we can give you a realistic idea of what improvement you may be able to see with appropriate physical therapy!