How to regain function in stiffness after hip replacement surgery?
Q: I have had a total hip replacement of my left hip 9 years ago. Since the cup had become loose I had a revision surgery done 3 years ago. Only the acetabulam was replaced. Subsequently, chronic infection had set in. Despite drainage surgery the infection persisted. The implant was removed last year. The left leg has become shorter by 11/2 inches and I wear corrective footwear and use an elbow crutch as a support while walking. But now I have a new problem. Due to new bone growth (calcification) at the hip joint I'm unable to bend, sit straight without a back support. I am verticularly handicapped while using a commode and need assistance to wear socks, shoes etc. I cannot sit in a low chair which makes travelling difficult. I cant bend the left knee more than 30 degrees. Chronic mild pain (at times severe) persists. The new bone growth had started within a few days of removal surgery. Can a surgery to remove the new bone growth help? Since I am prone to new bone growth can any treatment, such as radiation, be done soon after surgery to prevent new bone growth? Can I be normal and independent after such a surgery? What will be the success rate of such surgery? I am 68 years old and other than this problem I am in good health.
A:It seems you have developed heterotropic ossification in your hip joint. This results in stiffness of the hip joint and significantly restricts activities. Yes, it can be removed provided there is no evidence of activity in the ossification, this can be assessed by looking at serial X-rays. If two consecutive X-ray do not show evidence of increase in density or size of ossification, then it is likely to be a mature ossification. At this stage it can be removed, however, there is always a risk of recurrence of the problem. You are also right on radiation as a possibility. However, this is reserved for some of the bad cases and not often resorted to. More commonly, a drug called Indomethacin can be given after surgery. This also reduces the incidence of ossification. However, this does not remove it completely. At your age, if you are handicapped enough even for your activities of daily living it is worth considering repeat surgery and Indomethacin. It cannot be normal after surgery, but you should be able to regain movements sufficient enough for activities of daily living. I would recommend that you consult your orthopaedic surgeon and re-consider the whole decision after clinical assessment.