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There are several different ways of performing a hip replacement. In any operation some muscles will be split/divided and later repaired. Occasionally this disruption of the muscles can cause prolonged discomfort or weakness. It is important to differentiate any muscle pains damage to the adjacent nerves. In a small number of patients these symptoms can be intrusive requiring treatment in a pain clinic [ Function after total hip replacement for primary osteoarthritis. Johnsson R, Thorngren KG. Int Orthop 1989; 13: 2215 A rather old retrospective study of over 500 patients after total hip replacement reported an incidence of pain on sitting of 16% and pain on walking of 35% at follow up of 42171 months. The implants used were poor and there was no psychological assessment in this paper.].

Approaches to the hip joint

In this section you can see that the hip is en-sheathed in muscle. Access to the joint must allow easy introduction of instruments into the acetabulum and down the shaft of the femur.

All approaches traverse the tensor fascia lata, or its flat tendon. This may lead to post-operative trochanteric bursitis in a small number of patients.

Posterior Approach

As the majority of the dissection is at the back of the hip any residual muscle pain is commonly in this area. Sitting may cause some discomfort, especially on hard surfaces.

There is a very small risk of sciatic nerve irritation after this approach [ Sciatic nerve palsy--a complication of posterior approach using enhanced soft tissue repair for total hip arthroplasty. Lohana P, Woodnutt DJ, Boyce DE. J Plast Reconstr Aesthet Surg. 2010 Apr;63(4). A good review accompanies case report where the nerve was caught in a suture. http://www.ncbi.nlm.nih.gov/pubmed/19944660]. Nerve damage may cause weakness in the muscle to the foot, "drop foot". This is a rare complication and in the majority it is temporary.

Anterolateral Approach

These approaches affect the large muscle that stabilizes the hip during standing and walking. After six weeks of recovery a small number of patients will require additional physiotherapy.

Permanent weakness is rare in the absence of trochanteric avulsion.

Anterior Approach

Dissection on the front of the hip may result in discomfort during deep flexion. This may be due to scar tissue, or inflammation of the iliopsoas tendon.

Great care must be taken during this approach to avoid damage to the lateral cutaneous nerve of the thigh, otherwise chronic neurogenic pain is likely.

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