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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I had right hip surgery 4 years 5 months ago,,I ended up with

Customer Question

I had right hip surgery 4 years 5 months ago,,I ended up with drop foot now poor circulation right after surgery my foot still has limited movement.I went from a cane too a walker now I have idiopathic generalized peripharal neuropathy,,I have extreme pain in my groan my hip burns feels like my toes are being cut off and slabbing in my foot as I'm typing too you..I am on Gabpentin 300mg 6 times a day now the neurology said 8 a day,,why am I still in a lot of pain it doesn't even feel like I had,,had a total hip replacement it hurts just like before I had it done please I need some answers,,
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

neuromd2012 : Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.
neuromd2012 : hello
neuromd2012 : are you there?
neuromd2012 : can you enter the chat?
Customer: yes i am here
neuromd2012 : as this is now almost 5 years old, I would categorize you as havig a failed total hip replacement
neuromd2012 : have you had a bone scan?
neuromd2012 : or any evaluation of your replacement hip
neuromd2012 : you are on 1800 mg of gabapentin a day, and if this is related to the hip replacement,
neuromd2012 : I would consider getting an orthopedic opinion on the status of the joint itself, do you have
Customer: yes i had a bone scan
neuromd2012 : a malunion, or some other process leading to problems
neuromd2012 : as a neurologist, I would not push your gabapentin much higher than 1800
Customer: ?? malunion confussed
neuromd2012 : and would consider a change to a different medication
neuromd2012 : well you prosthesis can have a problem at the femur
neuromd2012 : where the shaft is not in good contact with the prosthetic itself, and the motion within the bone leads to periosteal pain
neuromd2012 : it is called a malunion of the prosthesis
Customer: I have had several opinions on my hip replacement and no one seems to no the problem
neuromd2012 : ok
neuromd2012 : well I am here online, so I am just bringing it up
neuromd2012 : but if you have been evaluated for hip problems, and still have hip pain,
neuromd2012 : I would still feel it is related to the prosthetic, rather than part of your idiopathic neuropathy
Customer: So how do I start to correct this problem
neuromd2012 : well I assume you have tried therapy over the years, has it helped?
neuromd2012 : you can consider other neuropathic medications, like pregabalin
neuromd2012 : or duloxetine, or amitryptaline
Customer: to an extend therapy helps but for limited time maybe 1 day
neuromd2012 : I see
neuromd2012 : is pain the major problem at this point? or your disability, an inability to walk?
neuromd2012 : for the strength issue, if determined that your replacement is as good as possible, you only
neuromd2012 : have physical therapy to try and improve muscle tone and strength
Customer: i want my life back i do not want this pain I have been to so many doctors and no one has a answer for my condition I am at my end I never had this prior now I'm worse and just my balance is of if I try to walk I loose balance and will fall so it.s been very difficult
Customer: I do once a week and follow my excerises faithly 3 times a day at home..i'm confused thou with the damage of my nerve
neuromd2012 : well online, I am at a distinct disadvantage, as you can imagine, but there are other medications for pain
neuromd2012 : foot drop is a known complication of hip replacement
neuromd2012 : you are aware of that correct?
neuromd2012 : has it not come back at all?
Customer: Not at the time of my surgery it was never dicussed with me only blood clots
neuromd2012 : it is a low percentage, just one or two percent
neuromd2012 : hang on
Customer: never heard of foot drop and yes my foot still flops and drags
neuromd2012 : here is a johns hopkins website discussing how hip replacement surgery can be an etiology of foot drop
neuromd2012 : http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/peripheral_nerve_surgery/conditions/foot_drop_injury.html
neuromd2012 : have you tried the synthetic opiates for neuropathic pain, like Nucynta?
neuromd2012 : I hope I was able to give you some useful information.
neuromd2012 : come back anytime if you have questions
neuromd2012 : Dr Frank T
Customer: no what is it??
Expert:  Dr. Frank replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Frank replied 1 year ago.
HI. Here is a webpage on this medication. It is a combination of a synthetic opiate medication that has NSAID properties (nonsteroidal anti-inflammatory) so it is useful in moderate to severe joint pain, it might help with the hip discomfort, and can be used with gabapentin on a daily basis.
Please get back to me to discuss as needed. Dr Frank t
http://reference.medscape.com/drug/nucynta-tapentadol-999202
Customer: replied 1 year ago.
I have more question to ask I sent the questions where are the answers to my question I sent 5 minutes ago
Expert:  Dr. Frank replied 1 year ago.
Hello. I do not see your questions. The website has been acting squirrelly today and many postings have been dropped. You may need to post them again.
Customer: replied 1 year ago.
I have another question to ask regarding my hip. Should I have this hip taken out and a new one again? I think they call it a revision. Also would this help with my drop foot. Did the nerve damage come from the hip replacment?
Expert:  Dr. Frank replied 1 year ago.
These are questions that I cannot answer online with any certainty, without any laboratory or physical exam information. I can give you some information that you might be able to ask your doctors.
If your foot drop/peroneal nerve palsy was temporally related to the hip surgery (started within 3 weeks of the surgery), then it is a known complication and would be related to the surgery. Your idiopathic neuropathy, if axonal type, could have contributed to the outcome of a foot drop in the setting of the hip surgery, as it potentially could make your nerve, which passes just behind the hip joint, become more vulnerable to injury during surgery. Since you have had this problem with a floppy foot that comes and goes over 5 years, it is unlikely that the revision of your hip would help this nerve, but I am saying that without your EMG data, that would help to answer that question. And finally, do you need a revision of your hip? That is hard to say from here, but your pain level as you state it suggests you might. My suggestion would be to see a PMR (physical medicine and rehabilitation) doctor and ask him to perform a functional capacity examination, and test your hip. Using that information, and the results of an imaging study of your hip (bone scan) you would have to ask an Orthopedist if a revision would give you additional strength and less pain. You mentioned earlier that you had asked several doctors and they had said no, so I am wondering why you are asking me here online, you must feel they are all wrong. This is difficult to answer, certainly there are risks for this surgery. I am here in NYC area, and we send people with prosthetic problems to the HSS, hospital for special surgery, in Manhattan, as they have a special program to evaluate these situations. If you read their webpage, they mention that up to a third of prosthetic knee replacements do need revision, but that the percentage of hip replacements are lower. Reasons for replacement are low grade infection, a worn out prosthetic surfaces, or the malunion I mentioned earlier.
I hope I was able to answer all of your questions, please get back to me if you have more, or rate my service is satisfied as that is how I am compensated for my answers Dr Frank T
Customer: replied 1 year ago.
Regarding my drop foot. I walked into the hospital normally, and after the operation, I had drop foot. I noticed it on the 2nd day when I was not so drugged and could not move my foot. My sister told me it was drop foot and we called the nurse in and they did indeed say it was drop foot. The drop foot was caused from the surgery.
P.S. The drop foot happened immmediately, right after surgery - not 3 weeks later and I have had 5 EMG tests done and it shows that I have Idiopathic generalized peripheral neurophathy. I have had blood tests done and everything is normal. I am not a diabetic and I do not drink and the 3rd reason they gave me was "we don't know what is causing all these problems, as I am deteriorating further. What does IDIOPATHIC generalized peripheral neuropathy mean? I have read and looked it up and it is too confusing for me to understand. Could you please tell me in laymans words and not medical terminology? thank you again.
Expert:  Dr. Frank replied 1 year ago.
3 weeks is the cut-off for your foot drop to occur, it can happen in 24 hours, but the longest time is 3 weeks.

idiopathic generalized peripheral neuropathy means we don't know. The other term is essential neuropathy. Idiopathic neuropathy is given to patients that have been screened for all the known causes of neuropathy, and come up negative on the screening tests. That includes heriditary, metabolic or nutritional, toxic, infectious, autoimmune, all these groups of diseases that are known to cause neuropathy.
http://peripheralneuropathycenter.uchicago.edu/learnaboutpn/typesofpn/idiopathic/

that is as simple as I can make it. But if you think about, just because we don't know the reason doesn't mean there is no reason. Did you get a nerve biopsy (sural nerve usually) and have it sent to a neuropathology lab?
The best peripheral nerve neuropathology lab in the country is run by Dr Peter Dyck, at the Mayo Clinic. They might be able to give you a reason. I will also attach his webpage.
http://mayoresearch.mayo.edu/mayo/research/staff/dyck_pj.cfm

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