Hip arthrodesis following DDH

by Kate
(Denmark)

Hi,

I was born with DDH. It went undiagnosed for 9 months until I was sent to a specialist who attempted to correct my problem. After splints, and several failed arthroplasties, the only option was to perform a hip arthrodesis, where my hip was set at approximately 30 degrees flexion, and I can't remember the degrees adduction. The fusion was performed when I was 12, and I am now 30.

Since then I have developed a slight ipsilateral valgus knee (9 degrees valgus I believe), and have had stiffness in my lower back, which is to be expected.

I have also been experiencing sharp pain in my buttock, and today extreme thigh pain (contralateral) which presents itself as a burning sensation after rest, which causes me to limp for about an hour, and then the pain disappears.

I am wondering if this could be MERALGIA PARESTHETICA. My physiotherapist tends to manipulate my spine, and massage my neck, without discussing ways to prevent further problems.

I train at the gym reasonably frequently, to keep my thigh muscles, and muscles supporting the knee (especially vastus medialis) strong. I am wondering if it would be better to see a Chiropractor. Do you have any thoughts about my case? I would love to hear from you.

Kate




Hello Kate,
Alas all doctors screw up sometimes, I know I do, but missing that hip dysplasia was a very serious ommission by the paediatrician. That splint has to be applied before 6 months.

You don't say where in your thigh you have the pain. Just to confirm... it's not in the leg where you have the hip arthrodesis?

The Superficial Femoral Cutaneous nerve supplies the side of the thigh, and a variant can go into the groin and anterior thigh. Definitely not the back of the thigh- then you are looking at the sciatic nerve.

Do you have any pain/ stiffness in the upper lumbar spine? When you bend backwards and sideways, is it stiff in the back, and does it radiate to the thigh?

Do you have any pain in the groin, and just medial to the ASIS where the nerve emerges from the pelvis?

It's an area that I have a particular interest in, but you would need to ask. I suspect a fair number of chiropractors (Physios, and medics too) have never heard of MP. They have to address the upper thigh and the high lumbar spine. Both, or it won't get better.

Important to rule out a Femoral nerve lesion, then the quad reflex may weaken, the muscle too.

But of course, it could also be a sacro-iliac joint problem. What's needed is a careful,thorough exam. Take your X-rays to the chiro.

Try the Maignes syndrome exercises at Chiropractic-Books.com. They might help.

Look too at a short leg. Even a few mm of a leg length deficiency can make a huge difference. Don't believe the stuff that it must be 15mm different to be clinically significant. Bunkum.

I hope this has contributed.

Dr B

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Oct 16, 2011
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Continued Meralgia Paresthetica / Hip dysplasia
by: Kate

Meralgia Paresthetica / Hip dysplasia

Hi Dr B,

Thank you for your prompt reply! Your website is amazing, I've spent hours reading your articles, and I'm grateful that you've taken the time to consider my story.

The pain I have been experiencing has been different on both sides of my body. On the left side (the healthy hip) I have had stabbing pain in my left buttock, which led me to think sciatic pain. However just very recently, I have had pain in the thigh on the right side (the operated side) which for me was quite unusual, as I have never experienced pain on that side.

The pain on the operated side has been in the outer thigh, which feels like burning and pinching. This always comes after rest, when I have tried to walk. The muscles don't feel weak, but the pain causes me to limp. I wondered (perhaps ignorantly) if a nerve after 18 years has finally connected up again after being cut so many times, as I sometimes experience pinching around the scar area (lateral thigh).

I have palpated the groin on the arthrodesed side, which feels tender, and sometimes I experience a sharp pain in the groin, on the operated side.

When I do a lateral flexion, it is stiff in the upper and lower lumbale area, sometimes the pain radiates down the right hand side towards the knee. Extension of the back is not stiff, but a forward flexion causes my spine to crack, especially in the morning (which oddly feels rather relieving!).

I will look into the Maignes syndrome exercises, as you suggest. My biggest fear is getting to the age of 40, or older, and having arthritis of the spine.

I really appreciate your time. It's funny because I am a physiotherapy student, and I've always been told that there was a rivalry with Chiropractors! However I have found your website professional, and extremely informative.

Thank you for your help.




Thanks Kate. There is rivalry, but it's mostly healthy. We both have much to offer to the patient in pain.

Our latest newsletter #25 was on arthritis. Read it. There's much to be done.

That right lateral thigh pain sounds pretty typical of MP, both the groin and the upper lumbars have to be addressed to get over it. Watch for a loss of quad reflex though.

Type Slump Test into the Search engine for a good test for sciatica. I hope you can find someone to help.

Dr B



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