Misdiagnosed hip disease and lumbar pain leads to unnecessary knee and back surgery

Back surgery for hip pain? Knee surgery for back pain?

Researchers are advising doctors that they must carefully examine and look for hip joint deterioration before giving a recommendation for back and knee surgery. Why? Doctors may be performing the wrong procedures. Writing in the medical journal Modern Rheumatology, doctors wrote “We suggest that rheumatologists be aware of hip disease masquerading as knee pain or low back pain.” 1

Here is another interesting study out of the United Kingdom. Writing in the medical journal International Orthopaedics, researchers sought to explain why “up to 20% (of total knee replacement patients) complain of persisting pain.”

So at Lister General Hospital, Stevenage, UK, Doctors looked at Forty-five consecutive patients with painful total knee replacement. Of the 45 patients, 15 patients had degenerative hip and lumbar spine disease. Nine patients had unexplained pain.

Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis

The doctors concluded: “Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.” (2)

In another study, researchers suggested “In elderly patients who do not respond to treatment for hip and/or knee joint diseases, Lumbar nerve root radiculopathy should be considered as the cause of lower limb pain.” (3)

At the Magaziner Center for Wellness we understand “referred pain.” Referred pain is defined as pain perceived at a location other than the site of the painful stimulus. For instance, a nerve or ligament problem in the spine causing pain in the lower extremities. This is why a thorough physical examination is necessary to determine the patient’s  true cause of pain.

Way back in 1961, pioneering Prolotherapy Abraham Meyers, M.D., presented a land mark paper where he acknowledged “that irritation of ligaments of the lumbosacral region may act as trigger points resulting in local pain and in secondary conducted pain to specific dermatome or areas in the lower extremities and that both the local and referred pain has its origin within the ligaments. (4)

Before surgery, please consider an appointment to help make sure the true source of your pain is identified.

1.  Nakamura J, Oinuma K, Ohtori S, et al. Distribution of hip pain in osteoarthritis patients secondary to developmental dysplasia of the hip. Mod Rheumatol. 2012 Apr 11. [Epub ahead of print]

2. Al-Hadithy N, Rozati H, Sewell MD, Dodds AL, Brooks P, Chatoo M. Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies? Int Orthop. 2012 Jan 11. [Epub ahead of print]

3. Hirabayashi H, Takahashi J, Hashidate H,Characteristics of L3 nerve root radiculopathy. Surg Neurol. 2009 Jul;72(1):36-40; discussion 40. doi: 10.1016/j.surneu.2008.08.073. Epub 2009 Jan 15.