Bilateral PN Following Hip Replacement
 

I am new to the group. I am a 61 year old male in good shape.

I had a left hip replacement in August 2010. On the 10th day after surgery the bottom of both my feet became slightly numb. Those symptoms, perfectly bilateral have persisted since then. The numbness moves around the bottom of the feet, but always the same for both feet. Sometimes after a day on my feet I get some burning.

I went to a neurologist and he confirmed slight PN in both feet. He says that this sometimes happens post surgery as some type of healing/immune response. I have researched the condition and can find no reference to post surgery bilateral PN. I see that RSA can be sudden onslaught but I do not have any symptoms of that.

The hip is great but the PN is annoying and a disappointment.

Has anyone heard of such a thing? What if anything can I do about it. I am trying vitamin B-12 so far to no avail. I am hoping it might eventually go away, but at this point I tend to doubt it.

Thanks so much for your collective help.

[BTW - I tried to post this before, but it did not appear where I thought it would be. If I posted twice I apologize.]

Welcome to the Neuropathy forum--
 

--and I did write a response in the New Members forum before I came here today:

http://neurotalk.psychcentral.com/thread162147.html

do to age, and being post op, I would think about Vit. B12

Nerve damage from hip surgery
 

My 91-year old mother has had both hips replaced. She is now suffering from peripheral neuropathy. Of course, her surgeons would not cop to any nerve damage, or simply say that her body would return to full sensation after a period of post-op recuperation.

We are seriously looking at Anodyne Therapy to mitigate the numbness and discomfort of which you write. Please keep me posted on your progress. Perhaps information could be shared for our mutual benefit.

Thanks.

Couple of possibilites. First, antibiotic tx given prior to surgical incision may have precipitated your PN. Would check to see which one you received.
Second, it has been documented that the inflammatory response to big surgeries can produce peripheral neuropathies, so this is another possible cause. Third, nerve damage during surgery also a possibility from retraction on your body from surgical instruments or positioning of your body for the procedure.

There is a factor to consider when an older patient undergoes surgery, has a life threatening event, like heart attack/stroke/ septicemia, etc, or is in an accident.

The elderly do not have a very responsive thyroid axis and may become hypo--as the body is stressed and needs extra hormone.

Some physicians know this and test rigorously for changes in thyroid function in the elderly under physical stress.

Hypo situations may resolve on their own. Or they may not.
It is possible this may be a factor in post surgical neuropathies, since hypo patients often develop neuropathies from low thyroid.

Also possible are inflammatory changes. There are studies from Britain and other European countries, showing that 1000mg of Vit C prevented RSD in a sizable number of patients (not elderly) who had wrist/ankle surgeries.
The Vit C seems to block the inflammatory attack on the nerves in some people, who will go on to develop the neuropathic RSD problem after the trauma.
There are several papers on PubMed on this subject:
example:
http://www.ncbi.nlm.nih.gov/pubmed/19840748

Anyone trying this, should consult with your doctor to see if you can tolerate 1000mg of Vit C daily. I suggest you use the Ester-C form as it is easier to tolerate.

The information on this forum is extraordinary and I really appreciate the help. Through your responses, and in particular the post by Glenntaj, I read the full report from Dr Dyck at the Mayo Clinic on post surgery neuropathy and believe that is what I have, as it is remote from the surgical site, bilateral and symetrical.

As a newbie however, I am still pretty confused. It looks to me that the post surgery neuropathy is the small fibre variety which is diagnosed by a nerve biopsy and would not necessarily be shown in an EMG. Is that right?

My doctor said that my EMG showed slight axonal damage, but I do not understand the numerical results. I do not understand if axonal damage is consistent with the post surgery neuropathy.

Finally, assuming the nerve assault was related to the initial post surgery healing process, does that mean the assault is over (surgery was in August 2010) and that the nerves, whether small fibre or long, will heal?

BTW, I did hundreds of hours of research, including investigating many of the hip forums and reading scientific and lay articles, before I settled on my hip procedure and my surgeon. So as a person who takes his own medical conditions and his health very seriously, I am disappointed that I have this problem. I think: I could have done better to do what others do - Just go with the nearest surgeon and do what he/she says and ask no questions.

Thanks again to all!

I believe that there is also the possibility that your body does not like the foreign artificial joint.

We've had other posters over the years who developed PN after joint replacements. Knees, and hips.

Axonal damage suggests an inflammatory process attacking the myelin insulation, perhaps. So concentrating on supplements to repair that may be the best way to go now.

I hope it is not the replacement itself. I would have no way out of that box. If we assume for treatment purposes that it is not the implant, what supplements do you think might help heal the myelin insulation?

Thanks again MrsD.

These are typically for repair:

methylB12
methylfolate
P5P (activated B6 pyridoxine)

Fish oil

and magnesium which is a cofactor in lipid metabolism.

Antioxidants may also help reduce further to prevent more damage:

Vit C
grapeseed extract
the various antioxidants found in foods like blueberries and strawberries.
Curcumin which has been enhanced for absorption.
R-lipoic acid stabilized