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femoral neuropathy after surgery

  1993 my 46 yr old husband had job injury.  Decompression done on right hip year later as told lack of blood to hip caused bone tissue necrosis.  Bone did'nt regenerate, deteriorated more. Total hip replacement done 1996 with poor results.  Dr. said bleeding into nerve during surgery caused femoral neuropathy.  Several series PT including elec. stimulation didn't help, and only OTCs given for pain.  Had numbness on outside of leg just above knee--radiates out if overdoes things, numbness in bottom of foot, burning and shooting pains deep in thigh and general muscle weakness.  Right leg cooler to touch/smaller than left but swells up after use.  Still uses cane due to pain/weakness if puts weight on leg, and to keep balance.  He was as limited in abilties as before surgeries.  In 03-98 shaft of 1st replacement found to be too short, so 2nd THR done.  Another type was used, and improved muscle control/flexibilty obvious immed. after surgery.  Neuropathy symptoms are unchanged--same limitations in ability.  Several months ago he began 250mg Ultram x 4-6 hours, limited to 6 daily by chest pains--decreases but doesn't stop pain.  Couple of months ago began 300mg Neurontin x 3 daily and lessens pain.  Worked very, very well 1st couple weeks, then less effective so went up to 1200mg but back to 900mg due to drooling.  He's worked 2 of last 5 years, and only part-time now even with desk job.  Any ideas, suggestions, resources (we live in Okla).      
Dear Lisa,
thank you for your question.
Femoral neuropathy is an uncommon but recognized complication following hip surgery. It is unfortunate what has happened to your husband. The prognosis is sadly very poor from what you described above. The key issue is pain management and continous physiotherapy. Neurontin is very helpful and the dose that he is taking right now is not  high enough. If titrated slower he may be able to tolerate it better. I have patients taking up to 5 or 5 grams a day with virtually no side effects. I supposed your husband has been evaluated at a comprehensive pain clinic. Newer technique are being developed here at the clinic.. Of course we start with conservative treatment first, followed by minimally invasive such as injection with analgesic and steroid, and last resort include dorsal column stimulator,
nerve stimulator, or nerve lesioning. We have a world class comprehensive pain management team here at CCF and if you would like to be evaluated please don't hesitate to call us for more info. 1-800-CCF-CARE.
Good luck and I hope the information helps.

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