Polio Place

Post-Polio Health, Volume 29, Number 2, Spring 2013
Ask Dr. Maynard
Frederick M. Maynard, MD

Question: Several years ago my right ankle muscles gave out after a cortisone shot. I wear a brace to steady this leg. Now, after two bad falls, my left hip will need replacement. My current orthopedic physician wanted to give me a cortisone shot, and I refused, recalling the reaction from my ankle.

Now I am frightened about hip replacement, because I fear after the trauma of surgery, it will cause my leg to completely give out, putting me in a wheelchair. Since my left leg was the stronger of the two, I am confused about the decision to have surgery.

Answer: Your concern about another cortisone injection is appropriate because some people have side-effect reactions to the “vehicle” ingredients contained in the specific cortisone injection drug preparation. However, a hip injection with cortisone is usually safe when done under fluoroscopic (X-ray) guidance. A trial test with a small dose put under your skin could clarify any negative or allergic reaction to the cortisone preparation to be used in the hip.

Regarding your fear of undergoing a hip replacement surgery, I would agree that it is a big operation with many possible risks. Before having it done, I would strongly recommend a thorough evaluation by a non-surgeon, rehabilitation medicine physician to learn of any other options for your specific symptoms. Even if the second opinion agrees that hip replacement surgery is a good option, the assessment would be useful for planning post-operative rehabilitation needs that may include need for a longer hospital stay in a rehabilitation unit, prolonged help at home or a nursing facility during the recovery period of several months when full weight-bearing activity will be limited, and/or pre-operative exercises and equipment needs evaluated in advance.

In general, hip replacement in a post-polio limb with very significant long-existing weakness should not be done except to limit constant pain at rest, and in these cases post-operative walking will not be anticipated or be only minimal. In a post-polio limb with only minimal/modest weakness at the hip and thigh (probably like your “good” leg), replacement surgery can be considered to relieve severe pain associated with weight-bearing walking and moving-about activity in order to permit those activities to continue to be done. In that case the risks and benefits are similar to people who didn’t have polio, and the important thing is to plan ahead for anticipated special post-operative rehabilitation needs.