[THR] End of stem pain - mid thigh pain?

My RTTHR was March 21st, 2012 and I have had what I would describe as a bone bruise since the beginning. As the swelling has diminished, and the tissues have healed, this "pain" not only is unchanged, but a bit more noticeable now that everythin else has settled down. My phys therapist did strength testing and I passed with flying colors, but I have what is called "start up" pain (when I get up from my chair, those first 3-4 steps are ouchy in that area and a little better if I keep that leg perpendicular to the ground). I still have a limp, that is due to pain not leg length discrepancy or in my head, but becuase that is the position I have to be in to lessen the pain in the mid thigh (just when I put weight on my leg, never sitting). I have a non-cemented prothesis, which I guess has more incidence of this end-of stem pain. It was so bad yesterday, I went back to crutches. It is just about the size of a spoon in diameter and hurts as well if I apply pressure mannually. I am just now putting two and two together, have been complaining about this bone bruise pain for weeks, and was told that everything takes time to heal. It was 10 weeks on Wednesay, the joint feels great, my muscles are back to very good, but I am wondering if anyone has information on their experience with this, specifically related to the thigh area pain. I plan on contacting the OS first thing monday to get either xrays or a bone scan. But I think the end of the stem is moving around - that is exactly what it feels like. Any help (information) would be appreciated.
Deidra Lewandowski
Right Total Hip Replacement - Direct Anterior Approach
Smith and Nephew Anthology with Oxinium head
March 21, 2012

Good luck dee I hope everything goes well and your new hip is how it should be I think when we have these hip/knee ops and we don't feel things are what they should be we get so down and disheartened but things will get sorted out when you see your os be thinking of you and keep everything crossed for you please let us know take care

I do not have an xray to post but am calling my surgeon Monday. I am ten weeks out and at week four saw his assistant. They said xray looked fine as far as the joint goes. I still had a lot of general soreness everywhere so the specific area was not a particular piece of the discussion because everything just ached a little everywhere when walking. My stamina is completely back to normal and I feel I could walk strength wise but it feels as if something is jamming into the bone. I am back to using cane and this takes the weight partially off that leg so basically zero pain walking with it.

Update; I contacted the surgeon's office and they are getting me in for this coming Monday. They did not sound concerned at all, did not ask any questions. They probably see this all the time and I am making something out of nothing. At the end of all this I will probably feel as if I over-reacted and will wish I would have just had more patience, but then a part of me thinks there is something not quite right wih this type of discomfort in that one spot.

Today it was easier to walk for the most part, with some pain, but not excrutiating enough to take pain meds other than tylenol and ibuprofen. I am not sure if I should use my cane or just limp while trying to walk as straight as possible. The first 2-3 steps are the worst, but then it gets a little easier. If any of the expert moderators see this, perhaps you could give your opinion on "thigh pain" when it feels as I described in detail in my initial post. I don't have an Xray to post, and when I have an Xray on Monday, how do I go about getting their digital film on here?

After reading Fresian's post with great interest, I am thinking perhaps I should just stay off of this leg until at least getting an Xray on Monday? There is no groin pain/low back pain that I had constantly prior to surgery. But, I can't even go to the grocery store and am going to be 11 weeks out from surgery tomorrow. I can't help but think that this is not normal, and especially not normal with a minimally invasive direct anterior approach where no muscles were detached.

Thanks for listening....

Hi Dee,

Let's tag @Josephine: and how about also @Jaycey: as she's the moderator that has had a THR and @Jamie: as well, because she's also super supportive. :grouphug2: Hope you feel better today!!

Take care,
Cardie

Josephine, Jamie and Cardie,

I will definitely get a copy of the digital file and post as explained. I am definitely back to using the cane, because I was told many times not to "limp", but no one ever really explained why. Jamie, can you explain for me? I am back to concentrating on heel/toe etc. type walk. With the cane there is just a little tiny bit of discomfort, front of thigh, in the bone it feels like. Maybe I am over-reacting and this is nothing. I have never had any surgery like this, and don't know anyone that has, so...all I got is you guys right now. In the meantime I am staying off full weight bearing, but still stretching. I am going to expect some answers Monday. Will let you know what I find out. I never did ask this surgeon how many of this type of surgery he has done, and feel stupid now that I did not ask more questions. They make fun of me at work, I ask so many questions, but in my own case, did not. He did this "bikini cut" incision, of which I have never heard of and can't find anywhere in the literature, and now my whole thigh is dead numb. That alone set up an atmosphere of distrust.

thanks for all of your help and wisdom

Dee

Back in my hysterectomy days, surgeons touted a "bikini" incision, because it didn't show when you wore a bikini. Big deal....I've never worn a bikini in my entire life! In the case of anterior hip surgery, everyone gets excited about the smaller incision that is used....sometimes just an inch or so. Contrast this with my four inch incision scar. So I'm thinking that the bikini nickname is used here in the same way....the scar is so small that you can wear a bikini and not have it be too obvious. Just in case you want to wear a bikini.

I also remember that when I first started reading posts here on Bonesmart about a year and a half ago, a few people were touting the anterior approach. The hype sounded great....even my brother had one and raved about walking out of the hospital after one night on his own...not even a cane. Few restrictions. No muscle-cutting. I was just a bit jealous that none of the local surgeons did the anterior approach. Flash forward to now, and I see more and more reference to the occurrence of numbness after the anterior surgery. Apparently it is a known possibility. I'm pretty sure it usually subsides though....think of it as just another part of your recovery.

At any rate, Dee, I hope you get answers quickly, and that they turn out to be part of the normal healing process. If not, get the problem corrected and move on to being able to enjoy your new hip. I'll be staying tuned for your news.

Sharon

Hi all,

Thank you for the explaination Josephine, regarding why alignment is so important. That is one thing my PT has worked with me on alot, and recently gave me some specific exercises to make sure my pelvis was not tilted, etc. I continue to use to cane, for more assurance that I am not stressing muscles/etc. that should not be overworked right now until I figure out what is going on.
Sharon, I also wanted to clarify that my "bikini" incision question revolved around not the size of it necessarily (anterior approach incisions are thought to be smaller, and "minimally invasive") but the orientation of the incision. An incision for the anterior approach (if you look at the literature) varies as to exact location, but is "up and down" or north and south as I think of it, with just a little swing laterally as it goes south. My incision was truly along the inguinal space, like where your undies sit. I am just pointing this out for anyone else who may be considering anterior approach, becuase this bikini type cut apparently cuts across the lateral femoral cutaneous nerve and not along side it as most anterior cuts do. I am dying to ask my surgeon what the heck he was thinking when he did this to me? A simple discussion with me would have been nice. I can't even tell you the last time I went in the water with anything but "shorts" for a covering. What was he even thinking?

Anyway, without this group to vent to, I would be lost. And thank you Josephine for your expert advise. Man, you rock as we say here....

I appreciate each one of you for your support.

Hi Dee,

I just want to encourage you to ask your OS the questions that you have -- bikini cut etc., it is never too late to ask!! Might not have an impact on how the actual surgery goes, obviously, but it feeds your brain with the answers your crave!! I had some hindsight questions for my OS as well...

Are you able to share the exercises that your PT gave you for the pelvic tilt? I have been trying to change the tilt of my pelvis since my surgery and cannot seem to get it to budge.

Have a good weekend,
Cardie

Dee,


I hope your OS has some answers for you, and can give a good explaniation as to why your thigh feels numb. As for the differant ways differant surgeons do the hip replacements, after being in physical therapy since 2009, I'd say theres pros and cons to each way of doing a hip replacement. I've heard patients complaining about the direct anterior approach as much as patients without... the incission is smaller, and some do great and some have problems. I've met many patients that have pain in their thigh and at the end of the stem, most have had a loose stem (micromotion) and even a micro amount of movement can certainly cause pain!

My scar is so long I'd have to wear a knicker type of bathing suit to try to cover it up, which I won't wear....so I'll stick with wearing bikini's... it's just a scar.

Hope you get some relief soon, and that your OS has some answers for you.

Thanks Cardie, you hit the nail on the head, I do need those answers...My PT had me lie on my back with knees bent and heels on the table flat, with my back flat against the table - then raise the pelvis upward hold that and back down. I will also ask her about the others, (I don't remember them in detail) as that day was the only day I did the exercises; she was attempting to see if one leg was shorter (I thought it was cause of the constant limp) and actually after these things she had me do, it felt I could walk a little easier, but that may have been psychological, who knows. I never went on to do the exercises at home, because the next evening after work, I could hardly take a normal step, and have been babying everything since then.

I met with a close friend of mine last night. She had two total hips done two years ago. She relayed that 3 months after her second one (they were 3 months and 6 days apart) - she was back on the tennis court (not diving for balls like she does now, but you know what I mean). I know we are NOT to compare ourselves to one another, but we are about the same age, she and I the same physical fitness level, etc. She said she had "end-of-stem" pain for several months (like something was pressing there, but certainly not enough to inhibit her movement, must less her tennis game). Anyway, she took one look at me walk, and said, this is not normal. She is not a surgeon, but when a trusted friend who has been in healthcare for 30 years tells you that, makes you think that you are not all crazy....I'll be anxious to let you guys know what the surgeon says, but quite frankly, I hope I am crazy and this is just a slight deviation from normal during recovery from a big surgery.

Dee

Hi SL;

Thank you for your input. I agree, definitely patients complain about direct anterior approach; I myself now will discourage someone to do this without getting alot of information first. My friend, above, showed me her incision (not that this is a hang-up, because the size of the incision was not the reason I went for anterior - it was the supposed "muscle sparing") - anyway her incision 5-6 inches long. Big deal. Who care about the incision really (well let's see if I talk this smart if I ever have a revision right?).

May I ask the reason for you needing a revision? And also, how did the revision go as compared to the first surgery?