@Josephine
Your response really made me apprehensive and honestly a little lost.
The Os rx "Trochanteric Impingement" .
You said "I never heard of that before"
maybe I didn't explain it correctly....so I am including a short abstract of the physicians who did the study...
Go to:
Abstract
While uncommon, trochanteric-pelvic impingement may lead to significant lateral hip pain. We defined “impingement distance” as the radiographic distance from the medial aspect of the greater trochanter and the corresponding lateral edge of the acetabular bone or component and compared this to the contralateral normal hip. We present two painful total hip replacement (THR) cases, each featuring a patient with severe lateral hip pain when walking and sitting. Both patients had diminished femoral offset and trochanteric-pelvic clearance, compared to the contralateral normal hip. The impingement distance was increased an average of 10 mm with the exchange to a longer femoral head. Both patients had immediate and complete pain relief with operative treatment to increase the impingement distance.
Introduction
Total hip replacement (THR) is one of the most popular orthopedic procedures performed in the United States today, and its utilization is predicted to rise over the next decade. While most patients are extremely satisfied with the pain relief THR achieves, a small percentage of patients experience persistent pain. In an otherwise clinically and radiographically stable implant, lateral hip pain is thought to be caused by trochanteric bursitis or the result of referred pain of spinal origin.
We have dealt with several patients who had residual lateral hip pain due to what we believe was trochanteric-pelvic impingement. These patients shared many common findings. Their pain was severe, in fact, incapacitating. The pain was described as “deep” and accompanied by a “catching sensation.” The pain was always lateral and described as involving the trochanteric region, not localized to an exact point. All patients had spine MRI scanning and consultation with a spine expert to rule out referred pain.
The gait of each patient was markedly antalgic. Passive hip range of motion in flexion was not painful, though forced abduction past 20° reproduced the patient's pain. Lateral pain was also present with flexion and external rotation of the hip joint. Muscle strength testing was not noticeably different as compared to the contralateral side.
Radiographic examination revealed stable implants. Of note, however, the medial aspect of the greater trochanter was closer to the acetabular structures present on the contralateral non-operative hip. Shortening of the hip was also present. Metal suppression MRI scan was negative for trochanteric bursitis, fluid collection or abductor muscle tear. A diagnostic injection (lidocaine, marcaine, depomedral 10 cc cocktail) was given at the proximal tip of the greater trochanter and deep to the gluteus medius insertion, as this was thought to be the site of impingement.
We hypothesized that symptoms were caused by trochanteric-pelvic impingement. We present a radiographic technique to measure relative impingement.
Josephine, I really need for you to have heard of this as this fits my symptomology and really no one (9-10 OS's) came anywhere close to what is causing my groin pain, lateral pain and limp after sitting for half hour...when before sitting I can walk pain free 3-5 miles , with no limp whatsoever...(it seems sitting (office or car) throws my muscles into spasm the rest of the day.
Secondly, I didn't quite understand - are you saying you disagree that a cortisone shot in the hip capsule or groin area or as they say above at the "tip of the trochanter and deep to the gluteus medius" would NOT relieve the pain on its own and there is no risk of infection under aseptic conditions 9 months out.
Thirdly, I meant that the revision is less difficult because he is saying he doesn't have to cut the bone just change the liner or "ball" to open up some space so the implant can freely pass the trochanter when sitting. Isn't that true? As well as less risky..
Lastly, if this isn't the answer or even a possibility, I am truly lost after nine months of searching os's and pm's on how to relieve and resolve this.
Could it be as simple as a intra-articular shot of cortisone in the groin or "hip cavity" or gluteus medius or??? to solve this...
Is this OS dx really not known ?(trochanteric impingement)?
I am really tired, frustrated, depressed and scared that I can't find a resolution and will have to live like this the rest of my life...please help.
All help would be appreciated. My life is not a life now, it's just about chasing doctors ...