THR My journey, if only I had known<

[Hip4life]

Another update. I saw my OS yesterday as the injection to the IP relief has worn off. Lasted about 2 weeks. The pain is not quite as intense but still present with all the limiting stiffness/tightness again. I’m seeing an arthroscopic specialist Monday for evaluation for IP tendon release. OS, knowing I like all the bases covered, said that the option after that would be acetabular revision. Yikes! I guess he also remembered I need perspective as well! It worked! Anyway, I’m okay with the IP release if it gets me to better ROM so I don’t feel like I’m misjudging my movements or afraid I’m going to fall if I catch my foot on something. OS assures me it is much lesser ordeal than THR recovery (of course, and backed up by others’ experiences here on the forum. You know that I checked!) I really think (and hope) it is the answer especially since I’ve been dealing with IP irritation with the hip pain BEFORE the THR. As always, I’ll keep you posted.

 

[Layla]

Hello @Hip4life
Wishing you the best with your appointment on Monday.
Please let us know how it goes.
I hope you're able to enjoy the weekend!

 

[Hip4life]

Update. The appointment Monday was pretty awful and confusing. First doc so far that I really didn’t care for. He seemed to not want to do the surgery (IP release) from the time he hit the door. He basically countered about everything my OS said and folks here on BS and not in the most professional manner. Being 39 years in healthcare, I KNOW professional bedside manner. Needless to say, he won’t be doing any surgery on me and I have contacted OS office to let them know and for another referral since they had mentioned someone else as well. Here are my questions: is it still too soon to be looking at a IP release? Will it help with the pain and associated stiffness/decreased ROM? I have been dealing with this groin pain for over a year now, since before my surgery. THR didn’t change it. Continued gentle stretching and exercise with limited effect. I’ve had prednisone, Meloxicam before THR, Celebrex x 2, 30 day rounds post THR. Cortisone shot into the tendon relieved the pain but only for 2weeks. I’m ready for IP release at my OS’s suggestion because all of this has had little to no effect. The hip is great. I have just plateaued and the IP pain is limiting me in so many ways. This referral doc said it was not an easy surgery and would not fix the problem. What? Really? I don’t know why I’m letting this guy get in my head and doubt my surgeon. I would like to tag @Jws. and @SaraK for your insights, please, if you wouldn’t mind. Thanks so much. Pat.

 

[SaraK]

Pat - I'm so sorry you had such a disappointing visit. I can't say whether it's "too early" or not, but I'm glad you do have an OS on your side that is listening. My issues started a few months after THR (after a period of no pain or problems), with decreasing range of motion and increasing pain. It took me several months to get someone to finally give me the diagnosis I'd already found through research, so you have at least won the first part of the battle. I tried meloxicam, muscle relaxants, PT, etc. and nothing helped. Even shutting everything other than essential walking down for several weeks and then starting just gentle stretching caused increased pain. I had 3 PT tell me "psoas impingement is rare, so it's unlikely you have it" on first visit and within a month saying "I think you have a psoas impingement and nothing we're doing is working so surgery is probably your best option." I had to switch OS, though, to get the diagnosis (went with a new OS that one of the PTs recommended.

The cortisone shot into the tendon was the final diagnostic tool and attempt to fix non-surgically. Shots into the psoas muscle in the back had helped but not long and not entirely. The shot into the tendon helped TREMENDOUSLY but, like you, only lasted a couple of weeks so that surgeon referred me to some who did psoas release. I don't know why this surgeon said it wouldn't fix the problem (sounds to me like it's just not something he's experienced with). I can understand him saying it's not a easy surgery, but that's the surgeon's side of it - it was very easy for me from the patient's standpoint. It should be done by someone who is skilled in hip arthroscopy and not any old OS. The surgeon who diagnosed and then referred me was a revisionist. Even he didn't do that type of surgery and referred me. As to whether it "fixed" anything, I knew within a week that the surgery was a success. While I still had much work to do to retrain the lengthened muscle, the pain was GONE! I could sleep without waking in pain each time I moved. I could walk, go up stairs, dance and just plain LIVE!

While work needs to be done to help strengthen and retrain the muscle, it was an easy surgery to recover from generally. With my surgeon's blessing, I went out for New Year's Eve (i.e., the day of surgery) and danced with friends and was back in the gym immediately. My only restriction was not doing anything that took the pain level above a 4. But I only took a couple of doses of painkillers and really didn't have pain after that (except some general discomfort in the tendon from having been cut, but that only lasted a few days and wasn't bad and some pain with rotating with knee flexed but that has eased). My range of motion is so much better now. Probably not as good as it was before the psoas started causing problems but close.

I'm not very active on the site anymore, but I do generally check in every day or two to see if I've been tagged and get emails if I'm sent a PM. Feel free to give me a shout anytime you want to talk!

Sara

 

[Hip4life]

Thank you so much for responding @SaraK. I have such confidence in my OS that I couldn’t believe he would refer me if he didn’t think it was appropriate. In fact, he had encountered my husband (works for the College of Medicine) to ask how the injection was working. I was getting relief at that point. The OS then told him that if it didn’t last that IP release was probably the next step. Unfortunately, as is normal, my OS would have to refer to a specialist. The OS didn’t dismiss it as without risk or technical challenges but said, of course, it wasn’t going to be anything like the THR. It makes me feel more confident that your experience seems to parallel mine. I don’t want to be “the difficult patient” and I don’t think I am in asking for a good look at a solution to be as pain free as possible. I’ve worked hard to do everything I’ve been asked to do. I’m at the point, like the THR, that I’m willing to undergo more surgery if that’s the answer to get back to a “normal” life. Definitely not ready for the rocking chair yet. Again, thank you for listening and responding. Peace and blessings. Pat

 

[Hip4life]

I think maybe I’m needing some perspective here, additional advice, or just a sympathetic ear. After I had the consult with the “arthroscopic expert” (upon further research, he has been only doing this 2 years after formal training and one of the staff said they were excited because they had never seen this procedure done by their [satellite] office before) it appears that my OS has done a 180 degree turn. According to my email communications with his nurse, all he can offer is what this consult doctor recommended: repeat the IP injection. Also, he has no one else he can refer me to. It’s just weird that with my last OS appointment
and an informal one he had with my hubby before that (as I mentioned in my last posts) his opinion was that the IP release was the next step. He didn’t do them (understandably) so referred me to someone who did. So I’m even more confused by the nurse’s above email reply yesterday (it was my second request asking for another referral after respectfully waiting 2 weeks.) It makes me wonder if what I’m saying to the nurse is getting completely communicated to my OS: especially, my vote of “no confidence” in the referral doc.
I’m terribly disappointed because I could finally see some light at the end of the tunnel and thought my OS was completely behind me supporting me to get relief from this lingering issue. Now it seems that door has shut. Something seems to have shifted since the consult’s appointment and his report back to the OS and I’m not sure what happened. I feel like I’ve been put in the “still having issues but don’t know what to do for or with you” club. With the volume of surgeries they perform, I’m having a hard time believing this major medical center ortho department has not run into this issue before (hence the OS’s suggestion at my last appointment for IP release and then possible revision if that didn’t work) and an even harder time believing this is the only arthroscopic guy they can refer to.
All I know for sure is that something still isn’t right with my hip’s soft tissues (the joint itself seems fine), it seems like more than just “finishing healing” issues, it’s impacting the quality of my life and I am so over it. I don’t think I would even be so upset if there hadn’t been all this apparent waste of time and back peddling.
Maybe I’m over-reacting due to my frustration and I should just start again at square one (which just makes me want to cry or scream or both!) with the repeat injection and maybe formal PT, again being cautiously optimistic in hoping it works for real this time. And who can say how long it will take to know that? I had hoped I would have had all of this way back in my rear-view mirror at this point. So discouraging! Thanks for letting me babble and vent. Any thoughts @Layla or @SaraK?

 

[Layla]

Good Morning,
I'm sorry you continue to struggle with this issue. I sense your frustration and can't blame you for feeling the way you do at 7 1/2 months post op and still suffering pain. I'm tagging @Jamie to get her thoughts, so please check back periodically. Wishing you comfort and speedy resolution.
@Hip4life

 

[Hip4life]

Thank you, so much, @Layla. It’s so great to have this forum as I feel like my family and friends don’t know what to say or do to help me anymore. Mostly I just put on a brave face and say everything is ok.

 

[Layla]

You're welcome.
Hugs We're here for you.
@Hip4life

 

[Hip4life]

Just to re-iterate my favorite Einstein quote: “There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” Well, a miracle just happened again. After all of the above wailing and gnashing of teeth, I finally surrendered to Spirit to find some peace. Two hours later, I kid you not, my OS shows up, unsolicited, at my husband’s office, sits down and asks what he can do to help me. During their discussion, it was obvious that he had NOT gotten the full communications from his nurse. I’m sure her intentions were good. In any case, my OS wants me to communicate directly with him now and he’s leaning toward an acetabular revision since the consult didn’t think I was a candidate for the IP release but it is totally up to me how to proceed from here. Now we have a new starting place from which we can work. Communication is a wonderful thing. So is faith. I call that a miracle. Thank you, angels.

 

[CricketHip]

I just caught up with your thread, oh my goodness! What a roller coaster. Your OS sounds like a decent guy.
So, what is your next step? Did he have a revisionist to refer you to? It will be interesting to get their "take" on what to do first.

You must be so relieved.. I bet you sleep well tonight.

 

[Hip4life]

Thank you @CricketHip. Yes, definitely a roller coaster. Actually, he will do the revision. I will be meeting with him formally most likely sometime in the next couple of weeks to discuss everything in detail, including any options. He is not sugar coating anything. Then I’ll decide. It’s just great to have options again. I cried myself to sleep last night with hubby’s arm around me. I’m looking forward
to a much more peaceful night.

 

[Jamie]

@Hip4life .... boy, I'm late to the party and you've already cut the cake and had the champagne toast!

But seriously, I'm so glad this has taken a turn for the better for you. Actually, talking directly with your surgeon was what I would have recommended. Sometimes things do get communicated poorly when you have a go-between. It's beginning to sound like the acetabular revision is your best option and it's good you'll be in the hands of a surgeon you know and trust.

I know it's frustrating when things don't turn out exactly like Plan A, but hang in there and keep working with your medical team. Persistence and tenacity alway pay off.

 

[Hip4life]

Lol. Thank you for your encouragement and support @Jamie. My husband and I had come to the same conclusion about direct communication before the surgeon beat us to the punch! More surgery? Not what most people want to hear but weird as it might seem, it feels “right” after the last few months of trying other things. I know that my OS would NOT be recommending this if he didn’t think it was the most viable solution as long as I understand the risks and pitfalls. This forum has been amazing in its support. I’ll keep everyone posted.

 

[Mojo333]

We know our bodies best I think.
Sending good mojo your way for getting this sorted for good!

 

[SaraK]

Wow! So much so quickly! I'm glad you're communicating directly with the OS now. I think, if it were me, I'd ask why he no longer thinks the release is the right way to go. Did the 2nd OS say so or is he assuming that because you asked for another referral? Explain why you didn't want to go with that one. You might even try to speak directly with the OS he words don't necessarily mean this is his first time - just the first at that location. Don't expect to find someone who does this every day, though.

I'd press for another referral (and search for someone myself?) And get another opinion before having a revision done. You're right - there has to be someone! In other words, take one more crack at using a hammer before the sledgehammer comes out. The sledgehammer will still be there if everyone thinks it's the right tool.

Best to you! Just remember that you've crossed the biggest hurdle - you have someone listening and believing! That was the hardest part for me - so many months that I tried to get people to even look at this diagnosis only to have them look every other direction!

 

[Layla]

Hello @Hip4life
Wow, what a pleasant surprise! Thankfully all is moving in a more positive direction. Please keep us in the loop as you move forward. We're here for you!
Things are looking up

 

[Hip4life]

Ok. I’m even having trouble keeping up. That’s what happens when you ask your angels. New update. OS didn’t realize that I was asking for a referral including one “outside” of the system due to insurance, etc. My husband got that cleared up, God bless him. Yesterday the ortho nurse called to ask permission to set up a consult with another OS specializing in arthroscopy, one with a great deal of experience. My doctor had already consulted with him and the new OS felt confident he could help me. Ummmm, YES! Funny thing, @SaraK, it was the same doc I had independently researched about a month ago for my own back up plan! October 30 I should know how this will go. I got a very kind reply from my OS today verifying he was sorry the last consult didn’t go well but that he was confident that this consult would be much better and more helpful. Good communication is such a sweet thing. I feel so very blessed and grateful. Thank you all for your great advice and support. Thank you, angels! I’ll keep you posted.

 

[SaraK]

Such good news! Hoping you have a good treat for Halloween!

 

[Fit4Family]

Just catching up on your news @Hip4life Wow. You sound like you are in very good hands with your OS. Need to read up on the revision you are considering. How long ago did the problems start? Will keep you in my prayers and hope your consultation answers all your questions. Sending lots of hugs.