THR 2+ years post-op pain and swelling.

[Josephine]

What does this mean for me?

It means you need to have it redone but there is no desperate rush. The new hip will need to be cemented in - much more reliable!

I guess specifically, for the moment, I need to not put any weight bearing on it?

Of course you can - within the limits of your pain, of course,

Is there any chance of it 'healing'?

Highly unlikely. The damage is done and the healing process has likely shut down.

 

[billyedtimmy]

The new hip will need to be cemented in - much more reliable!

I guess I'm grasping at straws now. Assuming a deep-joint infection isn't the cause of the loosening, is it likely they'll be able to at least preserve my acetabular cup and only switch out the femoral stem? Or are we talking everything goes?

Thank you again, Josephine, for pointing out the lucent lines on that one x-ray. I went to the GP today and showed him that 2nd x-ray, and he agrees it's suspicious and is writing a referral requesting an expedited appointment with my OS (since it can be a long wait, here in Canada).

 

[Josephine]

Could be but depends if they have the appropriate devices in stock or if the cup will match with a cemented stem

 

[Buttercup]

I don't know if it's of any comfort to know but my upcoming right revision (of a cemented MoM ) will leave the stem in place and replace the cup. The stem is not giving me any pain but the cup is and it's unstable as well as leaching metal ions. (the uncemented stem on the Left still hurts, 24 years later.... no pain at the acetabulum.

If your cup can be left in place and would match with a cemented stem if there's any likelihood that the appropriate replacement component is out of stock I think I'd be inclined to wait till it becomes available rather than go ahead to suit the OS's schedule. The less you have to have replaced, the quicker your recovery would be. All the best.

 

[billyedtimmy]

Thanks y'all, it would seem quite a waste if the cup is secured for them to yank it out. I'm more than happy to wait on that set of components if it's an option (we'll see).

The more I think back the more I think this problem has been with me a while and recurred multiple times, which may suggest that the stem never seated properly in the first place (despite my taking the first 12 weeks as per protocol).

I guess it's too early for navel-gazing, and I'll probably never know anyway, but it would be nice to have a realistic idea of how much walking is OK vs. overdoing it (so I don't make whatever mistake again, assuming that I'm even to blame). I know pain is supposed to be the guide, but mine always came on after such a considerable delay that feedback was too late to react to. I never figured that a few longer hikes in my 2nd year post-OP would be so dicey (seemed very realistic from others with THR that I know).

Anyway, sorry for all the whining. It just feels like this 'new lease on life' that I got after my initial replacement is all shattered and that I'm going to be playing catch-up the rest of my life now, if I'm lucky. Looks like I need to see a counselor.

 

[copsham]

Hi @billyedtimmy
You started your thread apologising for starting a new thread and finished it apologising for whining. I am pleased you posted as i am learning a lot from you. I do not think you are whining - I would say it is "telling it like it is " which is important. We do not want a sanitised site where no one speaks openly about their concerns!!

It is interesting about the waiting for the right components, i had never thought that was possible but hopefully it is!

I wish you well for your next stage of this journey and hope you see an end in sight soon.

Copsham

 

[Josephine]

it would be nice to have a realistic idea of how much walking is OK vs. overdoing it (so I don't make whatever mistake again, assuming that I'm even to blame)

Billy, please be assured of this one fact: IT IS NOT YOUR FAULT! If the implant was sited and seated correctly, it wouldn't have come loose. Also it wouldn't then have mattered how much walking you did.

 

[billyedtimmy]

Latest update: I have an appointment with my OS on May 5th for consult and more X-rays. Seems like a while away, but I consider it lucky in this province where waiting lists are disastrously long.

In the meantime, I'm resting most of the time but still trying to walk (well, hobble with 2 canes) as much as I can stand to stave off bone loss. I find mixed information online about how much walking I need to sustain to avoid bone deterioration. Anyone have any links on solid/specific information?

The pain is still changing. It felt like it was 'sinking' (literally) at one point when I was walking with just 1 cane. It's more global in the area (like a severe ache) now for the last few days. I'm hesitant to put too much weight on it for fear of the dreaded sharp pain though.

 

[Josephine]

I find mixed information online about how much walking I need to sustain to avoid bone deterioration

What kind of information are you looking at? Give me a couple or three links. I think those may be talking about something different.

 

[billyedtimmy]

What kind of information are you looking at? Give me a couple or three links. I think those may be talking about something different.

Like the NIH mentions that 5 weeks might be pushing it for inactivity in terms of recover-ability....

https://www.niams.nih.gov/health_info/bone/Osteoporosis/Conditions_Behaviors/bed_rest.asp

But, then they're vague on what they mean by 'brief intervals of weight-bearing' and how much is needed to 'lessen' bone loss.

This one suggests adverse effects after days to weeks:

https://www.nursingtimes.net/effect...tems-skin-and-self-perception/5003298.article

One week and beyond gets worse, and beyond 3 months... yikes:

https://www.livestrong.com/article/237364-disuse-osteoporosis/

etc...

It's just that none of these are very specific about how much weight-bearing activity I need to keep up. Even though it hurts, I want to make sure I do enough weight-bearing (e.g., does just standing in place for a few minutes at a time help? Standing is much less painful that walking. ;-)) to not lose any bone mass (I'm a small guy already - 140lbs-ish), but of course not too much to greatly increase the damage in my femur.

 

[Josephine]

ah I thought as much. Those articles are referring to a normal body. Right now your body - or rather your hip - isn't normal. You've got a loose implant. This gives you a specific reason for staying off your leg because to weight bear on it could cause bone damage and maybe even localised fracture. I believe I said this previously. This isn't going to be a long term issue for you and will be changed once you get it revised. I truly wouldn't worry about this now as there is precious little you can do about it!

 

[billyedtimmy]

I see, so my risk of fracturing the thing (and associated consequences) is greater than my risk of bone loss due to inactivity. Thanks again, Josephine.

 

[Josephine]

Sadly yes, you've got it.

 

[billyedtimmy]

Update: Saw the OS yesterday. He doesn't see any loosening on my x-rays and says that I have a 'raging' case of tendinitis of the psoas. On to an ultrasound next week to verify that and possibly cortisone shot if confirmed. Tentative RELIEF (mentally) at this point (but still cautious). Stay tuned.

 

[billyedtimmy]

Ultrasound results all look good: No tendinitis or bursitis or pseudo-tumours seen. No fluid/swelling in the joint capsule. All this seems to suggest no issue in the psoas area.

X-rays: Surgeon says bone-growth in the porous bone-metal interface looks excellent. Overlays of recent X-ray vs. post-op shows absolutely no movement. Doc suggests implant is solid as a rock. When I asked him about the lucent lines Josephine pointed out in the distal/stem area, he responded that this area of the stem of this particular implant design is 'smooth' (i.e., no bone/metal ingrowth is intended to occur there), and as-such those lines of fibrous tissue can be considered 'normal'. In the case of my implant type/design (uncemented), it's the proximal area that has all the porous material and where lucent lines would be considered problematic. I'm hoping this is correct. It certainly sounds plausible, but I'm merely caught between experts here. ;-)

So, while this seems good-news, it still leaves the question of what's causing my pain. Going back to the initial instigation of the pain, I was actually prying a heavy object (i.e., heavy upward force/strain) when I felt what seemed like a 'tear' in my groin area. I wonder if there could be something going on in adductor/abductor muscles or tendons? I note pain during either abduction or adduction (but not straight-leg lifts). The ultrasound didn't really investigate much below the lower boundary of the psoas, but I assume adductors/abductors are more along the inner thigh?

Anyway, to be thorough, he's ordering a bone-scan and an MRI. Bone-scan will probably be pretty soon. MRI may take a while to arrive, at least in this province. Fingers crossed...

In the meantime, continuing cold/hot baths (10 minutes in a cold bath does amazingly for inflammation!) and will start on a new anti-inflammatory in a week or so. I tried Flexoril (sp?) and noted some calming of the irritation, but at the level I tried (20mg per day) I just couldn't stay awake. ;-)

 

[Josephine]

When I asked him about the lucent lines Josephine pointed out in the distal/stem area, he responded that this area of the stem of this particular implant design is 'smooth' (i.e., no bone/metal ingrowth is intended to occur there), and as-such those lines of fibrous tissue can be considered 'normal'.

Oh - okay. I won't argue with him .... but

I'd agree with his diagnosis of a 'raging' case of psoas tendinitis

 

[billyedtimmy]

I'm feeling more and more like it's a raging something related to soft-tissue: Taking anti-inflammatories and now this muscle relaxer isolates the pain to a very specific locale. It feels like I'm straddling a rope on the right side of my crotch. There's a definite, deep tightness of something there. Palpating it doesn't seem to uncover anything, but it sure feels like something is there pulling, especially when I bend over to pick something up.

Maybe I'm grasping at straws here, but with adduction/abduction motions being painful (whereas straight-leg raise not so much), I'm wondering if the tendonitis is of the adductors:

https://www.physio-pedia.com/Adductor_Tendinitis

The symptoms described in the severe case seem to fit pretty well. I guess time will tell.

 

[Josephine]

That was what he meant by psoas tendinitis. The psoas is the principle adductor muscle.

 

[billyedtimmy]

Well, the latest update has arrived (and uncertainty/confusion continues):

(1) I had an MRI last week and got my results today. The area immediately around the joint is kinda 'clouded' looking, so the tech remarked that it was difficult to image precisely, but the radiologist didn't mention that in his report, so perhaps that means it's not relevant to what he was looking for (specifically, adductor issues).

Anyhow, no problems with the adductors reported (or anything else that they could see). Perplexing.

My GP thinks it might be Osteitis Pubis, but wouldn't that have shown up on an MRI (or X-ray)? He didn't think so, but the peer-reviewed Wikipedia says, "MRI is the modality of choice for evaluation, diagnosis, and treatment planning." (?!) He thinks it will show up on a Bone Scan, but I'm reluctant to go for that just yet since...

(2) I've been improving, and I presume I wouldn't see improvements if loosening or bone issues were the cause? Specifically, I've been doing lots of adductor and pelvic stability/strengthening exercises, and they're definitely having an effect (after over a month of starting back on 'physio' stuff). I'm still a long way from 'normal' (I'd estimate that I fluctuate betwen 40% & 60% better than when I was at my worst (with 100% being when I was best).

Even with the slow improvements, not knowing is completely disheartening. At least if I had something to work towards (or an idea of what kinds of things to avoid as far as exacerbation) I could imagine light down this tunnel.

For now, I think I'll keep with the exercises and put off the bone scan for another month and see where I'm at then.

Thanks for listening.

 

[Josephine]

My GP thinks it might be Osteitis Pubis, but wouldn't that have shown up on an MRI (or X-ray)?

Well it might but then again, it would need a radiologist par excellence to spot it. It's quite an uncommon condition a more often seen in women (childbirth being the culprit!) so they may not expect to see it in a feller!

I've been improving, and I presume I wouldn't see improvements if loosening or bone issues were the cause?

Correct!

not knowing is completely disheartening

I can imagine. But you know, very often, or even invariably, there is no answer to these aches and pain and mostly answer are down to inspired guesswork or Holmes-ien detective work. After all, surgeons and doctors are only human and not gifted with second sight! It's often just as disheartening for them.

He thinks it will show up on a Bone Scan, but I'm reluctant to go for that just yet since...

Just curious but why?