4 months after THR groin and thigh pain - thoughts?

[Josephine]

Maxwell, I merged your threads as per this request One thread for your recovery please?
Please don't keep starting new threads. It takes me a lot of time to find your old thread if I need to check back on a point.

scared to have tendon "nicked" - read medical research which had mixed results long term if do this. What has your experience been if surgeon suggests nick/cut psoras tendon?

it's called a tenotomy and is occasionally done for iliopsoas impingement. however, if the problem is a proud cup edge, then the real solution is a revision.

Could you tell me what that means? Had x-ray and radiologist said cups seem "deep"but not sure if "normal" for type of implant used - do not know if that means tendon could not be rubbing cup.

It means he's not sure! And it's not a tendon, it's a ligament (a small stringy muscle!).

I have had problems with groin since few days after surgery.

Then it's definitely not an impingement! That takes days and weeks to show up. In this case, my best guess is that it's a tendinitis that was present before surgery but was masked by the arthritic pain.
It therefore goes without saying that a revision would not be required after all

Now says maybe should get shot.

I agree.

Could scar tissue have formed and be causing this?

No.

Also the AAOS site said that "a Technetium99 bone scan can detect abnormal bone activity such as infection, fracture, or irritation from prosthetic motion". What do you think of this test?

A technetium bone scan is nothing but a regular bone scan with technetium used as tracer. The scan could also be called by other names such as "technetium 99 bone scan". It can be used to check on infections which would affect the bone. However diagnosing the reason would take more investigation and the scan alone will not help.

Also do you think "bone growth" medicine person said surgeon suggested she take to help build bone around stem is Fortero? Scared of that

Never heard of Fortero but if I recall the post correctly, she was advised to take Fossemax or alendronate which is a bisphosphonates. These are sometimes prescribed for AVN but are known to cause catastrophic things like jaw bone death! I certainly would never take them!

Finally, could fact that had AV be part of problem in thigh (or groin)?

Unlikely. VERY unlikely!

I went into this with such hope

Well, don't abandon hope just yet. It's still early days, believe it or not! These things can sometimes take months to resolve.

And I still want to know the date of your surgery!

 

[maxwellmedical]

tks again Josephine and others- Hope some of info you have shared with me will help others. Sorry about multiple threads - thought new one with different subject might lead other members/viewers to benefit from all the info/advice you (and a few others) have shared.

Hope you are right and my problems due to tendonitis and ligament problem in groin and shot all need in groin and time all need for thigh! Could move on with life and just continue to monitor other hip with AVN and live with bad knee "as is" for now. Since so much less active bad knee hurts less and guess won't swell again - so can put off TKR for now. Really hope "lucky" with other hip and AVN progresses more slowly in that one. And hope other knee which has problems but less than bad knee progresses with arthritis very slowly - and no other joints get AVN!

I will check and see if special "route" on site for people who are getting/gotten joint replacements due to AVN. Osteoarthritis bad enough but for most gradually gets worse over time (like me). As you know, AVN happens "out of the blue" for most and often both hips and typically at younger age, half the time without a known cause. Would like to do a post just on that so people with AVN can "find" each other easily and share info - but only if you think OK. Do you happen to know if people who get THRs due to AVN do as well initially and over time as people who do THRs for osteoarthritis? Don't know if study ever done. Will search PubMed a second time. That would be of interest to other AVN THR patients as well as me.

If nothing changes, will not ask you more until see doctor for what I read is "differential diagnosis" during which/or after will probably be given shot in groin. Hopefully can guide me on whether walking in pool will make thigh and groin worse or better. Its so helpful emotionally to do some form of exercise and hopefully maintain some muscle tone.

Digression, can't imagine why date of my surgery matters to you? Thought telling you about four months after surgery enough related to my questions - confused.

 

[Jamie]

Maxwell, what we need is for you to create a signature that has your surger date in it. You do that by mouse hovering over your username at the top right of the screen. Select Create A Signature from the drop down menu. The reason for doing this is that, in the future, no one has to look back to previous posts to see when your surgery was done. It really helps us to get the correct advice to you promptly. All of us staff members and the active members who respond to threads look at many, many posts on a daily basis. It is just too difficult to recall when a person had their surgery done without having that signature to refer to.

 

[maxwellmedical]

Thanks. Did not know to to hover over name and nothing in signature. I just followed your instructions. Signature is maxwellmedicaloct112013. Do you happen to know if people who get THRs due to AVN do as well initially and over time as people who do THRs for osteoarthritis? Don't know if study ever done. In addition to searching on AVN, avascular necrosis, and osteonecrosis on BoneSmart, I will search PubMed a second time.

 

[Jamie]

People with AVN do just fine. There really should be no difference between your hip and that of someone who had osteoarthritis and no necrosis. The bottom line is that the problems in your joint have been removed and replaced with your new prosthesis.

 

[Poppet]

Hi @maxwellmedical, here is the instructions to add a signature to your user profile. https://bonesmart.org/forum/threads/how-to-create-a-signature.14728/

Also, Just a tip, if you want to "tag" someone in response to their messages to you just type in the @ sign immediately followed by their user name and you'll see a small box in the posting area where the members user name will display. Sometimes there might be a very slight pause, but the member user name will appear.

it will show their correct name which you can click on -- then when you submit your post the member's user name/link will turn blue and send a message to them person, like this: @Poppet

I notice you are online, so have a go and tag me if you have a problem

 

[maxwellmedical]

So back to original request. Many of the doctors in the area (South Florida) claim to have a lot of focused expertise and experience and don't and can't do a well done, thorough differential diagnosis on a person who had a THR to see what might be wrong and then discuss how to correct it.

Dr. Leone has done a lot of joint replacements but do not know if he is qualified to determine if the Mako robot allowed for reaming that was too deep for the cup or that the components are the right size and are in right - or what the heck is causing groin problem. I HAVE to find out what is wrong as soon as possible since I need to look for work and I have AVN in other hip so only a matter of time before that one needs to be replaced. I should see a revision ortho just in case. And still have the original knee problem went to see doctors about.

Someone mentioned a doctor in Boyton Beach FL who had Hopkins training.

My other problem with having anything done here is the high infection rate in the hospitals. I will go anywhere for the diagnosis - is there a Boston ortho that can be recommended? Or one in Philly? Or one at John Hopklins.

Mayo Clinic in Rochestor scheduling person has NOT called me back although 9 days. In Boston heard name Dr. Bono. Luckily I can go out of state as long as hospital is in-network and doctor is as well. Any other suggestions. Don't know if Tampa has one. There is three month wait for head of surgery at Mayo Clinic in FL. I wish I could go back to HSS to see Dr. Bostrom since he has such good reputation, and think he does revisions (which I hope I won't need) but since has THR bys other surgeon at HSS probably not doable.

Someone who did study on using injections for psoas problems after TKR would see me and suggested doctors elsewhere he knows. I contacted first one list and doctor had 3 month wait. Another on list is friend of surgeon in NYC, and one senior surgeon at Mayo Rochestor -- it has been at least 10 days since called his scheduler. Suggestions please.

Another piece of useful info for Floridians and others. New software came out for GE MRI machines that can work better seeing much more tissue around implant. It is also in Naples Community Hospital, and will be in St. Mary/s and Broward General in Ft. Lauderdale). If you live in sate, get to sales dept and ask same question I did.

 

[Josephine]

I HAVE to find out what is wrong as soon as possible

with respect, Maxwell, you are asking the (almost) impossible. This is not like trying to find a fault in a car. You can spend ages going round in circles going from this surgeon to that one trying to find that elusive 'someone' who will go "Aha! Your problem is XYZ and I know exactly how to fix it"! It just doesn't work like that.

I make it my business to read a lot of peer reviewed articles (Journal of Bone and Joint Surgery mostly) and attending hip and knee conferences. And an awful lot of the articles/papers centre on the issues around idiopathic pain in hip and knee replacements, how to diagnose and treat them. If there is one thing that becomes apparent in these discussions it's that surgeons the world over do daily battle with this issue. Also that often there is no definitive answer. Often it's case of trial and error in finding something that helps.

I don't want to discourage you and I really, seriously hope you find a solution soon but I also want you to know that facts of these very common situations. I'd also emphasise that you are only 4 months out which is very early in the process. And I still feel it's more than likely that you've been somewhat over-enthusiastic in your PT and ended up with psoas tendinitis.

 

[Jamie]

I agree with Jo that you probably need to allow yourself more time before you jump into anything. Tendonitis can be quite difficult to address and it may take some time for it to resolve if that's what's going on.

But....if you decide you want to talk with a revision surgeon, here are some options for you:

Here are two possibilities on the north side of Atlanta at the PeachTree Orthopedic Clinic:

broken link removed: https://www.pocatlanta.com/physician_hips.asp?physician=70

broken link removed: https://www.pocatlanta.com/physician_hips.asp?physician=14

Here's another:

broken link removed: https://www.upmc.com/services/orthopaedics/experts/pages/joint-replacement-experts.aspx
University of Pittsburgh Medical Center


And one more:

Dr. James A. Browne
University of Virginia Medical
Charlottesville, VA

 

[maxwellmedical]

I made appointment with doctor at Mayo clinic since thigh pain getting worse. Now instead of intermittent shooting pain on left side thigh about 4 inches above knee, now have intermittent pain that last for hours when have it. He was recommended by Dr. who wrote good article on groin impingement saying that Dr. Lewallen among a few other names gave me would do a good "differential diagnosis" . Dr. Lewallen's info says he does revisions. Josephine, Poppet, and others, do you know if he is a well respected and experienced revision specialist? If not who is a good revision specialist there.

Reason asking about revision specialist is that since still six weeks away and thigh pain getting worse, and initial surgeon does not care to figure out what it is, I saw local orthopedist who has been doing hip and knee replacements for 20 years. From x-rays he took said thinks implant has "subsided" which started right at time of surgery. I believe he saw debris around stem. He said I need a revision. He is also checking to see if cup/ball not too big. Very depressed. He said his patients are fine at six weeks after THR and he was shocked waiting months to see someone. What are your thoughts? Josephine,thanks to you, in case Dr. Lewallen also says loosening, I now know to ask WHY loosening. I had a cementless Smith and Nephew cross ply and metal implant with oxonium coating.

As mentioned before, HSS surgeon said at six weeks check I was "unlucky" that had pain both places but did NOT try to figure out why - has replied to my emails every two weeks since then but never said come back so I can figure out what is causing problem. Josephine I would have gone back to HSS to someone else for evaluation but I believe you said might not get answer (even if willing to see) since all know each other.

Final question - wouldn't taking MRI be helpful? @Josephine you are expert at looking at x-rays and being able to see loosening but many doctors can't. Wouldn't an MRI help in seeing what is happening around stem and cup/femur? I would think Mayo in Minnesota would have the special software to see area around implant well, Dr. Lewallen had not scheduled any tests except x-rays. This is my "one shot" so important that he really cares to figure this out.

Thank you all again.

 

[Poppet]

Hi @maxwellmedical - thanks for the PM.

I have edited your post to enable Jo to see it as it wasn't tagged correctly (check my instructions in post number 26 on how to tag someone).

Jo will be alerted to your post now

Living in Australia, I am not familiar with your medical system or surgeons in the US - sorry you are continuing to have such discomfort. I can imagine you are quite distressed. Stick with us, we will help you through it

 

[Jamie]

Unfortunately there is not a lot of information I can find about Dr. Lewallen and his expertise. However, the fact that he specializes in revisions is a positive. It appears he has a lot of experience with hips and knees at the Mayo Clinic, so I feel like he would be a good surgeon to talk with.

Have you considered some of those folks I recommended that are closer to you as well? You know, there is nothing wrong with seeing several doctor for additional opinions.

An MRI is not necessary to diagnose looseniing or most problems with an implant. Xray is just fine. If you see another doctor, it is fine to take the results of your MRI with you, but don't be surprised if the surgeons just want to review a current xray taken the day of your appointment.

Jo will have to address the doctor's comments about the hip "subsiding." If the implant is loose, you may not be able to determine the exact cause of that happeniing and at this point it would really not be an issue. If it's loose, it just needs to be fixed. That would require removal and replacement (revision). In most cases, the entire implant is replaced, although sometimes (rarely) it's possible to just replace part of the prosthesis.

I agree that your original surgeon dropped the ball. It's time to move on now and find yourself a surgeon you trust to review your case and help you. Please let us know what you decide to do and keep us up to date on your progress!

 

[sandee]

I read in the title that you had some groin pain at 4 months post op? Well if this is true that you had that kind of pain after a THR, that is normal and common. I had that at 3 months post op after I got off the cane and man my groin hurt so much. I hated it. It went away after about 2 weeks of walking cane free. But I'm also only 38 years old. I think my progress is going way fast and I'm at 7 month PO now.

 

[maxwellmedical]

Thank you all for the continued support and thoughts. Poppet not sure what I am doing wrong. I will try tagging you in this one -- typing the "at" symbol" then your name then when little box opens clicking on it. I did look back at your prior explanation. Really trying. Please let me know if did correctly this time. @Poppet .Not seen a post from @Josephine about "subsiding" possibility. At one point think she asked in my thread not to be tagged. Jamie thank you for recommendations. Thought because have osteonecrosis and Mayo doing work in that area although its a rare disease they might have more insight about whether that is part of my thigh problem since read people with osteonecrosis have higher THR failure - and I still have osteonecrosis in other hip which unlike osteoarthritis proceeds quickly to joint collapse.

It is now 5 months post THR. I read with interest the thread by the woman from about 1 1/2 years ago who had sharp thigh pain, like me that comes on suddenly. Question in that thread if the sharp severe pain just started suddenly while walking and then when it went away, it did so just as quickly -- it turned out to be bursitis which showed up on an ultrasound done by her internist - her ortho did not see a thing or think of it -- there was also a discussion in her thread about the possibility of a micro fracture in her femur which might not show up on a x-ray and fact that would heal on own. I am so hoping don't need revision.

I think I gave the wrong spot on the grid - - since live alone and looking down when estimated spot on grid and no knees in grid model, it was hard to figure out where thigh pain is - it is actually lower if imagine knees on image, probably F5L-F6L (towards outside) but in bottom of G or in H. Should have stood in front of a mirror when trying to decide.

Never thought groin pain would require revision so not frightened over it - just hoped it was something a shot would help (tendonitis) and not require surgery (e.g. not be an impingement requiring a release). It keeps me from wanting to walk but I could still interview and hold a job. Just big loss in quality of life and fear what would be like when other hip eventually done.

The thigh pain is a different matter. Terrified about it. Today, walked five minutes on flat surface and even up three steps today with no thigh pain, just the continuing groin problem, and suddenly thigh pain so severe could barely walk. Could see my car in lot but thought might not make it. No one around to ask for help. Felt like I might become "Dorothy" since tornado warning and winds picked up so severely parts of palm trees ripped off in front of me - might be comical under other circumstances. Pain continued for at least an hour or two and then went away quickly. Still a month until Mayo appointment. Concerned because that doctor has only scheduled blood work and x-ray -- not MRI nor ultrasound. I assume Mayo has MRI with the special software so can see tissue around implant pretty well. Does anyone know if microfracture in femur occurring after surgery would show MRI or in bone scan 5 months post surgery? Think Jo said at one point she can see things some orthos can't but no mention in thread about uploading images.

The other person's thread noted in her case needed ultrasound to see bursitis and MRI to see microfracture in thigh. And I still have groin problem and x-ray would not show scar tissue if causing problem or if still inflammation there.

Revision if implant has "subsided" or loosened would now devastating. Revision not great at any age - and I have osteonecrosis in other hip which usually collapses quickly unlike osteoarthritis which occurs over long time (I know since I have that in knee and this all started with running out of things to try for that and initial misdiagnosis that had osteonecrosis in that knee).

 

[Poppet]

Hi @maxwellmedical - you did good I received your alert when you tagged me.

I edited your post so that Jo will get an alert to help you with your concern.

When Jo mentions about not tagging her, it is more to do with the fact that lots of members are not necessarily trying to get her attention to ask a specific question, they tag her in passing rather than just typing her name. So don't hesitate if you have a medical question to tag Jo.

I wish I could help you, I sense you are very concerned and a wee bit anxious and rightly so - take care...

 

[tiona]

@maxwellmedical, Hi there, I have a similar issue. A CT scan suggests that my implant is too large, impinging the iliosoas tendon. Unable to do a straight leg lift, lift my leg into a car to put on pants. In a nutshell, I can't flex my hip, and have groin pain 10 months post op. I also have knee pain which according to my PT is caused by misalignment. My leg is slightly internally rotated, which my surgeon meant to do to decrease the risk of dislocation (anterior approach)...however it changed the way my foot strikes the ground which affects everything. I have an appointment with a specialist April 28th. Please keep me posted about anything you learn about your own situation...I'd love to hear from ANYONE who has had a successful tenotomy and/or revision for this sort of problem...
T

 

[Jamie]

Please forgive @Josephine for not getting back to you yet. She has been having some computer problems and is unable to get online right now. But she will be back soon!

 

[Poppet]

Just popped by to see how you are doing - thinking of you from down under!

 

[Josephine]

Final question - wouldn't taking MRI be helpful? Josephine you are expert at looking at x-rays and being able to see loosening but many doctors can't. Wouldn't an MRI help in seeing what is happening around stem and cup/femur?

I wouldn't say an MRI is not helpful but a decent xray can tell almost everything one needs to know if it's just a loosening. Most decent surgeons can see the 'red flag' clues but some appear to choose not to look that closely or just don't want to know.

Think Jo said at one point she can see things some orthos can't but no mention in thread about uploading images.

A few tips on posting xrays
Uploading a Picture in a Post

 

[Tropic Lady/Special Lady]

Maxwell,

I'm familiar with Dr. Lewallen and his work. Trust me just because you do your research and feel that this one or that one is the best in revisions, isn't always the case. I won't put any surgeon down, but I will tell you Lewallen isn't the best out there, and his work can fail too. My best to you, and hope you can get some answers as to what is causing your pain.