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Revision THR 8wks post op - more pain than before<<

@AMR1879 Just wanted to give you a shout to say I REALLY hope you can get this resolved. AVN pain and treatment is such a pain. I'm really sorry you're having to go through all of this. Just reading it is giving my hip some serious sympathy pains. [emoji20]

I will also say that I think like @Josephine said I'd be super duper wary of getting a second opinion within the practice. It kind of goes against logic. I was given this option by my first OS who told me "Your AVN is only stage one come back in six months if you still have pain. Or consult with one of my colleagues here I'm 99% certain they'll tell you the same." [emoji35]

Needless to say I left that practice all together. Aside from the arrogant nature and dismissive tone of my first OS (which thankfully you're not dealing with) I think that most doctors (particularly within practice doctors) do their best to not go against each other. So just be careful dear.... Again I really hope you get relief because AVN itself is awful and unpredictable.

Good luck [emoji171]


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I am waiting to see a revision surgeon 16 months after my left THR which I have had constant pain through only masked a little bit as taking pain killers for my other hip which I have also had done.

@AMR1879 your xray looks fine compared to mine which is not very straight and also the cup has become loose.

Hopefully be sorted soon :))
 

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  • [Bonesmart.org] 8wks post op - more pain than before<<
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Hip Update: I had the bone scan. It ruled out infection but could not "entirely rule out loosening". Saw different Dr in the same practice to get a "second opinion". He is 100% certain the stem is fine and not loose. I reminded him of the location/type of pain I was having and even asked about taking a medication like fosamax along with the vit D to encourage bone growth. The fosamax was actually my primary care dr's idea after she read my records from my surgeon.

Anyway, 2nd opinion Dr prescribed Nucynta ER 100mg BID, but I am afraid to take it. I have taken all strength and types of narcotics and they are just not working to ease my pain. So my Dr prescribed this new drug. But I have 2 young kids, and I'm afraid the Nucynta XR will make me feel impaired all day, which I cannot be! Anyone have experience with Nucynta ER or IR?

He also wants me to have a lumbar plexus block which should help pin point the source of hip pain/lower lumbar pain. Anyone with experience with the plexus procedure? I hope it isn't something to mask the pain by numbing the nerves....sounds like a bandaid not a diagnostic tool.

So.... 2nd opinion Dr doesn't think the THR is the source of pain. What will this lumbar plexus thing do? I'm getting my real 2nd and 3rd opinions from outside the practice ASAP...I don't want to numb the pain and just have it come back not too long after. I want to know the source of my pain!


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If I were you, I would wait on taking any new medications until after seeing the those 2nd and 3rd opinions outside of the practice. Also, I refused to take Fosamax for my osteoporosis due to possible side effects. Am taking something different.
 
I think you're very wise to seek outside opinions from experienced revisionist ortho surgeons. I've read many times on here where a good revisionist OS has spotted the issue immediately. Problems are their specialty.
 
2nd opinion OUTSIDE of my current Ortho Surgeon's practice scheduled for Monday!! The new Ortho Surg reviewed all my records and saw every X-ray, bonescan and MRI and is "willing" to see me and do an assessment. I am so happy to be going somewhere new, a fresh perspective will be nice--even if he agrees with my original Ortho Surg or the 2nd opinion I received within my current practice.

As far as trying new meds and doing nerve blocks as the in house 2nd opinion Dr suggested, I saw the pain management Dr of my current practice and he thought I should hold off on any nerve blocks or injections of any kind. He suggested I wait, actually he said, "tough it out" until I hit the 6 month mark (6/23/17) and go from there. I agreed, reluctantly, that waiting to see if the pain resolves itself is a better choice right now than messing around with the nerves.

So, now I will see what the fresh set of eyes from the Dr at the new/different Ortho practice sees, wait on any nerve blocking and also follow up with my original Ortho Surg next week to see what he thinks of his OS partner's plan to start the nerve blocking vs holding off until the 6 month mark.

My main concern is that, if it really is the stem not being anchored in fully, will waiting and doing nothing in regards to encouraging bone growth now be a mistake and will I lose the window of opportunity to have this implant anchor? Or has that window (6-8wks post op) passed already, like I was told by quite of few on the site already, so it doesn't make a difference if I don't do anything. Or should I be taking something like Fosamax to help encourage bone growth now in addition to the 2000ius of Vitamin D I am already taking?

These are questions I have (along with many more) for at least my current Ortho Surg if not the 2nd outside opinion Dr I am seeing on Monday. The in-house 2nd opinion Dr made it clear that he felt the implant was 100% fine and the pain is coming from somewhere else, which is why he is all for nerve blocking.

Next week should be interesting. I will keep whoever is keeping up with my story up to date! Thank you to everyone who shares their opinions, experiences etc.! I am always open to hearing them!


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@AMR1879-
I really hope you can resolve this.
I suggest you see Dr SU at the HSS (hospital for special surgery) in NYC for an opinion. If he can't fix it nobody can.
 
@AMR1879 good luck on Monday, hope you get the correct diagnosis. It can be tough to self advocate when you're experiencing chronic pain, you deserve a pain free hip :SUNsmile:

@jlm has a good suggestion about HSS if that's possible.
 
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I also forgot to mention, I have an appointment to see a Dr who looks at your body as a whole. On top of his sports medicine certification, he is a board certified internist and pediatrician who focuses on non-surgical orthopedic treatments. He came highly recommended by a Dr friend. He takes a totally different approach to things, and best yet, he takes my insurance, so I have nothing to lose!

stephie33 said:
I will also say that I think like @Josephine said I'd be super duper weary of getting a second opinion within the practice. It kind of goes against logic. I was given this option by my first OS who told me "Your AVN is only stage one come back in six months if you still have pain. Or consult with one of my colleagues here I'm 99% certain they'll tell you the same."
[Bonesmart.org] 8wks post op - more pain than before<<
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@stephie33 Yes, in-house second opinions are definitely not the best idea. I was given a totally different diagnosis from the OS in the same practice which wasn't what I was expecting. I thought he would most definitely agree with his colleague! Unfortunately, I found it unsettling rather than helpful especially went I talked to the pain management Dr in the same practice who did not agree with the OS's opinion! I am looking forward to my out of house 2nd opinions next week--new practice, new Ortho surgeon and with the sports medicine Dr it is a whole new way to look at things, which will be refreshing (hopefully).


jlm said:
I suggest you see Dr SU at the HSS (hospital for special surgery) in NYC for an opinion. If he can't fix it nobody can.
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@jlm HSS is my next stop. My dad had his hip done there and never had a problem. I keep saying I should have just gone there first but my OS here has great credentials and is well qualified, he actually worked at HSS for many years. I choose to stay local and not travel to NYC. If it was a few years ago, when I lived closer to the Manhatten, it would have been a no brainer!! I already have the name of a Dr at HSS, the chief of pain management, who I will be seeing if I have to go the pain management route and not the revision route.

@Krista thanks for keeping up with my "saga", haha!

@Horseshoe Thank you! Yes, I agree HSS will be my ultimate place for care if anything major has to be done or if I have to explore the pain management route. I am too young to start poking at my nerves this early in life! Many of the injections can only be done a certain amount of times before they are ineffective or it becomes too risky to keep poking at the nerves.
 
My Ortho Surg called me yesterday and asked if I would go into the hospital the following day for an aspiration of my hip. So I did that today.

The Dr who was doing the aspiration said that normally they do not get fluid out of an artificial joint for obvious reasons (the joint doesn't need synovial fluid or other fluids to keep it moving smoothly). So they usually check for fluid and if nothing is aspirated, they inject saline into the joint so that will collect cells and then they remove the saline and send that to the lab.

I have to say, I have had a few x-ray guided cortisone injections directly into the hip joint, so I wasn't nervous about this aspiration, but this was NOTHING like those injections. It was so painful when the Dr rooted around in the joint. It was as if someone was pushing the pain button and not letting up. It was the area where I feel my pain, but it was constant. I was almost in tears!

The Dr actually did aspirate some fluid from both around the joint and directly in the joint. The fluid from inside the joint was a little thicker than the first bit of fluid he aspirated from around the joint. Both were blood tinged, but he said that was because a small vein could have been nicked. So now I wait to see what that fluid is.

@Josephine do you have any thoughts? Just curious of your experience with joint infections. Does fluid aspirated from the joint definitively mean infection? Or are there other reason fluid may be there?

Just a reminder, my blood work (BMP, CBC No Diff) a few weeks ago were all normal except for a slightly high Sed Rate of 37 (Ref is 0-20) and C-Reactive Protein level of 7.47 (Ref is <3.0). I know elevations in those tests can mean infection, but they thought they were elevated b/c I was a little over 3 months post-op. I also had a 3 Phase Bone Scan and that did show some increased radiotracer uptake "in the region of the greater and lesser trochanter and intertrochanteric region of the left hip" -- but they also thought this was because of the "recent" surgery. I guess they were looking for extremely elevated levels. So now that there was fluid in the joint, I wonder if they will look at the results differently?
 
@AMR1879, so sorry you had that much pain during your hip aspiration! I am hoping for good news for you, that there is no infection. Just for comparison, I had a hip aspiration 7 months post THR. He could not get any fluid from me, and it didn't hurt much while he was probing. I got to watch it on the monitor. Then he added the saline, and that was painful. I ended up not having an infection.
 
@Krista Thank you, I will take any news at this point...good or bad, I just want answers! That is very interesting that you felt pain when they put in the saline. I watched too, until the pain started, then I had to concentrate on not moving my hip....so I grabbed the table and said some inappropriate words....lol, they didn't care. I felt pain the whole time he was in the joint. I am so curious about what the fluid was that he aspirated from the joint. It doesn't seem like it can be anything good, since they don't expect to get any fluid, that's why they use the saline, to grab some cells in the joint, so they have something for the lab to test. I hope it leads to answers!!
 
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I think it will be a little while before you hear back, since I believe that they try to grow things from the fluid. Wow, it was hurting the whole time the needle was in your hip. Ouch! Crossing my fingers for you.

It was fascinating for me to watch. The radiologist took some screenshots for me, and I was able to photograph them afterwards. You could see the needle, bowing as it touched the neck and other parts of the implant.
 
Krista said:
I was able to photograph them afterwards. You could see the needle, bowing as it touched the neck and other parts of the implant.
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I got a photo too! It was so interesting to watch, it was hard to believe that that hunk of metal or whatever it is made of, is in my body! In my photo you can see the needle faintly, coming up from the right bottom corner and it's going behind and into the joint....

[Bonesmart.org] 8wks post op - more pain than before<<
 
@AMR1879 and @Krista, you are both brave hip warriors to undergo hip aspiration :yikes:

Great xray, hope OS can get an accurate diagnosis, look forward to reading Josephine's opinion too.
 
I can see that needle snaking up into the joint! Here is a scan from my aspiration. I'm shuddering...

[Bonesmart.org] 8wks post op - more pain than before<<
 
AMR1879 said:
Both were blood tinged, but he said that was because a small vein could have been nicked.
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Nonsense! a) there is always fluid in the joint, even in an artificial joint! It can't be avoided. b) that fluid always looks blood tinged because that is the normal colour of tissue fluid. Even saliva has a faintly yellowy-pink tinge. Perfectly normal.
AMR1879 said:
So now I wait to see what that fluid is.
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It will most likely be, as I said, normal tissue fluid.
AMR1879 said:
so I grabbed the table and said some inappropriate words....lol, they didn't care
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Well they wouldn't. I can promise you that all surgeons have a fairly rich vocabulary of "medieval epithets" which they use freely in the operating theatre! I went in an innocent and naive young girl and pretty soon learned a LOT of words I'd never heard of before!
 
Just sending you supportive hugs I have no wisdom being new to this myself but my heart goes out to you
 
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