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

[AMR1879]

@Irish Joe you're exactly right. I am very much spinning with all the different opinions but they are ALL very much appreciated and taken into consideration. I wouldn't be on this site or seeing as many different Drs as I have if I wasn't looking for as many different viewpoints as possible. I was just hoping there would be more of a consensus between everyone, lol! Thanks for the reminder to read back. I think taking a step back and reveiwing all of the information I have received is what I need to do now. I am also communicating with Jamie about highly qualified revision surgeons in my area.

 

[Irish Joe]

That's great.
Your in a safe pair of hands if @Jamie is helping you.
Be Well.
Joe.......

 

[Josephine]

I joke sometimes that she was wrong once

Irish Joe, I'm very okay with your jests! I'm quite sure there have been many, many times I've been wrong but not infrequently, my wonderful staff keep me straight!

AMR, this is getting totally ridiculous. It's clear to me (though I could be wrong!) that this other chap doesn't have a great amount of expertise in these kinds of situations. They are a special kind of case and need a surgeon who is going to look and think outside the box. It doesn't appear to me that any of the ones you've seen thus for have that capability.

 

[AMR1879]

I saw my primary care Dr today, just to kind of touch base and talk about what I'm dealing with. My hip pain has been pretty bad these last few days! She ordered a DEXA scan to check my bone density. If I have any signs of osteoporosis, she wants to start me on a Bisphosphonate to maybe encourage bone growth around the stem. She also ordered hip x-rays so she can see exactly what is going on and to have a different radiologist's view the hip and the prostheses--a fresh set of eyes. I will attach the X-rays from today, maybe someone on here will see something off with them?

I am waiting to retest my C Reactive protein and Sed Rate in 3 weeks and repeat the bone scan and possibly the aspiration--good times ahead, lol! I also have a Dr in NJ who my father is friendly with who will be looking at my records, X-rays, etc....


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[Irish Joe]

@Josephine is recovering from surgery herself so she is not active on the forum at the moment.
I might as well look at the inside of a bottle of Guinness as an X-Ray.
I do recall though that there is no hope of bony growth possible from the earlier analysis by Josephine.
To my untrained eye this x-ray looks the same as the earlier one.
I do hope you stay on the road of chasing a good revision surgeon. So many people make full recoveries from revisions and resume daily life with there families.
Best Wishes AMR.
Joe.......

 

[Krista]

@AMR1879, I would trust the opinion of a good hip revision surgeon (not associated with the original surgeon) miles above that of any other type of physician. He would be the expert. So sorry about your pain!

 

[KarriB]

I agree, a revision specialist is who you need to see. He has been trained to see potential problems with implants.

 

[AMR1879]

DEXA scan came out normal and radiologist doesn't see anything suspicious in my hip x-ray. So more good news that nothing is "wrong" with me, but still no clues as to what is actually wrong and why I am in pain.

AMR, this is getting totally ridiculous. It's clear to me (though I could be wrong!) that this other chap doesn't have a great amount of expertise in these kinds of situations. They are a special kind of case and need a surgeon who is going to look and think outside the box. It doesn't appear to me that any of the ones you've seen thus for have that capability.

@Josephine I hope you are recovering well from your surgery!

@Irish Joe @KarriB @Krista @Jamie I couldn't agree more about finding and seeing a revision specialist, however, most won't see new patients until at least a year if not 18mo out from their THR. Also, in defense to my OS, there is nothing obviously wrong that can be detected without physically opening me up (which isn't going to happen until they know what they are going in for). I am doing as much research and using the resources I have in hopes that my scenario will be familiar to someone--some Dr, some patient, some friend who has a friend, and they can say it was this or that and I would then see if I had the same issue. I am tossing up a bunch of stones and hoping at least one lands in the bucket. Until I am a year or more out, a revision specialist will not see me, so I am left to try to figure this out myself with the resources available to me now.

 

[Krista]

@AMR1879, I saw a revision specialist 7 months out from my THR, who eventually participated in my second surgery. I was never told that I could not be seen until after one year. I am surprised, and sad for you, that that is the policy in the area where you live. Regarding your comment that "there is nothing obviously wrong that can be detected without physically opening me up", well, Josephine stated earlier in your thread:

I tinkered with your xray which was of rather poor quality and found, as your surgeon said, there is a significant gap between the bone and the implant. As I said previously, this was destined to never achieve bony ingrowth and never will now.

If a revision surgeon were to see your xrays, I'm guessing he'd see what Josephine saw, a loosening of your implant that dovetails exactly with your pain symptoms. If I were you, I would continue to search for a revision specialist that will see you now. If it truly is a loosened stem, it isn't good for you to be walking around on it until it gets fixed. If it isn't, then you will be able to cross that off the list. Only a revision specialist can tell you for sure. I wouldn't trust the opinion of that radiologist, if it were me. I had two radiologists miss my eventual diagnosis.

 

[KarriB]

A friend had the same issue with getting another surgeon to see her so soon (2 months) after her TKR. She had a suspected infection which her original OS refused to admit to and was unable to see an infection specialist due to booking. So the docs receptionist advised her to go straight to the ER and gave the times the doc would be in the hospital. She went the first day possible the doc was at the hospital. My friend was admitted immediately and had to undergo a 2 part revision. A revision surgeon on staff at the hospital took care of it.

Another friend (my bestie) had a TKR that was painful for a year. She went back to her highly rated OS who told her she was just getting older (50) and would have to learn to live with the pain. A month later she went to another OS who after looking at the x-ray said, "something doesn't look right, you need to see a revision specialist". He sent her to the specialist who determined the implant/post was too big for her bone.

Finally my mother's best friend in her 70s had a THR that was painful for months. Her OS said nothing was wrong, x-rays looked good, however she was in miserable pain. She and her son packed up the car and drove from Pittsburgh to the Mayo Clinic who admitted her, opened her up and the hip implant proceeded to fall right out of her body during surgery.

So while others have not had your same issues they have had problems and pain. You may need to call many revision specialist to find the right one and be an advocate for your own health. But if I were you I would not waste money and time with anyone who isn't a specialist in the area of implants.

 

[Marvy]

Unfortunately, I've had similar experiences as @AMR1879 with being told that I had to wait 1 year post surgery (not with my hip, but another surgery). I'm not sure why it really makes a difference or what the doctors reasoning is. My surgeon at that time told me to go to a pain management clinic and get a shot for lower back pain. The first thing that office asked me was "have you had any surgery in the last year?". While being an honest person, as soon as I said yes, they pretty much told me to call back after 1 year had passed. It is frustrating to say the least and I can totally relate to how @AMR1879 feels...

Just keep researching and pressing on to find answers and someone who will see you and listen to you and your concerns!

 

[Josephine]

If I have any signs of osteoporosis, she wants to start me on a Bisphosphonate to maybe encourage bone growth around the stem.

They'd have to tie me down before I'd take those. Evil stuff!

Also, I see no evidence of union between the bone and the implant anywhere on the stem which, after 4½ months, there should be.

Hope this helps
I've looked at your xray and see there is a smidgeon of a gap where the top two arrows are. And where the bottom arrow is, there is just a suggestion of remodelling of the bone where the prosthesis has been moving. We call it 'toggling' as it wobbles to and fro. The bone doesn't like this and will recede under the moving metal - this is remodelling.

 

[AMR1879]

@Josephine Thank you!! You are the first person to point out something wrong or questionable on my x-ray. I cannot tell you how much I appreciate the time you take to help me and everyone else with questions on this site. I hope you are recovering well from your surgery.

 

[Josephine]

Well, I just hope you will find a surgeon who will take it seriously.

 

[AMR1879]

Well, I just hope you will find a surgeon who will take it seriously.

I see the Dr that tries to fix Ortho problems without surgery on Tuesday. I know a loose stem cannot be fixed without surgery, hit maybe he can help me with the secondary pain in my back, I seems to be the piriformis muscle that is giving me trouble. I also have blood work and a bone scan set for the end of next week. The pain is definitely the same if not worse at times...so there hasn't been any improvement.


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[AMR1879]

So I had my appointment with the new Dr. An interesting discovery of scar tissue either pinched within or growing around the metal of my hip. He found it using his ultrasound machine, after doing a super thorough exam of my hip and surrounding soft tissue. He was focusing in on my hip flexor area while doing the ultrasound, this is where he spotted the scar tissue. He would like to do a temporary block with lidocaine and something else (I forget what it he said) to see if I get any pain relief. The injection is purely diagnostic. It may be completely unrelated but it is more than my OS exams have come up with. Why didn't any of them use the ultrasound machine before? I am hoping to have the injection in a week or so.


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[Marvy]

Unfortunately, I think a lot of doctors out there almost "forget" about ultrasound. I know mine would never think about it. Sometimes they are focused on the "big picture" - such as making sure there is nothing wrong with the implant, no fractures, loosening, etc. that they don't think about scar/soft tissue issues. My OS has taken the approach of "if there's nothing wrong the the implant, then you are fine. And if it is muscle/tissue related, then that's your problem not mine". So my question back to him was, then what doctor is responsible for muscle/tissue issues if it is not an orthopedic (esp. if a possible surgery is involved). I never received an answer.....

If it was me in your situation, I would consider having the injection even if it is diagnostic. Who knows, maybe this would provide some longer term pain relief??

I know this situation has been frustrating, but hang in there. At least now it seems as if the new doctor is being more investigative than the others.

 

[AMR1879]

I am so disappointed, my Ortho Surg doesn't want me to do anything regarding the scar tissue. I was hoping he would have me come into the office so he or another available Dr could run the ultrasound machine over it and check it out--but nope. My pain has become more consistent and I am now getting a sharp, stabbing pain if I take a bad step. I asked my Ortho Surg for pain meds, b/c sleeping is now becoming increasingly difficult, I can't find a position that doesn't effect my hip, but he wants me to wait to take anything until we get the blood work back--I had the C-reactive protein and Sed Rate bloodwork drawn on Fri, I should hear what the results are on Tues. I am in so much pain, it aches when I am sitting, kills when I start to walk, and the stabbing unexpected pain is awful! I wish I there was something I could do to make getting around easier and less painful. This has to get solved soon or I am going to lose it.

 

[KarriB]

Have you tried contacting several revision specialists? I know you said it was hard to find one who would see you so soon after surgery, but there has to be someone. Have you tried not telling them you've had surgery when calling, just stating you have hip pain? It's more difficult for a dr to say no when you're standing right in front of him.

 

[Krista]

Oh, @AMR1879, I am so sorry for all of that pain! Are you using walking aids? They have been so helpful for me over the two years between my THR and tendon repair surgery and recovery. I still use trekking poles or a cane when outside most of the time, and a cane inside sometimes, too. It really helps with pain since you are putting less pressure on your leg. When I was in more pain and weaker, I used a crutch and a rollator walker. The rollator lets you get around quite quickly and allows you to step smoothly. Very helpful to me.

I don't understand why the doctor can't give you pain medication until you get those results on Tuesday. You are hurting now, have been hurting a long time, and it's getting worse. Why wait?

If it were me, I'd be continuing the hunt for a revision specialist, if only to give me something positive to do. Even if I only got negative responses!