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THR acetabular cup problems

@allj, I'm sorry you had a bad experience with the revision surgeon you saw. Was it one of the doctors I gave you? I'd like to know who you're seeing as you search out an answer for your pain.

You must remember that doctors are human like all of us and they have their "specialties" and interests just like we all do. Even though this one revisionist basically blew you off, that just means you didn't "click" with him. It's important to keep seeing doctors until you get one who can relate to your case (because he's seen it before) or he's intrigued enough to want to pursue a solution. Sometimes you have to kiss a lot of toads before you get the princess. :heehee:
 
Hi @allj Took a look at your thread. I am so sorry for your ongoing issues. I, too, had ongoing groin pain post RTHR. I had trouble flexing my leg (couldn’t bend to put shoes and socks on, lift my leg to step over things etc), go up stairs or get into/out of cars without pain. Definitely could not do straight leg raises. It was diagnosed as iliopsoas tendinitis from cup impingement. I also was dealing with the soreness pre-op. My OS was very patient in helping me but resolution took time. We did Celebrex, self-PT, consult for and completed steroid injection (which eliminated the pain for 2 weeks,) eval to arthroscopic specialist for tendon release (that OS did not want to do it which was okay by me because we didn’t communicate the best, anyway) and then considered cup revision. In an effort to avoid another major surgery, at my request, my OS then referred me to another arthroscopic OS (who was a great communicator and very experienced) who did a complete tendon release as a fairly minor procedure, comparatively. Now, I’m free of that pain and strengthening the leg with regular exercise (this OS also did not recommend PT.) Any residual soreness and stiffness is improving daily (arthroscopic OS said it could take up to 3 months, which coincides nicely with my 1 year post op anniversary.) It was a frustrating road and I wish I had been able to do it sooner, but again, you need to jump through the conservative hoops first for the chance in it helping and to satisfy insurance later. I know there have been others here that have had similar experiences. I hope it helps to know you’re not alone. Let me know if I can help further. Best wishes for a solution and relief from your pain. Pat.
 
Jamie thanks for your support. If I have a revision, I will go to one of the surgeons in Boston you mentioned but it will be a last resort and I'll have my antenna up this time.

Hip4life - Pat, did the surgeon say how much strength you would lose with a tendon release. Where did you have this done? Wishing you a speedy recovery.

Mojo thanks for your continued support and interest. I'm hoping for a better New Year and wish you the same. Maybe I'll see clearer in 20/20. I am doing better but not much. I'm seeing a specialist to assess whether I have tendinopathy or a torn minimus or medius glut on the side I had the thr on and getting another MRI to assess the progression of edema in the femoral head on the other hip. The past MRI says I also have extensive labral tearing on this side. Beside this I'm a happy soul. Maybe I'll think about having revision surgery at some point but have other fish to fry first.
Everyone - Keep the faith and be well.
Alan
 
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Alan, I’m in Omaha. I had my THR at the UN med center. The arthroscopy was at OrthoNebraska, so completely different clinics. The arthro OS (again, highly recommended and experienced) was confident that I should not lose too much, if any, strength because other muscles would take over the function. He said he always totally released IP tendons at lesser trochanter in post THR because there was a chance that the partial released tendon could heal back up short and there you’d be again. Again, different docs have different experiences and opinions. That is what you want as well-someone experienced in the procedure you need to have done. Anyway, I was up and running, pun intended, immediately. I used walker/cane at first for my peace of mind but down time was minimal based on my comfort.
I hope for the best for you. It is difficult to sort out what your next priority is when you have to look at so many possibilities and don’t have any clear answers. One thought I have is if you talk to an arthroscopic hip specialist, like I did, he might be able to offer you more options or definitive answers on your THR ongoing issues. Maybe even your other hip as well. There are so many advancements in arthroscopy that I was so unaware of. No wonder it’s its own specialty now. Navigating the medical system isn’t easy and I work in it! I’m wishing you the best and I’m following along. Shout out if I can help. Pat.
 
@allj Hi, Alan. Just stopping by to see how you’re doing. Any updates? Pat.
 
I, too, have been wondering if any answers have crystallized since your last update...:unsure:
Hope you are hanging in there @allj
 
Thanks for not forgetting me
Pat how are you doing?? I hope recovery is as expected if not well. Can you exercise without pain yet? Are you satisfied with the results? Would you still recommend it or is it too soon?

For me, I'm a mess. Nothing is resolved.
Can you answer or comment of a few things that are part of my worrying mind.
1- I was told the angle of the prosthetic is within acceptable limits. I was also told the cup should be flush. Can/should it be both flush and at the angle correct?

- Several years prior to surgery I had an injury to my minimus, medius, glutes with tendenitis. A few years later my leg collapsed inward leaving me in some pain but able to function fairly well. Though I couldn't open my leg sideways completely, as long as I stretched and kept in shape I was able to keep active even with a torn labrum (hike, bike ride, etc). When my leg started giving out standing on it I went for surgery. I now have more pain in the glutes than before especially when sitting and sometimes waking in the night. The pain is at the sciatica and to the backside closer to the prosthetic and sometimes nearer the hamstrings. I just had an MRI of the pelvis. There is no tendenitis but the report says I have a herniated L4-L5 disc. I occasionally have some lower back pain but not that often.
2 -Do you know if mild herniated disc could cause these problems with the glutes?

I have an appt with a revision surgeon in Boston that Jamie recommended, whose online reviews were positive, to address the pain caused by the psoas catching. One other thing - I got tired of my leg being weak and not functioning after over 2 yrs so did some planks, lifting one leg at a time. I did gain a modest amount of strength before I heard a loud crack! (sure hope it was my SI joint).

I'm still trying to be an optimist but I'm not getting much help from the medical experts I see and more often than I want I feel despair and too much pain. I just hope the surgeon at Mass General takes an interest in my case and can help. (Dr. C. Melnic)
3 -Any suggestions on what to do with the glute pain or anything else?

I really do appreciate you kind people! WISH ME WELL IF YOU HAVE THE POWER!!
Alan
 
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Hello again. Hope everyone is keeping safe. It's seeming like "Groundhog Day" mixed with "Twilight Zone". I hope this ends sooner than later. I finally decided to have revision surgery my hip. The pain and discomfort has become unbearable. I'm having pain in the front of my leg - rectus femoris- and buttock even though the cup is only about 2mm high. Can someone please recommend a reputable revision surgeon in Connecticut?
As Always Thanks,
Be well,
Alan
 
Alan,
Glad to hear you have decided to go ahead with a revision. You can use our Surgeon Locator link at the top of the page to search for a surgeon. You will have to check the web sites or call the surgeons offices to see if they have someone specializing in revisions/complex joint reconstruction.
Did you interview the surgeon in Boston that Jamie recommended. You also might want to take a look at HSS in NYC, they have more than one revision specialist.
 
I did go to a surgeon that Jamie mentioned, Dr. Melnic but I messed it up. At the time I had a flare up with my other hip and we scheduled surgery for the end of May (however, now all non-essential surgery is postponed at Mass General where he practices). When alone after briefly discussing my non-revision hip, I asked about the risks of revision surgery. I think I became momentarily overwhelmed with my ambivalence and fear because I sabotaged what was going well. I mentioned that the original surgeon would do the revision surgery without a guarantee. He said Carl, the original surgeon, used a cup that was slightly too large. I wanted a clearer idea of whether he thought the same and asked whether he had many procedures that didn't go well. I didn't mean to but this put him on the spot and offended his integrity. He said he only operates on those he thinks will be successful. When I asked if he thought I was a candidate he looked at me and said no. He shook my hand, walked out and had his staff come in to schedule my other hip and had me follow through with a non-steroid injection of my psoas we discussed earlier to assess pain reduction. What should I do? It was clear he was OK doing the surgery before I opened my mouth. He seemed a likable person. Maybe I could re-ask him in a more appreciable way?? I could try another surgeon Jamie mentioned but they are all part of MassGeneral and will want to know or be suspicious of why Melnic wouldn't operate on me. Unfortunately, I am in significant pain and have been using a TENS unit on my buttock and having lots of pain at the top of the femoris. I had an MRI of my pelvis and my Lumbar area indicating no problems so am assuming the buttock pain is related to the acetabulum - the more reason to get this done. Any advise you could offer is much appreciated. Please advise me, I'm really screwed up!
As Always Thanks,
Alan
 
Hi Alan.
I know you are so ready to be out of pain and get this fixed.

allj said:
What should I do? It was clear he was OK doing the surgery before I opened my mouth. He seemed a likable person. Maybe I could re-ask him in a more appreciable way??
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I certainly think I would try ...
Going to him humbly and explaining that you have been in so much pain and did not mean to portray that your hesitance was a lack of confidence in him, it is just an unfortunate byproduct of your first surgery not having the expected result.I wpuld let him know you are highly motivated to get this done and have all go well.

i did look up Orthopedics New England that apparently has revision specialists and declare their office hours are the same with special provisions made for the coronavirus situation.
i don't know these surgeons stats but maybe worth checking in to?

Still hoping you find a surgeon soon as I hate to see you suffering.
 
Hi Alan, I'm sorry to read your updates and continuation of pain. Goodness, of course you questioned the surgeon. I agree with Mojo and maybe you could speak to him again and clear some things up.

Wishing you good luck with this.
 
Hello,
Unless I’m misunderstanding, I don’t think there was anything wrong with asking the surgeon about his track record. You’re interviewing him, he isn’t interviewing you. Are you saying he determines whether your surgery will be a success, or not, solely based on you posing questions before you decide whether he's your guy?

I’d seek a second opinion from Jamie’s other reference and if pressed, be honest about the communication between you and Dr Melnic as an obvious misunderstanding. I don’t see how you’re at fault here, but it is clear you need to move forward in an effort to obtain relief. Wishing you comfort and discernment in choosing a surgeon.
Stay well and in touch. We’ll be here.
@allj
 
Hi, Alan. Here’s my question: so did you do the diagnostic injection of your psoas? Perhaps he didn’t think you needed a revision if the psoas could be the issue and could be treated a different way. My OS offered revision if that was my only option which it seemed like after my first arthroscopic consult but then I got a econd opinion. Maybe that could be something you could clear up with him as well. A revision is a very big next step.
There is an interesting article about this from AAOS:

A Review of Iliopsoas Impingement in THA Patients

During the AAOS 2019 Annual Meeting, Robert T. Trousdale, MD, professor of orthopaedics at Mayo Clinic in Rochester, Minn., discussed diagnosis, management, treatment, and prevention of iliopsoas impingement after total hip arthroplasty (THA).
www.aaos.org www.aaos.org
It is always a bit unsettling when the consult seems to go sideways but like you alluded to, it might be a miscommunication or misinterpretation. You have every right and need to feel comfortable and confident with the surgeon, in any case, considering what you are asking him to do, revision or otherwise. Peace and blessings, Pat.
 
Hello
I have another consult with the surgeon via telehealth this Wednesday. I have a few questions that hopefully can be answered before then.
1- How long do revisions last? Can I expect 20 or more years?
2- How likely are infections? I understand they can usually be treated successfully with antibiotics but can one die from them? I also read in the worst case the prosthetic needs to be taken out until the infection is gone. (Wouldn't want to be in a nursing home especially now). Is the prosthetic then put in again?
3- Another problem is dislocations. How often does this happen and how big a problem is this? (the surgeon said he is going to drill 2mm to accommodate the high cup).
Thanks as always for your generous and kind help.
Alan
 
allj said:
How long do revisions last? Can I expect 20 or more years?
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Of course we can't predict any one case but yes, the new implant should last quite a long time. Technology is on your side!
allj said:
How likely are infections? I understand they can usually be treated successfully with antibiotics but can one die from them?
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There is always a risk of infection whether it be THR or revision THR. If you were to develop an infection it can be treated with antibiotics. In severe cases the prothesis is removed and replaced by a spacer and antibiotics in the joint. Once the patient's blood results show they are clear of the infection the spacer is replaced by a prothesis.
allj said:
Another problem is dislocations. How often does this happen and how big a problem is this?
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Here are some articles from our Library on dislocation. Ask you surgeon if you will be given restrictions post op.
Dislocation: incidence of dislocation after THR
Dislocation risk and 90 degree rule
Dislocations: what are the risks?
 
Thank you Jaycey much appreciated. One more question, please. I have pain in the buttock that is relentless and often drives me up the wall. I had some pain before surgery but not as much as I do now. I went to a physiatrist who did MRI's of my Pelvic and Lumbar that were unremarkable for pain. Could the pain be due to prothesis?
Thanks again,
Alan
 
allj said:
Could the pain be due to prothesis?
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It could but only a revision specialist could access and answer this question. Is the surgeon you are speaking to on Wednesday a revision specialist?
 
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