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THR acetabular cup problems

Hi @allj
I know that most screws (I have some) don't cause issues, but as Pumpkin notes...there are rare cases and resolutions.
Can't speak to actual positioning in regard to your case vs case in this link, but might want to give this a read.

I know you have had to be the detective, but if you feel pain and you are The One who is feeling it, I do hope you could find an OS willing to investigate.
 
Mojo333 Thanks for the link and info. I have an appt next week with the surgeon. I think this is going to be about the "the squeaky wheel getting the grease", if at all possible, or suffering in silence! I sure hope it isn't the latter!
 
Squeak!
We are all wonderfully and uniquely made, which is why there are rarities or I've heard the word "anomaly" (defined as something that deviates from what is standard, normal, or expected.):nah:

"That shouldn't be causing you pain " doesn't mean it isn't.
Perhaps there IS another explanation.
I'm sure you'd love to find that out.

Wishing you all the best @allj
 
I get that.:unsure:

:fingersx:
 
@allj When is your appointment? I do wish you the best and that you get some answers. I sometimes wish the docs would actually listen to what they're saying. I bet if the tables were turned, they wouldn't like being dismissed they way they sometimes do us. We're just looking for answers because we're still not right, in a real sense, need to be heard and given some direction as to the next step. You just keep right on squeaking away until you find the right mechanic. Lol. I'm anxious to hear what this one has to say. Keep us posted.
 
I left my appointment with some unanswered questions leaving me unhappily resigned and confused. The MARS (Magnetic artifact reduction Software) MRI showed thickening of the indirect and direct rectus femoris head. I was told this was likely the explanation for groin pain which gets worse with walking or doing too much exercise. I looked on google and couldn’t find anything about thickening of the tendon at the head. I thought the surgeon said this happens with normal cutting during surgery and nothing can be done?? I tore what I thought was the adductor but wonder if it was the rectus femoris and that is why it thickened. Would tearing cause thickening? Also, there wasn’t any evidence for my ongoing pain and weakness near the trochanter. He thought it was my back which isn't looking pretty (l;umbar image from another MRI). I want to believe this is the reason but an injection in the lumbar didn’t help and besides it feels like a muscle but what do I know. Could a pinched nerve cause muscle weakness as well as pain even when an injection and using an inversion table to hang upside down on doesn’t help? This is the only place I know I can get a straight answer if the questions that are unfamiliar. I know there are some incredible knowledgeable and talented people here so hope someone can help. Thanks so very much!
Alan
 
Hi, Alan....I'm sorry you are still having problems. Who is the surgeon you are currently seeing? Someone at Mass General?

I am a bit confused about the tearing you mention during recovery. You initially said you had torn an adductor muscle. Was this a diagnosis you received from a doctor? How did this injury happen?

Pinched nerves can cause problems with muscle weakness, so if you think there may be nerve problems, it would be good to continue to investigate this option.

You also mentioned using an inversion table. Have you mentioned this to the doctors you've been seeing? I don't know if this could be causing you problems, but you might try doing without it for a couple of weeks and see if it makes a difference.
 
Hi Jamie,

The surgeon is Christopher Melnic. However, I was operated on by his fellow? Wayne Brian Cohen-Levy. At my yearly visit I was told by Judith Walsh, NP that the groin pain was likely a hernia. Even though I didn't think so I had a CT scan to rule it out. The physical Therapist in Springfield, MA thought the pain was from an adductor. It wasn't until Melnic ordered the MRI that I got an accurate diagnosis of the groin and was told by the MD I met with before meeting with Melnic at the same apt that the groin pain was due to the thickening of the heads of the rectus femoris and happened when they cut the muscles during surgery. I interpreted this a normal if unfortunate event. I guess I wasn’t thinking clearly because I didn’t ask how the front of my groin was cut when the procedure was done from the posterior approach. He also said there isn’t anything in the image to explain the pain in the trochanter area and thought it was nerve pain from my back. When Melnic came in he spent most of the time telling me why it was normal for the screw to be in the muscle and that it wasn’t in far and not to worry about it causing a problem. He also said there wasn’t anything in the MRI to explain the hip pain.


I may have made my back worse with the inversion table. I continue to use it but only incline it to 45 degrees. I have a pinched nerve at L3 and pain down the other buttock. My back cracks using the inversion table which relieves the pain. I had a back injection but there was limited if any improvement. I have an appointment next week at Spaulding, Medford.



Can you recommend anyone in MA or CT that would give an honest evaluation regardless of who the surgeon was?

Thanks for you help,
Well Wishes,
Alan
 
Dr. Melnic is an excellent surgeon and one we routinely recommend. I'm sorry he has not worked out for you. That happens sometimes. Here are some suggestions for additional consultations:

Massachusetts

New England Orthopedic Surgeons
413-785-4666
Springfield, MA (approximately 100 miles west of Boston)

Dr. Jordan Greenbaum (I couldn't find his bio on the linked website, but everything I see says this is where he practices, so call them to find out)
(Primary TKRs and THRs)
Dr. Stephen Kelly
(Primary and revision TKRs and THRs)
Dr. Robert Krushell
(Primary TKRs and THRs)
Dr. Andrew Lehman
(Primary TKRs and THRs)


Connecticut

Dr. Terry Reardon
Orthopedics Associates
Middleton, Connecticut
860-347-7636
 
You talk also about some fairly significant issues with your spine. If you haven't seen a neurosurgeon for these problems, I suggest that you do so. Many people go to a spinal specialist with an orthopedic background, but it has been my experience that neurosurgeons are much better equipped to address spinal and nerve problems. It wouldn't hurt to get a different opinion on this as well as your hip.
 
Alan also in Massachusetts is University Orthopedics with several orthopedic surgeons, although not as many as Boston but they do have a location in Mansfield.
I find surgeons sometimes do not like to comment/care for a patient that has been to one of their colleagues.
I do hope you find the answers you are seeking.
All my best.
 
Thank you Myglasshalffull. I agree!
@Jamie
Before approaching the surgeon it would be helpful to have more info so am hoping you can help. I was told by a PT at Spaulding Rehab in Boston that the obturator internus is causing my pain and difficulty with walking (over 2 yrs out). It is my understanding that this muscle is cut during surgery?? and I assume repaired. During recovery while doing a sidelying hip abduction I tore a muscle (there was little or no resistance opening my leg}. I've had groin, inner side leg and groin pain since then. I had a Magnetic artifact reduction MRI that showed "expected postsurgical tearing of the obductor internus and obductor externus". Another complicating factor is the MRI showing thickening of the indirect and direct portions of the rectus femoris tendons. Am I right the muscle is cut and repaired? And if so and torn can this be my problem? Any thoughts are appreciated. Thanks again!
Best Regards and a Happy and Wonderful Holiday,
Alan Schwartz
 
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Hello Alan,
I am sorry you're still dealing with pain.
I've tagged. Jamie, for you to be certain she sees your question. I hope you have a Merry Christmas!
@allj
 
allj said:
It is my understanding that this muscle is cut during surgery?? and I assume repaired.
Click to expand...
There are muscles cut during a hip replacement so that the surgeon can gain access to the hip joint in order to remove the arthritic portions of bone to be replaced with the metal implant. Any muscles cut would be repaired and should heal with no problems.

allj said:
During recovery while doing a sidelying hip abduction I tore a muscle (there was little or no resistance opening my leg}. I've had groin, inner side leg and groin pain since then.
Click to expand...
Surgeons will sometimes advise against doing side steps early in recovery and it's unfortunate that you received a muscle tear. Especially since you had pain after this event, you should have consulted your surgeon. Did that happen and, if so, what was his opinion for treatment of the tear?

allj said:
I had a Magnetic artifact reduction MRI that showed "expected postsurgical tearing of the obductor internus and obductor externus".
Click to expand...
The term "expected postsurgical tearing" confuses me a bit. It's not "expected" that muscles will tear during recovery from a hip replacement. Perhaps they mean that the tear was expected due to your complaints about the pain.....I'm just not sure of that part of the radiologist's report. Depending on the extent of a muscle tear, it may need some medical intervention, though. Your surgeon is the best person to determine this and discuss options with you.

allj said:
Am I right the muscle is cut and repaired? And if so and torn can this be my problem?
Click to expand...
Any muscles that are cut during surgery are repaired and expected to heal properly during recovery. Long term pain because of this process does not usually occur.

Unfortunately there are a variety of things that might impact post op pain a year or more out from surgery. It can be very difficult to pinpoint the issue. Your surgeon is the best person to start with to get answers to your questions. He will be able to tell you what muscles might have been cut and repaired. He should also be able to offer an opinion on the muscle tear that imaging shows you have. But there can also be impingement problems with the various soft tissues and the acetabular cup. Bursitis is sometimes a problem, as is tendonitis or bursitis.

I'll be interested to hear how your next meeting with your surgeon goes. I'm sorry I don't have any definitive answers for you, but hopefully my post can help you begin a good discussion with your surgeon.
 
Thank you - will do. I am attaching the report for your perusal.
Best,
Alan
 

Attachments

Thought I would give an update for those who may find themselves in my position. After surgery the fellow of Dr Melnic, Wayne Brian Cohen-Levy, did the operation. After the surgery he came to my room and said there is an 8-10% chance of complications without saying anymore. He isn't experienced like Melnic but thought Melnic would closely oversee him (I didn't even know Melnic wasn't going to do the surgery nor was I told he wasn't doing it). I'm of the belief that his lack of experience he caused chronic damage to my soft tissue during surgery. He also put in a screw that holds the cup 1cm (.4") into my gluteus minimus abutting the medius and piriformis. An MARS MRI also showed torn obturators muscles and thickening of the rectus femoris tendon. My surgical leg wobbles and worse I have significant pain with both the front and side of my leg. I have gone through extensive PTand exercise to no avail. If you are going to a teaching hospital BEWARE this could happen to you as well!!!!
 
Gee, I was glad to see you posted but I was hoping you had a better report.:sad:
Isolated injuries of the obturator internus are very uncommon and they are rarely reported in the literature -according to my reading -

..which leads credence to your thoughts of it being a direct result of your surgery...

I really hope you are able to manage the pain...don't know if you have had injections or been put on a steroid regimen?
Sure wish you could find another facility with new doctors to take a fresh look.
 
@allj I am so sorry you are dealing with ongoing pain issues. Where has Dr. Melnic been in all of this? Does he have an explanation of what happened then and now? Something doesn't seem right. It would seem a screw penetrating a muscle could cause pain. Torn muscles can cause pain. What does anyone have to say about these? It does seem like you need a different team to investigate this if your OS has not been helpful. A sports medicine orthopedist might be able to address these soft tissue issues. You may need to talk with your primary care doctor for a referral.
It's too bad you have had to suffer with this for so long. You need to be the squeaky wheel if you are to find any possible solutions. Persevere and keep us in the loop.
 
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