THR Almost 5 months post-op and still a lot of pain & swelling

[Layla]

Hi @snay502
Sorry you're still suffering. Don't beat yourself up over going back early, it's of no use now.
I know this is a long shot but is a career / job change possible? Or are you expecting this will work itself out?
Hate to think of you suffering at work 40 hrs a week.
I'm tagging the forum Nurse @Josephine to weigh in. She will be off the forum though for several days, possibly the rest of the week.

Please check back periodically because she could have some good advice for you through a series of questions she may ask.
Wishing you some comfort.

 

[Josephine]

It feels like I have a baseball under my incision

That's very usual. It sort of reminds me when I first went riding (horse!) and when I got home, I gratefully sank into a nice hot bath only to find I thought I was sitting on a bath sponge! But no, it was exactly what you have - a nice big bulge of swelling! It took ages to go away as well!

Pennsaid 2% gel in a pump. I guess it doesn't have all the potential side effects of oral Diclofenac 75mg.

Oh yes it does! Every single one of them! Plus it's been shown that these topical aids only penetrate into the body by about 3-4mm. So it definitely doesn't get as far as the joint!

I don't notice any improvement at least not yet.

I've never been a fan of NSAIDs for that very reason. They make pathetic pain meds. If you want something non-narcotic, I suggest you try Tylenol 1,000mg 3-4 times a day.

Simply put I went back to work too early. I don't know why the Surgeon would have released me back to work so soon.

I don't know either but he never did you any favours!

 

[snay502]

Sent for a CT scan - 11 months post THR now - CT showed "nothing" with the implant except for some mild degeneration in my back L4 and L5. Now he wants to do a Nuclear bone scan. Searching for infection I suspect. Same amount o pain if not worse than my last post. Hip, Groin, Thigh and now lower back. I have never had back issues before the THR. I am very concerned about the potential for infection as the doc said "you should be able to do whatever you want by now, pain free. Ummmmmm - nope.... not even close. Is the nuclear test expensive? Will it show what is going on in there. This can't be normal.

 

[SaraK]

Have you seen anyone that specializes in the soft tissues? It sounds like your surgeon keeps looking at the bones and implants and not the soft bits that are swelling and rebelling! It may be worth a visit with an orthopedist that does sports medicine and is more inclined to look at the rest of the hip (or back, etc.).

 

[Small1014]

You also might see if a cortisone injection is an option to help with the healing process- if no infection is found. At 11 months, you should be mostly pain free.

 

[snay502]

Nuclear test scheduled for tomorrow. Wish me luck.

 

[Layla]

Wishing you only the best.
Keep in touch, we're here for you!
@snay502

 

[Mojo333]

Best of luck
for some answers!

 

[Marvy]

@snay502 Hope your nuclear test went well and that you will find answers to your pain.

Out of curiosity, did your surgeon actually look at the CT images or just the radiology report?? When I had my CT, the report said that nothing was wrong with my hip. My original surgeon never looked at the images-he went by the report only. Took a revision surgeon who actually looked at the images to diagnose the issue.

I agree with SaraK that you may need to find someone who will look at all the surrounding muscles/tendons and not just the implant and bones....

 

[snay502]

CT scan showed normal. Nuclear scan showed normal. Now the surgeon is right back to what I have been complaining about all along.

I have an extreme amount of scar tissue and it seems to be impinging the joint. Ii is actually getting worse and I am right at one year post THR. It is difficult to walk as the joint is extremely TIGHT. It feels like fiber tearing every step I take and while sitting/standing too. He wants to go back in there and "clean up the scarring" to remove the impingement.

Anybody else have this clean up done and how long were you off work after? I don't want surgery again but I cant take the discomfort pain through another summer.

I have a contact in radiology at UVA. I am going to get my CT and Nuke results and take them to her for a second opinion.

 

[Layla]

Hi there @snay502
Good idea on the second opinion. Let us know what you hear. Wishing you comfort in the interim.
Let us know if you'd like us to tag Josephine in regard to your question two posts above...
A great rest of the week to you.

 

[snay502]

I would love to have Josephine’s opinion on the clean up the scar tissue and healing time. @Josephine Thanks!

 

[snay502]

Anybody had a arthroscopic surgery to release tension in the psoas tendon?
This may be a root cause of my issues.

 

[Mojo333]

@snay502
Not sure about arthroscopic but your old friend @SaraK who seemed to think that this sounded familiar to her has had release and seems very pleased!

 

[SaraK]

I had a psoas impingement that resulted in a hip arthroscopy 13 months after the THR. I had been getting progressively worse and it took forever to get the right diagnosis (I had it figured out at 6 months). I had pain with anything that engaged the psoas. Lifting the leg into the car, putting on pants, lifting the knee or leg in general, turning over in bed. Walking made things worse and eventually started causing pain on its own. I had the hip scope and was released the same day with no restrictions other than not doing anything that caused pain.

Surgery was bright and early New Year's Eve. I felt up to going out with friends that night and even danced a little. I only need pain killers the first day (althou I do apparently have a high pain tolerance). A lot of it the first day was tightness but I could tell a big difference every few hours. I was back at work that Thursday and driving that Friday.

Weakness after surgery is a given because they're lengthening the psoas by an inch or more. My surgeon prefers to make the cut next to the acetabular cup because he feels it leaves less weakness than a cut by the trochanter.

It took a few weeks of PT to get normal day to day strength back. It will take longer to get larger motions (I can do them passively without pain now but can't do them without using gravity or my hands to assist.

The biggest thing is being pain free, though. Within a few days I felt better than I had in months.

The best test for this is a cortisone injection into the psoas. If it relieves the pain, you get the diagnosis of psoas impingement (essentially, the tendon is rubbing on the acetabular cup and often the rough edge of it). I had almost full pain relief from the injection but it only lasted a couple of weeks. Sometimes, though, the injection can provide permanent relief or can work for long enough to do an injection every 3 months.

Happy to answer questions about my experience before and after the release.

Good luck!

 

[M_Mar]

Hi, I’m in the same boat. 8 months after the procedure.
Did blood, few X rays and CT. Everything is good.
However the hip is painful and stiff.
Did you have hip aspiration?

 

[Josephine]

I have an extreme amount of scar tissue and it seems to be impinging the joint.

Anybody had a arthroscopic surgery to release tension in the psoas tendon? This may be a root cause of my issues.

This sounds like a much more likely cause of your problem. Personally, I have never heard of adhesions ("scar tissue") in the hip. Just doesn't happen. But a surgical release of the psoas is much more likely to be successful.

 

[snay502]

Josephine,

I have seen 2 other surgeons for second opinions. Both do not think it is infected but they can't 100% rule it out (even with blood test normal) unless they aspirate - which they do not want to do. However, it hurts quite badly and it is extremely stiff. I have also been quite tired lately and no amount of sleep is enough to rejuvenate. I am scared to death that it is infected. I don't know what to do. I had Left THR March of 2018.

 

[Layla]

Hello
Let's tag @Josephine to make sure she catches this since you haven't posted in over two months.
I'm sorry you're still struggling with pain, stiffness and fatigue. Let's see what, Jo, has to say.
Wishing you comfort, pain relief and answers.
@snay502

 

[Josephine]

Oh dear, I hear you. So let's start at the beginning.
Can you show me the site of your pain using this chart?