THR Arthroscopic hip bursectomy post THR?

Perplexing is the perfect word. It’s frustrating and difficult to comprehend. I keep being told that everyone’s body heals differently and some of us take longer to heal. I have had several post op visits with my surgeon and since the trochanter injection he gave me did nothing to relieve pain or swelling, I’m going to get a second opinion and have been researching surgeons the past few days. Unfortunately, not too many perform anterior hip replacement and so far, the few I did research had horrible reviews. Actually, my surgeon had the best ratings and reviews. In my opinion, once they are done with the surgery and determine the implant is okay, they are done with you as a patient. They are not at all concerned with whether you have existing issues and pain. At least that has been my experience so far. It’s now our task to find out what went wrong.
Take care and hopefully, we’ll both find some answers soon.
 
It’s been helpful to know I’m not alone but now important to find answers to multiple problems.

The corticosteroid injection administered by my hip surgeon was given May 7. I really have not received much relief and today, swelling in thigh, buttocks and nerve pain are back. So I have a few questions wondering what to pursue first. Should I see a new surgeon, find a reputable pain management dr. and try another injection first?

My surgeon did not give the injection using guided X-ray or fluoroscopy. Maybe that should have been done? He was reluctant to even give the injection but finally agreed since I was in such pain. He was worried about damage to the implant and small risk of infection.

I had a lumbar MRI last week and will see my spine surgeon on June 2. As mentioned in my recent posts, it’s highly unlikely all this pain is coming from my spine.

My hip is tingling and burning right now; feels like something is crawling in my thigh and also pain around the incision area since PT said psoas is also a problem. Is trochanter bursitis a permanent issue and perhaps aggravated by something pertaining to implant?

My PT insists I should return to therapy so she can work on stretching and glute atrophy but I’m nervous about pain she caused a few weeks ago. I did work all week and averaged 1.5 miles per day on the school blacktop so that’s encouraging. At least I can walk!!

Only took Tramadol one day. However, I am feeling results of this week right now. It’s hard to do housework, bending over and other tasks when pain and swelling take over.

My surgeon is supposed to be one of the best in my area. If you research his background, you can see how amazing he is. At least that’s what I thought when I chose him. Also, reviews are all from verified patients!! So it looks as though I’m the only patient who has had a really negative post op experience.
 
You have been diagnosed with multiple issues that could cause you pain, and as I've mentioned before, it's going to take a long time (could be months) to work through them one at a time for resolution.

If you're in pain, you're not doing yourself any favors by not taking something for it. I could be Tramadol, if that works. Or it could be something over the counter like and NSAID or Tylenol. But trying to tough it out allows any inflammation to remain and possibly worsen. If you wanted to talk with a pain management specialist to find out what may work best for you, that would be fine. Just realize that managing the pain should only be a temporary resolution while you address the problems that have been diagnosed.

It's impossible to say whether or not the injection might have been more successful if the doctor had used x-ray or fluoroscopy. I'm not sure I understand why he would not have done that, but it's done now and it didn't work. So you need to move on to other options.

If you could find one or two good revision surgeons, it wouldn't hurt to get some additional opinions. It's always helpful to have new eyes look at a problem. Any doctors you see do need to be revision specialists, as they are the ones who see and deal with the problem cases. There is no need to pursue additional opinions OR a pain management specialist. You can do both at the same time.

If you have muscle atrophy, you probably do need to begin some type of physical therapy to help resolve that. Just make sure that you are clear with the therapist that you do not agree to any treatments that involve more than just mild discomfort. They need to take things slowly with you because of all you have going on. Any pain or swelling after therapy will not help you and could make things worse.

If you're working all week, I'm not sure why you are attempting the additional walking each day. My suggestion would be to stop all that until you get your pain and swelling under control. At this point you are likely getting enough exercise with your activities of daily living and work. If you add in therapy, you definitely should watch how much extra walking you do for a while.
 
My prior posts state that the 1.5 miles per day is primarily at work, five days a week. I have not been doing additional walking! I’m certainly not a masochist and do not enjoy being in constant pain. Also, I cannot take NSAIDs due to having GERD. Tramadol helps with pain but as you know, it is not an anti inflammatory medication and I’m sure you are aware of the gastrointestinal side effects of this medication so I’m trying to limit taking this too often. Tylenol does nothing for pain.
 
I did work all week and averaged 1.5 miles per day on the school blacktop so that’s encouraging.
I'm sorry I misinterpreted your activity. I made the assumption based on your comment about walking on the school blacktop that it was above and beyond what you walked while at your job. It sounded like you were doing laps around the track at school. My error.

Good for you for taking care with NSAIDs since you have GERD. That's very wise.

If your "gastrointestinal side effects" from Tramadol refer to constipation, you can avoid that problem by taking stool softeners or Metamucil along with eating certain foods. Here is an article from our BoneSmart Library that has plenty of suggestions so you don't get constipated when taking prescription pain medication. Even though Tramadol is not an anti-inflammant, it can do a great job of managing pain if it's taken on a schedule that works for you. It won't do much for you if you only take it now and then when you are fighting chronic pain like you describe. If you decide to consult with a pain management specialist, these are all things you could discuss with him/her. Injections are not your only option with this type of doctor.

When you've tried the Tylenol in the past, were you taking 1000mg (two 500mg of Extra Strength Tylenol) each time you took a dose? With joint replacements, this level of the medication is usually what works best. It's also best to take it on a schedule so you always have some medication in your system. You can take up to 4000mg total in a 24 hour period. So if you are having fairly consistent pain, it's best to be on a schedule of taking this dose every 6 hours. But sometimes even that doesn't get the job done, so I understand if you've already tried this and it doesn't work.
 
Hi @Nyc1961
I'm sorry you are having alot of pain same feel things are not getting well quicker.
When you've tried the Tylenol in the past, were you taking 1000mg (two 500mg of Extra Strength Tylenol) each time you took a dose? With joint replacements, this level of the medication is usually what works best.
Tylenol never worked for my pre-op pain but this c combiination of Tylenol and Tramadol regimen made a remarkable difference for me post-op.
Also I was still doing alot of icing, even while sitting at work.
since surgery I I have been diagnosed with severe trochanter bursitis, psoas syndrome, piriformis tendinitis, glute muscle atrophy and weakness, hip flexor and iliotibial band problems, and now a baker’s cyst behind my left knee.
That's an awful lot of issues and the bursitis and tendonitis alone can take months to resolve and benefit tremendously from ice and rest
I'm sure it's hard when you are dealing with diagnoses of atrophy, but I think you will have to concentrate on these issues and once they are better, work on strengthening weak muscles.
I agree with Jamie that any PT will need to be extra gentle and I think you should try the extra rest and ice regimen (boring, I know:bored:) as well as trying the med protocol and see if this helps any.

Hope your Sunday is easy and restful.
 
I have been in PT for about 4 weeks now going twice a week. I started out very slowly, and put heat on my hip for the bursitis. I've had tremendous success just stretching my muscles and taking it slow. I do not have the swelling that you mention, but do have trochanter bursitis, and I had IT issues. I had 1 bursitis injection in January that helped some, and PT has helped a great deal. I'm so very sorry you are dealing with all of this. I know how disheartening it is. Hang in there, and I hope you find some answers.
 
I usually start off with two extra strength Tylenol pills and yes, it works better if I take Tramadol later on in the day, usually at bedtime. Taking four extra strength Tylenol pills usually does nothing to relieve pain. I have always followed a healthy diet; lots of fresh fruits and vegetables and the past few days have even increased the amount to ward off constipation from Tramadol. I was taking miralax every day but it does take a few days to be effective so hopefully, increasing fiber and drinking more liquids will help. I’m finding dealing with the emotional aspect of being in constant pain is very difficult for me. I can’t even touch my thigh due to pain and burning. Groin pain is also constant.My surgeon said this is a side effect of anterior hip replacement and I knew that could occur. It’s worrisome and painful. My PT also told me weeks ago that all these problems are connected to one another. I couldn’t understand why I had so many issues.
Hope it’s not femoral nerve damage. I’ll probably never know, at this point, what caused so many problems; surgeon’s error or just muscles not in great shape to begin with. I now have to concentrate on getting well and hope this is not going to be permanent. It’s becoming a full time job, in addition to my work schedule. Sadly, I know stress makes things worse.
 
Hello @Nyc1961
Welcome to BoneSmart. Thanks for joining us. I think you’ll appreciate the support and encouragement you’ll find here. While I don’t really have any advice to follow all you’ve already received, my heart goes out to you in your pain and struggles. I wish you comfort and hope these issues resolve in time.
 
My heart goes out to you, @Nyc1961... I certainly understand how it feels when you are worse off after the surgery then you were before. I'm just coming up to 3 months after a posterior THR, but I've had steady groin pain since week 5, which my surgeon diagnosed as psoas tendonitis. I've been told to do as little as possible in the hopes that it will settle down, so spending a lot of time resting, icing and elevating. No walks, which I sorely miss.

That in itself is not so awful, but like you, I'm finding that the uncertainty about when this might resolve, and the worry about whether it's going to resolve is wearing me down. It's a struggle everyday, mentally.

Hoping for a good outcome for us both, and sooner than later would be good too!
 
Hello Sashimu,
I know exactly how you are feeling!! I have severe pain in my groin today from psoas tendinitis along with all my other issues. Honestly, if I had known what was in store for me after 8 months of pain, I would have kept my labral tears and arthritic hip for awhile. I knew about possible nerve damage, which I have, but who would have thought psoas tendinitis as well as trochanter bursitis, iliopsoas and Iliotibial band problems would be causing such pain and major depression. Is my surgeon the culprit? I would feel better knowing the cause which infuriates me every moment since I’m in constant pain. I also miss my walks along the ocean which he assured me I would be doing after a few months; what a gullible person I was
Today, my hip is so swollen and hot to the touch and groin pain is miserable. I’m waiting for a call from a hip surgeon and hopefully, he can find out what is causing so many problems. Also meeting with my spine surgeon next Tuesday to review the latest Lumbar MRI. My hip surgeon keeps telling me it’s my spine; spine surgeon is saying it’s my hip; life is just a bowl of cherries right now! Take care and know you are not alone and I’ll be thinking of you!
 
I guess I have to consider myself lucky that I only have one issue (at least as far as I know!) It is very hard to deal with constant pain, that you didn't expect to have, without succumbing to depression completely. I wouldn't wish this on anybody, but it also helps to know I'm not the only one out there. I'll be thinking of you too @Nyc1961!
 
I was able to schedule an appointment with a hip surgeon on Wednesday for a second opinion and have to remain optimistic that he’ll be able to give me some answers. Pain and swelling is worsening since Friday in groin, buttocks and thigh; starting to really become worried. Swelling seems to have accelerated near the injection site where my surgeon administered the trochanter bursitis injection two weeks ago.My worst fear is that I may need revision surgery but trying to keep those thoughts out of my mind tonight; very difficult right now.
 
I’m sorry for the pain and mental anguish this is causing you. Hopefully the second opinion tomorrow is enlightening and leads to a plan and resolution. Best of luck to you, please let us know how it goes.
@Nyc1961
 
I've been following here a bit, and I'm so sorry to hear of the rough road you're on right now.
Ive had both hips replaced and know it's both a blessing and struggle.
I've been learning about the SI(sacroiliac) joint, as well as the Lumbar systems and nerves that go with them. I'm no surgeon or anything of that caliper, but I've learned the nerves that extend from the L's go down to/through the frontal thigh area... and the SI joint is what ties the Lumbar to the pelvis.
If the L2-5 nerves are compromised because of degeneration of discs(herniated, bulging, etc...) that can certainly lead to numbness and odd/pain like sensations in the thigh/groin. I'm experiencing a bit of it as well, but I knew going in this time what I was potentially dealing with.
My recent RTHR isn't my culprit... but my SI and L2-4 are most likely at fault... and confirmed by my nuerogolist.
It's not debilitated me at this point at all,
but its taught me there's alot more going on then we realize.
I've found the SI(sacroiliac joint) most interesting...(not to be confused with the sciatic nerve).. as it's the very foundation of our upper body to lower body,and all upper body weight is carried and transferred to the pelvis through that joint... and the SI actually moves very little.. for what it does. Lower back pain, buttocks, groin, etc.. pain can all be generated by that huge joint.. and any nerves connected can radiate dramatically. When we're already sensitive in those tissues/muscles it can be excruciating.... and bewildering when we don't understand it.
I'm definitely not saying this is the problem you're experiencing, but I'm sharing my experience and a bit of what I'm learning along this road we're on.
I had my LTHR in 2015 and it's been golden... had my RTHR May 5th, its golden... and I'm somewhat believing now that I have 2 proper working hips, other parts of my degenerated osteo system are rearing their problems.
The hips are working and telling the other joints "get to work".. and we're going in the right direction now.
I'll look forward to your story.. I see we're both here in Cali.. nice to see someone close to home too. Hang in there.
#KeepFightingtheGoodFight!
 
A huge thank you to my fellow Californian for the informative and very helpful information.

Everything I’m dealing with is like an ongoing mysterious puzzle with many clues and wishing I could finally have a resolution. I now realize I’m probably dealing with multiple issues and the one question that I would love answered is this: did the THR activate all the problems that I know already existed and were dormant until disturbed by my surgery? An MRI I had right before surgery also noted gluteus minimus tendinitis and trochanter edema; yet another pre surgery clue that was never mentioned by my surgeon.
I did have an SI injection on January 27 to rule out the cause of pain. I felt a little better for awhile but again, uncertain if that was the main cause of all the problems.

A month ago, after yet another lumbar X-ray, the urgent care orthopedic practice I visited suggested an epidural of my L4-5, L5-S1 to rule out nerve root impingement which was worse on left side. I do have stable mild to moderate degenerative facet arthropathy in those areas. Again, immediately felt relief from the lidocaine but corticosteroid didn’t help that much. And two weeks ago, the corticosteroid for trochanter bursitis which was definitely diagnosed and didn’t offer relief.

What is maddening is the realization that multiple injections may be required in each joint, up to three to see if I get results. Dealing with side effects of corticosteroids caused many side effects which made me ill for several days.
Could nerve pain also be caused by sciatic nerve and SI joint?

So many unanswered questions and I’m weary of hearing the words”rule out” but I guess that’s how it’s going to be until the pieces of the puzzle all fit into place. I know it’s counterproductive to look back but I really wish I had left my labral tears and moderately arthritic hip alone. Surgery was definitely not critically needed but I thought, based on what my surgeon also told me, I would be doing great after a few months. I obviously was totally unrealistic.

I also believe I went back to work too quickly, after only four weeks! My job requires being on my feet each day, standing and walking, and since he gave me clearance, I also was walking to the beach a few days a week thinking I was fine. Now I do recall, all the problems started around November, two months post op. Glutes, tight hip flexors and all the rest of my unhappy muscles and tendons.

As I mentioned earlier, I was convinced that since I had an anterior approach, and initially was doing well, it wasn’t really a major procedure. I have learned the painful truth and honestly, my surgeon also contributed to my ignorance.
So tomorrow will visit a new hip surgeon, next week a visit to my spine surgeon who is also chief of neurosurgery. I’ve never seen a neurologist before. If my surgeon thinks that will help, I’ll certainly schedule an appointment. I sure hope I’ll have at least a few answers to the many issues I’m dealing with. I’ll be bringing my increasing cd library with me; what a cruel joke!

I do hope other patients who read this will learn from my mistakes in judgment. It’s awful to be feeling miserable and limited by pain and unable to do simple things each day. The whole purpose of having surgery was to feel better; not worse! Also so important to choose a surgeon who is not dismissive or evasive when you ask why you’re having pain after so many months. Maybe that’s wishing for the impossible but again, how do really know until you’re faced with a difficult situation. I based my selection on his CV, background, hospital and amazing patient reviews.

Thanks again for the valuable information; really appreciate your insight and caring.
Be well and I’ll keep you updated.
 
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I do think the aftercare instructions are often very vague and we at Bonesmart have seen the "quick recoveries" bring on chronic issues that are seem to even be harder to resolve as folks are back to work and life and the finite amount of energy your body has to dedicate to deep healing is compromised.
We often say things here like...
Just because you Can, doesn't mean you Should.
And...
It never hurts until you stop.

We have also been accused of having an ultra conservative approach to recovery, but our collective experiences are the basis for our collective wisdom.

There certainly seems to be a disconnect with many surgeons to find postop guidelines to ensure successful outcomes....seems like they would care more about protecting their work.
I feel sure much could have been avoided with more time to heal.
Thank you for sharing your story here.
:fingersx: you get some answers with you new consult.
Prepare yourself for the possibility that if all is well with prosthesis and hip anatomy, it may require some stepping back to allow issues to resolve.
Frustrating as it may be.
 
Thank you for your response. No doubt you have some complex issues arising.
It's hard to say if they were brought about by a THR, or inevitable regardless.
I actually lean to the inevitable side for myself... knowing the wear/tear I've put my body through, and riding the weight train up and down the tracks several times through my life.
Gosh dang I wish I had solid answers to your questions. I so agree we're like puzzles...literally as we think about every intricate piece... down to the microscopic nerves.
I'm hoping you get some pieces of your puzzle in place, and I look forward to hearing what your findings are with your second opinion and nuerogolist.
I've been seeing a nuerogolist myself, but I'm not yet comfortable with him. He's always in too much of a hurry, and hard to understand(heavy accent) along with the thick mask he wears.. I do understand he's very busy, but dang these are my nerves he's talking about... and I need to understand every word he's saying.
My orthopedic surgeon on the other hand is incredible... and I'm very impressed by his demeanor and manner. Which for me is very assuring. He takes the time and speaks clearly(no accent).. and is brilliant in my eyes.
If you find one of those hang on every word they say. In my mind, even if we have a few set backs, they'll be in our corner.
Ive been fortunate to have two of these guys.. the first one did my LTHR 5yrs ago, and since retired from surgery(still does treatments/referrals) and he referred me to my current surgeon. If needed I consult with both of these guys.
You need a team... I hope you get the right players on that team too.. and I encourage you to keep searching for your team players until you have it built. It will happen. There's many skilled and talented physicians as your aware of.
I'll look forward to hearing your findings and watching your journey.
*KeepFightingtheGoodFight!
 
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I did forget to mention that my doc put me on Gabepentin for the nerve pain. It works wonders!!!
 
This was a very difficult day. I had a second opinion with a hip surgeon and he was a great communicator, unlike my surgeon but I’m very upset after what he told me.

He examined me and went over all my records. Where do I begin? All the issues I have do fall under the greater trochanter syndrome, something I already knew.

He does not think PT or additional corticosteroid injections would be beneficial, and agrees with my surgeon that multiple around the implant is not a good idea. He also is certain problems are not caused by my lumbar spine.

So I asked him what he thought was causing such pain. After viewing the X-rays, he told me the bone has not yet healed to the implant cup. After 8 months, this is a concern. He felt the way the cup was placed could be the reason for all my pain.

He explained revision surgery but would not recommend that right now. Said to come back in September which would be a year since surgery and see how I’m doing. He was very forthright and explained even if I had revision surgery, there is no guarantee I would be better; could also be worse.

I definitely felt he would have placed the hip cup differently and he talked about microns which wouldn’t show up on CT scan causing problems. Not entirely sure about what he was talking about. I know he felt very bad about not having a better answer for me. He also prescribed lyrica for my nerve pain. Way too expensive for me to fill that prescription right now. It definitely is being caused by the cutaneous femoral nerve. He was surprised to find out I had so much pain; usually it’s just numbness.
Came home, had a glass of wine and cried out of fear and desperation. The thought of being in pain for another four months is too much to comprehend. He will be sending my surgeon his notes.

I came home and sent my surgeon a text to please call me. I wanted to let him know what I learned today. Maybe that was a mistake but it would make me feel better. He had not called me back! This surgeon has also worked with him before and also said he has an excellent reputation but I guess mistakes or errors in judgment happen. I just didn’t think it would happen to me.
 

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