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THR Arthroscopic hip bursectomy post THR?

Sashimu

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@Nyc1961, haven't heard from you in a few days. Hoping you have gotten your tests scheduled, at the least, and are a step or two closer to getting some answers, and that the pain situation has improved.
 
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Nyc1961

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Hi,
Nice to hear from you and thanks for caring! I also hope you are doing well. What a journey and it’s still ongoing m!

I did see a second hip surgeon a few weeks ago and he is convinced all my problems are due to greater trochanter syndrome and in addition, he looked at the latest hip X-ray taken on April 24 when I went to an orthopedic urgent care and had the lumbar spine. I was astonished when he told me there is still no in growth of the hip cup!!

What’s more upsetting is the fact that I brought this X-ray to my operating surgeon on May 7 when he finally agreed to give me an injection for trochanter bursitis, didn’t do much good! He gave me his usual five minutes and didn’t even bother to look at the hip X-ray I gave him. I also asked the second hip surgeon how long it usually takes for in growth to occur. Usually two months; my surgery was performed on September 22.

Needless to say, this is very upsetting. Why did I need to find this information from another surgeon after 8 months He also said that perhaps the size and placement of the acetabulum could be the problem. He knows my surgeon and actually worked on a few operations with him. I made an appointment to see him in four months and he unfortunately said there isn’t much he could do until a year after surgery but in his opinion, the pain is not coming from my lumbar stenosis and other issues. I sent my surgeon a text that night informing him that I consulted with another surgeon and told him what he said. Let’s just say he was more than a little angry.

The next day, I received an email from the second surgeon who told me my dr called him in the morning. In his email to me, he backed down on several things he told me; shocking to say the least! After that, my surgeon said now we should have more tests that he never mentioned before. One I asked him about 8 weeks ago and he never responded to a request for a mars MRI. When I asked him why, he said he has been busy and has other things going on. Great for a patient in pain to hear that. So I had the MRI, a nuclear bone scan and an MRI of my lumbar spine that my spine surgeon ordered to go along with my recent lumbar spine X-ray. I had an appointment with my spine surgeon last week and he also confirmed after reviewing results of my spine test, pain is coming from my hip.
I'm now going to see the chief joint replacement surgeon at the hospital where I have all my tests done. Going to see him this Wednesday and bring all my latest cd’s. My surgeon knows him well too and said after I meet with him and get his opinion, I should schedule an appointment to see him again; that will never happen! I am fine with a dismissive evasive defensive surgeon.

Meanwhile, I looked at all the reports of the radiologist which are posted in my chart and there does not appear to be anything that would state why I’m still having groin and thigh pain, and why I can’t rotate my hip and leg outward. I also have femoral nerve damage but I can live with that. Decided not to take medication for it and it’s not as bad as it was a month ago.

There was also a real problem over the order he gave me for the bone scan. The hospital called me a few days before the test and asked me to contact his office and have him amend the test because they prefer a 3 phase bone scan. The hospital also called him and he refused. When I asked him why, he told me if I wanted a different order, go find someone to do it! I stated that I didn’t request it, the hospital did and said it was preferred and more comprehensive. He disagreed and said his order was better. I think it was a one dimensional Spect? Not sure about the spelling.

So here I am with still no conclusive answers, lots of new reports and cd’s but did find out about the lack of bone growth. I also wondered if some of the implant problems are due to the osteopenia in my hip. Because of the poor quality of bone he found during surgery, he did use a cemented implant and also two iliac screws, plus a cerclage cable because he found a very small crack in the femur during surgery. He did not classify it as a fracture but just decided to use the cable as a precautionary measure.

My questions to ask the dr Wed, what happens if there is no in growth on the hip cup? Does that mean the implant will eventually loosen? And is revision surgery a necessity if there is no bone in growth. Is this also happening because of osteoporosis or the implant and the way it was placed.

Of course, this surgeon will undoubtedly not say that was the case, since he knows him well too! One more clue to this giant jigsaw puzzle. Both surgeons said a very rare occurrence sometimes occurs when particles or microns break off the implant and it’s impossible to see that on a CT scan or X-ray. He said it never happened in his 15 or 20 years of surgery but it’s a possibility.

I hope I explained this correctly. I’m just so exhausted and overwhelmed right now. In addition, still on my feet working as an elementary school aide 3.42 hours a day, walking and standing on my poor hip.

And I walked a few miles to the beach last weekend so I sure realize things could be much worse! Haven’t taken Tramadol in four days; yay! I’m beginning to wonder if I’ll ever be free of pain or be able to bend down, rotate my leg and do so many every day things my obnoxious surgeon told me I’d be doing after three months.

A million thanks for being here for me. It’s really hard being alone and getting no answers.
 
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Nyc1961

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Sashimu,
Sorry for all the typos! I didn’t proofread and I guess exhausted after a rough day with screaming kids.
 

Sashimu

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I'm sorry to hear that your situation continues to be so up in the air, @Nyc1961. Sounds like you're seeing the third surgeon next week? Hopefully he can shed more light on things. At least your surgeon finally ordered the tests and you now have that extra information to go by. I really hope you get some answers soon, and a clear path forward. Wish that for myself too

I envy you that walk to the beach though! I bet that does wonders for your state of mind! I'm still "resting" here, and trying not to get too anxious about the stubborn lack of progress. It can be really hard to focus on, or even notice, the things that are (still) good.

Keep us posted! Hope you have a good weekend.
 
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Nyc1961

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Hello,
I do hope things will improve for you too! I completely understand how difficult it is to remain positive when lack of progress and pain cloud over our emotions. It wasn’t supposed to be this way and I also find myself going over the past months trying desperately to figure out if I did something to cause the pain and lack of progress; counterproductive but we’re only human.

I came home from my job at school today completely wiped out so I’m unable to do anything but sit back, relax and hope tomorrow will be a better day. Fighting pain each day adds to fatigue so I am trying not to be so hard on myself. And I am cautiously optimistic that I may find some answers to this ongoing emotional and physically draining time in my life.
Are you able to do some walking? I had forgotten when you had surgery. I am sending all my best wishes to you for a peaceful pain free weekend. Try to do one or two things, no matter how small they may seem, to lift your spirits.
I’ll let you know what the next surgeon says on Wednesday. I certainly have enough material for quite a novel about my experiences in getting a THR!

Take care!
 

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@Sashimu @Nyc1961
i hope you will both have a good weekend and even some progress with healing soon. I have been a slower healer but have seen progress in the last week, so I hope that time will resolve some of this for you too.
 

Sashimu

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I also find myself going over the past months trying desperately to figure out if I did something to cause the pain and lack of progress; counterproductive but we’re only human.
I can totally relate to that, @Nyc1961. I'm constantly wondering if I am still doing too much, even if I just drive down the street to the drugstore and walk in to get a prescription, I'm second guessing myself. Maybe I should have asked somebody to do it for me!
Are you able to do some walking? I had forgotten when you had surgery. I am sending all my best wishes to you for a peaceful pain free weekend. Try to do one or two things, no matter how small they may seem, to lift your spirits.
It's been three and a half months since my surgery. No walking for me, for the foreseeable future. That's hard. But sitting on my patio and watching the birds does lift my spirits... Got to hold on to that!
 
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Nyc1961

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Today is a good day! I wonder if it’s just an anomaly but probably wise not to question why my pain level is not too bad. I walked 2.5 miles on Sunday and struggled going home but I’m determined to keep on going.

Monday morning was difficult but icing and Tylenol helped a bit. I worked Monday and today, 1.8 miles yesterday and 1.7 today. More importantly, pleased with the amount of steps taken each day.

I’m seeing a third surgeon tomorrow to discuss lack of bone growth and also ask why I cannot rotate my leg outward. Trochanter bursitis and femoral nerve damage have not diminished but I did get a reprieve today; have no idea why. Yesterday, my leg was on fire with jolts of burning pain. Maybe the constant walking and time is finally helping?

I read the post about steroid phonophoresis helping with scar tissue. I never heard of that before but will mention that to my dr. tomorrow and the pt I had been seeing until several weeks ago. She mentioned feeling the scar tissue when working on me but doesn’t everyone have problems with scar tissue causing pain or just a select few of us. In reading so many similar stories of patients dealing with greater trochanter syndrome, glute atrophy and weakness and nerve damage, I wonder if everyone who has undergone anterior hip replacement has to deal with this pain and nerve damage. And is this a permanent disability?

I can’t conceive of a lifetime of corticosteroid injections in my future. PT can be helpful sometimes but Medicare will not pay for treatment forever. Where are all the success stories on bonesmart.org that my surgeon’s patients in LA posted on his website, the hospital website, and Heathgrades? Only one thing is certain at this time, I will never go back to the operating surgeon again. June 22 will be nine months post op and I am nervous about what no in growth in my hip cup will mean for recovery. Hoping for many answers tomorrow.
 

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Good luck with your appointment with the surgeon today. I hope you receive the answers you’re seeking and a plan that brings relief. Let us know how it goes.
Wishing you comfort and resolution.
@Nyc1961
 
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Nyc1961

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A busy no nonsense surgeon but aren’t they all that way. This is a factory orthopedic practice with some excellent surgeons but it’s like and In N Out Burger. The surgeon downloaded all my films, listened to me for several minutes and examined me. Very succinct and told me his yes and no answers to prior surgeon’s diagnoses.

No, it’s not my spine causing pain; yes it’s a severe case of trochanteric bursitis and no, he definitely and respectfully disagreed with the second surgeon who said there is no ingrowth. No ingrowth and loosening go together and he said the surgeon may have been confused by looking at a slight white line about the implant. Leg length is perfect and I also asked him if there is a possibility that trochanter bursitis will never go away and his answer was yes; very depressing to hear that news.

He does know my operating surgeon and of course praised him; didn’t expect him to say anything negative about him. Why some patients have such a severe case is unknown. Is it something that the surgeon did or did not do will probably never be known. Also talked about the femoral nerve damage. Again, it may or may not fully recover. He gave me another corticosteroid injection and this was the most painful injection I have ever received. Said he was spreading the wealth around; real funny! And also received a new prescription for PT to address bursitis and the IT Band.

Did mention next time I needed an injection, probably should see a pain management dr and also talked about an IT Band release that can be done. I know in severe cases of trochanter bursitis, sometimes surgery to remove the bursa is the only way to fix the problem but I won’t evenly myself think about that right now; that’s not an easy surgery! I know it’s also not advisable to have too many of these injections.

So here I am, icing my swollen thigh and can’t stop wondering why all of this happened. I know sometimes it’s the way the retractors are placed when the surgeon is stretching the muscles and tendons or maybe it’s something to do with the implant size or placement but all my constant ruminating will just keep my anxiety level high. I asked him if perhaps I caused this to occur by doing too much initially and going back to a job four weeks after surgery, walking and standing on my feet for a few hours each day. He said no, it was a result of the surgery.

Now I understand why people postpone this procedure until it’s bone on bone. Looks as though too many are left with these awful and perhaps permanent painful disabilities. Could be much worse! I’m walking and traded a slight limp for a very chronic pain problem. lol the only way to keep sane!
 

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Now I understand why people postpone this procedure until it’s bone on bone. Looks as though too many are left with these awful and perhaps permanent painful disabilities
I am truly sorry you’re dealing with pain and uncertainty. I hope you find a solution that allows you to function without discomfort or pain. I would be remiss in not mentioning for those reading here who are contemplating surgery, or are scheduled for surgery that joint replacement surgery is one of the most prevalent surgeries performed world wide. The outcomes of these surgeries have become excellent based on a number of techniques changing over the years. The implants are durable and long lasting, with longevity much greater than before, offering an increase in the likelihood you’ll never have to experience the procedure again.

There are risks involved with any surgery, but we often take a chance for a brighter future. While some suffer issues and much discomfort as a result of their surgery, I believe many more have successful outcomes. Hopefully one day soon we can count you amongst the latter. I wish you comfort and answers leading to permanent resolution.
We’re here for you always. :console2:
 
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Nyc1961

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I agree that joint replacement procedures today are, for the most part, highly successful.

Just be fully aware and educated regarding the possibilities of nerve, tendon and muscle problems before making such a major decision. Three to 17 per cent of patients undergoing thr are diagnosed with trochanteric bursitis and know that you could be one of them. It is excruciating painful! I wouldn’t wish this on anyone!
 
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Nyc1961

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Just one more comment regarding your response to my post. Obviously, reading all the hundreds of posts on this blog from people going through similar and much worse scenarios than what I’m dealing with will perhaps furnish many prospective patients with very critical important knowledge before making their decision to undergo surgery. Of course I remain optimistic that I will feel better soon; it’s only been 9 months post op!. Perhaps after more injections and ongoing PT for months, I’ll post a nice reply filled with rainbows and sunshine.
 

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I do believe by the time the great majority schedule surgery they’ve heavily researched and concluded that the benefit of joint replacement surgery most often outweighs the risks. Are there exceptions? Yes. Are there risks? Yes, but we encounter risks on a daily basis in simply leaving our homes. I believe most surgeons explain there are risks with any major surgery, but they can’t possibly list every possible complication and it’s outcome. Many members notice progress beyond nine months and into their second and even third year. Possibly you won’t need further injections and if you engage in PT and find it’s helping I hope you’ll share that encouraging news with us. We’re rooting for you and will be here to support you going forward.
@Nyc1961
 

Jamie

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@Nyc1961 .... you might read this account by one of our members who had problems resulting from her cerclage wire. Assuming that your hairline fracture has healed, it may be possible to remove this cable. It might be something you should talk to your surgeons about.
 

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Obviously, reading all the hundreds of posts on this blog from people going through similar and much worse scenarios than what I’m dealing with will perhaps furnish many prospective patients with very critical important knowledge before making their decision to undergo surgery.
On BoneSmart it's easy to get a skewed impression of the overall results of hip replacements, because it's often mainly those with problems who come to us.
Those with an uncomplicated recovery never need to find BoneSmart. They have their surgery, recover without problems, and go back to leading a normal life again.

Our members here on BoneSmart are a very small percentage of the thousands of hip replacements that are done every year.
 

Sashimu

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That was a sobering report, @Nyc1961. Now you have two different opinions about ingrowth or lack thereof to contend with. Plus the trochanteric bursitis diagnosis sounds grim. I'm hoping that at least the injection is giving you some relief now that a few days have passed.

Speaking for myself, I can appreciate that many or even most THRs are very successful. Even though we are in the minority, that's not much of a consolation right now. But I couldn't have postponed mine indefinitely, and even if I knew then what I know now about outcomes, sooner or later it would have come to this. So I tell myself.

I walked around too much on grass on Thursday, so I'm suffering the consequences (again) and not feeling very positive. Hope you're feeling better than I am!
 

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@Nyc1961
Hope you can sort through this and have decreasing pain soon. Sorry you are experiencing this.

The success rate may depend on the definition of success. If a person is better than before surgery, although not perfect, some might call that a success. My surgeon said my surgery was a success based on my xray. But, you are not feeling better than prior to surgery for the time being at least, so that can’t be success at this time, I think.
 
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Nyc1961

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I really hope by today, you’re feeling much better! It is discouraging but we just have to remain optimistic that we will constantly improve.

I also know that eventually, this surgery was necessary and it was probably the best decision for both of us. After endless amounts of time researching why I had so many issues, I do have a clearer picture but have decided to take each day in stride and hope for incremental improvements. There are so many causes for trochanteric bursitis and I’ve decided to stop trying to figure it out.

It could be related to scar tissue, the way the hip is aligned or just the fact that this is a new hip and I’m walking differently. I also realize having two screws and a cerclage cable were definitely necessary because of my weak bone tissue and a very slight displaced crack in the femoral neck. Having osteopenia complicated things but better to have had the surgery now than wait and perhaps deal with a major fracture. I’m going for my two year Dexa Scan on June 28 and curious to see what the numbers show. This aging process is not fun but I’m doing much better than so many other patients.

Sitting in the surgeon’s office Wednesday and observing patients was very sobering. I have no idea which diagnosis is correct, but my instincts tell me this surgeon is spot on, so I’m done with additional doctor visits right now. It’s too exhausting to continue right now.

The last few days were an absolute nightmare mainly due to horrific side effects of the corticosteroid injection. I foolishly went back to work yesterday after taking Thursday off. Chest pressure, extreme thirst, insomnia, fluid retention, headaches, fatigue and of course the flushing in my face that is finally dissipating today. Today, I felt like the energizer bunny and couldn’t sit still; cleaned my apartment from top to bottom. I’m positive this sudden spurt of energy is also due to the corticosteroid.

I have five more days to work at the elementary school and considering not going bank on Monday. Being on my feet for 3.5 hours did much harm to my swollen hip. I am doing walking while I’m there but it’s the periods of standing, while watching the screaming students, that cause most of my hip pain and it’s wearing me down physically and emotionally. It’s time to relax and recharge. Listening to music all day while accomplishing so much today was just wonderful. I’m going to try and walk to the beach tomorrow if I’m feeling better. These injections are so powerful and I’m hoping this last one will help for awhile. I’ve had three since April; one in my spine and two in my hip. Not advisable to have more for a long time.

I’m starting PT again next Saturday and will really commit to going every week; no other options and I do want to get better. I also feel the femoral nerve damage will be with me for the duration! I keep hearing it sometimes takes a year so maybe I’ll have some luck with eliminating that problem. I also realize that my glutes and tendons were probably deteriorating and were very weak before surgery; another aspect of the aging process so striving for acceptance of everything is what I really need to work on to obtain some peace of mind.

We’ll get there Satsumi! Take it slow and maybe soon, you’ll send me a message that pain is diminished and you’re feeling so much stronger!!

Smile and know I’m sending positive thoughts your way!
 
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Nyc1961

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Actually, when remembering how I was feeling last spring and summer before surgery, I guess this has been successful; just problems that I really didn’t anticipate and I was totally shocked at having this occur. I remember becoming so annoyed last year because I started to have pain climbing up a flight of stairs, couldn’t lift my leg getting dressed without pain and my walks were abbreviated due to increased pain and developing a limp. That’s all gone but now replaced with different types of pain. However, no more labral tears! Whenever I reread the operative report which clearly states severe degenerative acetabulum, femoral head, osteophytes and exposed bone, I know I made the right decision. The initial X-rays did not indicate it was so severe but during surgery, this was what they found, including the very slight displaced crack in the femoral neck. Your comments about success were helpful. I could have waited until it was bone on bone but I made the decision to proceed and as my daughter would say, “it is what it is”! I do believe waiting would have caused even more serious complications.
 

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