THR Arthroscopic hip bursectomy post THR?

[Jaycey]

I discovered that surgeons do not have great communication skills so we have to be our own advocate.

Often true! Then there is the problem of so many patients to see in so little time. Finding a surgeon who will take the time with you is a real gem! I so glad you found a PCP you can work with!

 

[Nyc1961]

My surgeon’s office administrator actually shared some information about him months ago, stating he was having financial difficulties due to Covid-19 causing less surgeries; not something I needed to hear. I guess things were really tough for him, living in a posh neighborhood of LA with his custom wine bar. Maybe that explained his dismissive arrogance on visits.

After another PT session that did nothing for pain or swelling, and realizing trochanter bursitis is a chronic permanent condition, I’m now researching arthroscopic bursectomy and iT release which is the only permanent solution. To go through THR and be miserable and endure constant pain for the rest of my life is not how I want to live. I’m not going to have any more steroid injections and there are no other options. Read about PRP injections and shock wave therapy; none covered by insurance. I also know my glute muscles are contributing to the trochanter swelling and pain. All of this occurred after surgery. You suffer through a major procedure, fix one thing and wind up with this condition; almost laughable but of course, it’s so depressing.

 

[HelenaM]

@Nyc1961
i spoke to an orthopedist who is also a pain specialist today. He has found that many people take a long time to recover fromthese issues. I have meralgia parenthetica and probably it band issues along with it. He thinks I need to strengthen my quads and more because quad weakness may be affecting my knees which look good on X-ray and ultrasound but hurt. My hip pain is possibly referred to my knee now! So, I am going to keep trying with pt with the expectation and hope that I will see more improvement during this second year. I know the feeling of frustration and hope you see improvement whatever you try,

 

[Hippielife]

when my surgeries were done the surgeon removed the bursa sac. We don’t necessarily need them as the main function was to libricate the joint from what my surgeon mentioned.

 

[Nyc1961]

I also have meralgia parenthetica and it’s so depressing and frustrating to have my PT tell me at every visit how weak I am; glute muscles, IT Band needs to be released, hamstrings and on and on! After Saturday’s session of stretching on my thigh, glutes and iliopsoas, I was in such pain yesterday, I stayed in all day rubbing Voltaren gel on my hip, along with icing. Anyone who hasn’t gone through this journey couldn’t possibly understand the anxiety and depression it causes, especially after a year. Last September, I naively assumed after a few months post op, I would be pain free which is usually the outcome with other surgical procedures. But having a THR is unique because of all the powerful muscles, ligaments and tendons surrounding the hip and I now know how many things can go wrong during and after surgery. It’s comforting to hear that time may resolve some of these issues but every day, I have to constantly find ways to combat depression and anxiety, especially when I was told there is no cure for trochanter bursitis. I guess all we can do is plod along and hope each day will bring some improvement for all of us. I would give anything to just wake up one morning and be pain free and give my mind a rest from thinking about this every day. I’m sick of dealing with drs. and trying to find the correct answers to overcome all these problems that refuse to go away.

 

[Nyc1961]

Gosh, If only I had known this was an option but who knew I would be one of the 3 to 17 percent of patients who would get severe trochanter bursitis! Well, if I live long enough to have the other hip done, that will definitely be mandatory! LOL. I wonder how many surgeons routinely remove the hip bursa?

 

[HelenaM]

I have seen several people recommend on this site that you ask a pt for fewer exercises or repetitions. You could see if a few help and then increase. I stopped after a few sessions in March - at 10 months- and I am trying again now at 14 months. I hope that I have found a pt who will understand that I am still healing And work to strengthen slowly.
If not I will try to find another pt or stop for another break.

 

[Nyc1961]

I am really starting to have doubts about pt and have discovered it’s challenging to find a very competent therapist; they all seem to follow different guidelines and so many inconsistencies in treatments and opinions! Who do you listen to? Perhaps just our own instincts and paying more attention to how our body feels. The surgeons insist pt is the only way to improve by stretching and strengthening the IT Band, glutes, etc. so it’s so confusing to know what to do sometimes. All I know is that I couldn’t do much after my pt session Saturday. I stopped seeing this pt a few months ago after she worked on me and I couldn’t walk for a week! I haven’t found one pt yet that helped me feel better. I recovered from that session and yesterday was able to walk 2.9 miles to the beach! Some groin pain but not disabling. Will walking alone strengthen weak muscles? And is pain after all those stretching snd massaging exercises on my muscles part of the necessary treatment plan to get well?

Tomorrow is 10 months since surgery and I wonder if my body is still healing. I know trochanter bursitis is permanent but maybe my continuing to walk will help improve that condition or will it worsen that problem? I feel fine today and will try to walk again later. At this point, not sure who I should listen to or if so much walking will increase swelling and pain? Would welcome all your advice! I do not want to be a slave to pt forever and Medicare certainly won’t pay forever. I’ve only been going once a week and have the feeling the pt is just drawing these sessions out solely for more income. Sad to think that might be the case.

I also received a phone call from the surgeon’s PA that I saw a few weeks ago. He gave me the name of an orthopedic surgeon who performs arthroscopic procedures and very skilled in hip bursectomy. That would be the last resort if I don’t continue to improve but it was comforting to have his name and know this option is available if necessary. It took two visits to different surgeons before I finally felt 100 percent confident in what was being told to me. Lessons learned; if your surgeon isn’t helping you post op, and you are not getting answers, don’t hesitate for a moment to get additional opinions! I’ve said that before in my posts, but need to say this again. I was one of those reluctant people who was initially afraid to question my doctor. I grew up in an era where I thought all doctors were God! Actually, many of them believe they are and arrogant too, particularly surgeons!

 

[Mojo333]

I am really starting to have doubts about pt and have discovered it’s challenging to find a very competent therapist; they all seem to follow different guidelines and so many inconsistencies in treatments and opinions! Who do you listen to? Perhaps just our own instincts and paying more attention to how our body feels.

Your instincts are most certainly priority and you know your body better than Anyone!

Will walking alone strengthen weak muscles? And is pain after all those stretching snd massaging exercises on my muscles part of the necessary treatment plan to get well?

Moving about as comfortable is important and exercises can be helpful IF they are helpful and Hurtful IF they are hurtful

I know trochanter bursitis is permanent but maybe my continuing to walk will help improve that condition or will it worsen that problem?

Chronic bursitis can last from a few days to several weeks. Chronic bursitis can go away and come back again. Acute bursitis can become chronic if it comes back or if a hip injury occurs. Over time, the bursa may become thick, which can make swelling worse.
I am glad you are at least considering a surgical option if it appears it might be an answer to your pain- but I see no harm in dropping anything you deem unhelpful.
Strengthening and toning can be reattained if rest and healing is necessary.
So sorry you are continuing to struggle.

 

[Sashimu]

@Nyc1961, I'm really sorry to hear that the relief you got from the injection has worn off already. Especially given all the side effects that you had to endure.

I wish I had some answers too. My pain has been worse for the past few days, maybe because I tried a 20 minute walk last week? I'm not too sure about PT either; I don't feel like I've gotten much out of it, at least not so far, but what other options are there to deal with the problems? Like you, I've found that everybody I've seen has a different approach and set of exercises that don't seem to help. It's all very discouraging right now, as I know it is for you too. Never thought things would turn out like this...

 

[Jamie]

Who do you listen to? Perhaps just our own instincts and paying more attention to how our body feels.

Absolutely! You are the best judge of what is working and what isn't. Your body will tell you if you pay attention. When something hurts or bothers you even a day or two after the activity or exercise, it's not the right thing for you at this point in your recovery.

Will walking alone strengthen weak muscles? And is pain after all those stretching snd massaging exercises on my muscles part of the necessary treatment plan to get well?

Yes, walking, swimming, cycling - non-impact activities are all good for your recovering hip as long as they are not done in excess.

Tomorrow is 10 months since surgery and I wonder if my body is still healing.

Yep, some people just require a year or more for recovery. There are things too numerous to list that can affect recovery. This is why we tell people not to compare with anyone else. Your body, your health, and your history are all unique to you and mean your recovery is unique as well.

 

[Nyc1961]

Sashimu,
I am also very sorry your pain has increased the past few days. I feel as though I’m a mirror image of you and only wish we could have one day that is pain free. Walking is such a joy and I know the frustration very well when pain interferes with that. Just dealing with the roller coaster of emotions is what I’m finding very difficult to deal with. I had a good day yesterday and my spirits were high; totally depressed today after trying to repeat the same amount of walking I did the past two days. I came home awhile ago in such pain and angry at myself, the operating surgeon and everyone else who contributed to my misery over the past 10 months. I obviously overdid my walking and furious because it seems there is no end to all of this. So tonight it’s all about poor me but I’d better snap out of this mood quickly. I also have learned that stress will contribute to my pain and my whining won’t help make this chronic condition go away. It’s a constant challenge every single day to remain positive. I keep telling myself how fortunate I am to be able to walk and continue to count my blessings. Honestly, I wasn’t prepared for any of this and I know you feel the same way! I’ve always been so independent and this has been a real eye opener as to what can go wrong after a major surgical procedure.

I’m having cataract surgery the end of the month and the second one in August. After those procedures are done, I’m going to make an appointment with the arthroscopic surgeon recommended by my new surgeon’s PA to discuss whether he feels I would a good candidate for a hip bursectomy procedure. I can’t imagine dealing with this pain forever. I certainly never thought I would be contemplating another surgery but perhaps he’ll have some other options. If getting rid of my hip bursa will solve the problem, it may be worth it.

 

[Nyc1961]

Jamie,
Some of us have to learn the hard way and unfortunately, I’m one of them! Today was a reminder not to forget about my trochanter bursitis. I really overdid it!

I wonder what your thoughts are about taking CBD. My pt said taking gummy bears work to relieve anxiety and the sublingual pills which are more costly definitely help alleviate pain. I don’t know if it’s also anti inflammatory but will mention it to my pcp when I see him in a few weeks. It can be very costly and I’m sure there may be side effects too but may be something to consider since I can’t take anti inflammatory medication because of GERD.

 

[Jamie]

Do talk with your GP before taking any herbal medicines like CBD. It can interact with other medications and should be coordinated with your medical team. It is not an anti inflammatory medication, though. CBD over the counter products are not regulated, so you must take care with that too. They may or may not have the ingredients stated on the label.

 

[Donny.T]

@Nyc1961

Sorry to hear of your negative outcome post THR. After reading your thread a few things stand out. It seems majority of your issues are due to swelling. Bursitis, Tendonitis etc.
Naturally you will swell post any surgery, however the anterior hip approach causes ALOT. Quadriceps, glute, hamstring and the joint. Post operative care should be to rest and reduce swelling ( you have had major surgery ).
The effort to increase Glute strength by your physician and PT's are so that you can stabilise your hip joint. In someone your age, i would of expected a thorough pre-op strengthening program. The stabilising muscles in your glute are activated by small controlled movements which you build over time. This strength gained will assist in taking on correct load in movement and relieve the other muscle structure's in the area, which sound like they are already overloaded.

When you have THR, the way in which your joint works differs from before, resulting in all structures in the area to " wake up ". If you have had long term issues with the joint then it is possible those structures can be irritated for longer periods of time. If those structures are not working properly and your gait is affected then you will have a joint that does not work in the manner it should, causing symptomatic responses in the surrounding area.

If i was in your shoes i would see My doctor. Request blood tests to test for underlying conditions that can cause your symptoms - Perhaps see a Rheumatologist if your Doctor thinks its viable to check for any underlying Auto Immune Disease.

BUT most of all, i would get a second opinion. Your anxiety is caused by not knowing what has happened, why it has happened and how to fix it. A second opinion will go a long way to remedying part of the worry.

 

[Elf1]

@Nyc1961 not sure if you'll find this helpful but came across an old thread where someone was experiencing pain, well after their initial replacement. Josephine, Bone Smart Nurse Emeritus is now retired but she really knew her stuff.

THR - Muscle pain<

I am seven years out from surgery and have had zero issues with my left hip replacement. However, for a month I have had sharp occasional pain and muscle spasms I think following my attempt to tie my shoes when noone was available to help. Wondering if I should see my surgeon, go to PT, etc.

bonesmart.org

 

[Sashimu]

Hi again,@Nyc1961... Saw that you had mentioned CBD. There is a clinic in town here where you can go and get a prescription for medical cannabis from a medical doctor. I went to see the doctor and explained my hip situation and she seemed to think that CBD could help reduce the inflammation. I haven't really seen that corroborated elsewhere but I thought it was worth a try, since I already had some CBD oil on hand from when I was using it for chronic headache.

I tried it for a couple of months or so, and worked my way up to 50 mg a day, but it clearly didn't do anything for me, since I'm as bad now as I've ever been. Not to say it might not help you though.

 

[Nyc1961]

Big Don,
I appreciate your comments; however, the only statement I agree with is it definitely would have been beneficial to have pre op strengthening. Regardless of age, anyone can have some weakness in their glutes, hamstrings and the other muscles surrounding the hip joint.

I am well aware that I underwent major surgery. Trochanter Bursitis, iliopsoas bursitis, and IT issues are very common occurrences after THR. It has absolutely nothing to do with what approach was used. 3 to 16 percent of patients, in all THR unfortunately have Trochanter Bursitis. By the way, I was very active prior to surgery and was also a competitive ice skater in my youth so not an aging coach potato and was walking four miles a day until osteoarthritis and labral tears hindered my daily exercise schedule. I have had three opinions from renowned orthopedic surgeons and undergone every conceivable lab test and imaging tests several times. I have no autoimmune diseases and all three surgeons and my PT concur that my range of motion and gait are excellent. I may have caused some of my problems by doing way too much one month after surgery and going back to work at a school which required me to walk and stand for a few hours each day. I asked my surgeon at the time if he felt that was appropriate. He assured me I would be able to resume my work schedule since I was progressing so quickly and he gave me clearance to return one month post op. In hindsight, that was obviously the incorrect decision and all the issues I’m now dealing with started two months post op.

My surgeon's post op care was abysmal and I now have an excellent surgeon who will continue to monitor my care. I’m 10 months post op and will continue PT. Moving forward, my goal is to continue to improve and hopefully that will occur. If I feel I’m not making sufficient progress , I will consider arthroscopic bursectomy as a permanent solution.

 

[Nyc1961]

Elf1, thank you so much! I reread the old thread Josephine posted and I will continue to read this when I’m in need of encouragement. It’s so simplistic and I wonder how many recovering patients wish we had this advice earlier in our healing process. I really feel if I hadn’t gone in a million directions and just walked, albeit slowly, perhaps I wouldn’t be in this situation right now. PT so far has only caused more pain after each session. I decided to take two days off from my goal of walking a certain distance because of pain and feeling a little better right now. I’m not going to beat myself up or feel as though I’m a disappointment if I don’t walk a specified distance each day. I read all your posts on another thread a few days ago; they really helped me through a rough night. I just become so discouraged when everyone keeps telling me trochanter bursitis is permanent. I’m going to give myself more time, and then think about bursectomy. It’s not quite a year yet!

 

[Nyc1961]

Sashimu,
It’s been quite a day; pain and swelling but I’m blaming myself for really overdoing my walking Tuesday and Wednesday. I haven’t yet learned that just because I may have a decent day, it’s not a “get out of jail card” to walk way more than I should be doing. I have a real problem with the phrase “baby steps”!

Take care and I hope you have a wonderful weekend!!