THR Arthroscopic hip bursectomy post THR?

[Nyc1961]

Helena,
It’s a glimmer of hope to hear your comments. I’m just so discouraged because my pain has accelerated recently and when surgeons tell you there is no cure for recalcitrant trochanter bursitis and psoas bursitis, it’s so depressing and hard to remain optimistic.

 

[Layla]

Wishing you comfort and a peaceful weekend!
Hopefully your weather is nice. We’re getting a reprieve from the heat in my neck of the woods. Only 64 degrees as I type, no humidity and fresh air streaming in open windows. AC was getting old, probably because I‘m not really a fan, but heat and humidity aren’t my fave. Sometimes it’s just the “little things” that make my day. I hope your weekend brings you a lot of those little things.
@Nyc1961

 

[Nyc1961]

Today I had another test at the hospital and after that, decided to treat myself to a leisurely lunch outside at one of my favorite outdoor restaurants. In the past, before my life with constant hip pain, this would have boosted my spirits for days. Sadly, I found myself unable to smile and enjoy myself. Pain is overtaking every moment of each day and is taking all the joy out of my life. Nothing seems to cheer me up these days and all my energy is concentrated on this miserable hip.All I can hope for right now is that somehow tomorrow will be a little better and I do try and count my blessings each day and I have many!

 

[Spex10]

So sorry to hear this @Nyc1961. Sounds like you've hit an especially bad spot. Living with such pain is wearing. Do you have access to a pain clinic? My friend found this very beneficial.
I hope you have a better day today.

 

[Nyc1961]

I am at a complete loss trying to figure out what to do next! The surgeon’s PA said I definitely have left psoas strain, adding to my trochanter bursitis. He highly recommended a PT that I remember seeing four years ago for my cervical spine issues. I honestly can’t remember any negatives about the visits but stopped going after awhile since I didn’t think she was helping me feel better. Things actually improved after an epidural. I decided to try a few visits and after feeling worse doing some bridges to supposedly start strengthening my weak muscles, I’m wondering if I should continue. She also used the tens unit on my greater trochanter. I certainly didn’t feel any relief from pain. I have two questions to ask everyone at this point, almost a year post op. Does the fact that I now have constant groin pain from my psoas and thigh pain from trochanter bursitis indicate I need hip revision surgery? I’m going to see the arthroscopic surgeon in September to discuss the possibility of bursectomy, which the PT said not to think about that for many reasons, but now with psoas pain, I’m wondering if it’s all attributable to surgeon errors, or is it due to problems with muscles and tendons that I had prior to surgery. Will I ever be able to function pain free? And who knows if revision surgery will even fix this? I keep looking at the operative report, reading about the implant, angle, anti version, hoping magically someone will jump off the page to give me an answer and tell me what to do. I must be losing it tonight; just tired of hurting and in the back of my mind, still thinking about the lack of ingrowth in the acetabulum after 11 months.

 

[Jamie]

You are rightfully concerned about the statement you heard about lack of ingrowth after 11 months. I realize your other doctors have not supported that possibility, but quite frankly if that IS the case it is most likely the source of your pain.

My suggestion would be to revisit this issue with either the surgeon you saw who made that diagnosis or a completely different revision surgeon. A good revisionist should be able to tell a lot about whether this is true or not by your x-rays. And, since the pain is worse, my feeling is that you do need a current x-ray to see if things have changed since April.

I know you don't want additional surgery. But if the implant did not properly bond with your bones, there is nothing that will fix that other than to do a revision, most likely with a cemented prosthesis. Please consider at least talking with someone about this and have them show you on your x-rays why they are making this diagnosis.

If you want to see a different surgeon, it's about a 2-hour drive for you, but I recommend you talk with Dr. Raj Sinha at Star Ortho in Palm Desert. He will be straight with you about what is going on.

 

[Puggles]

Hi, you asked for info, but I have absolutely NONE! But I did want to offer
you some (( hugs )). I hate to hear of anyone going through such agony!
By the way, I'm pretty sure it was your thread that led me to
wonder how my bone density was....so I want to thank you for that!

And don't worry, you are NOT "losing it" as you said----you are just
sooo exhausted from being in so much pain, no clear answers, etc. More
(( hugs ))

 

[shep1487]

Nyc1961, I am so sorry you’re dealing with these issues. I had both hips replaced in 2011. I’ve had problems with both and feel that I waited too long. Always had trochanteric bursitis and got injections for years. Finally found a doc who could do it correctly. I unfortunately got two other opinions and could not get consensus on what was going on with my hips. And I agree that you don’t always see negative reviews...just positive! I have had five joint replacement surgeries, and I did not have to go to PT for my shoulders. The last time I went I left in tears...not going to do that again. Bless your heart. I’m also suffering from spinal stenosis and difficulty standing and walking. Chronic pain is depressing. Get as many opinions as necessary to make you feel good about a plan of action. I’ll be saying a prayer for you.

 

[Nyc1961]

Your well wishes and support are so appreciated right now! It’s so depressing and discouraging to feel as though none of these doctors really care after they are done with the surgical procedures. After reading your comments I no longer feel so alone. For a long time, I felt as though I was the only one who was experiencing long term problems. How I wish all of us would get well and be pain free! The fact that we have such similar stories will help me to cope through the bad days, hoping I’ll find someone to help me. It’s so exhausting to wake up every day knowing I’ll be in pain. I will think long and hard before I leap ahead and schedule any more joint replacements. It will require being in agony before I let any orthopedic surgeon cut into my body!
A million thanks for being here for me!

 

[Nyc1961]

Puggles,

Hugs will certainly help right now. All the wonderful support I’ve been receiving from everyone on this blog takes some of the fears and anxiety away for awhile.
Best wishes to you and I hope you are doing well right now!

 

[Nyc1961]

My pain is worsening each day. I’ve only had a few PT sessions with my new therapist and even though I’m confident in her experience, psoas impingement and trochanter bursitis are making my life miserable. I have swelling in my thigh, groin and now radiating to my lower back and buttocks. It also feels hot to the touch and when I raise my leg, I always hear clicking which she said confirms psoas impingement. She also mentioned the
pain could be coming from scar tissue, adhesions, etc. In her opinion, many of her patients who presented with the problems I have underwent anterior hip replacement. She’s been a pt for over 25 years and many top surgeons have told her they are not proponents of this procedure; too many severe problems with the psoas muscle and trochanter. Perhaps he did find more damage than originally expected. This was mentioned in my operative report. Bone quality was not good and he inserted two iliac screws and a cerclage cable. Maybe that caused additional problems with soft tissue?

My therapist mentioned possibly finding a dr to administer a trigger point injection in the psoas and also asked if I ever tried acupuncture. She gave me a few names to call but uncertain if they accept Medicare. I’m panicked about the prospect of revision surgery and the more I read about the size and angle of implants causing these conditions, the more my stress level rises. Finding a dr who really cares is challenging and one seems to contradict the other! And like so many of us, I still can’t believe I’m in this situation 11 months post op. What to do next? I have no idea! Financial concerns are limiting my choices right now and of course, COVID-19! Not a good time to consider a second hip replacement procedure! I’m having a second cataract surgery tomorrow and in between dealing with the hip problems, just trying schedule the usual medical appointments; I’m so overwhelmed right now!

 

[Spex10]

Sorry to hear this. You're really having a bad time. I'm sure your cataract op will go well.
Good luck with finding the right help with your hip problems.

 

[Mojo333]

Hi @Nyc1961
I really don't want to say anything that would increase your understandable anxiety and stress over your ongoing issues and subsequent ongoing pain.
But I would like to respectfully lend some comments and thoughts.

She also mentioned the
pain could be coming from scar tissue, adhesions, etc.

Our now retired nurse Emeritus from the UK, who was a long-time surgical nurse for decades under some of the pioneers of joint replacements had these thoughts about THR and scar tissue.

It's highly unlikely to be adhesions because they are actually pretty uncommon. It seems to me that any time there's a hitch in progress, US PTs immediately say 'scar tissue' which is a nonsense! Besides which, it's almost rare in hips!

Personally, I have never heard of adhesions ("scar tissue") in the hip. Just doesn't happen.

In her opinion, many of her patients who presented with the problems I have underwent anterior hip

I think there is a tendency with anterior replacement patients to try to push their recoveries due to the hype and lack of restrictions.

Perhaps he did find more damage than originally expected. This was mentioned in my operative report. Bone quality was not good and he inserted two iliac screws and a cerclage cable. Maybe that caused additional problems with soft tissue

Possibly, but the iliac screws are rather common and meant to be used with some acetabular components and one of my hips has two screws used to affix it.

I think the lack of ingrowth with the cup means there will be movement as it is not affixed, so this will have to be addressed.
I certainly understand how this cannot be pleasant to think about, but I fail to see how PT with an unstable liner, is going to be helpful.
Of course, these are only my thoughts....and I continue to keep you in my thoughts and hope you find a surgeon you have confidence in when you feel you can pursue this.

 

[Elf1]

@Nyc1961 sorry that you're still having pain and not seeing any improvement. @Jamie and @Mojo333 shared some good insights with you.

I have to agree that PT might be causing you more problems than its worth. Not trying to bash PTs, just think there are a lot that are kind of one size fits all in approach.

If you're still having swelling I would suggest, from my own experience at just over 2 years out, that you go back to icing those areas. It sure can't hurt. The clicking sound/feeling could also be what they call snapping hip. It's basically your tendons/muscles sliding back and forth when you're doing movements. I think if you search snapping hip in the forum you'll find others that have dealt with this, me included.

The hot to the touch kind of makes me wonder, have you mentioned this to any of the doctors/PTs? And is this something new? You might want to have that checked out.

Sorry this is so long, just trying to share anything I can think of that might be helpful. I know how frustrating and depressing having continuing pain can be. Unfortunately I'm dealing with multiple issues, guess being a Tom Boy growing up and doing silly things like climbing on large tents in the Army weren't exactly good for my 5'2" frame!

One last suggestion, there is a female Orthopaedic surgeon out of Austin that does a blog, one of the things she says we females should practice is SLAM (sit like a man). She says we were taught to sit with our legs together, crossed, bent up next to us in the chair, etc, causing our hips undo pressure. She says to basically sit with our legs a bit more comfortable apart, not in dresses of course !.. Hope you find something that works for you.

 

[Sashimu]

Good morning, @Nyc1961... Looks like you've gotten plenty of good advice above. I've got nothing to add; just want to say I've been thinking about you and hoping that things get easier somehow. And of course I hope today's cataract surgery is completely routine and successful. At least you'll be able to check that off your list of things to deal with. All the best to you.

 

[Nyc1961]

Good morning,
All the advice I received has been really helpful and I was actually comforted and a little less anxious after reading the comments and suggestions. Perhaps I’m slowly coming to terms with accepting I may need revision surgery.

I did contact the PA this week who diagnosed psoas impingement and asked about the possibility of scheduling a trigger point injection in the psoas. The PT mentioned that procedure had been successful for many patients. I was surprised to receive a phone call back that the division chief of surgery and he wants to see me again for another evaluation before he orders any additional injections; that made me feel much better! Even though I wound up in the ER from the strong Kenalog injection, I had confidence in my initial meeting with him. The only nagging thought that still remains is his complete denial of the second surgeon‘s opinion that there is no ingrowth or loosening. It’s hard to believe he wouldn’t be telling the truth just because he’s friendly with my operating surgeon. I hope I’m not becoming paranoid! It’s just hard to know who to believe or trust anymore. My anxiety has mainly been caused by such a different diagnosis and the denial by my operating surgeon for 11 months that it was my spine causing the problems. I have an appointment with him on October 4 and an appointment with an arthroscopic surgeon in late September to discuss bursectomy and psoas injections. All my research indicates that psoas impingement and trochanter bursitis are usually caused by problems with the prosthesis What else would cause these chronic conditions? That is what is constantly on my mind! I have been walking and not pushing myself to do a certain amount. Icing does help for my thigh but no relief from groin pain. I have an appointment for PT on September 1 and not certain if I’m going to continue. They always tell you it takes a long time to improve but I’m becoming weary of hearing this and not seeing results. I also have togo back to work when schools reopen in September. I’ll be on my feet walking for about two hours a day and trying to fit pt appointments in an already busy month will be too much for me.

In the meantime, I’ve been busy with a visit to my cardiologist and had more lab tests, along with a very specific test he ordered. I’m very relieved and happy about the results and he does not want me to start on statins right now. I’ll have a follow up appointment with him in October but grateful not to have one more thing to worry about.

Cataract surgery went well on Thursday and thank you for your well wishes. I only have four dr appointments in September, including a dentist and dermatologist appointment. Things are looking up! LOL.

As always, sending you my best wishes and hoping you are also feeling much better!

 

[Kriztina]

How has your outcome been?

 

[Layla]

@Kriztina
So thoughtful of you to inquire about Nyc1961. I want to let you know she hasn’t been on the forum in almost four months so it’s doubtful she’ll respond, but we can hope, right?
Wishing you a great week!

 

[AllieBucks]

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) as well as trying the med protocol and see if this helps any.

Hope your Sunday is easy and restful.

I have an annoying case of post THR tendinitis behind the knee. I use compression bands, ice and the Tramedol/Tylenol combo.works so well on all of the nerve problems. I feel like your bursitis will go away once the it band stretches more from walking. It’s all connected!