THR Avulsion Fracture Greater Trochanter & Seroma

[Puggles]

Hi there.....my story is so weird, I wonder if anyone has been through this!!???

Left (anterior) THR in November 11, 2022 ---been doing great!
Right (anterior) THR June 29, 2023 ---doing okay working hard in PT.

The reason for my post----while doing some strenuous PT (for my recent *right* THR),
my fully-healed (?) *left* hip started feeling a bit wobbly. Not painful, but weird.

*edited to add that what makes my situation more "fun" (ha ha!) is that I
put off these surgeries for over 10 years (due to extreme fear).

Tried
to ignore it, thinking it was just from all the PT and my hips being so damaged for
too many years, which had me walking incorrectly (100% dependent on walker).
I figured, I've been walking bent over with a walker for about 3 years, and now
I'm slowly starting to walk correctly---so it makes sense my 9-month healed
hip might be upset.

At my one-month post *right* THR, surgeon X-rayed *left* hip and found an
avulsion fracture of my left greater trochanter. He wasn't worried about it, so I wasn't.
Google tells me most just resolve themselves...okay, fine. (SOME need surgery,
but if that was required, I'm sure my excellent surgeon would have told me).

But now it's painful, not unbearable (like before surgery), and the pain sometimes
radiates *upwards* on my left side. I've read that REST is the
main treatment. Surgeon said nothing about
resting, and he is well aware of how disabled I was before both THRs; thus,
he knows PT is VERY difficult for me.


I'd appreciate hearing from others about this...thanks in advance.

 

[Puggles]

Anterior RHTR on June 29, 3023. Around 2 weeks post-op, a lump formed. Google told me it's very common,
and either a hematoma OR seroma. Called my surgeon's office, told them I'd been checking my
temperature twice per day, no drainage, no pain, it felt a bit hot, and the rest of my incision was fine.

Now I'm 1 1/2 months post-op, surgeon saw me 2 weeks ago, and wasn't concerned about it. Still
no drainage, no fevers, or other s/s of infection. I was briefly terrified that I was septic/ might
have cellulitis, etc.

It calmed down a lot, but the last few days, it's feeling HOT and, I'm not sure, but it seems
to be getting bigger.

Getting an appt. with my regular doctor and/or hip surgeon will be a long wait. Curious
what others have been through.

 

[Jaycey]

@Puggles Welcome to the other side of surgery. I've combined your 2 threads regarding your recovery. We like to keep your history in one place in case we need to advise you.

while doing some strenuous PT (for my recent *right* THR), my fully-healed (?) *left* hip started feeling a bit wobbly.

Strenuous PT is not necessary - especially for hips. Your left hip is telling you to slow down. Listen to it and stop trying to push through any PT.

And yes, resting is the best therapy for a fracture.

It calmed down a lot, but the last few days, it's feeling HOT and, I'm not sure, but it seems to be getting bigger.

If the seroma is hot and getting larger please get in to see your family doctor as soon as possible or call your surgeon's office for advice.

 

[myglasshalffull]

Well I'd stop all this strenuous PT, rest and ice. Early days just walk a bit, grab a snack and enjoy the laziness.

 

[Eman85]

Like the others I'll say that all of that PT really isn't necessary. I put off my THR's for decades and going in to the first I thought PT was necessary. Luckily my OS warned me about any formal PT as it would hurt me. I was still in the PT state of mind doing more on my own then I needed to. I found this forum and learned what works and it isn't PT. Luckily I' never experienced a fracture or a seroma. What I did and have done is had setbacks from over working muscles.

 

[Puggles]

Hello
I appreciate everyone's responses last time I posted.

# 1. The avulsion fracture to my left greater trochanter is now healed, as is the
seroma---yippee!!

However, I'm still having *almost* daily pain from the fracture. There is also burning feeling that
goes upwards from the hip several inches.

I use ice all over the area, and it's great. But sometimes I wonder if I should
alternate with heat?

My surgeon was happy to see the recent x-rays of the healing,
and I wish I could remember the very longggg anatomy lesson he gave me about
why the pain is still there.

He suggested a steroid injection, which is in a week. I'm concerned that
the injection is more for JOINT pain, and wonder if it's going to help the
burning pain that goes up my side.

#2....Recently, a SECOND problem has developed.
Sometimes, there is severe pain
of what some call "the sit bones." (the pain is ONLY on that left
cheek, same as the trochanter problem). After reading
a lot, I believe it is probably ischial gluteal bursitis. It makes sense,
since I sit wayyy too much.

I sat and scoooted on a hard surface the other day, and had
extreme pain afterwards. After a full day of sitting on ice, it was much better.
Since this is very new, I haven't seen a doctor about it (yet). The
waiting times to see any doctor lately are quite long.


Thoughts / advice appreciated.

 

[benne68]

Have you considered trying therapeutic massage, @Puggles? I had issues with pain across my buttocks and down into my hamstring following my hip replacement and a few massage sessions really helped.

Also, have you tried heat instead of ice --or even alternating?

 

[Puggles]

@benne68....Yes, I sometimes alternate heat with ice. The other day, the heat made it
feel a bit worse, though. Sooo....back to lots of ice and I felt much better.

Therapeutic massage sounds great, I'll look into it.
Thank you for your reply

 

[Puggles]

I decided to cancel the steroid injection, since they've never helped me in the past. I hope
I'm not making a mistake.

 

[benne68]

I would make the same decision, @Puggles, if they haven't helped you in the past.

Do either of these threads describe what you are feeling? Both are common after THR surgery:
Trochanteric bursitis with THR
Piriformis syndrome - a pain in the butt!

 

[dnordo220]

Just catching upon your story. I’m so glad your fx healed. It sounds like you’re trying different methods and committed to your recovery with your dr. Keep us posted. Best wishes to you.

 

[Naps]

@ Puggles-.
I will be a year post op anterior THR January. Hip is perfect, but I, too am still suffering with tendinosis of the tendons that attach the hamstrings to the ischial spines (seen on mri). Initially the pain intensified after returning to work 3 mos post op. Diagnosed with sacro-iliac dysfunction I successfully rehabbed that in PT. However, the sitting bone pain got worse. In PT again since October, I opted for the EPAT treatment ( along with PT), which has helped so much but it is not all better. Also have trochanter tendonitis.
I definitely had these 3 conditions prior to THR but my pain was so diffuse that it was difficult to tease out what was what. OS did say the THR was not going to help the trochanter pain.
Having completed the 6 weeks of EPAT, I am discussing PRP or a steroid injections for the sitting bones with my physiatrist. I am glad I did the EPAT as it has improved me 70 % but sitting for any length of time is still a problem. The PT for it is mostly stretches but also strengthening your gluteals.
My take is get some treatment for the sitting bones as it only gets worse. I wish I would have told my MD in April.

 

[Puggles]

@Naps....Thank you !!! I hope you're doing even better now! I appreciate all the great info you've given me.
It's so ironic that you ALSO have sit bone pain, (in addition to trichanter issues) because I've developed
HORRIBLE ischial tuberosity pain just recently.

My greater trochanter avulsion fracture is fully healed, and I've been loving PT in a pool. However, the
PT has greatly improved my mobility and flexibility in some ways, but once in a while, that trochanter
pain starts again. I think that may just be something I'll have to deal with long-term. It's not horrible,
and I'm still just *thrilled* to have the hips replaced and be able to (almost) walk without a walker.

Now, onto the newer ischial tuberosity pain.... I was getting into the pool at PT, which is a hard
surface, and when I turned, the pain was awful. From then on, I made sure to sit on a towel before
turning. Unfortunately, it's gotten much worse lately.

The other day, I felt a pop in my greater troc. and worried it had fractured again. And the sit bone
pain was still terrible.

Saw surgeon yesterday, who assured me the troc. fracture is still fully healed, the replaced hips
are fine, and that having a "pop" once in a while is normal (in the gr. trochanter).

He thinks my pain in the ischial tub. is actually a *hamstring* issue, so he's ordered some
extra modalities to my pool PT. I look forward to starting tomorrow! I googled "EPAT"
that you had, and maybe my clinic has that.

Today, the ischial pain is just horrible, so I just did some hamstring stretches that usually
help. I also have a special cushion where the ischial t's area has holes, which also helps.

I also Tylenol, Ibuprpfen, and alternate between ice and heat, too. I logged on today
because I'm starting to get hopeless that something is always going to hurt.

Since sitting
is (unfortunately) the majority of my day, this new problem is very discouraging !!!! I do
get up at least once and hour to stretch. It's sad to remember all the years my
career had me on my feet 12-hours a day, and I LOVED it !

On the bright site, at least
my trochanter pain is (mostly) gone. Not to mention, two brand new hips! Thanks
again for replying.

 

[Puggles]

I would make the same decision, @Puggles, if they haven't helped you in the past.

Do either of these threads describe what you are feeling? Both are common after THR surgery:
Trochanteric bursitis with THR
Piriformis syndrome - a pain in the butt!

Thank you for your reply My trochanter fracture is fully healed, but now I'm having
severe pain in the ischial tuberosity. I'm also losing hope of ever being pain-free.

My regular doctor thought I had piriformis syndrome,
but yesterday I (finally!) got into my hip surgeon, who says my ischial tuberosity pain is related
to the hamstrings. It makes sense, since I've been doing a lot of PT recently. My poor
hamstrings didn't do very much all the years I delayed THR, so I'm sure they're in shock.

I just hope the extra modalities he added to my pool PT will help. I'm also getting up
and stretching every hour, and using a cushion that's open in that part to take the
stress off.

I hope to hear from more people with "sit bone" pain---it is driving me crazy ! I'd
take the trochanter pain back over this!

 

[Eman85]

Just my opinion but it sounds like the harder you pull the tighter it gets. Ever consider a vacation from working your painful hip and see how it feels after a couple of weeks? It costs nothing and causes no pain.

 

[Puggles]

Just my opinion but it sounds like the harder you pull the tighter it gets. Ever consider a vacation from working your painful hip and see how it feels after a couple of weeks? It costs nothing and causes no pain.

Thank you for the idea...It's so hard to know what to do. I just took 2 weeks off from PT because I needed to be sure I
didn't have another avulsion fracture, injury/ whateverrrrr that horrible pain was.

Today, PT (in the pool, I love it!) was GREAT. My ischial tuberosity is much better, but now my
greater trochanter is killing me again. It's *almost* funny how the two change day by day.


Now tonight, I'm back to terrible pain and relying too much on the walker. I am extremely
discouraged. I may just do what many here have talked about and just WALK....walk, walk,
and walk some more. Forget PT, forget worrying that I have another avulsion fracture, etc.

Ultimately, no matter what happens, this is all my own fault because I delayed THRs
for wayyyy too many years.

 

[mendogal]

....no matter what happens, this is all my own fault because I delayed THRs
for wayyyy too many years.

I'm so sorry you're in this cycle of pain.

Please, PLEASE don't beat yourself up. You made the best decisions you were ready to make... and there's no guarantee with *any* of these surgeries, regardless of how much sooner or later they're done.

Even those of us who chose surgical.options earlier on find that our entire bodies' structures have been altered by the localized arthritis, and from preop it's impossible to forecast what are the loose areas that will need to tighten post op and what are the exact opposite.

Hang in there. Vent, question, share.... We're with you.

 

[Eman85]

Ultimately, no matter what happens, this is all my own fault because I delayed THRs
for wayyyy too many years.

You've never read my recovery thread, I had a replacement prosthetic in my hand in 1985. I don't think many have topped my waiting period.
If you read most of our threads on here you'll find the best recovery tool is to do nothing but walk. The pool feels great and I enjoyed walking in it but I was much further along in recovery before I got in the pool mostly because of the weather and it was an outdoor pool. Didn't take long for me to figure out that it was good way to overdo and get hurt. Water takes away the weight but also easy to pivot incorrectly, hips don't like pivoting.
Again, take the weekend off rest and ice. I guarantee you won't regress in your recovery.

 

[Puggles]

@Eman85....I actually have read your recovery thread! Albiet it was a while back, but I remember many
of your posts---esp. when you overdid it---and they have been very helpful. I have read MANY other recovery threads here, and am
familiar with how most people recommend JUST walking.

Interesting what you said about the weightlessness and incorrect pivoting!
Probably explains the pain in the pool yesterday. Yes, I'm going to take it easy and use
ice, rest, and just walk. Thank you for your input.

 

[Puggles]

@mendogal.....Thank you for your kindness and support !!!
This site has helped me so much the past few years!