Revision THR Constant pain continuing 1 year after THR<^

Thank you @ljpviper I know that my surgeon does not do (or believe in) cortisone or prolotherapy injections. I agree that if the glute medius muscle isn't functioning properly, it can cause other issues. That is definitely one of my concerns. My surgeon does not want to deal with muscle/tendon/soft tissue issues. He only wants to deal with bone issues.

The sports medicine doctor thinks it could be a nerve issue (I don't think it is, but it is the best thing I have to go on at this time). And now with the new issues since the fall I just don't know what's going on.
 
Hi @Marvy
Is that you under there? > :blackcloud:You need to come out from under that black cloud.
Let's see if our Nurse Director @Josephine can look at your story and advise.
I've tagged her for you so please check back in case she has questions for you.
I hope you feel better soon.
 
Well perhaps we could start with you telling me the site of your pain using this chart?

aa hip-references-horz.jpg




After that, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Thank you @Layla Yes, I need for that cloud to disappear! The sooner the better.... I thought about wrapping myself in bubblewrap until it leaves....
 
Hi @Josephine Here's the chart. The darker blue is the area that I have been having issues with since the original surgery and it has gotten worse since the revision. The physical therapist said that it is my glute medius not responding.

The lighter blue is the area that since the bicycle crash has been giving me a snapping/popping/clicking sensation and I feel it down through the red area. It stops about mid-thigh. I have no knee pain, tingling, etc. It is worse if I am walking up any type of incline or steps or turning a corner. It still snaps on flat land, but not as bad. The light blue are, is not directly on my side, but a little more to the back...

aa hip-references-horz.jpg


Unfortunately I do not have a current image of my hip. My surgeon, when I brought up the glute medius issue, said that there was nothing wrong and that I needed to work harder on getting it strengthened.

The sports medicine doctor said he didn't think it was a tear but possibly a nerve issue. The physical therapist ordered an ultrasound of the glute medius (and surrounding area), but the sports doctor said I didn't need one. He ordered (and I am having) a nerve conduction study/EMG on Wednesday.

It is very uncomfortable when I try to lie on my left side.

It doesn't matter how many Tylenol I take (or even the oxycodone) - nothing helps the pain and discomfort.

As for exercise, I've stopped doing my PT exercises (which were side leg lifts and clamshells). After 15 sessions of PT, they said I was not making any progress so I was discharged. This is OK with me as it was becoming a slight waste of time and money.

I still have a very pronounced Trendelenberg gait.

And to answer your question, yes! I will be more than happy to answer any questions you have and give you whatever information can help! Thank you!
 
Sorry you are struggling, Marvy.
So much conflicting information between OS, sports doctor..:shrug:
I'd be frustrated too.
Hopefully you'll get some answers soon.
Hope today is a Good Day:) :-) (:
 
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Oh how lovely! You've marked the places for me! Thank you
The lighter blue is the area that since the bicycle crash has been giving me a snapping/popping/clicking sensation and I feel it down through the red area. It stops about mid-thigh. The light blue area is not directly on my side but a little more to the back.
I'd say that it's either an ITB (ilio-tibial band) issue or could also be Piriformis syndrome which also radiates down the back of the leg (the sciatic path).
It doesn't matter how many Tylenol I take (or even the oxycodone) - nothing helps the pain and discomfort.
No, sorry to say but it won't!
As for exercise, I've stopped doing my PT exercises (which were side leg lifts and clamshells).
Very good.


Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
@Josephine - here are my answers:
1. Lateral (although I think my surgeon called it a posterolateral)

2. The pain varies between 5-7 - depending on the day. I found a picture online and thought I would include it as it is more on the direct side of my hip... The red area always feels as if there is a knife stuck in my hip. It was this way prior to the revision and is now worse after the fall. This area is also the area that has started clicking/popping/snapping... This sensation radiates down the blue line... I do not have any numbness or tingling (or the "typical" sciatica type pain). It just always aches - a very deep aching feeling. There is no swelling.

Ignore the black line and dot - this is an image I found online....

hip1.jpg


3. I was taking Tylenol - approx. 3-4000mg per day for about 3 weeks but stopped as it was not helping. I am currently not taking anything.

4. Yes I am icing. 2-3 times per day for about 30 minutes. It does not seem to help - as soon as I take the ice off, it doesn't feel as if I've iced at all...(It's hard to ice during the day at work).

5. elevating: Only at night while watching TV- but like icing, etc. It does not seem to make a difference

6. activity level: Grocery shopping (I lean on the shopping cart so I won't limp as bad), helping with laundry - folding clothes.

7. (slow)walking - with walking sticks. If I don't use the sticks or a cane, the Trendelenberg gait becomes dramatically worse (the read are in the picture becomes too "fatigued" and basically gives out). I try to go out every other day.

Exercises done at home
Only slow walking.

Anything done at PT
I had been going to PT 2 times per week for about 30 minutes. They were focusing on the glute medius muscle so the exercises were clamshells and side lying leg lifts - 3 sets of 10 each. PT ended mid-July so I have not done these since.

I had been doing the leg exercises at home but it seemed to be a futile effort as the muscle identified by the red circle was/is not responding to any exercise - it is as weak now as it was after surgery. Plus PT said that I was not making any progress and they were at a loss as to what to really do to help me.

I wish the sports medicine doctor would have at least done an ultrasound. I am concerned about the snapping that is now happening as a result of the fall, but the doctors seem to ignore my concern. (hoping I didn't tear anything) I am afraid that if I keep limping the way I am that my back, etc. will suffer. If I walk too far or am on my feet too much, my right foot becomes very painful. I know that it is the result of my gait and how I stand...

I still cannot walk up stairs unless I have a railing to hold onto - because the area in red feels like it gives out and collapses.

Thank you Josephine!
 
Thank you @Mojo333 It is frustrating when no one can seem to agree. My surgeon does not want to be "bothered" with muscle/soft tissue issues. As long as the x-ray looks OK, then I must be perfect....

The sports medicine doctor, because I'm not in excruciating pain thinks that it is either a nerve issue or just weak.

I keep thinking however, that the revision only replaced the ball and liner. A new stem didn't have to be inserted, etc. So yes, I know the hip has to be dislocated, etc, but in my mind, the revision wasn't "as bad" as the original surgery. I was extremely strong prior to the original surgery, so it's just hard for me to believe that my muscle has atrophied this badly.
 
1. Lateral (although I think my surgeon called it a posterolateral)
Yes, the two are distinctly different!
2. The pain varies between 5-7 - depending on the day. I found a picture online and thought I would include it as it is more on the direct side of my hip.
I got it.
The red area always feels as if there is a knife stuck in my hip. It was this way prior to the revision and is now worse after the fall. This area is also the area that has started clicking/popping/snapping... This sensation radiates down the blue line... I do not have any numbness or tingling (or the "typical" sciatica type pain). It just always aches - a very deep aching feeling. There is no swelling.
Yes, that red spot is indubitably Trochanteric bursitis with ITB (ilio-tibial band) issue and is responsible for all this. Having had it myself - twice in fact - I recognise the description!
3. I was taking Tylenol - approx. 3-4000mg per day for about 3 weeks but stopped as it was not helping. I am currently not taking anything.
I actually never asked you how much you were taking daily but how much and how often per dose! So I would assume you took 1,000mg 4 times a day. If you took less, that's why it never helps! But ice is better for those two maladies.
4. Yes I am icing. 2-3 times per day for about 30 minutes. It does not seem to help - as soon as I take the ice off, it doesn't feel as if I've iced at all...(It's hard to ice during the day at work).
You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.
5. elevating: Only at night while watching TV- but like icing, etc. It does not seem to make a difference
Elevate when you ice.
6. activity level: Grocery shopping (I lean on the shopping cart so I won't limp as bad), helping with laundry - folding clothes.
Okay.
7. (slow)walking - with walking sticks. If I don't use the sticks or a cane, the Trendelenberg gait becomes dramatically worse (the read are in the picture becomes too "fatigued" and basically gives out). I try to go out every other day.
You're in a poor state for 18 weeks out.

Only slow walking.
I had been going to PT 2 times per week for about 30 minutes. They were focusing on the glute medius muscle so the exercises were clamshells and side lying leg lifts - 3 sets of 10 each. PT ended mid-July so I have not done these since.
Clamshells and side lying leg lifts - absolutely the cause of your ITB issue. Absolutely designed to cause it!
I had been doing the leg exercises at home but it seemed to be a futile effort as the muscle identified by the red circle was/is not responding to any exercise - it is as weak now as it was after surgery. Plus PT said that I was not making any progress and they were at a loss as to what to really do to help me.
Some points here
1. NEVER do any exercises for a THR
2. Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.
3. Try the stretches suggested in the articles
4. See a chiropractor for remedial massage
5. You can do some for yourself as well Acupressure massage
 
Thank you @Josephine yes I know I’m in a poor state at this point .... (sigh....)

I’m not sure at this point what concerns me the most (except everything) - the fact that I’m not getting any better or being afraid that I damaged something when I fell to cause the snapping.

I was taking 4000 mg of Tylenol throughout the day (some days I would forget to take the last dose at night though) - therefore the 3000mg day
 
I was taking 4000 mg of Tylenol throughout the day (some days I would forget to take the last dose at night though) - therefore the 3000mg day
:scratch:
 
Hi Marvy!:wave:
Hope today will be a Better Day.
I know it seems like forever but I'm just hoping that you can hang in there and that not attempting to stress this new surgery's aftermath might get you some relief and back on track.
I'm sure this recovery business is getting frustrating and Old..:bored:
I will be praying all behind to turn around soon.
Keep the faith!:friends:
 
Hi @Mojo333 :)
I had the nerve conduction study/EMG last week. The neurologist said that he did not see anything wrong. He asked why I had been referred to him and I explained my situation and symptoms. He was surprised that the sports medicine doctor suggested the EMG as well as him not doing any type of imaging test.

I haven't heard anything back from the sports medicine doctor (they said they would call with the results of the EMG) and I don't have a follow up appt. scheduled. If I don't hear in the next couple days, I will call them.

I am still concerned that when I fell I may have done some damage - even if it is muscular. The sports med dr., if he doesn't order any imaging, then I will go to the emergency room to get images done....

Yes, the recovery is getting old and I am so frustrated I am exhausted.

Thank you for the kind words and prayers - they really do brighten my day. :thankyou:
 
Your welcome and please do let us know what you find out.
We do know our bodies best and if you think there is something more serious than just a prolonged recovery...I would also want some Xrays to make sure all was still good.
 
I finally heard back from the sports medicine doctor. He reiterated what the neurologist said - there isn't any nerve damage.

Initially he just said "well, you've had 2 surgeries and it's just going to take time". I was persistent in the fact that I know the revision was not that long ago, but should I not see at least some improvement by now? He knows the physical therapist so when I said that even they said I wasn't making any progress, isn't there anything else to look at? I reminded him that the PT is also the one that suggested at the least of having an ultrasound done to look for any tears... His mindset was of "you just need to work harder to strengthen the muscle". :sigh: I pretty much asked him "what part of "the muscle is not responding" do you not understand"???? :flabber:

So, after a lot of convincing, he finally agreed to do an ultrasound of my hip to check for any tears. Finally! So, I have that scheduled for next Friday.

Maybe there aren't any tears and my muscles have atrophied that bad. However, being that I was an active and strong person and now can't even walk up a flight of stairs, I just don't understand how I cannot be making any progress....

to be continued......
 
Gosh - a long and frustrating battle for you @Marvy ! Keep fighting - sounds like you are making slow progress.
 
Hey Marvy.
Good for advocating for yourself for answers.
I also hate that you are having to deal with such a frustrating recovery.
Also realize it's one of those situations, just like when they didn't diagnose my back pain and sciatica as OA...where you want them to find something to explain the pain but are afraid they'll find something.
:fingersx: for definitive answers next week.
We are rooting for you:console2:
 
where you want them to find something to explain the pain but are afraid they'll find something.
@Mojo333 that is exactly how I feel... I keep thinking that there has to be a reason, but what is it (and depending on what it is, do I really want to know?)
 
I can certainly understand...but we can't do anything if we don't know, right? No choices...
Sending good mojo your way!:friends:
 

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    Staff member since August 15, 2017

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