Revision THR Constant pain continuing 1 year after THR<^

[Layla]

Thankfully there's no nerve damage.
I hope you find answers soon so you're able to move forward.
Let us know how the Ultrasound goes. Wishing you the best.
A great day to you!
@Marvy

 

[Marvy]

I had the ultrasound of my hip this morning. Unfortunately, nothing definitive was found. However, the doctor did say that I had alot of fluid under the gluteal tendons - around the trochanter - but that it was not bursitis. He "suspects" that there could be a tear, but he said that due to the amount of fluid, he couldn't really see one. The only thing he mentioned finding (outside of the fluid) was a little bone spur on the trochanter...

I asked him more questions as to why there would be such a large amount of fluid in that area, and just as I suspected, he said it was due to inflammation. But then the question is, what is causing the inflammation? My gut feeling is that there is a tear - somewhere.

He suggested more PT (of course), but I said that if there is alot of fluid and inflammation, then why go to PT and exercise my hip more? My thinking is that more exercise would cause more inflammation, and then more fluid.

So, he has now referred me to an orthopedic surgeon for more definitive tests/diagnosis (the sports medicine doctor that I saw is not a surgeon). He said that this ortho is familiar with revisions. I have an appointment on Tuesday afternoon.

I just want to find out what is going on.

If I was reading a book, I think this would be Chapter 103..... sigh.....

 

[Jaycey]

My thinking is that more exercise would cause more inflammation, and then more fluid.

Well done for pushing back on this. Why on earth would you want to have more PT! Please let us know how your appointment goes.

 

[Josephine]

but that it was not bursitis.

Don't believe him!

a little bone spur on the trochanter

another symptom/sign of TB!

But then the question is, what is causing the inflammation? My gut feeling is that there is a tear - somewhere.

Give you two guesses - TB!

My thinking is that more exercise would cause more inflammation, and then more fluid.

Quite so!

the sports medicine doctor that I saw is not a surgeon

Oh well that explains a lot!

 

[Mojo333]

Sometimes I wondered if it was killing me OR making me stronger?
You do need to see the OS...and this thing will have to be resolved so you can get relief.
Hang in there dear Marvy!

 

[Marvy]

Chapter 104
Had my appointment with the OS today. He didn’t think a cortisone injection would help (duh!). He did asked me questions, read the notes from the ultrasound and said “let’s just get a MARS MRI scheduled”.

So I have to wait for the insurance company to approve it and then I can schedule it. Hopefully the insurance company will approve it in the next week.

He did say that since I’ve had 2 surgeries there is probably a lot of muscle loss. But I told him things are getting worse and not better. I am back walking with a cane.

Little by little we are chipping away at this....

Chapter 105 - TBD

 

[Mojo333]

Hurry up and wait
Still hopeful they will get something figured. Keep the faith @Marvy

 

[ljpviper]

Marvy, look at my thread under hip resurfacing I am having very similar issues with my Glute Medious. I too have had a scope then the resurfacing in the right hip.

If you get an MRI have your surgeon review it with you. The report showed nothing was wrong that was not the case. My glute medius is getting atrophy. He showed me the difference between the glute max and glute medius muscle quality.

Good luck

Larry

 

[Marvy]

oh yes, @Mojo333 - definitely in the hurry up and wait period. It's frustrating that the doctors have to plead and beg the insurance companies to get permission to do a test. But, as the patient, what can you do? I am trying to hang in there! I feel as though I need to type up my situation and just hand it out to the doctors. I've repeated the same information over and over again - surgeon - PT - sports medicine - surgeon's PA, surgeon, x-ray tech - MRI tech - back to the surgeon... this is getting close to insanity...!

@ljpviper - I will definitely read through your thread. I understand that I've had 2 surgeries and that there will be muscle atrophy. But when nothing that you do is helping and you're not making any progress (and in fact going backwards), "something" is going on...

As wrong as it may sound, I do hope they find something with the MRI. At least then we know what we are dealing with. But, whatever the MRI findings are, I am already planning to get a second (and who knows- maybe even a third opinion).

 

[Layla]

How frustrating for you, I'm so very sorry.
Wishing you comfort as you wait for the MRI and results.
Stay in touch, we're here for you.
@Marvy

 

[Marvy]

Thank you so much @Layla I am so glad I have found this forum - if only to vent.... (Goodness knows I can't offer any advice! ) Everyone is so kind, supportive and you always have a listening ear. My family is tired of hearing about my hip issue of the day. I know they really don't understand - and I get that. It is hard for anyone to truly understand what someone is going through.

 

[Layla]

We get it! Stop by as often as you need. The lights never go out here.
You'll always find someone to offer comfort or reassuring words.
Hugs...it will get better!
@Marvy

 

[Marvy]

Well, I had the MRI and had the follow up today to get the results. The surgeon did not mention bursitis at all. He called it "quite a large seroma". I can see why as one of the pictures looks as though my hip had been hit by a white paintball that exploded....

I asked about a potential tear and he said "it wasn't mentioned on the report". gah! It's as if the radiologist said "oh look, there's fluid" and didn't even bother to look at the MRI any further.

He did end up aspirating it and will be sending the fluid off to be analyzed just to be sure there is no bacteria or infection going on. I'm not confident that they got much fluid either as they didn't do the aspiration under ultrasound or anything - they just did it more by feel. They had to move the needle 3 times to get enough fluid for the sample. At one point he asked me "can you feel the needle against the bone?". umm. yea!!!! At this point I was clenching my fists.... After the aspiration, they did give me a cortisone injection. Normally I would have said no, but I need something that will help the pain. I have a follow-up next week to get the results of the fluid draw and also to let them know if the cortisone is helping or not.

I asked if the fluid/seroma can come back and the only reply I got was "it depends on what this fluid is".....

So, I will be getting a second opinion to hopefully put my mind at ease. Based on the fact that the radiologist (different one from this MRI) missed the screws in my psoas, and after reading @Krista story of doctors missing tears, I believe that I have to get another opinion.

I just don't know anymore.

 

[Mojo333]

I certainly think it would give me some piece of mind to have some fresh eyes.
So sorry you have to deal with this.
Please let us know when you get some answers Marvy.
Hope the shot gives you a bit of a reprieve from pain.
Hugs

 

[Krista]

@Marvy, yes, another opinion is a good idea. I'm surprised they didn't do the aspiration with guidance. I was able to see exactly what was going on during my hip aspiration, and it obviously made it much easier for the procedure to be done. I read about seromas, and I wonder how much that is contributing to your problems.

An orthopedic surgeon, a physiatrist and two radiologists missed my torn gluteals in MRI. Your MRI scans have been recorded. Make sure you get a CD of the results that you can show to another physician and keep for your own records. I found a program online that allowed me to see them, and I did a little bit of educating myself about how normal hip MRIs look versus what mine looked like, and I could see the differences. I found detailed MRI scans online of normal hips and those with problems to compare mine with.

Keep on keeping on, Marvy.

 

[Marvy]

Hi @Krista There was a sports medicine doctor at the facility that was going to do the aspiration under ultrasound, but the surgeon said "I don't need that!". After the third needle stick I bit my tongue but wanted to say "well, if you had done this under guidance, you wouldn't be having this issue". But at that point, I don't think they would have changed as then I would have had to move rooms, etc.

The image is one that shows the fluid that they (attempted to) aspirate.

I have all of my CD's and reports and will be sending them off to the surgeon you had suggested for review today...

I have looked online of normal hips and hips with tears, etc , but I can't seem to find anything that look like mine.... And yes, there is alot of fatty atrophy in my hip as well.

 

[Marvy]

Well I called the surgeon's office that I was going to be sending my MRI and reports to, but today I was told that they would not review my case because I had a revision done and they do not specialize in revisions. However, I could send the MRI reports and they would review them. I also said that the prothesis is fine and I am not concerned about them reviewing that.

I told the person that the reports indicate that nothing is wrong (except the seroma) so how could they make a determination of me being "worthy" of a case review? I said I was concerned about soft tissue issues and possible tears, but she still said they would basically not review my case.

I called this same office last week and explained the situation and they at that time said once I had my MRI report to call back and they would assist me in getting it reviewed.

I do not understand why having a revision would make a difference in reviewing an MRI for soft tissue injuries and tears.

Devastated.....

 

[Krista]

I can't understand why having had a revision would make a difference in whether you had tendon tears or not either! There is no point in them reviewing the MRI reports. They need to see the scans. I am so sorry. I've been in contact with another surgeon who repairs gluteal tears in Wisconsin, and maybe he can help you. I'll PM you the info.

 

[Josephine]

quite a large seroma

The definition of a seroma is "a pocket of clear serous fluid that sometimes develops in the body after surgery. This fluid is composed of blood plasma that has seeped out of ruptured small blood vessels and inflammatory fluid produced by the injured and dying cells." which pretty much describes a bursa!

I'm not confident that they got much fluid either as they didn't do the aspiration under ultrasound or anything - they just did it more by feel.

What's wrong with that? A perfectly good way to 'contact' it!

After the aspiration, they did give me a cortisone injection. Normally I would have said no, but I need something that will help the pain.

But you know, a cortisone injection is THE best treatment for bursitis!

I do not understand why having a revision would make a difference in reviewing an MRI for soft tissue injuries and tears.

I think it would make a difference. There might be different bits of surgery or similar that could have been done. But if they're self-declared as 'not specializing in revisions' then they should be ashamed of themselves!

 

[Marvy]

@Josephine - how long does it generally take for a cortisone injection to work for bursitis? I had the injection late Tuesday afternoon. By Thursday I could feel the pain coming back and it has gotten progressively worse. It now feels as though I have a knife in the side of my hip. So far, the pain is the same (and even a bit worse) than it was prior to the cortisone.

How long do you wait until you know that it's not going to work?