Revision THR Constant pain continuing 1 year after THR<^
- Thread starter Marvy
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Krista
post-grad
How very disappointing, @Marvy. Is the doctor experienced in seeing gluteal tendon tears via ultrasound? You have atrophy in gluteal muscles, you have trendelenburg gait, you have pain in that area. What else could it be? These doctors have to brush up on their anatomy and figure it out. The problems exists. As I've said before, it's not rocket science. The mechanics of muscle/tendon/ligament/bone have been known for a long time. Sending you my sympathy for having had so many physicians who don't know their stuff. I only went through two orthopedists, one of whom was the surgeon who replaced my hip, who couldn't fathom what was wrong before I found one who did correctly diagnose and treat me. You have been through more than that. 
@Harryn1 - thank you. This has been so taxing both mentally and physically. I cannot believe I am still dealing with issues for almost 2 years.
@SaraK - I did have an injection in my lower back, but it did not provide any relief. It only made my whole leg numb so that I could not walk for almost 3-4 hours.
@Krista - The doctor who did the ultrasound is "supposed" to be a specialist in MSK ultrasounds. The surgeon specifically wanted him to do the procedure because of his experience. In the surgeon's words "he is the doctor who teaches all of the other doctors how to do the ultrasound to look for tears and damage". Unfortunately, this is at a fairly major university hospital system. The ultrasound was mostly done by his Fellow. The MSK specialist came in, took a couple of images while he held my leg in different positions. I was not impressed by his "expertise" at all. They watched me walk up and down the hall. Both of them agreed that "you have all of the signs of a tear without the tear". Then, what really tweaked me was that they knew they were going to give me a cortisone shot as they had everything laid out on the table. I said that I had already had one and it didn't work - in fact I have felt worse since. Their only reply was "well, obviously they didn't inject it in the correct spot". I ended up with a pretty severe headache from it - and I very rarely get headaches... I know I should have refused the injection, but I know that the surgeon would say "well, they didn't find a tear so let's do injection, pt, etc". I feel as if it's a game they play. This surgeon is the only one I have found in my area that specifically states gluteal tendon "expertise".
They then mentioned that it was nerve damage. I explained to them that I have the nerve studies done and the results were perfect.
They said the injection was a success as they had me stand on my left leg. They held my arms so I could balance and the doctor pushed inward on the side of my hip so it wouldn’t drop. How can they claim this as successful?? I’m beyond words.
I have taken so much time off of work for my hip that I have no vacation or sick time left to take.
The surgeon who reviewed my MRI is going to try and get a bone scan approved, but they cannot make any guarantees that it will be approved by my insurance. That surgeon will not see me until I have the bone scan. If I make an appointment at their office, it will be with one of the PA's instead. Then I would have to make a second trip to see him. (More plane trips and hotels, rental car, etc) The local surgeon I saw laughed at their idea of wanting to do a bone scan with the comment "well, you had revision surgery 6 months ago. I'm sure that your surgeon checked for loosening, so you don't need one".
Having my hip replaced has definitely been the worst decision I have ever made.
@SaraK - I did have an injection in my lower back, but it did not provide any relief. It only made my whole leg numb so that I could not walk for almost 3-4 hours.
@Krista - The doctor who did the ultrasound is "supposed" to be a specialist in MSK ultrasounds. The surgeon specifically wanted him to do the procedure because of his experience. In the surgeon's words "he is the doctor who teaches all of the other doctors how to do the ultrasound to look for tears and damage". Unfortunately, this is at a fairly major university hospital system. The ultrasound was mostly done by his Fellow. The MSK specialist came in, took a couple of images while he held my leg in different positions. I was not impressed by his "expertise" at all. They watched me walk up and down the hall. Both of them agreed that "you have all of the signs of a tear without the tear". Then, what really tweaked me was that they knew they were going to give me a cortisone shot as they had everything laid out on the table. I said that I had already had one and it didn't work - in fact I have felt worse since. Their only reply was "well, obviously they didn't inject it in the correct spot". I ended up with a pretty severe headache from it - and I very rarely get headaches... I know I should have refused the injection, but I know that the surgeon would say "well, they didn't find a tear so let's do injection, pt, etc". I feel as if it's a game they play. This surgeon is the only one I have found in my area that specifically states gluteal tendon "expertise".
They then mentioned that it was nerve damage. I explained to them that I have the nerve studies done and the results were perfect.
They said the injection was a success as they had me stand on my left leg. They held my arms so I could balance and the doctor pushed inward on the side of my hip so it wouldn’t drop. How can they claim this as successful?? I’m beyond words.
I have taken so much time off of work for my hip that I have no vacation or sick time left to take.
The surgeon who reviewed my MRI is going to try and get a bone scan approved, but they cannot make any guarantees that it will be approved by my insurance. That surgeon will not see me until I have the bone scan. If I make an appointment at their office, it will be with one of the PA's instead. Then I would have to make a second trip to see him. (More plane trips and hotels, rental car, etc) The local surgeon I saw laughed at their idea of wanting to do a bone scan with the comment "well, you had revision surgery 6 months ago. I'm sure that your surgeon checked for loosening, so you don't need one".
Having my hip replaced has definitely been the worst decision I have ever made.
Last edited:
ljpviper
member
Marvy, I understand your situation I am going through the same exact issus for close too 2 years. Did your MRI show atrophy in the glute medius? Sorry if I asked before as the thread is getting long.
I have tried everything as well, presently doing the active release therapy. It's helping a little but after 2 months I am getting frustrated again. I had a miserable day at work, sitting just kills my hip.
I too do not understand how these things are missed on MRIs like kristas glute tear,etc. Medically there has to be wrong with you and me. I was fine for 11 months after my surgery, very frustrating.
Hang in there, all the best
Larry
I have tried everything as well, presently doing the active release therapy. It's helping a little but after 2 months I am getting frustrated again. I had a miserable day at work, sitting just kills my hip.
I too do not understand how these things are missed on MRIs like kristas glute tear,etc. Medically there has to be wrong with you and me. I was fine for 11 months after my surgery, very frustrating.
Hang in there, all the best
Larry
Krista
post-grad
@Marvy, just what did they mean by saying the injection was a success? Did they have you walk unassisted, and did you still have the trendelenburg gait? They were propping you up in three places while you were trying to balance on that leg! And you still have debilitating pain. Sounds to me like nothing has changed for the better. I am so sorry for you that they cannot figure this out.
I'm not sure I can blame my THR for my gluteal tendon tears. My surgeon did everything correctly and the implants were perfectly placed and have not loosened. The antero-lateral approach that I had requires that the gluteus medius muscle be dissected (teased apart lengthwise) to gain access to the joint. But the tendon was not cut and the muscle stitched up again. I've been told that muscle of older people may not heal as well as muscle in those who are younger. Maybe that is what happened with me, i.e. the lack of normal healing, and then eventual tearing of the tendon. So, in a way, it happened because of the THR. But if I hadn't had it, then I would have been in enormous bone-on-bone pain, maybe confined to a wheel chair.
I'm not sure I can blame my THR for my gluteal tendon tears. My surgeon did everything correctly and the implants were perfectly placed and have not loosened. The antero-lateral approach that I had requires that the gluteus medius muscle be dissected (teased apart lengthwise) to gain access to the joint. But the tendon was not cut and the muscle stitched up again. I've been told that muscle of older people may not heal as well as muscle in those who are younger. Maybe that is what happened with me, i.e. the lack of normal healing, and then eventual tearing of the tendon. So, in a way, it happened because of the THR. But if I hadn't had it, then I would have been in enormous bone-on-bone pain, maybe confined to a wheel chair.
Yes, the MRI I had in September did show atrophy. And interestingly enough, I know this is 4 years and 2 surgeries ago, but an MRI I had back in 2014 showed "partial thickness tearing of the anterior fibers of the gluteus minimus".
After the injection on Monday, I waddled out of the office with the Trendelenburg gait and all. They did not have me walk after the injection - except to leave the office (and the doctors were no where in sight at that point).
The surgeon who did the hip replacement and revision did say that he didn't cut any muscles, but somehow moved them out of the way as a "flap" as he called it. In the surgery notes it did say that he released the muscle (but doesn't that mean it was cut?)
After the injection on Monday, I waddled out of the office with the Trendelenburg gait and all. They did not have me walk after the injection - except to leave the office (and the doctors were no where in sight at that point).
The surgeon who did the hip replacement and revision did say that he didn't cut any muscles, but somehow moved them out of the way as a "flap" as he called it. In the surgery notes it did say that he released the muscle (but doesn't that mean it was cut?)
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I'm not a medical expert but, as I understand it, "release" is detaching the tendon and then it's reattached after. Not the same as cutting the muscle. Can you ask your doctor to compare the ultrasound with the 2014 MRI and focus on that particular area? Sometime concentrating on one spot rather than looking for something in a larger area can make it easier to find.
Hi @Mojo333 ! I have the follow up with the OS Wednesday afternoon. I am still trying to get a copy of the ultrasound images. The medical records/radiology department said they cannot see them. I was told I would have to contact the doctor’s office that did the ultrasound. Based on this information I’m not sure if the surgeon will actually see or look at the images. I’m guessing that he will base his opinion on what the ultrasound doctor says.
The injection really didn’t help. On a scale of 1 to 10 where 10 is “I’m healed”, I’m about a 1.
Thank you for checking in and enjoy the rest of the weekend!
The injection really didn’t help. On a scale of 1 to 10 where 10 is “I’m healed”, I’m about a 1.
Thank you for checking in and enjoy the rest of the weekend!
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Praying for answers along with your other BS pals.
I'm sure you get very weary of all the uncertainty...not to medium the pain.
Hope today is a better day
I'm sure you get very weary of all the uncertainty...not to medium the pain.
Hope today is a better day
I had my follow up with the surgeon today. He said the same thing that the ultrasound doctor said - I have all the symptoms of a tear but nobody can find the tear.
He also said that if a tear was small or a partial tear that those are harder to see on an mri and ultrasound.
Also, the fact that I’ve not had any real relief from the injection last week means that something is amiss.
At this point he said the only options are to live with it or have surgery. From everything that he said, we (my spouse and I) feel that he sees “something” that unfortunately he cannot definitively diagnose. I asked what his gut feeling was and how confident he was that he would find a tear. He said in other cases that were similar to mine that he has found a tear. He also said that he has found “things sutured together that shouldn’t be “ as well as permanent stitches that were irritating the tissues, along with other things....
So, to make a long story shorter, I opted for surgery. It is scheduled for January 31. I wished I could have had it this year, not only is he booked up, but he will not do surgery until a minimum of 3 months past a cortisone injection.
Now it’s sit and wait....
He also said that if a tear was small or a partial tear that those are harder to see on an mri and ultrasound.
Also, the fact that I’ve not had any real relief from the injection last week means that something is amiss.
At this point he said the only options are to live with it or have surgery. From everything that he said, we (my spouse and I) feel that he sees “something” that unfortunately he cannot definitively diagnose. I asked what his gut feeling was and how confident he was that he would find a tear. He said in other cases that were similar to mine that he has found a tear. He also said that he has found “things sutured together that shouldn’t be “ as well as permanent stitches that were irritating the tissues, along with other things....
So, to make a long story shorter, I opted for surgery. It is scheduled for January 31. I wished I could have had it this year, not only is he booked up, but he will not do surgery until a minimum of 3 months past a cortisone injection.
Now it’s sit and wait....
oh, Marvy, I wish the news was better! On the other hand, the surgeon is willing to trust his experience and instincts rather than simply relying on what the tests show. In your place, I think I'd trust the surgeon and opt for the surgery as well. Sometimes the things we say given our situations can sound wierd, but I'm going to hope and pray that he finds something wrong when he opens you up and that he can fix it quickly and easily!
Hi Marvy.
I definitely can't imagine not doing anything either...too long to be in pain and feel like things will not get better.
I only imagine that because the OS wasn't able to find the specific cause and the wait because of the shot (heard that before...my dad had to wait for three months after injection that didn't work for knee replacement) that this will be such an anxious time for you.
I really feel for you.
It will take one heck of an effort to keep your body and your mind in the best shape to get this done so you can FINALLY get better.
You can do it...you have already been through most of this year frustrated, I know.
Keep the faith, friend.
I definitely can't imagine not doing anything either...too long to be in pain and feel like things will not get better.
I only imagine that because the OS wasn't able to find the specific cause and the wait because of the shot (heard that before...my dad had to wait for three months after injection that didn't work for knee replacement) that this will be such an anxious time for you.
I really feel for you.
It will take one heck of an effort to keep your body and your mind in the best shape to get this done so you can FINALLY get better.
You can do it...you have already been through most of this year frustrated, I know.
Keep the faith, friend.
Krista
post-grad
@Marvy, terrific news that you will be getting surgery so that surgeon can see with his eyes what is going on in there. A friend of mine has a tear that was seen in MRI and ultrasound, and she doesn't even have a limp, just pain and some loss of strength. With your extreme limp and pain, there is something serious that needs to be addressed. Wish you didn't have to wait until the end of January, but you will have an answer and a solution then! This has been a nightmare for you, and I hope that soon it will be over!
So sorry you have to have more surgery. But at least your surgeon seems very focused on finding the issue and resolving it. Also sorry you must wait but yes, they won't do surgery just after an injection. Please keep us updated. We will be here for you!
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