Revision THR Constant pain continuing 1 year after THR<^

[moodybluestoo]

Marvy: I know how frustrating it can be when people don't believe you. Just a question, do you still have a limp and is your hip weak. ( trendellenburg gait). Stick with advocating for yourself because if you don't , no one will. Only you know what you are feeling. I can only identify with stiffness as i had no hip or surgical pain after either surgery. I took no pain medication. If i had not continued to advocate for myself i would not have found out the muscle was detached in time and the muscle would have been so retracted that it could not have been put back in to place. I am still not able to return to work because they won;t let me use a cane but i am way better than after the first surgery. You are the only one that knows what you are feeling so stick with your insistence on getting your mobility and health backI imagine that you are having a problem with stamina as well. That would tell me that something is wrong, i still have trouble with stamina. Are you able to get down on your hands and knees and get back up or does that cause you pain as well. I can get down but am not comfortable and have real trouble getting back up. I sit on a little chair to do gardening but it is still exhausting. They found my muscle was detached by doing an MRI. Best of luck and keep your chin up and know others care Moody

 

[Horseshoe]

@Marvy my take is to seek out an unrelated revision OS or a physical medicine dr and get a different opinion. At eight mos out, you're still experiencing pain, haven't had LLD properly addressed and are getting the brush off. It's difficult to move forward and plan a strategy when you don't know what the problems are. Hang in there.

 

[Marvy]

@moodybluestoo, Thank you for your encouragement. I do still have a limp, but not the trendellenburg gait. The PTs and sports medicine doctor that I have seen all say my hip muscles are strong. I wear a heel lift. It doesn't really help much. Like you, I can get down on my hands and knees, but have trouble getting up. I either need something to hold on to to help pull me up, or I have found that if I straighten my operated leg while trying to get up, it is a bit easier (while still holding onto something).

Sitting for any period of time is also hard as it puts pressure where the "lump" is resulting in more pain.

I'm not sure how much this matters, but I did find out that my hip was cemented. I've been trying to research hip issues, but most seem to revolve around cementless.

@Horseshoe, I did get the name of a revision specialist a few hours away from me. Unfortunately they stopped carrying my insurance so I would have to pay out of pocket :( Even though I could do this, I would rather find one in-network if I can.

I'm going to continue my quest in finding an answer. It's just not moving as quickly as I would like.

 

[Josephine]

But he's never said really what he's looking for.

This does happen on occasions. I've heard surgeons discussing it at conferences on several occasions. Most of them then went on to say that though they did innumerable scans and tests, they could find no reasons for the pain bit in the end, a revision anyway and found. amazingly, that it did work. Nobody could offer an answer to that.

I'm concerned too that if they do find something that needs to be fixed quickly, I won't have the time to seek out a revision specialist or another doctor to get a second opinion.

My friend, trust me when I say that should they find anything amiss, it will not be something that requires urgent surgery.

Can I ask you for more detail on some points you raised?
Where is this lump you speak of? Can you point it out in this chart for me?

Do you have a fairly recent xray of your hip you can post for me to look at?

I'll be back ...

 

[Marvy]

@Josephine, thank you for following up. The only X-ray that I have is from March (I had posted it earlier). I was supposed to have one when I had the bone scan, but since my insurance didn't approve the scan, everything got cancelled...

My doctor did say that possibly the cup needed to be adjusted to a different angle..? Does this sound right?

The "lump" is at L1B Y. It is a very distinct pain and location. It feels as though I am being stabbed in that area. It is a constant pain (that is getting worse, not better) and even gets a lot worse when I walk- even 2 or 3 blocks. Hydrocodone, tramadol, Tylenol or ibuprofen don't help at all. I've stopped all exercise to rest it but that doesn't seem to help either. I've gone to a couple massage sessions but afterwards it ached so bad I couldn't stand it. I can't sleep on my side either as the pain worsens the longer I lay on my side. The therapist said they didn't think it was bursitis or it band related. The massage person was in agreement with the therapist. My primary dr also didn't think it was bursitis or it band related. So my fear is that it has loosened. But with a cemented hip is that common??? Or could the cement have "cracked" or failed?

Since the pain is now constant, it makes me feel somewhat nauseous too.

Once I walk 2-3 blocks then the front of my thigh starts to ache and it goes up into my groin area and down almost to my knee.

I have so many questions....I just don't understand what's going on.

 

[Josephine]

My doctor did say that possibly the cup needed to be adjusted to a different angle..? Does this sound right?

Could be. Quite a number of ongoing pain can be caused by poorly aligned implants.

The "lump" is at L1B Y. It is a very distinct pain and location. It feels as though I am being stabbed in that area. It is a constant pain (that is getting worse, not better) and even gets a lot worse when I walk

This gives me considerable cause for concern because what you are describing seems to be a classic case of a loose stem. Can you get hold of a copy of your last xray so I can see it? Even from March it might give me a clue.

 

[Marvy]

@Josephine here are my x-rays... Thank you for looking at these.

 

[Josephine]

They look like uncemented implants to me, is that correct?

Well the cup looks okay but I have concerns about the stem. There is rather too much shadowing around it (yellow arrows) which indicates there has been no bonding of the bone to the implant.

There is also a sign, a very slight sign, of remodelling at the tip of the stem. This indicates a 'toggling' of the stem tip, a slight micro movement, much like a clock pendulum. Bone doesn't much like this kind of movement and dies back when it occurs.(blue arrow). But this is so slight that it takes a very experienced eye to see it!

I would very much like to see a more recent xray to see if there is any development in this. Do you think you can get one done?

 

[Marvy]

Thank you so much @Josephine I really appreciate you taking the time for this!

I thought that the doctor said that it was a cemented hip.

I do have an appointment for the week after next for X-ray. That's the soonest I can get it done due to my schedule.

It doesn't surprise me about the loosening. It's maddening though that the radiology report said that the X-rays looked perfect. Even in my searching on line comparing my X-ray to those that showed loosening, to me mine looked like some of those. But I guess it depends on the radiologist and how closely they really look at things (how much of a hurry they are in)...

 

[Josephine]

My friend, if there is cement in your hip, I'll eat my frilly nurse's cap!

You can see the cement in this xray all round the stem. There is a radio-opaque substance in bone cement.

 

[Marvy]

Well, the X-rays that I had look better than the last one. I will try to get a copy and post. There is no infection either.

The only thing that the doctor mentioned is to re-position the cup. My question is, if this is the case, is it still recommended to seek a revision specialist? Is this the surgeons fault from putting it in at a wrong angle or just a case of bad luck? I'm so hesitant on having another surgery - by anyone - as I'm afraid I will end up worse.

My doctor is taking this very serious as he now sees that time has passed and there is no improvement and the tests I've had to date all come back "perfect". In hindsight, I think he was always concerned, but he does have an odd way of showing it. I want a confirmed diagnosis and a plan of action, and he won't give one until he is 110% certain of what to do. So, now that we have ruled out more things that aren't wrong, re-positioning is what he is advising.

 

[Josephine]

Getting the opinion of a revision surgeon doesn't inevitably mean that you will have more surgery. You just want this opinion!

 

[Marvy]

One question that I forgot to ask is about impingement. I guess after another surgery was mentioned, my mind went numb..

He thinks that there is a possibility of impingement but it didn't show on any tests. (From my understanding it won't show up?)

But if something is impinged, what caused the impingement? Is it something that I did(bending too far, etc) or just over time something now is hung up in my hip and won't release?

 

[Josephine]

No, it's nothing you did, bless you! It's caused by the cup being badly aligned so it connects with some tissue somewhere or the stem. And you are correct, it very rarely shows on an xray not even an MRI scan.

 

[Marvy]

thank you @Josephine! I've attached the latest x-ray. If you can be so kind to look at it.

I feel so lucky to have found you and this site! I am learning so much...

So, if the cup was mis-aligned, that's an error on the surgeon? I feel like I was doomed from the start...

 

[Josephine]

No, I can't see anything untoward on that. Looks like a good hip from here but that doesn't say everything.

So, if the cup was misaligned, that's an error on the surgeon? I feel like I was doomed from the start...

Indeed it was but sadly not an altogether uncommon one. And I can sympathise with your ending comment.

 

[Marvy]

Well, I called new surgeons office this morning. I explained to them what was going on with my hip. Unfortunately they would not make an appointment for me as they said it had not been a year since surgery.

So then I called surgeon #2 (different practice) and I was told that I could get an appointment with a PA and they would then make the determination if I was "worthy" of seeing the surgeon.

Other than the practice that my surgeon is in I don't have any other local choices for revision surgeons. The sad part is that my surgeon is highly recommended and is experienced in revisions of hips and knees... I just happened to have a case of bad luck.

my family is against me traveling to see a surgeon due to the expense involved.

Right now, it looks like I'm stuck with surgeon 2....

 

[Jaycey]

Right now, it looks like I'm stuck with surgeon 2....

Remember as Jo says, you are just getting another opinion - so not necessarily "stuck".

Unfortunately friends and family aren't always as supportive as we need. They just do not understand the unrelenting pain. I think you are definitely doing the right thing. Press on toward a resolution to your pain. Life is just too short!

 

[Marvy]

I called a revision surgeon to make an appointment. I explained to them my situation and that I wanted to get a second opinion. I was asked if I had my medical records, images, radiology reports (which I do).

What surprised me was that I was told to bring them to the doctor's office. The doctor would review them and then determine if I would then be eligible to make an appointment with him. I was also told that the doctor, in revision cases, goes by the radiology report. (Unfortunately), The radiology report says that there is nothing wrong - no signs of loosening, etc.

My doctor's office now want to do a hip aspiration. I've had bloodwork done as part of my yearly physical and everything came back OK (ESR, CRP, etc). I'm not sure what the aspiration will show. I think they are now guessing.

@Josephine, I've colored where the pain is. The pain on the side of my leg starts around Y-L1B and stops about 4 inches above my knee. The pain on the front of my thigh starts around T/V L2F also stops about 4 inches above my knee. It is preventing me from doing any type of activity.

I'm still trying to find a revision surgeon who is willing to make an appointment with me.
I don't know what else to do.

 

[Josephine]

My doctor's office now want to do a hip aspiration. I'm not sure what the aspiration will show. I think they are now guessing.

He sure is! But often they will do aspirations to exclude anything as well as reveal it.

What surprised me was that I was told to bring them to the doctor's office. The doctor would review them and then determine if I would then be eligible to make an appointment with him.

I suggest you include with the records a letter explaining your side of things and how much pain you've been in since this replacement.