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[REVISION THR] Constant pain continuing 1 year after THR

Discussion in 'Hip Replacement Recovery Area' started by Marvy, May 2, 2017.

  1. xthoney

    xthoney junior member

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    Are you in the U.S.? You have certain protections regarding your job under FMLA. If you have questions, you should contact the Department of Labor, 1-866-487-9243.

    Sent from my SAMSUNG-SM-J727A using Tapatalk
     
  2. YoungHippy

    YoungHippy member

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    I hope this all works out for you! I agree with xthoney, you need to contact the labor board and see what your rights are. Which I guess all in all, it depends on how much of a butt your boss wants to be, and if you even still want to work with said butt by the time all of this is said and done. Who knows, maybe you could spend some of your recovery time (after you feel better of course) checking for new jobs online and polishing up your resume.
     
  3. Gone again

    Gone again senior

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    Sounds like you need a new job if your employer is unconcerned of your pain and only wants you to return to work. I am totally unable to do the manual labor my job required. Now I'm on SSDI
     
  4. Marvy

    Marvy junior member
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    Well, I have indefinitely "postponed" the surgery that was scheduled for next month.

    I went yesterday to revision surgeon #2. I had debated in my mind if I should go or not and in the end, I'm glad I did. He took a couple new xrays. He also reviewed my x-rays and CT scans that I had done a couple months ago.
    The screw was brought up as being a potential issue, but he said it is not unusual to put the screw in at that angle in that spot - in fact he said that he does it as well sometimes. He was a little more concerned with the angle of the cup (which is what my original surgeon was thinking after I brought up the pain months ago). In his opinion, he mentioned that the cup wasn't inserted up enough in the socket and he thinks that it is sticking out just enough so that the psoas is rubbing against it. He is not "rushing" towards surgery like revision surgeon #1.

    So, the plan is (for now) that he is going to sit down with the radiologist and review the x-rays and CT scans and then formulate a plan. Hopefully I will know more tomorrow. If not, it will be sometime next week.

    I feel more comfortable with surgeon #2. And if surgery is in the cards, it will be with surgeon #2.

    Even with surgeon #2 also being a revision surgeon, he said that my hip issue is definitely not clearly defined as some are. (ugh...why do I get to be the lucky one?!)
     
  5. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Just read your entire thread....ugh, my heart goes out to you!
    Prayers for answers and sound resolution.
    To brighter days ahead....
    @Marvy
     
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  6. Marvy

    Marvy junior member
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    Yesterday I had a CT guided injection into the psoas tendon to (hopefully) give me some pain relief. The surgeon wanted to see me an hour after the procedure as well. The radiologist said that I should get some immediate relief from the Novocaine, then it would wear off and the pain may return. He said that the steroid may take a few days to take effect.

    The injection procedure went fine - it wasn't painful at all - just a little pressure feeling from the medication being injected. Unfortunately, as time went on, the pain started to get worse. So by the time I saw the doctor, the pain was worse than before the injection. The surgeon was really hoping that I would get some relief as his initial thought was the psoas was rubbing against the edge of the cup as to him it looks like the cup is sticking out a bit. By the time we arrived back home, I felt so bad I sat down in my recliner and fell asleep.

    I don't think that now he really has any idea of what the issue may be. He has ordered blood work to check for infection. I told him that I had this bloodwork back in July and everything was normal. His only reply was "that was then, not now"; along with "well, you are coming up on a year". (so at the 1 year day am I going to wake up and have a perfect hip?) So I guess it's back to square one with him. It's a 4 hour round trip to see him, so I'm not sure at this point if I want (or should) continue to take a full day off of work for an appointment. I guess I'll wait and see what he says when after he gets the blood test results.

    @Josephine, do you have any other suggestions/thoughts? Here's where I'm at currently:

    Had epidural in back at L4/L5 to see if hip/groin pain was being referred from a couple of bulging disks I have. This provided no pain relief.

    Had femoral and obturator nerve block - this gave me 3 days of pain relief. The pain management doctor said that this means the problem is in the hip (most likely muscle related) and if I get more nerve blocks that I am only masking the issue.

    Has psoas tendon steroid injection - no immediate pain relief as should have been expected.

    I know that I can have surgery with revision surgeon #1 to remove the screws in the cup, but unfortunately he does not know if this will resolve any of my pain. He also was contemplating adjusting the angle of the cup, but never made any definitive decision on this. In some ways I felt as he may have been rushing to surgery.

    Revision surgeon #2 - he is trying to avoid surgery (which is OK, but if it's needed, then it needs to be done). Even though he has many more years of experience than surgeon #1, I think he is totally baffled by this and he won't even give me a hint of future treatment at this point.

    I would think that if the screw(s) in the cup were causing pain then wouldn't the psoas injection have provided some relief??

    To say that I'm at a total loss as to what to do next is truly an understatement. I told the surgeon yesterday when he asked how this was affecting my life, that the active life that I knew and loved ended the day that I had my hip replaced.
     
  7. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi @Marvy
    I am so sorry for this journey you're on. My heart goes out to you
    in suffering this pain without knowing the cause.
    Hopefully Josephine will have some answers for you.
    Sending up a prayer and healing thoughts your way.....
     
  8. Marvy

    Marvy junior member
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    Hi @Layla, Thank you for the kind thoughts. I really do appreciate them. I hope you have a wonderful weekend.
     
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  9. Marvy

    Marvy junior member
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    Revision surgeon #2 (the one that had the psoas injection done) has pretty much thrown in the towel I think. We got the blood test results back and just as I suspected, no infection (which is a good thing I know!). He mentioned about doing the metal allergy tests (even though my hip is ceramic) and I said no. I had those done and everything came back normal. His final words to me were "give it more time, you're not quite at a year yet".

    I talked with revision surgeon #1 yesterday and he is ordering a bone scan, but he really doesn't think that it will reveal anything. I did find out from him though that the pain that I have on the side of my thigh where the incision is, is because of muscle atrophy and that I'm pretty much lying on the greater(?) trochanter. So he fully understood why this is painful for me. Unfortunately, he said that no surgery would be able to correct this. The best he could offer on this was topical pain medication. I understand about the muscle atrophy, but this has been an issue since surgery. All this surgeon recommended is to correct my leg length and remove a screw that he thinks is too long (but surgeon #2 thought the screws were OK).

    One comment he made was that for hip replacements, "hips don't hurt, and if they do, something's not right". The downside in my case is that my original surgeon and 2 revision surgeons have no idea what is going on with my hip.

    :sigh:
     
  10. Marvy

    Marvy junior member
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    Revision surgeon #1 said that these screws were WAY too long and are actually through the bone and into the muscle. In his opinion he thinks that this is causing me the groin pain and why it gets worse the more I walk. He is recommending removing the screws (he says I won't need them any more if the cup is not loose). However, he cannot/will not make any guarantees on this...

    Revision surgeon #2 mentioned the screw location, but never gave them a second glance.

    @Josephine, what do you think?

    upload_2017-11-20_8-17-41.png
     
  11. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    I'd really need to see the other lateral view to be sure but I don't agree with #1! The screw looks pretty standard to me and from this antero-posterior (or front) view, it's looks perfectly normal! In fact, I almost thought you'd nicked a picture from my computer files!

    screw fixed cup 4.jpg
     
  12. Marvy

    Marvy junior member
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    @Josephine, here's the only other x-rays I have. I've cropped them since we are only concerned with if the screws are the cause of my pain. The are from a lateral x-ray. Thank you for looking at them!

    upload_2017-11-21_7-46-41.png upload_2017-11-21_7-47-15.png
     
  13. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    Yep, they look perfectly okay to me, Marvy
     
  14. Marvy

    Marvy junior member
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    Well, I had my bone scan yesterday. Injection in the morning, scan in the afternoon. Before I left the hospital, I picked up a CD with the images on it. However, once I got home and looked at them, they only gave me the uptake images from right after the injection. There were no scan images from the afternoon on there :doh:

    I called the hospital this morning and they are sending a new CD to me.

    Now I am waiting until I hear from the doctor's office...
     
  15. Marvy

    Marvy junior member
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    I received the results of my bone scan:
    FINDINGS:
    Angiographic phase: Symmetric uptake to the hips.
    Blood pool phase: Physiological distribution of the radiotracer with equal uptake to both hips
    Delayed phase: Photopenia due to the left total hip arthroplasty. Increased radiotracer uptake along the acetabulum and femoral shaft at the tip of the arthroplasty.
    Background activity: Normal.
    CONCLUSION:
    Favor no loosening or infection in the left hip arthroplasty.

    Even though I am glad that the scan did not show anything, in the end, I am totally worn out, deflated, and beyond words.

    Revision surgeon #1 said that it is completely normal to have the tip of the stem "flex" as that is how the stem was designed. My only option with him is to have the screws out (which really isn't an option any longer due to the result of the tests and injections).

    Revision OS #2 just said "give it more time"

    @Josephine, I know you had said that you really aren't familiar with scans, but what do you think about the comments? Unfortunately I am still trying to get a CD of the images and will upload one once I receive it.

    I just don't know where to go from here
     
  16. Josephine

    Josephine FORUM ADMIN, DIRECTOR Administrator

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    I'm sorry - I really cannot comment on something I know almost nothing about!
    If your second cd has any xrays on it, I will gladly look at them.
     
  17. Krista

    Krista post-grad

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    Hi, @Marvy. Sorry about your problems post THR. I read through your thread, and saw that you've had x-ray, hip aspiration, CT scan, and bone-scan, which didn't reveal the problem, along with injections, which didn't help. You said earlier that a physician was considering an MRI. It took a MARS MRI (Metal Artifact Reduction Sequence) to provide evidence of the soft tissue injury that plagued me after THR. I also had additional x-rays, aspiration, bloodwork and bone-scan, which showed nothing. My original surgeon and two radiologists missed the gluteal tendon tears on the MRI scans, but surgeon #2 saw them, and did a surgical repair.

    I googled and discovered that differences between normal and abnormal tissue are often clearer on MRI images than on CT images. So that's another avenue for you and your physicians to explore if soft tissue injury is a possibility. If you do have an MRI on your surgical hip, it must be a MARS, which my original surgeon didn't even know about, but that I discovered on my own. Good luck on your quest to recovery!
     
    Last edited: Dec 1, 2017
  18. Marvy

    Marvy junior member
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    thank you @Krista I remember reading your thread, but had forgotten about the MARS MRI. I will ask revision OS #1 about this. If he will not order this, I guess I can go back to my original surgeon and ask.

    In my record from revisionist #2, along with "let's give it more time", "someone" added that the next step would be for me to lose 11 pounds. I'm not saying that I can't lose a couple of pounds, but I am not considered overweight or obese by my family doctor. I wish it was that easy though - lose 11 pounds and your hip will be perfect....
     
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  19. MammaT

    MammaT supremo

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    It seems strange that 11 pounds would be the difference maker
     
  20. Layla

    Layla FORUM ADVISOR Forum Advisor

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    So sorry you're still struggling / searching.
    I pray you get answers soon and clear direction as how to proceed.
    To brighter days..... @Marvy
     

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