Revision THR Constant pain continuing 1 year after THR<^
- Thread starter Marvy
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Horseshoe
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@Marvy sorry to read you're still having pain with this hip. Now that it's been a year, are you able to seek out an unrelated revisionist surgeon? Jamie may be able to help you find one near or just outside your area. You've been suffering for a long while, have received various possible reasons. A fresh set of expertly trained eyes would be useful.
@Krista, I'm sure you mentioned it in one of your posts (I couldn't find it), but do you know what type of hip hardware you have? ceramic, metal, etc?
@Horseshoe - unfortunately I've been to 2 different revision specialists in different practices. I have not told any of them that I am seeing other surgeons...
Revisionist #2 will not respond to me at all about the MARS MRI (or anything for that matter). So he is totally done with me. I've never been "fired" by a doctor before....
Revisionist #1 said that a MARS will not be of any value as I do not have a metal-on-metal implant.
I keep thinking that the pain is the psoas based on the location. It starts at the leg fold/crease and radiates down my thigh. Even though the psoas injection I had didn't provide any relief, revisionist #1 said that there are multiple areas to be injected for a psoas issue, so even though this did not work, it could be that if I had a psoas injection in a different location, there may be different outcomes. Of course, revisionist #1 wouldn't order an injection as he just wants to do surgery to remove the screws. I want to exhaust all possibilities before I have another surgery.
One thing that is interesting about the pain I have is that even though it is painful while I am walking, etc., the pain actually is worse an hour or two later after walking, or any activity.
![[Bonesmart.org] Constant pain continuing 1 year after THR<^](https://bonesmart.org/forum/attachments/upload_2017-12-6_10-58-25-png.63421/ "[Bonesmart.org] Constant pain continuing 1 year after THR<^")
@Horseshoe - unfortunately I've been to 2 different revision specialists in different practices. I have not told any of them that I am seeing other surgeons...
Revisionist #2 will not respond to me at all about the MARS MRI (or anything for that matter). So he is totally done with me. I've never been "fired" by a doctor before....
Revisionist #1 said that a MARS will not be of any value as I do not have a metal-on-metal implant.
I keep thinking that the pain is the psoas based on the location. It starts at the leg fold/crease and radiates down my thigh. Even though the psoas injection I had didn't provide any relief, revisionist #1 said that there are multiple areas to be injected for a psoas issue, so even though this did not work, it could be that if I had a psoas injection in a different location, there may be different outcomes. Of course, revisionist #1 wouldn't order an injection as he just wants to do surgery to remove the screws. I want to exhaust all possibilities before I have another surgery.
One thing that is interesting about the pain I have is that even though it is painful while I am walking, etc., the pain actually is worse an hour or two later after walking, or any activity.
Krista
post-grad
@Marvy, I have a ceramic head, and my metal acetabular cup has a plastic liner. The stem is, of course, metal. Mine is cementless, and requires metal on the outside of the cup and on the stem which has a bumpy surface so that the bone would grow into it.
Your said that "Revisionist #1 said that a MARS will not be of any value as I do not have a metal-on-metal implant." Even though I do not have metal-on-metal, I have plenty of metal in my prostheses. My second opinion surgeons insisted on the MARS MRI, since it made the MRI much clearer than it would have been otherwise.
So is your Revisionist #1 ordering you a regular MRI?
Your said that "Revisionist #1 said that a MARS will not be of any value as I do not have a metal-on-metal implant." Even though I do not have metal-on-metal, I have plenty of metal in my prostheses. My second opinion surgeons insisted on the MARS MRI, since it made the MRI much clearer than it would have been otherwise.
So is your Revisionist #1 ordering you a regular MRI?
@Krista, no, Revisionist #1 is not going to order any additional tests because the CT and bone scan showed nothing unusual. Mine is also cementless. I had read where the MARS is more "sensitive" than a CT in showing soft tissue. But, he still thinks it's the screws that "could be" the cause of my pain - even though he said it's a "**** shoot" as to if removing the screws will help or not.
I did hear from Revisionist #2. He wants to go down the road that I've already been down - ordering a lower lumbar MRI and doing an epidural. I explained that I've already had these done and don't see the point in getting them done a second time. Especially since the epidural was 2 months ago and did absolutely nothing. His only reply was "that was then, not now and it wasn't me that ordered it". Seriously??? I can't afford to keep having the same tests repeated by every doctor when (unfortunately) the likelihood of them working on try #2 is slim to none.
I've thought about trying to find a Revisionist #3, but that would definitely mean travelling more. #2 is 2 1/2 hours away so I already have to spend 5 hours in a car to see him. This is so frustrating....
Normally when a person has medical tests performed, you are hoping that they do not show anything. Now I am hoping and praying one of the tests would show something.
I did hear from Revisionist #2. He wants to go down the road that I've already been down - ordering a lower lumbar MRI and doing an epidural. I explained that I've already had these done and don't see the point in getting them done a second time. Especially since the epidural was 2 months ago and did absolutely nothing. His only reply was "that was then, not now and it wasn't me that ordered it". Seriously??? I can't afford to keep having the same tests repeated by every doctor when (unfortunately) the likelihood of them working on try #2 is slim to none.
I've thought about trying to find a Revisionist #3, but that would definitely mean travelling more. #2 is 2 1/2 hours away so I already have to spend 5 hours in a car to see him. This is so frustrating....
Normally when a person has medical tests performed, you are hoping that they do not show anything. Now I am hoping and praying one of the tests would show something.
Krista
post-grad
@Marvy, I also wonder why Revisionist #2 wants to do another lower lumbar MRI and an epidural. Makes no sense to me, especially since the previous epidural did nothing for you.
I have a screw from my acetabular cup into my bone also. Never had a physician suggest that could have been cause of pain.
I wonder why #2 is willing to order a second lumbar MRI but not willing to order a hip MRI, when you've never had one of those. I saw the reasons he gave in your previous post. Well, the bone scan would only show problems with bone. And, as we have read, soft tissue injuries might not show up on CT scan that would be evident on an MRI.
How frustrating for you, indeed! I get what you are saying, about hoping that they see something in a test result. I was practically crying with relief, and so happy when my second opinion orthopedic surgeon diagnosed my gluteal tendon tears from physical exam and MRI!
I have a screw from my acetabular cup into my bone also. Never had a physician suggest that could have been cause of pain.
I wonder why #2 is willing to order a second lumbar MRI but not willing to order a hip MRI, when you've never had one of those. I saw the reasons he gave in your previous post. Well, the bone scan would only show problems with bone. And, as we have read, soft tissue injuries might not show up on CT scan that would be evident on an MRI.
How frustrating for you, indeed! I get what you are saying, about hoping that they see something in a test result. I was practically crying with relief, and so happy when my second opinion orthopedic surgeon diagnosed my gluteal tendon tears from physical exam and MRI!
Horseshoe
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@Marvy just to put it out there.. some of the top US revisionist surgeons eg., Dr Maale, Dr Matta, etc. will look at your xrays and give an opinion, x rays are sent by fed ex, not sure of any fees. May be something to consider.
Also, Josephine once mentioned a case, not sure whose thread it was, where the screws were removed which fixed the persons pain; screws were irritating tissues, nerves or something.
Also, Josephine once mentioned a case, not sure whose thread it was, where the screws were removed which fixed the persons pain; screws were irritating tissues, nerves or something.
Hi @Horseshoe Thank you for the surgeon referrals. I have requested the records from the last few tests I've had. Once I get those, I will reach out to Dr. Matta and send him everything for his review ( I saw where he has joined the Steadman Clinic this year). According to the website it is a $50 case review.
I think I remember reading the thread on here about the screws as well. The only thing with my situation is that I had this pain prior to surgery. The hip replacement has only made it significantly worse. That's why I keep questioning having the screws removed.
@Krista - even Revisionist #1 came back and said that the MARS is only for MOM hips and will not be of any value to find soft tissue issues around the cup area. If I hadn't had the CT already, maybe I would have had a chance to get a MARS done...I don't know. But since I have had a CT scan, the doctors are using that as the "be all end all" test..
I think I remember reading the thread on here about the screws as well. The only thing with my situation is that I had this pain prior to surgery. The hip replacement has only made it significantly worse. That's why I keep questioning having the screws removed.
@Krista - even Revisionist #1 came back and said that the MARS is only for MOM hips and will not be of any value to find soft tissue issues around the cup area. If I hadn't had the CT already, maybe I would have had a chance to get a MARS done...I don't know. But since I have had a CT scan, the doctors are using that as the "be all end all" test..
Krista
post-grad
I see, @Marvy. I guess the CT images are all you are going to have.
There is metal on the outside of my cup and there is soft tissue around it. The MARS images ordered by my #2 of my hip and the muscles surrounding the cup were quite clear, and showed the tendon tear and muscle atrophy because of the tear. My gluteus medius muscle was full of fatty inclusions and looked very different from the other muscles, which I saw myself when I studied the images. I wonder if they saw any muscle atrophy in your scans? Neither my #1 or #2 ordered CT.
I'm glad you are going to have a case review with a physician Jaycey suggested.
There is metal on the outside of my cup and there is soft tissue around it. The MARS images ordered by my #2 of my hip and the muscles surrounding the cup were quite clear, and showed the tendon tear and muscle atrophy because of the tear. My gluteus medius muscle was full of fatty inclusions and looked very different from the other muscles, which I saw myself when I studied the images. I wonder if they saw any muscle atrophy in your scans? Neither my #1 or #2 ordered CT.
I'm glad you are going to have a case review with a physician Jaycey suggested.
@Krista I also have metal on the outside of my cup with soft tissue around it. I think that the doctors here are "stuck" on the premise of MARS is strictly for a MOM hip replacement to look for metal artifacts and nothing else. Revisionist #1 said that I had some muscle atrophy on the outside of my thigh (but more towards my knee vs hip) and he said that the pain I am having there is just "something I will have to live with". I know that with surgery there will be some muscle atrophy, but the "get over it" attitude just tweaks me...
Krista
post-grad
That is definitely not true, if only for my orthopedic surgeon here in a suburb of Chicago. I'd be happy to share his information-rich website with you via private message, if you'd like. Maybe it would give you some other ideas to explore.
I'd be willing to bet that if any of these surgeons had such pain, they would be pushing hard to get a proper diagnosis and treatment plan. The ways that muscles, tendons, ligaments, other soft tissues and bones work have been known for a long time. It's not rocket science. There should be solutions. And there are new solutions and procedures all the time. Feeling badly for you. Hope something can be done to help.
@Krista, well, lo and behold, Revisionist #2 called and scheduled a MARS MRI. I had that done. Unfortunately, it did not show anything.
My only option is to get the screws out, but no one can guarantee any pain relief from that.
Then, out of the blue, my original OS called to see how I was doing since it has been a year (well, 13 months...). I told him everything as I feel at this point, what is there to lose? I told him how both revisionists suggest taking the screw(s) out and he does not think that this will resolve any of my issues. He wants to do a hip aspiration as he thinks there is still a potential for there being an infection even though the bloodwork came back OK.
My spouse is absolutely and totally frustrated with everything going on with my hip that I seriously feel this may have us in divorce court before everything is over.....It has gotten to the point that we cannot have a calm, logical conversation about my hip and treatment. They think if I get the screws out that I will have the perfect hip... My gut feeling is that getting the screws out may help some, but there is more going on than just the screws...
I am not sure what to think at this point.
My only option is to get the screws out, but no one can guarantee any pain relief from that.
Then, out of the blue, my original OS called to see how I was doing since it has been a year (well, 13 months...). I told him everything as I feel at this point, what is there to lose? I told him how both revisionists suggest taking the screw(s) out and he does not think that this will resolve any of my issues. He wants to do a hip aspiration as he thinks there is still a potential for there being an infection even though the bloodwork came back OK.
My spouse is absolutely and totally frustrated with everything going on with my hip that I seriously feel this may have us in divorce court before everything is over.....It has gotten to the point that we cannot have a calm, logical conversation about my hip and treatment. They think if I get the screws out that I will have the perfect hip... My gut feeling is that getting the screws out may help some, but there is more going on than just the screws...
I am not sure what to think at this point.
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Hi @Marvy
I'm so sorry for all of your pain and struggles in seeking answers and resolution.
This has to be maddening.
I feel it's difficult for our spouses / significant others to relate to our pain and limitations.
In most cases as our world gets smaller, it negatively affects them also. At least it did in my situation.
I began declining invitations due to my limitations. I never really felt much in the mood to socialize. I was always concerned about the length of the drive, were stairs involved / how many, what if I became miserable shortly after arriving, the list went on. I'm sure many here can relate. So basically our partners are forced to give up things due to our pain and limitations.
It's also difficult to helplessly watch a loved one struggle with pain, unable to help.
Ultimately it's your decision what you do with your body. Consider limiting hip related conversations with your spouse unless absolutely necessary, or until you formulate a definite plan. Being in pain makes it difficult to live life freely and sadly at times our pain can become our main focus.
All I can offer is prayer for pain relief, your marital relationship surviving all, comfort, answers, resolution.
Hopefully you can gain some relief long enough to enjoy the holiday weekend with loved ones.
Wishing you a :merry christmas: and a happy healthy 2018!
I'm so sorry for all of your pain and struggles in seeking answers and resolution.
This has to be maddening.
I feel it's difficult for our spouses / significant others to relate to our pain and limitations.
In most cases as our world gets smaller, it negatively affects them also. At least it did in my situation.
I began declining invitations due to my limitations. I never really felt much in the mood to socialize. I was always concerned about the length of the drive, were stairs involved / how many, what if I became miserable shortly after arriving, the list went on. I'm sure many here can relate. So basically our partners are forced to give up things due to our pain and limitations.
It's also difficult to helplessly watch a loved one struggle with pain, unable to help.
Ultimately it's your decision what you do with your body. Consider limiting hip related conversations with your spouse unless absolutely necessary, or until you formulate a definite plan. Being in pain makes it difficult to live life freely and sadly at times our pain can become our main focus.
All I can offer is prayer for pain relief, your marital relationship surviving all, comfort, answers, resolution.
Hopefully you can gain some relief long enough to enjoy the holiday weekend with loved ones.
Wishing you a :merry christmas: and a happy healthy 2018!
Krista
post-grad
Not great news, @Marvy. Maybe Revisionist #1 and OS should look at the MARS MRI images, too. Remember that two radiologists and my Surgeon #1 saw nothing wrong with my MARS MRI scans, but my Surgeon #2 did see the problems. I educated myself on reading them. You can download a program from the internet to be able to see them from the disc, and there are plenty of images of normal and abnormal tissue in MRI scans that you can compare yours with. I could clearly see the issues myself.
My Surgeon #2 ordered a hip aspiration to check for infection, and it found nothing, but he felt it was important to eliminate that possibility. If it is being offered, then why not explore all avenues? It wasn't too painful, and my insurance paid the lion's share of the cost.
So sorry about how your spouse is feeling. I had the great good fortune of a husband who was behind and with me every step of the way. Yes, he was frustrated, as I was, when we were still searching for answers. But he always made me feel better instead of worse, bless his heart! That makes a huge difference to the sufferer. I can only recommend that YOU stay as calm and confident as possible, so that she won't be feeding on any anxiety coming from you. Too bad it has to be that way, but you can only work with what you've got.
My Surgeon #2 ordered a hip aspiration to check for infection, and it found nothing, but he felt it was important to eliminate that possibility. If it is being offered, then why not explore all avenues? It wasn't too painful, and my insurance paid the lion's share of the cost.
So sorry about how your spouse is feeling. I had the great good fortune of a husband who was behind and with me every step of the way. Yes, he was frustrated, as I was, when we were still searching for answers. But he always made me feel better instead of worse, bless his heart! That makes a huge difference to the sufferer. I can only recommend that YOU stay as calm and confident as possible, so that she won't be feeding on any anxiety coming from you. Too bad it has to be that way, but you can only work with what you've got.
I received a copy of the MARS MRI report. It stated that one of the screws is indeed protruding into the psoas
muscle with the tip "almost" touching the psoas tendon (red arrow). Nothing was mentioned about the other screw (green arrow). Revisionist #2 said that even if the screws are removed that I will most likely always be in pain. He also stated that he doesn't know if I would need a cup/ball/liner revision until he has me opened up. (Although I'm not sure how he could make a statement like that (regarding the pain), other than he is trying to cover himself for if there are continuing issues post-surgery)..
My original OS said it is complete and utter nonsense and impossible that the screw indicated by the red arrow is the cause of my pain. Interesting... I guess he just doesn't want to admit that the screw is mis-placed or too long (or both).
Revisionist #2 did have me get an injection into the psoas at the tip of the screw (red arrow) and it did give me pain relief. The pain relief did not last very long though - 2 days. He said that this confirmed that the screw is at least part of my issue.
![[Bonesmart.org] Constant pain continuing 1 year after THR<^](https://bonesmart.org/forum/attachments/screws-jpg.64067/ "[Bonesmart.org] Constant pain continuing 1 year after THR<^")
muscle with the tip "almost" touching the psoas tendon (red arrow). Nothing was mentioned about the other screw (green arrow). Revisionist #2 said that even if the screws are removed that I will most likely always be in pain. He also stated that he doesn't know if I would need a cup/ball/liner revision until he has me opened up. (Although I'm not sure how he could make a statement like that (regarding the pain), other than he is trying to cover himself for if there are continuing issues post-surgery)..
My original OS said it is complete and utter nonsense and impossible that the screw indicated by the red arrow is the cause of my pain. Interesting... I guess he just doesn't want to admit that the screw is mis-placed or too long (or both).
Revisionist #2 did have me get an injection into the psoas at the tip of the screw (red arrow) and it did give me pain relief. The pain relief did not last very long though - 2 days. He said that this confirmed that the screw is at least part of my issue.
Mojo333
Former BoneSmart Staff Member
I'm far from any kind of medical expert but looks problematic to me.... @Josephine What do you think?
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Krista
post-grad
@Marvy, so are you considering having surgery to remove the screw and check the cup/ball/liner? I don't understand how the OS can say with such certainty that the screw is not the cause of your pain. It is impossible for him to know that.
And the injection into that very area soothed the pain for two days, which does make it look like the screw may be the culprit. I'm with you on wondering how Rev. #2 is saying that you will probably still have pain even with screw removal. He probably doesn't want to raise your expectations and cover himself if it doesn't improve. It only makes sense that, if the screw is what is digging into soft tissues causing trouble, that its removal will cause that pain to stop.
And the injection into that very area soothed the pain for two days, which does make it look like the screw may be the culprit. I'm with you on wondering how Rev. #2 is saying that you will probably still have pain even with screw removal. He probably doesn't want to raise your expectations and cover himself if it doesn't improve. It only makes sense that, if the screw is what is digging into soft tissues causing trouble, that its removal will cause that pain to stop.
@Krista - yes I'm considering the surgery - even though I wish I had a better/more definitive diagnosis about the cup/ball/liner...my gut feeling is that the screws should come out and all of the acetabular components revised. But I don't know how I can convince the revisionist of this other than "this is what I want to have done"... It is now trying to find a date which works. He is booked up into April already...
I have been telling the original OS that I thought it was an issue with the psoas almost from the start, but he kept telling me that it was impossible that it could be a psoas issue. If only doctors actually LISTENED to patients instead of formulating their own opinions....
It is also interesting that on the CT scan, the screw was never mentioned in the report done by the radiologist. I think the radiologist was focused on looking for loosening, not a screw poking into a muscle... (still no excuse for this though). Revisionist #2 saw it - and confirmed it with the MRI (and the injection).... (which I know based on your experience, that things are missed by both doctors and radiologists).
I have been telling the original OS that I thought it was an issue with the psoas almost from the start, but he kept telling me that it was impossible that it could be a psoas issue. If only doctors actually LISTENED to patients instead of formulating their own opinions....
It is also interesting that on the CT scan, the screw was never mentioned in the report done by the radiologist. I think the radiologist was focused on looking for loosening, not a screw poking into a muscle... (still no excuse for this though). Revisionist #2 saw it - and confirmed it with the MRI (and the injection).... (which I know based on your experience, that things are missed by both doctors and radiologists).
