Revision THR Constant pain continuing 1 year after THR<^

[Marvy]

Hi @Krista I have thought of you often during this process. After this most recent surgery, I can walk without the original pain. It's now that I have acquired a horrible gait. This has been going on about a month. Even walking with the cane, I start to limp more, then my gait starts to get worse, then my right foot starts to hurt... I don't want to walk too much this way as I am afraid of developing back, foot and knee problems....

I can stand for a few seconds on my operated leg, but it takes every ounce of concentration and strength to do so.

The PT has me doing very simple exercises either sitting or lying down. They tried to do a couple of standing exercises, but my hip collapses, so they said no more of that!

I am going to ask the PT if they think that any type of water exercises may help. I don't know.

 

[Krista]

It should not take all of that effort to balance on one leg! And for just a few seconds! It sounds to me like there is something really wrong with one or more of the muscles that is supposed to hold the hips steady when standing on one leg. I looked up Trendelenberg Gait in wikipedia, and it mentions causes such as weakness of leg abductor muscles, gluteus medius and gluteus minimus. It is possible that whatever is wrong can heal on its own over time, but it is also possible that it won't. I know how my second opinion surgeon diagnosed my torn gluteus tendons. It involved physical exam (palpating the area and seeing what I could and couldn't do with strength and balancing) and MARS MRI. The radiologist did not see the problems with the images, but my orthopedic surgeon did. You need an expert in soft tissue problems with the hip.

 

[Marvy]

Thank you @Krista I am so afraid that I have traded one problem for another....

I really do not have much faith in radiologists any more as they missed the issue with the screws, but yet 3 surgeons saw it....

I had a MARS MRI before this most recent surgery. I am going to look at it to see if I can see anything. I hope that there is nothing wrong, but I also have to wonder that once the surgeons saw the screws, if they missed something else? But I didn't have this issue prior to this latest surgery (unless since I wasn't doing anything, even I didn't notice it)...

In going up stairs, I am OK as long as I have a railing to hold on to and I lead with my good leg. If I try to go up with alternating legs, then my left hip tends to "collapse" unless I put enough weight on the railing to help pull me up.

The muscles you mentioned for the Trendelenburg Gait are the muscles that PT is trying to focus on. But it's a fine line between working the muscles to get stronger and over doing it - esp. if there could potentially be something wrong. I have a PT appointment late this week, so I am going to ask them if they think there could potentially be a tear, etc...

I guess time will tell.....

 

[Krista]

@Marvy, yes, the stairs were the same for me. Since my tendon repair operation I can do stairs much better, but still have problems to this day.

There is definitely something wrong somewhere in your hip, since you have great difficulty bearing weight on that leg and can only do so for such a very short time. Physicians have to figure out exactly what is wrong. Personally, I would require an accurate diagnosis before starting on any PT. Perhaps your physical therapist may be helpful with a diagnosis. I hope so!

 

[Marvy]

Hi @Krista I had a PT session today that was probably more discussion than exercise...but it's good.. We talked about the possibility of a tear or "something" not right with the muscle(s). They just aren't responding to any type of exercise.

We went to a stadium event last weekend and there were no railings After sitting a couple of hours, it was tough to get up the stairs as my hip kept feeling as though it was going to give out. I had to hold on to another person's arm to help me get up the stairs.

Anyway, at PT, they gave me the name of a sports medicine doctor that can help in cases like mine. PT is at the least suggesting that I have a diagnostic ultrasound done. I'm not sure how much that will tell us, but at least it is a start. My appointment with the sports medicine doctor is July 16th. I am not sure if they will do the ultrasound at this appointment or not. I guess they could determine that I need another diagnostic test too.. Time will tell....

 

[Krista]

Good news, that the PT thinks you should have the diagnostic ultrasound. Yes! And you are going to see a sports medicine physician. Chances are really good that they will be able to diagnose your problem. Sports medicine sees lots of soft-tissue injuries, all over the body. Good luck on July 16!

 

[Mojo333]

I am also happy you are going to see someone soon to get answers.
Kept the faith!

 

[Marvy]

Thank you @Krista and @Mojo333 Just when I thought things were going OK, a wrench falls in the way!

My PT is at a loss as to what to do as they haven't seen muscles not respond to exercise the way mine are (or aren't). They know that I am an active person and are trying to get better/stronger, but the muscles aren't cooperating. PT did suggest doing an electrical stimulation (TENS unit on steroids....), but they didn't even know if that would do anything.

I hope everyone has a nice and peaceful weekend!

 

[Mojo333]

I hope you do too, Marvy.
They will get it figured out...try not to project about what it could be...(I know, I know, easy for me to say..)
Sending you all the best.

 

[Marvy]

I went to the sports medicine doctor yesterday. Thinking I would have an ultrasound of the glute medial tendon and area, but alas, not...

He watched me walk - and said I had a pretty severe Trendelenburg gait (which I knew). He asked alot of questions about when my surgeries were, why did I need the original replacement, why I needed the revision, etc. Even though he didn't say this directly, he did say that having the revision done in April, "it was still early" in the recovery period (and I can agree with that to a point). I did mention to him that I had been dealing with this issue since the original surgery, but that did not sway his opinion. He also measured my leg lengths by having me lie down and then measured from the iliac crest to the medial malleolus(ankle). I am not sure if this is the best way to measure, but the measurements according to him were the same for both legs!

It is his recommendation that no further imaging be done. However, he does want me to have a nerve conduction and EMG study/test done. I do not think this is a nerve related issue, but at this point, I guess I have to go with the flow. I have no numbness or tingling sensations. I have no pain going down my leg. It is a distinct area of discomfort. I know from the last time that finding another doctor will be hard since the revision was about 3 1/2 months ago.

My physical therapy time has run out and I do not think I will try to get another referral at this time. They said I had reached a plateau,so in essence, it was not the best use of my time (or theirs) to continue going. I can continue the exercises at home. I am unable to do any bodyweight exercises (which I told the doctor) as my hip gives out and then I have to catch myself so I will not fall.

I know that the muscles have atrophied, but I am having a hard time grasping the fact that prior to the original surgery, I was fairly strong and now I can barely balance on the operated side unless I have something to touch to keep me upright and prevent my hip from collapsing...

sigh......

 

[Mojo333]

Oh Marvy, I do wish you weren't feeling so discouraged.

. I am unable to do any bodyweight exercises (which I told the doctor) as my hip gives out and then I have to catch myself so I will not fall.

I really don't think you should try to do anything like that as it is early days after a revision.
I found that added weights and even tension bands were only adding additional stress on muscles that had to be moved about during surgery.
I know you want to work on muscle strength but certainly if all gets sorted in you can work on it more.
Certainly all just my thoughts and I tend to be very conservative, but two surgeries within 6 months is alot to have to deal with.
What is an EMG study?
I truly hope things improve for you soon.

 

[Marvy]

Thank you @Mojo333 The physical therapist knew better than to do any bodyweight exercises - even with bands for the reason you mentioned - the added stress. I can use the bands for exercises when I'm lying down and that seems to be ok for my body. The issue is when I stand and try to do anything. The doctor said that I should start climbing steps, etc. ugh. Just the thought of that fatigues my hip!

An EMG test is similar to a nerve conduction test, but with the EMG a needle electrode is inserted directly into the muscle. The doctor did warn me that it is an "uncomfortable" test and compared it to a type of medieval torture! oohhh...I can't wait....

 

[Layla]

Ugh! The EMG sounds painful. I'm sorry you're dealing with this.
Hopefully they find a solution for your discomfort and a way for you to move forward.
I can imagine your frustration but also read over and over again how it can take up to a year,
even longer in some cases, to completely heal. Wishing the best for you!
@Marvy

 

[Marvy]

Thank you @Layla Like so many here, recovery seems to take forever. After more than a year and a half I am getting anxious to get back to being active. It feels like this has been going on forever!

 

[Mojo333]

The doctor did warn me that it is an "uncomfortable" test and compared it to a type of medieval torture! oohhh...I can't wait....

Oh my stars
Thanks for the honesty doc but could you find a slightly less disturbing analogy?
Wishing you all the best, Marvy!

 

[Marvy]

I agree @Mojo333 ! I am glad that he did warn me, but when I think about it, it's not good for the blood pressure!

I am waiting for the neurologist office to call and schedule the shock treatment...

 

[Gidget]

Ive had one, it’s okay. Just a little discomfort sometimes..if you’ve had hip problems the emg is nothing.

 

[Marvy]

Thanks @Gidget The EMG is scheduled for August 8th. I’m a wimp when it comes to needles!

 

[Marvy]

so.. sometimes I think I have a little black cloud over me - but then again, maybe things are self-induced.... either way, disaster seems to find its way to me.

I decided to go for a bicycle ride - no mountain biking, just on pavement. well, I don't know what I was thinking, or what happened as it happened so fast. I crashed... Luckily I didn't land directly on my left hip, but still took a good tumble.

Ever since the "incident", on the side of my hip, I now have a snapping/popping/clicking sensation. Especially if I walk up the slightest incline, or turn. It does happen when I walk on flat ground, but not as much. In addition, it now feels as if someone is snapping a rubber band against my outer thigh and hip. The snapping sensation stops around mid-thigh.

This new development is in addition to the pain in the glute medius area that I have been dealing with.

I'm not sure if it is the IT band having issues or what, but it is a constant source of discomfort and pain. Tylenol, icing, etc. does not help. It is very uncomfortable if I try to lie on my left side.

I haven't had an x-ray or called my surgeon. I know I should, but I am totally exhausted dealing with hip issues. At times, I feel as though my hip has consumed my life and taken control....

 

[ljpviper]

Marvy, I had two cortizone injections and when they did not work a prolotherapy injection in the glute medius muscle and tendon. I can say after the two weeks of the prolo my pain has lessened. I am just walking 30 minutes a day with a proper gait. If the glute medius does not function all other muscles will compensate. This will cause an array of pain, issues in all other hip muscles.

Keep u posted.

Larry