Revision THR Continuing left hip pain

[DEL2019Sep-7]

Nine months before my revision, I made an appointment to see the OS due to moderate off-and-on pain in my hip. He said the xray indicated everything was fine with the prosthesis. When I showed this same xray to the OS at the Hospital for Special Surgery, he said "100% of my colleagues here would have diagnosed a loose femoral stem." So I suffered for many months thinking the problem was just with the soft tissues.

@prairienut you hit the nail on the head, or prosthesis, as the case may be! Surgeons are human and fallible. You were wise to get that second opinion. When I had my LTKR done in 2011, and from the very beginning my entire leg from groin to foot was electrically charged and painful, I asked my surgeon what the hay was going on. I loved my surgeon...likable, reputation for being very good, and to top it off, very handsome. Great combo right? When he looked at the x-rays, he almost bubbled over with joy, claiming that I was the poster child for knee replacements. Everything was great! He couldn't look past the x-rays and his admirable surgical skills Finally, months out, after hours of PT, massage, and searching the internet, I was diagnosed with moderate Reflex Sympathetic Dystrophy (now called Complex Region Pain Syndrome), which a small percentage of knee replacement people end up with post op. Not fun and difficult to treat. Fortunately, CRPS is almost nil in hip replacement patients. Though I will keep my eye open on this because I am one of the small percentage of people whose sympathetic systems is a bit supercharged.

My point is that had I listened to my handsome and capable surgeon and not mercilessly researched and pushed, I wouldn't have gotten to the truth of my condition. Of course, we should listen to our OS guys...what would we do without them and their amazing skills! But they can be myopic when it comes to their work, only zeroing in on "bones." Thanks so much for your post! Be well...

 

[ebair23]

Thanks @Layla. I have a recliner. I think that idea is great and what I will plan on.

 

[prairienut]

@Kona Girl , I have a close friend who acquired CRPS following a TKR. Yes, very difficult to treat, and I read it is important to treat it right away so central nervous system pathways don't get burned in. She went to a special pain management class sponsored by Mayo to learn how to best live with and manage her condition.

The OS who misdiagnosed the loose femoral stem was not the same doc who did my THR. I settled for an associate because I was leaving for an extended overseas trip and wanted an appointment before I left. I believe my original surgeon probably would have identified the problem correctly. I later called him to suggest they establish a procedure in their group practice where follow-up x-rays are always reviewed by the surgeon who performed the joint replacement. I wonder if they listened to me. They weren't thrilled that I decided to have my revision done elsewhere, but I was determined to go to the best place I could find and go with a highly experienced revision specialist. That's how I ended up at the Hospital for Special Surgery. I want this re-do to last for the duration!

 

[SaraK]

@prairienut - I'd actually have a different suggestion on trays - it should be reviewed by original OS and someone else - sometimes the surgeons see what they want to/expect to see on a x-ray of their work. Or any patient with continuing pain should have their case reviewed anonymously - neither patient nor surgeon's name shown. Even consider doing one or both of those with a different practice for any patient with an ongoing issue. It can be interesting to see how opinions change when the egos and personalities are taken out of the mix!

 

[prairienut]

@SaraK , I really like the idea of a third party reviewing a case of ongoing pain after THR and better yet, an anonymous review. I'm sure bias as well as incompetence/inexperience contribute to missed diagnoses. I have read some threads here where the patient has severe 24/7 pain several months after surgery, and the surgeon is suggesting that anxiety or PTSD might be a factor. I highly doubt it! The chronic pain causes the anxiety, not the other way around. Sure, stress often aggravates back pain, but not so much hip or a knee. You don't have to wait a year to know something is wrong and not getting better. My case shows that it is not a simple thing to diagnose a prosthesis failure from just an x-ray. I had the classic clinical symptoms of a loose femoral stem that should have been noted -- start-up pain, pain with a simple leg left from a prone position, sense of instability, etc. I even lightheartedly suggested a new indicator to my revision surgeon, and that is, my hip would twinge with pain whenever I sneezed! It could be called the Prairienut Sign. That symptom disappeared with the revision, never to occur again. It was evidently caused by a lurching of the femoral stem when muscles contracted during the sneeze.

@ebair23 , I hope this discussion is not hijacking your thread. It seems relevant to your case considering you likely have a loose component, and your diagnosis was delayed for way too long.

 

[ebair23]

Anyone else ever have this happen? I was sitting on the toilet last night and when I got up my THR popped really loud and hurt extremely bad. I already know it is lose in there, but would that cause this to happen? I am still throbbing from the pain. Man, I wish my RTHR was tomorrow!

 

[CricketHip]

I have no idea why that happened but wanted to send you my condolences for having to struggle through this until
December. It could be tendons that aren't gliding properly since the implant is loose, but I seem to recall @prairienut commenting on painful movements, in fact I scrolled up, it is right above in post #265. She referred to the femoral stem "lurching." I tagged her so she can weight in from her experience.
I hope the next 2.5 months go smoothly. ((hugs))

 

[mainegirl1]

I hope that the next 2.5 months shrinks to days! I feel so bad for you as an routine innocuous toilet visit is part of our day and you won't look at the appliance the same now.
Any way to report to the surgeon about this?

 

[Layla]

I'm so sorry @ebair23
Wondering if you suffered a subluxation...When the ball has not dislocated, but not properly in the socket.
I agree that you should touch base with your surgeon. It may fast track your Revision. Under the circumstances it's definitely worth a try.

Following is an article on Dislocation, which didn't occur or you would have been in major pain on the floor waiting for medical transport to the ER. Look toward the bottom where it shows and explains Subluxation a bit.
https://bonesmart.org/forum/threads/dislocations-what-are-the-risks.8759/

You may also be able to get something to help you move through the pain you're experiencing so I'm really encouraging you to call the office of your OS.
Hugs and wishes for your comfort.

 

[Mojo333]

I'm sorry that you have such a wait!
I thought of subluxation too when I heard your description but I certainly dont have any medical experience.
I'm guessing you had some sort of armed toilet riser for your recovery?
I think I would use it now so as to be able to put weight on your arms for rising...and sit in chairs that you can do the same.
I would also relay all my continued issues to the OS office.
Hey, if nothing else...maybe that will keep you first in their mind should a cancellation come up?

You know you have lots of folks rooting for you, @ebair23

 

[ebair23]

One down. One to go! Had my colonoscopy yesterday. All went well. Now the wait until December........ I am not looking forward to it all, but I also am. Hahahaha. I just want to feel somewhat normal again. I long for the time I can run around with m granddaughter.

 

[Layla]

Hello ebair
Great news! Nice to get that colonoscopy out of the way.
I hope time flies until December. I understand your apprehension but I'm betting it's going to bring you relief and give you back your life.

Granddaughter? You don't look old enough to be a grandma!
Wishing you many hugs, kisses and snuggles with her in the future.
Have a great weekend!
@ebair23

 

[Mojo333]

I will be so happy for you when you ate finally back on the trendy road.
Stay healthy and know you have alot of bonesmarties rooting for you.
XxxcHugs @ebair

 

[ebair23]

Thanks to everyone. It is so nice to have someone out there who can relate to what I have been struggling with. And yes, my Granddaughter is one in a half. he is my happy place.

 

[CricketHip]

Hi again @ebair23 I'm guessing that the time will pass quickly, now that we are getting into the various holidays. I hope the next 2 months go smoothly with none of the painful popping moments!!

Grandchildren are great, aren't they? Just think of the things you can do with her by next spring..

 

[Layla]

Hello and a happy Monday to you!
Wishing you a nice week, Erica
We're here if you need us....always.
@ebair23

 

[ebair23]

I meant SHE. Hahahaha

 

[Layla]

Hello and a Happy Tuesday to you
I noticed and got a chuckle off that @ebair23
Figured it was a girl though because you typed out granddaughter.
One and a half is such a cute age. I'll bet you love her to pieces.
Enjoy those cuddles and kisses and stay in touch.

 

[ebair23]

Having "one of those days" today...... No sleep because of pain in my left AND right sides of my hips. Lordy. I am so scared that I have messed up my right side after all my issues with my left. Man..... I know its in my head, but, how am I going to know? I can't wait until December!!

 

[Layla]

Good Morning @ebair23
I'm sorry you're hurting and with all you have going on I'm sure your right hip acting up now is very unsettling. Please refresh my memory, was it OA that led you to THR? If so, when is the last time you had both hips x-rayed and was there any OA in your right hip at that time?
Wishing you comfort and peace of mind.