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[THR] Could Really Use Some Help<

Josephine

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Yes, it is your doctor's job but I would say you'd probably get better advise here!

To start with, show me the site of your pain using this chart

aa hip-references-horz.jpg



And after that, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
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MobileMel

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Of course, Josephine!
I appreciate any advice you could give me. I am scheduled in to see my OS's PA on Tues. Feb 19th to be assessed. Ok. So my pain is W L3F L2F L1F . I am unsure if the pain is also in the back along that same path. I do know that if I bend forward at the waist, the pain comes on. Thanks again!
 

Josephine

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You mean like this?

mel.jpg


Do you have an xray of this?


Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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MobileMel

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@Josephine . Yes. The pain is where the red line that you have added across my thigh is. I have an xray from Aug 28th, 2018. Approximately 6 weeks after my replacement. I will try to attach it. I'm so not technically inclined.

1. Anterior Approach

2. Pain when I bend over at waist or am standing straight for a few minutes such as doing dishes 6 -8. Pain first started as when I would bear more weight such as when standing upright and slightly be relying on my weight being distributed more on the left side ( replaced hip) side and when I would relieve that weight and shift, the pain would radiate through my hip and across the top of my thigh. Now the pain just occurs if I bend over and straighten or just stand upright for a while. I can always feel tenderness and pain upon touching my outer left thigh high up. I would rate it a 2. This strange weight shifting pain began about 2 weeks ago. I've been having increased stabbing pains and popping in the hip since late November.

3. Iuprofen 200 mg twice daily starting this week. Prior to this, just occasional use of ibuprofen

4. Icing for 30 minutes in early evenings

5. Legs stretched out in a recliner

6. I stay at home with my two girls. I do dishes, laundry, pet care, weekly grocery shopping, picking up numerous things off floor, and vacuuming floors.

7. No exercises outside of house and childcare

8. No PT. Only home PT for first 12 days.


I really hope that this helps!
I will try to send my xray in a moment
Sincerely, Melissa
 
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MobileMel

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20190214_153724.jpg
xray August 28 6 weeks post op
 
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Josephine

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2. Pain when I bend over at waist or am standing straight for a few minutes such as doing dishes 6 -8.
I can always feel tenderness and pain upon touching my outer left thigh high up. I would rate it a 2.
Okay
3. Ibuprofen 200 mg twice daily starting this week
Ibuprofen is not a good pain killer. Very poor, actually. You'd be better of taking Tylenol 1,000mg 4 times a day, maximum per 24hrs, 4,000mgs.
4. Icing for 30 minutes in early evenings
You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.
5. Legs stretched out in a recliner
Okay
6. I stay at home with my two girls. I do dishes, laundry, pet care, weekly grocery shopping, picking up numerous things off floor, and vacuuming floors.
OKay
7. No exercises
8. No PT.
Pleased to hear it!

I will try to send my xray
Mel, I need to be able to see the whole of your left thigh on the xray. I understand your need to make it private, but if you send it to me in a PM, I can do that much more easily.
 

Josephine

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Okay, got them. As I suspected with your pain area, your femoral implant is loose.You can see there's a hefty gap all around the stem. Sorry for the bad news.

mel 1-horz.jpg
 
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MobileMel

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Josephine ,
Thank you for your response. I am quite upset. I do not understand how it could be loose. This xray is from 6 weeks after replacement surgery. How could my OS not have seen it loose and with a gap?

I take it popping in the replaced joint is never ok? I go in to his Physician Assistant on Tuesday. Have you ever heard of any ligament or connective tissue diseases that may cause a problem with implants staying tight and secure? I've been researching conditions and coming up with dead ends. Again, thank you so much!
 

Mojo333

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@MobileMel
I hate to hear that Jo is fairly certainly your stem is loose.
She has alot of experience with this sort of thing, and though you Know that things aren't right, I'm sure it is the last thing you we've to think about.
Something will have to be done and you have lots of folks wishing you comfort.
:friends:
Popping and clicking doesn't always mean a loose stem, so You couldn't know..not sure about OS.
 
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Layla

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Hi @MobileMel
I noticed you have questions above for @Josephine. I've tagged her for you so that she notices them. With the time difference between the US and where she lives in the U.K. she won't be on the forum anymore this evening. Please check back tomorrow for her response and let us know how your appt with the PA goes.
Wishing you peaceful sleep tonight.
 

Josephine

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Have you ever heard of any ligament or connective tissue diseases that may cause a problem with implants staying tight and secure?
That's not how it happens. Your implant is uncemented which means the femoral canal has to be carefully prepared before the implant is inserted. Read this for more detail Cemented and uncemented hips

If it's not secured securely during the operation, then it will work loose. No doubt about it. But one thing you should bear in mind is that it is NOT your fault, nor your body's fault. Nothing you did or didn't do caused this. Nothing. The really bad news is that you need to have it done again (called a revision) in order to have it sorted out.

If you have any questions to ask me, please feel free. You can tag my by putting @ in front of my name.
 
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MobileMel

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@Josephine , Thanks for all your input and advice. I was lucky and was able to be seen by my OS and his PA this morning. They took detailed notes on my symptoms and did thorough exams of my hip. They did xrays and I went for CT scan as well. My surgeon does not think my implant is loose, but said that we would know for sure from the CT scan. He is thinking tendonitis, scarring of the deep tissues in the joint, possibly calcifications, and something with the ligament (he lost me there). I will get CT results tomorrow. If implant is still secure, then he gave me an order for PT to do deep tissue manipulation only for a few weeks. If it's not improving, then he wants to do some sort of Ultrasound guided dye injection into my ligament? I don't know, I'm just trying to find out about my implant and go from there. Thank you so much for reassuring me that I or my body did this. I really tried to take care of this hip because I will need another later in life ( I'm really hoping). Update you all tomorrow!!! XXX
 

Josephine

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then he wants to do some sort of Ultrasound guided dye injection into my ligament?
Yes, that would be a good thing to do. I had something similar but it was called a bone scan.
Thank you so much for reassuring me that I or my body did this.
I hope you mean "neither I or my body did this".
I really tried to take care of this hip because I will need another later in life
Who told you that? I hip replacement should last upwards of 35 years which means you will be 7or more before this becomes a reality. But there are more and more cases where hips are lasting a lot longer than that. Read these
Hips that have lasted 32, 40, 41 and 45 years
67½ year old - the THRs, not the patient!
 

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