Lounge Doctor
Ask the Expert Webinar

THR End of stem pain starting 4 months after THR

NewCreature

new member
Joined
Sep 16, 2020
Messages
1
Age
55
Gender
Male
Country
United States United States
I am new here but am thrilled to have a place to go to talk about my THR issue. First a little background.

I had my right hip replaced when I was 49 (anterior approach). I spent two nights in the hospital and I was about 75% after 4 weeks and good as new with no complications after 6 months. I would go weeks at a time without even thinking about it.

Fast forward to February when I got my left hip replace, also via anterior approach. This time, I did my surgery on an outpatient basis. Surgery at 8am, home by 5pm. Pretty incredible. I started up PT after 4 days and was as strong at two weeks as I was after 6 weeks of PT my first time around. COVID hit, so my PT said that because I was doing so well, I could just continue my exercises at home. At two months, I was back to full strength, though still trying to take it a bit easy. I am a computer guy, so I spend 8-10 hours per day at a desk, so I probably didn't get as much exercise as I did the first time around.

At about 4 months, I started getting some bone pain mid-thigh, about where the stem tip is. Over the course of 3 weeks it progressively got worse, to the point where I need to go back to a cane. Fearing loosening of my implant, I went to my OS. Xrays all looked normal. ESR and CRP were completely normal, so there is very little risk of infection. Because the pain isn't getting any better, my OS is suggesting a bone scan, cat scan, and aspiration to check for infection. Seems like overkill given studies have show that ESR and CRP are very sensitive and diagnostic for implant infection.

The best way I have found to describe pain, and what makes me think it is an "end of stem" issue is this...I can balance with 100% of my weight on my troublesome leg just fine, with little or no pain. However, when I shift my weight off that leg to my other leg, the pain is 8/10 for about 2 seconds. It radiates down toward my knee and up into my pelvic region.

I am inclined to wait out the pain for a few months to see if it is just a combination of a nerve coming back to life and the bone growing around the end of the stem. I figure if it is an infection, it will get worse and the likely outcome is a revision. If it is something else, it will stay the same or improve. I am wondering though, if it is just end of stem pain and/or micro-movement, is weight-bearing exercise good or bad for it. I read somewhere that if it is micro-movements, the bone won't grow and resolve the problem as long as the micro-movements are happening.

Thoughts?

Mike
<><
 

leejaa

FORUM ADVISOR
Forum Advisor
Joined
Feb 3, 2013
Messages
3,139
Age
66
Location
NY State
Gender
Female
Country
United States United States
It is your choice what to do but the CT scan is not for infection but to see if there is loosening or healing at the distal tip. Having some movement is not really good for the femur and as you say it will not heal and can cause harm. Bone scan will possibly show infection and or loosening or bone reaction at the site. Aspiration with appropriate lab tests will provide definite information and also provide information how to treat if there is a budding infection.

As with any infection and this one more so it is important to get on top of it early before it spreads or becomes systemic. Your surgeon sounds like he is trying to find and eliminate any possible causes for your pain whether it be loosening or infection so that you do not get into a worse situation or have a bad result. Your surgeon is trying to help and ensure your health. It is always good to have more information and rule out serious possibilities.
 

Layla

SENIOR FORUM ADVISOR
Senior Forum Advisor
Joined
Jun 26, 2017
Messages
23,340
Location
Minnesota
Gender
Female
Country
United States United States
Welcome Mike! Thanks for joining us. I’m sorry it’s under circumstances that are causing you anxiety. I hope next steps give you some answers and a revision isn’t necessary. However, if it is, you’ll get through it and we’ll be here to support and encourage you through the process.

Please share your two surgery dates and which hip was replaced on each date. We’ll apply the info as your signature which will give those who stop by to comment a better idea of how far along you are with each hip. Please stay in touch, we’re here for you!
@NewCreature
 

New

Active Antibacterial

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
52,557
Messages
1,399,183
BoneSmarties
32,785
Latest member
TKR. 2019
Recent bookmarks
0

Top Bottom