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THR End of stem pain starting 4 months after THR

NewCreature

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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

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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

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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
 
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NewCreature

NewCreature

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For the record, I had my right hip replaced mid-June, 2014. Anterior approach, Stryker implant. I had my left hip replaced on 2/25/2020. Again, anterior approach and Stryker implant.

Mike
 

Kevmo

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Hi Mike,

Like you I am happy to find this forum. I had right THR one year ago on November 7th 2019. I knew something wasn't right but I kept following doctors orders. I had severe pain in my thigh, I was told it is most likely the IT Band and it will go away. About 4-5 months after surgery I started getting severe thigh pain, what's odd about this is it is mostly when I take the weight off my leg. I never realized how much you lean forward while shaving, brushing your teeth or loading the dishwasher. There are times when I shift my weight I yell out loud in pain.
I was able to walk/hike and golf a bit, but now I'm afraid it will cause more damage.

Fast forward, when I saw my surgeon last week he said I need a bone scan. Of course he ordered lab work to rule out infection. I had a bone scan on Tuesday November 17th, received an email the following day from the doctor saying the bone scan definitely found something and he will do a video chat Monday the 23rd (today). Today he told me I have "end of stem pain" and I have two options. Option 1 is to be on crutches for 3 months and take meds either in a pill form or by injection. Apparently, this helps bone strength? Option 2 is to have surgery. He said they will make an incision in my thigh approximately 8" and attach a cadaver bone along the stem then wrap wire around it. As you can imagine, this is devastating news. I am a snow skier, golfer, motorcycle rider and hiker. He told me if I choose option 1, I need to be committed to the use of crutches 24/7 which I think will be hard to do.

Mike, you are the first person I found online who has the pain while shifting weight. My doctor believes the prosthetic hip is not loose, it's just pain from the stem tip. He said if I choose the surgery which is pretty rare but the success rate is 80-90% in a small sizes case study.

I would love to hear back from you and what you plan on doing, hopefully you check this forum frequently. I'm not of the rules here but let me know and I'll be happy to give you my email address or phone number.

Hang in there...

Kevin
 
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NewCreature

NewCreature

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Thanks for responding. It sounds like we have very similar issues. After my post in September, I started taking calcium supplements figuring it couldn’t hurt. I also eased up on my disc Frisbee) golf training. I am very competitive and tend to overdo it when training. Disc golf puts a lot of torque on my femur implant and may be the cause for my issues.
Within a few weeks, I would go days without a single thought about my THR, let alone experience any pain.

However, I started feeling so well that I started throwing again and the de-weighting pain came right back. I am thinking that I may need to give up disc golf, which would be really tough for me as it is one of the main things in my life that keeps me sane and fit. Maybe 6 months off will be enough.

Keep me posted on what you decide to do...and do some more research. I heard about another procedure where they remove the tip of the stem. It seemed to be very successful and much less invasive than the surgical option you mentioned.

Best wishes and prayers.
Mike
 

Jaycey

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@NewCreature I'm not familiar with disc golf. But I just watched a few videos to get an idea of what is involved. One especially telling video was a slow motion shot of a disc throw. Many new hips hate that twisting motion you are using to throw. I know both of mine did.

My suggestion is to find a physio who could help you address this. You will need to build up very slowly, perhaps strengthen muscles that haven't had to work for awhile.

Do keep us updated.
 

golfer67

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How can they remove the tip of the stem without surgery? Just wondering because I think I have the same problem that you have. I am having pain in my thigh at around the bottom of my pocket and I am at the 16 week mark.



Golfer67
 
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NewCreature

NewCreature

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If I recall correctly, they access the femur at the tip level through a small incision. I don’t have any details, as it has been 3 months since I found the article and haven’t been able to find it again.
 

helenium

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That's interesting @golfer67.
I had a fractured stem, the pain was excruciating. I was unable to bear weight, and was unable to move my leg in the bed. When anyone moved it for me my pain went through the roof. Spent the best part of 19 days in the hospital bed, on my back, waiting for surgery.
Apologies, @NewCreature, you don't have this problem. But I couldn't resist as it's the first reference to a fractured stem that I've seen in anyone else's thread.
I don't know how it was removed, but I do have copies of my x-rays showing the fractured bones to enable the removal. And here's a pic of the broken stem.

Broken Stem.jpeg
 

CafeFan18

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@NewCreature
Wow! just checking in after being away from Bonesmart for a while. I had the exact same pain (when pain was at its worst, it was at point in walking cycle of stepping OFF the leg). Very interested in what you discover. I had right THR replacement 1.5 years ago. Right now, pain is lessened due to less walking due to COVID-19 restrictions. But every time I try to up my walking pain starts up again. My bonescan was inconclusive and xray didn't show loosening. So...??? I was never told what @Kevmo was told by the doctor. Very interested in what that non-surgical treatment is. Can I ask where you found that doctor? I'm in Boston.
 

CafeFan18

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Apparently the technique of cutting off the stem tip is called "Distal femoral stem tip resection" and I also read about it online. No idea if it is a good idea or not! But I never heard about this plan with cadaver bone and wire.
 
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