THR Follow-up appointment...possible loosening at 12 months????

[rhino1]

I had similar feelings in both of my hips, given injections in psoas in both of them with minimal relief. I still had alot of pain in left, which has the look of possible loosening and they chose to inject the joint. So boring story short, there is a chance for relief with the psoas injection if it is in fact the cause of pain.

 

[Kim22]

I too had iliopsoas tendinosis which was diagnosed at 9 months by ultra sound I had to rest from all activities which aggravated the psoas. That included any activity involving flexion of the knee or hip.I went back to going up and down stairs toddler style and avoided walking inclines.Once the acute pain settled down I started with some gentle stretches which you will find on here in the library named "Iliopsoas Syndrome " I also had a course of physiotherapy to strengthen the muscles supporting the hip once I was pain free.I did make it back to both yoga and Pilates classes and had no issues with these until by left hip went downhill.I did have a cortisone injection which did not work but this was probably because I waited so long for it and by the time I got it all the inflammation had settled down and the discomfort was now due to scar tissue.Like @zauberflöte and @craftdee I had trigger point massages from my chiro which helped with this but it does come back especially if I overdo things but I am pleased to say that I also have long periods when I am pain free on that side but I can't say the same for the other hip which is being replaced next month.I hope you find a solution to this problem which is so annoying and more common after THR than I realised.I felt like I was the only one in my cohort who hadn't reached the stage of the forgotten hip.I will be thinking of you please let us know how you get on.Regards
Kim

 

[Samy]

Thank you all so much for the encouragement and for sharing your stories. I had never heard of this and all I was seeing online indicated a poor cup placement sort of thing. which was extremely worrisome. I have continued with NSAID, icing, and stopped some of the biking leg lifting exercises for a few weeks now, and am happy to say i can lift my leg into the car and bed. While not 100% there is improvement and that I am grateful for. I have been mainly focusing on the stretches (thank you Donna for the suggestions) rather than the exercises I was doing. Of course am still walking the dogs and doing the play groups on the weekend, but I don't find those activities to bother me as much.
So feeling optimistic tonight...and very appreciate of knowing that others have experienced something similar. So many things you don't know about going into this surgery!
thank you again!!

 

[Poppet]

Hello @Samy -- Did you know how the body goes about the process of healing following surgery (or an injury)?

Here is an article which explains this process....

Healing Phases & Nutrition

This second link is to other nutritional articles which you may find interesting, including one relating to bone health.

Nutritional advice for pre op and recovery

This third link refers to my ongoing research..

nutritional-snippets-did-you-know

 

[JanetLynn]

I am at 16 weeks post-op. I had not planned on coming back, but here I am, under this 'suspecting iliopsoas tendonitis' thread. At least I am in good company! My 2nd THR (right) was May 6th and I had the groin pain in the beginning during PT. I don't know if it went away or I just got use to it. It is now back and I'm not happy. I can't ignore it anymore as I am limping because of the pain.

I have taken Naproxen for years (a really long time) with a bit of Vicodin when hip pain was severe. I take a prescribed opiod (1/2 tablet) when I start to limp.

So it's back to the beginning. Restarting the beginning PT exercises and tracking the pain and progress so I know what it is that requires complaining ... and to the ortho doc or my primary? Would massages at PT be better than the exercises?

I did start massage therapy on my own because every muscle is soooo tight. But that's not covered by insurance. It sure feels good (a good hurt)!

Other than that, I love my new hip. Which, I am sure I have agravated the muscles/tendons unintentionally. I spent a week in San Francisco at 7 weeks walking the streets. And just recently spent 10 days, helping my son and his family move (in Indio, CA, 115 degrees), going up and down stairs, lifting, all that fun stuff. And I have been exhausted since. Retirement looks very appealing.

Another reason to come back for help is lack of sleep. I'm still not sleeping well, just restless and 'awake'. I was just prescribed Belsomra, but after a week, it's not working at all.

So glad that you all are still here.

 

[sandydog]

Hi@samy, i am under the thread THR-STILL IN PAIN. I was glad to have found your thread today. Our problems sound very similar. My surgery was march 20, and went back to work at 3 months post op as a flight attendant. Only, 2 weeks later I was back on disability. The pain in hip and upper thigh had reduced me to a walker again! I was taking ibuprofin and tylenol in between. Xrays, CT Scan, and blood test all showing normalcy with the replacement. I have an upcoming MRI of the spine sept.8, to look at a possible nerve problem. I take it easy, but walk every day mostly with a cane. I was doing all kinds of stretches and exercises too but had to stop, because of the doctor's orders. Laying around does not help, or sitting. My worst pain is in the morning. I can barely walk, then. I stay busy, and the longer i am on my feet, the happier i am. For me, I am doing better with my attitude change, of being more patient, keeping in contact with my doctor and by staying on this forum! I cannot work now, but hopefully that will change! Keep us informed!

 

[Samy]

Hi all....wow am sort of reeling. Had my 3 month follow up for my right hip, and my 1 year for my left.
X rays done and as I am talking to the surgeon he shared that there is some space at the base of my stem on the left side..space that wasn't there on the 3 month xray. He shared that we will just monitor it, unless something changes we will do an xray in a year. Sooooooo help me understand how in the world is this loosening already? I am not doing high impact sports, and while i am active its mostly walking stuff, not sports or impact activities.
Very very frustrating and scary as I was hoping for the 30 year plan on my next replacement, and to hear this well, took my breath away.

So revisionists (for aseptic loosening) if there are any here what is that like? is there anything I should be doing now?
Is there anything aside from pain I should watch for?

Thanks for listening..am feeling pretty low at the moment

 

[Pumpkin]

Samy,
Sorry to hear of your loosening, you must be shocked to receive that news.
I am going to tag @Josephine to help answer your questions.
If you go to the Hip Replacement Recovery Area, and click on a yellow revision prefix a list of hippies with revisions will pop up.
Hope it all turns out well for you,

 

[Jamie]

I've merged all four of your recovery threads as when I went through them all your two surgeries seemed to be quite intertwined. So I believe that Jo will need all of that history to talk to you about where you are now. I'm so sorry to hear you may have loosening. Please know, if that's the case, it is not anything you did or didn't do with your first hip. And if for some reason you do need a revision, they are usually very successful as long as you select a good and experienced revision surgeon.

The main thing to watch for that would indicate additional loosening will be pain when walking or standing.

 

[Hip Hip Hooray!]

Boy, this thread is really teaching me not to do too much. Thank you for all of your stories. Less is more.

 

[Josephine]

Sooooooo help me understand how in the world is this loosening already? I am not doing high impact sports, and while i am active its mostly walking stuff, not sports or impact activities.

Samy, I so very sorry to hear about this. However, you will be pleased to hear that loosening is nothing whatsoever to do with what the patient has done. A well seated implant will resist any exercises you might do except high impact things like trampolining!

I do have more information and reassurance to offer but it depends which type of hip you have. So before I go further, I need to know if your hip was fixed with cement or not.

Another thing, now your four threads have been merged into one and I've read through the entire new thread, I can see that sometimes I have left you information and advice, you've then started a new thread which makes me wonder if you read my advice at all. So I do urge you to go back and read this thread from the start to catch up with what you missed.

 

[Samy]

Hi @Josephine
Thanks for reviewing this. I apologize if I missed something you left, I will go back and review.
My left hip is showing the bone recession, and this is an Smith and Nephew Oxinium stem, the was press fitted, no cement.
I still have some IT flares on this leg, but they are no where near as severe as they were after surgery, and then again after my right hip surgery. There is an area about 4 inches above my knee on the lateral aspect that sort of aches..again I associated this with the IT band, but in light of the xray I am wondering if this is a symptom from the potential loosening. I do ice and do massage on this area, and for the psoas issue on the opposite leg continue with the stretches, and have limited activity.

I am going to follow up with the PA as well..I have several questions now. I was in complete shock when he first said this and didn't think quick enough to even come up with what to ask.
I appreciate your reassurance that nothing I did caused this, I don't really have a clear understand of what would cause this to happen so early on, or if there is anything I can do at this point to delay further bone loss or loosening.
thank you again for your time

 

[Josephine]

My left hip is showing the bone recession, and this is an Smith and Nephew Oxinium stem, the was press fitted, no cement.

Thank you, that's what I suspected. Generally the cause lies in how well the stem was seated at the time of the surgery. There only has to be a suggestion of poor fit then to result in loosening some months later. If the implant is held firmly in the middle but has a looseness of even just microns at the tip, then the implant can toggle, meaning it can make micro-movements. Over time, the bone will be reshaped inside the shaft.

there is some space at the base of my stem on the left side..space that wasn't there on the 3 month xray

Exactly so. The tip of the stem keeps knocking on the bone as it moves and the one thing that bone doesn't like is having a metal device tapping on it repeatedly. In the end the bone gets worm away - remodelled - like this

This amount of remodelling or wear, can take months to get to this state and means your stem has been loose since very early on but only in micro-movements so you'd not be aware of it. If left, the remodelled point can actually break out of the bone like this one (where the arrow is) is about to do.

Sooooooo help me understand how in the world is this loosening already?

So you can see, this has not 'just' happened, it's been loose for a while only you weren't aware of it.

 

[Samy]

Yes the loosening is at the tip, so I believe what you are describing is appropriate to my situation. And there is nothing I can do at this point to optimize this implant? Do bone stimulators help in any way?

I was mentally on the 20-30 year plan on thinking I would not have to do deal with a revision until then, so to think I am going to be dealing with this much sooner is just beyond words. and how many revisions can a femur endure..I am 48 so to lose the longevity on the first prosthesis is sort of devastating.

Josephine what do you typically see done with revisions? From what I have read the bone loss is a significant concern for stability, grafts (auto or allograft) are used, and are they cemented?
Can it be done from a minimally invasive point or does it revert back to a traditional posterior through muscle.
These are question I am going to discuss with the PA as well, but any information at this point would be helpful to allay my fears.

 

[Pumpkin]

Samy,
You should think about seeking a second opinion about your hip, preferably from an OS who specializes in revisions, they have the experience you want to address failed implants.
You can click on the find a clinic button at the top of the page to locate surgeons in your area, their websites will state if they do revisions or complex joint reconstruction.

 

[Samy]

Thank you Pumpkin...I guess this a bit confusing as my surgeon just left this as let's see how it looks in a year unless you start having pain etc.
While I am in no rush to go through a revision, I guess I am also wondering at what point do you have one??

And also how do you differentiate a surgeon who is proficient in revisions from one who isn't?

 

[Jaycey]

As Pumpkin said in her post, the surgeon's clinical qualifications will state whether they do revisions.

my surgeon just left this as let's see how it looks in a year

I really don't understand this attitude. Things are not going to get better. If it were me I would seek out a revision specialist and get this done and over with.

Use the clinic finder as Pumpkin suggested and call the surgeons' offices if you need to clarify their qualifications.

 

[Pumpkin]

I agree with Jaycey, you will need a second opinion, or more. You will want to know how many revision the do in a year, it should be 50+. The office staff should be able to give you the number of revisions the OS does.
I have had a knee revision, I know what an arduous task it is to find a surgeon that specializes in revisions.

 

[Josephine]

And there is nothing I can do at this point to optimize this implant? Do bone stimulators help in any way?

Sadly not. What's done is done. It's toggling and the leverage inside the bone is significant. The only recourse is a revision.

how many revisions can a femur endure..I am 48 so to lose the longevity on the first prosthesis is sort of devastating.

I can imagine but it will be okay provided you get a good revision surgeon.

Josephine what do you typically see done with revisions? From what I have read the bone loss is a significant concern for stability, grafts (auto or allograft) are used, and are they cemented?

Well it depends upon the reason for the revision. a loosening is about the least problematic kind. Usually the stem will be cemented a second time around. And since most hips area available in a cemented or uncemented type, it may be possible to just replace the stem and leave the cup alone.

Can it be done from a minimally invasive point or does it revert back to a traditional posterior through muscle.

Also usually a revision is done through the pre-existing scar.

While I am in no rush to go through a revision, I guess I am also wondering at what point do you have one??

As soon as possible. Remember the second xray I left you? And said that in that case the loose prosthesis was about to break through the bone? Well this is always the risk and the reason why I would urge action sooner rather than later.