THR Grannyhippy's Recovery Thread

[Josephine]

I am not sure that the professor who did my shoulder can do anything more for my hip if I seek his help or even if continuing with PT will help.

Surgeons tend to specialise in areas. So you get a lower limb, upper limb, spine, foot or hand surgeons. Obviously the chap you refer to here is an upper limb specialist and wouldn't be too knowledgeable about hips.

My husband's friend who has a torn gluteus minimus and is waiting to have it repaired says I should go and see my former OS who is the same OS he has. I was very happy with the tendon repair he did on me before.

And the same thing here. There are also surgeons how specialise in 'general' orthopaedic surgery which is everything left over from the above list. He is not one I would suggest you consult.

I don't want to offend my OS if I end up going back to him after getting another opinion.

Why? Don't you think these chaps are accustomed to their patients getting second opinions? Because let me tell you - they are!

As for the CT scan report, can you tell me if you have a metal on metal hip - that is a metal cup and a metal ball?

 

[Grannyhippy]

@Josephine I have a ceramic on ceramic Synergy stem R3 cup.

All SYNERGY femoral stems are made from high-strength, forged titanium and feature a 3° proximal to distal taper. Parallel and longitudinally arranged flutes on the stems provide good axial and rotational stability.

I mentioned the metal in the prosthesis in case you think I may be having a reaction to it. The three anchors in my shoulder are titanium and I have not had a reaction to them. However when I used to wear pierced earrings I had to have good quality ones because I would have a reaction to the metal in cheap earrings. My ear lobes would become very red and itchy after a few hours of wearing them.

The orthopaedic surgeon I had considered seeing for a second opinion and who did a good job with my shoulder repair years ago does do hip replacements and revisions.

His name is Assoc. Professor John Ireland and one of his web sites is Sydney Bone and Joint Clinic. https://www.sydneyboneandjoint.com.au/john-ireland-joint-replacement-specialist.html

Areas of Interest

• Adult Reconstructive and Replacement Surgery. This includes Joint Replacement and Revision Surgery of Hip, Knee, Shoulder and Ankle.
• Arthroscopic Surgery of all major joints. This includes ligament reconstruction.
• Stem Cell Therapy.

His profile states that he has done 4000 joint replacements and 2100 shoulder surgeries.

He operates at several large hospitals and used to be head of orthopaedics at Liverpool Public Hospital which is a large teaching hospital in New South Wales.

Oh, and one other thing. My physiotherapist sister-in-law emailed me back saying
"Any surgery you get will not be as effective because of the buildup of fatty tissue, which indicates long term degeneration
Please delay the surgery
Why don’t you see a surgeon under 50?"

 

[Krista]

@Grannyhippy, I wonder what your PT sister-in-law's definition of "long term degeneration" is? I had the fatty tissue build-up after only 6 months of not using the muscle. And I didn't have my surgery until 9 months after that. I hope I will get back full use of my gluteus medius. For you, wouldn't delaying surgery just make the muscle even weaker?

 

[Josephine]

I have a ceramic on ceramic Synergy stem R3 cup.

Oh phew! I was worried you might have a metal on metal hip!

All SYNERGY femoral stems are made from high-strength, forged titanium and feature a 3° proximal to distal taper. Parallel and longitudinally arranged flutes on the stems provide good axial and rotational stability.

Not being funny, but after a lifetime in joint replacement surgery, you really think I didn't know that?

Oh, and one other thing. My physiotherapist sister-in-law emailed me back saying
"Any surgery you get will not be as effective because of the buildup of fatty tissue, which indicates long term degeneration
Please delay the surgery
Why don’t you see a surgeon under 50?"

Huh?

 

[Grannyhippy]

Sorry @Josephine I did think twice about whether to put the information in about the metal in the prosthesis. Somehow when editing my post I also deleted that it is a Smith&Nephew prosthesis but you probably already worked that out from the little information I gave you.

@Krista , I have a feeling my sister-in-law does not seem to think that the muscle will regenerate well if I have the surgery. Maybe because of all the fatty replacement but I really do not know. She did ask me to send her a copy my scans and was going to show it to others at her work and get their opinion but I don't have them and they are too big to scan anyway. I did send her a copy of the report though. She only works part time these days.

When I saw her on Christmas day she said to me then that maybe the damage has already been done and nothing is going to help. She had not seen a copy of the CT report at that stage. A long time ago I read that a person can lose up to half their muscle strength after just one month of not using that muscle.

Remember my OS observed that I was not using my gluteus muscles when I walked and thought that somehow the message from the brain to the muscles was being interrupted somewhere along the line. That is why he sent me back to the Neurologist mid last year to have the nerves to my glutes tested and the Neurologist said they were OK. When the needles were inserted into my gluteus max and gluteus med I could hear the machine buzzing away like a Geiger counter which had hit the payload.

In 2015 I had a nerve conduction test done on both legs and the conclusion was that there was Neurophysiological evidence of moderate chronic partial denervation in all muscles tested, consistent with a lumbar polyradiculoopathy, in particular L5. My Neurosurgeon said I don't need surgery.

I have not been back to physiotherapy since early November when I had a dry needling session with her. I did run into her just before Christmas and she suggested going back for more sessions because she said she had success with other clients. I did say I would keep her up to date after I saw my OS and I sent her a copy of the CT report but have not heard back from her. I still may return to her in the future if I need to but I probably won't.

 

[Krista]

@Grannyhippy, thanks for the explanations! So maybe your SIL thinks that that the muscle will not regenerate well if you have the surgery. However, if you do have a torn tendon or two that have not healed on their own after all of this time, and if you don't have surgery to repair them, then it is certain that you will continue to be disabled. With surgery, if that is the recommended treatment, you at least have a chance of being able to walk without a limp someday. Also, wouldn't it make sense that having the surgery (if that's what you need) sooner rather than later would be better? The muscle only gets weaker over time with non-use, so delaying the surgery would make recovery that much more difficult.

 

[Grannyhippy]

Yes @Krista I agree with you in that if I do have a tear it will only get worse the longer I leave it but the OS is not sure if I have a tear and just wants to have a look around. I would hate to think he cut into me again only to find nothing to repair. Then I would have to go through the healing process again and probably have more scar tissue and risk further injury but then again he might find something that does not show up in the scans. I have not put off the surgery yet and may not do so. It won't be until February 28th.

 

[Krista]

Got it, @Grannyhippy. I agree that none of us would like to be opened up in surgery only to find nothing wrong. Wish you could get that MARS MRI and a person who knew what he was looking for in those scans. Of the 4 doctors who looked at the results of my two MRIs, only 1 of them, the surgeon who did my repair, was able to see the tear of my gluteus medius in the images. The two radiologists and my original orthopedic surgeon didn't catch it. And no one could see the gluteus minimus tear.

 

[Josephine]

It's all about the skill and previous experience. I have a modicum of both in certain circumstances (regarding reading xrays) but if a thing is outside my comfort zone, I will say so. Many doctors don't!

 

[Grannyhippy]

Yesterday I picked my scans up from my OS's secretary and posted below is the report from the Bone study - whole body and single; CT scan performed at the same time.

Clinical Assessment:
Trendelenberg gait of the right hip. Chronic right lumbo-sacral and right hip pain. Right hip THR (June 2015). L3/L4 discectomy (2008).

Whole Body Bone Scan with Fusion Tomography
There is a mild increase in blood pool activity to the posterior infero-medial margin of the right hip. This area had no corresponding delayed tracer uptake and is in keeping with non specific inflammation.

There is increased blood pool activity and increased delayed tracer uptake to the superior and lateral margin of the right greater trochanter in keeping with enthesopathy/bursitis.

There is a uniform tracer uptake around the remainder of the right hip without evidence for complication.

There is active right L2/L3 and active right L4/L5 facet joint arthritis; there is moderate left L4/L5 facet joint arthritis; there is low grade facet joint arthritis at the right L3/L4 and L5/S1 facets bilaterally.

There is a pattern of degenerative disease in the left sterno-clavicular joint, left T12 coso-vertebral level, medial compartment of both knees and the mid feet. There is bilateral rotator-cuff enthesopathy.

(A low dose non-diagnostic CT scan was performed for fusion SPECT localisation).

Conclusion
Moderate right greater trochanter enthesopathy/bursitis (arrowed).

No right hip peri-prosthetic complication.

Active right L2/L3 and active right L4/L5 facet joint arthritis.

Degenerative joint disease pattern elsewhere.

My OS wants to explore the gluteal attachment to fascia lata of the right hip and exchange the ball with trunnion plus offset the ball.

I also noted that I have bilateral rotator-cuff enthesopathy as well as enthesopathy/bursitis in my greater trochanter.

@Josephine. What do you make of the above report. Does this mean that I could have a tendon tear in my hip or maybe even in my shoulders? Obviously there is bursitis and it looks like an abnormality in my hip and shoulder joints where the tendons insert.

What do other Bonesmart people think? I would be interested in hearing from other BS buddies or experts who can understand the report.

I am not entirely ignorant about the report I just want other people's opinions on whether having further surgery to investigate would be worth it or whether I am likely to have a poor outcome. One thing though it would be good to have the LLD fixed by replacing the ball with a larger one.

 

[Josephine]

Does this mean that I could have a tendon tear in my hip? Obviously there is bursitis and it looks like an abnormality in my hip

I don't quite understand why your surgeon wants to change the ball.
Nor why you think you might have a tendon tear - I read nothing in that report that leads me to suppose that.

Does this mean that I could have a tendon tear in my shoulders? Obviously there is an abnormality in my shoulder joints where the tendons insert.

As for your shoulder, you appear to have a rotator cuff impingement which is first treated with PT and cortisone injections and if needs be, with a surgery called acromioplasty - this is a link to my thread where I've explained the procedure in some detail. The really interesting stuff begins at post #42!

 

[Grannyhippy]

@Josephine , I know what an acromioplasy is as I had a right rotator cuff repair five years ago and the surgeon shaved out under the AC joint then. I have three anchors in my right shoulder. Upon leaving the day surgery at that time the attending PT said that the space beneath my AC joint was very narrow. I also had another tear in my biceps muscle, tendinitis, bursitis and a cyst behind my AC joint. By the way before my shoulder surgery I had an ultra sound which only showed a partial tear and not the full tear and other damage I had. It took an MRI to show the rest. I had a different OS then.

Both my shoulders are sore at times and my hip has a similar constant ache/tightness all the time. My shoulders are not as bad as my hip because I am not weight bearing on them all the time when I walk and stand. My right shoulder was so bad before my surgery I could not even mash potatoes without pain.

My hip juts out even when I am standing and I have noticed that if I point my right foot a little to the right when I am walking the limp is not so bad and it does not feel as unstable. I am even wondering if the acetabular cup could be slightly in the wrong position. I seem to be OK going downstairs but not coming up. Of course muscles and tendons could be the problem. Even my GP said that sometimes if the leg is shortened the tendons can then be loose and flop around when I walk and that could be part of the reason.

A friend from my husband's fishing club also developed similar symptoms seven years after his hip replacement and has a torn gluteus minimus which is going to be repaired. It was picked up when he had and MRI. He said he tore it himself by doing too much and lifting too much when at work. His limp is not as bad as mine.

My surgeon is going to change the ball on my hip to try to make up for the leg length difference. When he suggested surgery to investigate why I am having difficulties still I asked if anything could be done about my LLD while he was already "in there". That is when he said he could put in a larger ball and that should make up for the LLD. I guess he does not want to change the stem because it is not loose but there was some subsidence after the surgery and he did say initially that he should have put in a longer stem.

Anyway I have made an appointment to see another OS for a second opinion at the end of this month. When my GP gave me the referral to see the other OS he said only a brave surgeon would touch someone else's patient. I just want to put my mind at ease and make sure I am not going in for unnecessary surgery but I know something is not right with that hip. My OS is not sure if I have a tear and that is why he wants to operate. I don't know why he did not order an MRI. I will ask the new OS if I can have a MARS MRI.

 

[Josephine]

Both my shoulders are sore at times

Have you ever considered using a TENS machine? I've used one on my shoulders for years and it has an even better effect than pain meds!

That is when he said he could put in a larger ball and that should make up for the LLD.

That would be a very practical solution and one that is often used.

When my GP gave me the referral to see the other OS he said only a brave surgeon would touch someone else's patient.

What rubbish! There are surgeons who actually specialise in sorting out problems of other surgeons!

 

[Krista]

Regarding what your GP said about only a "brave surgeon would touch someone else's patient", that happens frequently. Revision specialists are always going in after other surgeons before them. I had two surgeons different from my original surgeon work on my second hip op.

 

[Grannyhippy]

@Josephine, I already have a TENS machine which I bought back in 2008 when I had really bad sciatica before my lumbar microdiscectomy. My treating physiotherapist at the time suggested I buy one and use it at home. They are good. I also used it prior to my shoulder surgery back in 2011. My present PT has set my machine for chronic pain levels. She also tried some muscle stimulation with her machine once but it did not go deep enough to do what she wanted. I tend not to use it unless the pain gets really bad. I take Panadol Osteo occasionally if I can't get to sleep because of pain. I used to take Pandole Osteo daily but not now. I don't believe in taking pain killers long term. I also used to take Celebrex but my GP told me to stop taking it as it was sending my blood pressure up.

@Krista, Is your recovery still going well? I have to catch up with your latest posts.

When I phoned to make the appointment with the second OS his secretary said that he often gives second opinions and sometimes tells a person an operation is not needed if that is the case. She never said whether he will operate on someone else's patient if needed. She also said that the surgeon I have now is a good one.

My husband's friend who was waiting to get his gluteus minimus tear fixed had a fall and ended up in hospital. He told my husband he has broken his femer around the stem of his prosthesis so now it looks like he might be in for a revision hip replacement. He discharged himself from the public hospital today and will see his orthopaedic surgeon as they said he might have to wait days or longer for surgery in the public system whereas he is already under the care of an OS privately and has private health insurance. They advised he would be better off seeing his own OS. His wife and son took him home. Private patients no longer get priority admittance in the public hospital system. They have to wait their turn like everyone else.

 

[Krista]

@Grannyhippy, that is bad news about your husband's friend, although it is fortunate he has private insurance. Hope all his problems get taken care of soon!

I'm doing fine and was just about to post about it on my thread. Am getting more and more active, although I still have a bit of a limp and some aches and pains. I'm only 12 weeks, so to be expected. The pain in the fronts of my thighs (both of them) on standing up after sitting for awhile is awful, but I kind of think that goes with my age. Doesn't seem to have much to do with my gluteal muscles or on the side of my hip at the greater trochanter where they did some other work during surgery. Next time I get up I'll try to pinpoint where all the shooting pains are; usually I try not to focus on it, but just try to get through it. I'm doing PT 3 times a week, and it is helping enormously with getting me more flexible and increasing strength in all of those wasted muscles in my hip area that didn't do much for a year and a half. The limp gets better every week, and I expect it will be gone soon!

 

[Grannyhippy]

@Krista, Glad to hear you are doing well and slowly regaining muscle strength. That must be reassuring to know the muscles are recovering after lack of use for so long. I hope your thigh pain improves with time as you heal.

 

[Josephine]

I tend not to use it unless the pain gets really bad.
I take Panadol Osteo occasionally if I can't get to sleep because of pain.

I use it prophylactically. Like meds, it is more effective if you get in early rather wait until it's really bad. It has less work to do. Besides which, isn't it better to use a TENS which is pretty near instant, than take pills which not only take 15-20 minutes to work and have side effects?!

As for the sleep, I always found that if I used the TENS for about an hour before bed, I got relief for the night!
So many benefits with a TENS and so many disadvantages with pills!

 

[Grannyhippy]

Today I sort the opinion of another orthopaedic surgeon and he has given me a referral to a top orthopaedic surgeon at St. Vincent's Hospital in Sydney. Apparently this doctor is very good and does many revision surgeries.

The orthopaedic surgeon I saw today thinks that the stem of the prosthesis is too short and needs replacing. He said revision surgery is quite a challenge for the doctors because the prostheses are not designed to be removed and there is a bigger chance of complications and infections also. If I do have the surgery and get an infection the prosthesis will have to be removed again for a period of six weeks. He thought I should get another opinion from the surgeon he has referred me to and maybe even another surgeon as well.

The doctor also said that when the stem is too short it affects the way the muscles work. My GP had virtually said the same thing last year and again recently.

I was booked in for investigative surgery later this month with the surgeon who did my THR. He was going to check the gluteal attachment to the fascia lata and was going to replace the head and trunnion and offset set it. The doctor I saw today thinks that replacing the head and offsetting the trunnion is not likely to help because there is a limit to how much the head can be adjusted. He feels that replacing the stem is the best option. He also said that a LLD is quite common and I could still end up with a LLD after revision surgery but hopefully it will be corrected with the longer stem.

I now have an appointment with this other orthopaedic surgeon on 23rd February. I have phoned my original OT's secretary and cancelled my surgery date. I had not sent my admittance papers in yet and I did get all my x-rays and scans back off her a couple of weeks ago.

My husband phoned my PT sister-in-law and told her of the situation. She said she was glad I sort another opinion but still thought I might not have a good outcome because of the fatty replacement in my gluteal and other muscles.

 

[Krista]

How terrific that you are getting these other opinions, with more to come. I just had my 13 week follow-up with the surgeon who did my gluteal tendon repairs. My gluteus medius and minimus had been deteriorating for 15 months before I had the surgery and had lots of fatty replacement. I still have a slight limp and some weakness in the glutes, but they are getting stronger all the time. I specifically asked the surgeon if he had seen good recoveries from people who had had very compromised muscles after long term non-use, and he said that he has. I can balance on the surgical leg for 20 seconds now (the same time as my good leg!), and before surgery I was not able to balance on it at all, due to the tendon tears.

So good luck in all of this, @Grannyhippy. Sure, it is possible that you will not have a good outcome (as your sister suggests), but if you don't have a surgery, then you definitely have NO chance of recovery. WITH the surgery, there is at least a chance!