THR Groin issue after anterior THR

Denpucc1

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Hi everyone. I had an anterior full right hip replacement after a bad fall playing pickle ball. its been over 12 weeks and I have intense groin pain. I’m also a weird case because I have a rare condition where scar tissue doesn’t stop forming and it hurts to break it up. The surgeon recommending some kind of shot and if that doesn’t work surgery. Has anyone out there heard of this shot and what’s it called so I can do some research. Thank you!
 

djklaugh

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@Denpucc1 Welcome to BoneSmart :welome: Please tell us the date of your hip replacement - we will make a signature for you and the information will help us address your concerns more specifically.

Do you have the name of the kind of injection your surgeon suggested? Without that information it is hard to assess how helpful it would be to you. If you do not remember perhaps you could call or email your surgeon and ask?
 

Jaycey

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@Denpucc1 Although it's been awhile since your surgery, I think you might benefit from reading our recovery guidelines:

Hip Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Magsmom

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@Denpucc1
I’ve heard of steroid injections for painful exterior scars but not for “internal” scar tissue that formed and replaced the soft tissue.

I have lupus and apparently some autoimmune conditions are connected to production of excess scar tissue. Apparently I’m an exuberant (their term, not mine) producer of it. It was a real problem w my knee replacement in 2019.

I’ve had both hips done in late 2021 and so far, no scar tissue issues. We think it’s partly bc I’ve been in Plaquenil for the lupus for 2+years now.

I hope they can take care of yours! Good luck
 
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Denpucc1

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Hi,

Thank you for getting back to me so soon! My surgery was on 10/31/2021. I don’t know the name of the injection but the surgeon told me it contains cortisone. The surgery is called iliopsoas tenotomy. How do I know it’s not the scar tissue causing this issue. I have incredible sharp pain in my groin when I try to lift my leg, getting in/out of bed or a chair and when I start walking.
 
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Denpucc1

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@Magsmom

I also had issues with with my right knee replacement. Internal scar tissue kept forming and coming back. I did have an MUA for the knee. Right now I’m having issues with my hip replacement and I don’t know if it’s a tendon issue or due to scar tissue. My surgeon says I present as having groin pain due to the tendon. Ty for your response!
Best to u!
 

CricketHip

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@Hip4life isn't this what you went through? @SaraK also?

@Denpucc1 Welcome to the forum... I think you will get some good feedback soon from members who have experienced this. I'm thinking that regardless of it being scar or tendon, it could be addressed during a surgery, if needed. Some members had an inflamed tendon and a steroid injection seemed to help in diagnosing the extent of the problem. I believe in mild cases it was all that was needed. The colleagues that I mentioned above will visit your thread soon and give you some advice... good luck!!
 

Hip4life

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Hello, @Denpucc1 I am so sorry to hear of your ongoing issues and pain. Although I don’t have scar formation issues, let me try and shed some light here as I experienced the tendonitis.

The injection is usually a combination of anesthetic and cortisone (a steroid.) The purpose is two-fold: pain relief and diagnosis that it is the tendon causing your issues. Mine was done guided by ultrasound. If it is tendonitis, you will experience immediate relief. The cortisone could take a day or two to fully work in which you still might have some pain. Once it works: glorious pain relief. Then it’s wait and see how long it works. You may get that tendon’s inflammation to subside and you’re good. It may be short-lived and then you have more decisions. Mine lasted two weeks. In my case, it was the tendon but the inflammation was not going away. My acetabular component had a slight overhang and my tendon kept sliding over it. It would continue to be aggravated unless we did something else.

So I then faced the surgical options: tenotomy or acetabular revision.
Revision: this speaks for itself. Repeat surgery and replace the acetabular component.

Tenotomy: two procedures: based on the anatomy of the iliopsoas muscle and where its tendons are located. Partial is where some fibers are cut in the part of the tendon closest to the capsule (where your THR took place.) This essentially releases the tension and lengthens it. A complete is accomplished by completely cutting the tendon at the other end of the muscle at the lesser trochanter. This also releases the tension along the whole muscle. The complete is what I had done.

These procedures are usually done arthroscopically. The advantage here is the surgeon can see what’s going on in the hip area and take care of any issues including, I would imagine, those that might be caused by scar tissue.

If the injection doesn’t give you lasting relief, the next procedure will be chosen based on your OS’s expertise, your circumstances, and your goals.

I hope this helped. This road can seem daunting when you don’t know where it goes but I tried not to overwhelm you with details at this point. Just know there are options. Remember that it is a process that can take some time as you figure out the next best step both literally and figuratively. Keep asking questions. We’ll try and help fill in the blanks as we can. We are happy to support you along this journey. Tag us as you need (use the @ followed by our username e.g. @Hip4life ) Blessings.
 
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Denpucc1

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@Hip4life
thank you so much for your very detailed response. It helped me tremendously. I know some wanted to know the injection‘s procedure name. It is called Psoas Tendon Sheath Injection according to my surgeon. Since my surgery was due to trauma and was done on an emergency basis on a weekend I didn’t get a choice of surgeon but was guaranteed he would take my insurance. True as far as the surgery but his practice does not take my insurance. I need to find a way to get this injection done through my insurance.
 

Hip4life

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Perhaps your surgeon could refer you to a couple of other specialists. My OS didn’t do the injections and referred me to a doctor who specialized in doing the procedure. With this in mind, referral would help narrow down your search. Keep us posted.
 
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Denpucc1

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@Hip4life
thank you again for all your help! My pain management doc can do the injection procedure. I’m scheduled for 1 pm on 2/9. I was given no instructions as to not eat or anything else. I’m guessing the shot is done similar to the 3 nerve ablations I had done on my right knee (also ultrasound used) to deaden these nerves which gave me wonderful pan relief for 8 months. I had these shots done again and they are live changing! I have to go to a different surgeon cuz my current one doesn’t take my insurance for office visits (the US healthcare system in the US is awful). Luckily this new surgeon will take me on as it’s very difficult to find a surgeon who will even look at you if another surgeon did the THR. I’m just concerned it is scar tissue causing the issue and I don’t know if that can be fixed‍♀️
 

Hip4life

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You will have a better idea after the injection. If you get relief, it will narrow down that something is causing that tendon to be angry whether that is scar tissue or something else. I’m glad you found another surgeon who can help guide you through this process.

The injection is only a couple of weeks away. There was no prep for my injection except to show up. Lol. You’ve had some experience so you know how you react to them. I annoyingly tend to feel light headed after anything that involves a needle. So I eat lightly and ask to sit for a while afterward. It hasn’t ever been a problem. I hope the next two weeks pass quickly for you and you finally get some answers.
 
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Denpucc1

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Can anyone tell me how long it will take me to be able to sleep on the side I had my THR? I sleep most of the night in my right side but haven’t been able to since the surgery. Thank you!
 

Elf1

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@Denpucc1 :wave: nice to have you join us. Sorry you're having some issues but hope the upcoming injection gives you more insight and hopefully relief.

As far as sleeping on the op side, totally depends on the individual. Assuming you don't have any restrictions from the OS. It took me quite a while and I still have some discomfort. I do have various other things going on that may contribute to that though.

If I remember correctly when I first worked up the nerve to try it I used a small, very soft pillow under my incision area. I had anterior-lateral (sp?) so my incision/scar is right down the side of my right leg. Kind of like those rectangular travel pillows you can get, not the loop one that goes around your neck.
 

SaraK

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Hello- late to the party, but I also has psoas issues. I finally got the diagnosis confirmed at around the 1 year post surgery mark after months of pain. The injection is fairly quick and easy and no prep needed. The pain lifting leg and getting into the car are hallmark signs of a psoas issue. The anesthetic in the injection should give immediate relief if the psoas is your issue but it will only last 30 minutes or so. The cortisone will take a couple of days to work fully.

It gave me full relief but only for about 10 days. Good news/bad news - it was the psoas and they could address it, but injections weren't going to be the solution. The injections are the gold standard for diagnosing the issue. I had the lengthening at the capsule/groin by arthroscopic procedure and have recovered wonderfully.

You are still in very early days, though. Some doctors won't do injections this early but I've heard of some that a single injection at this point was all they needed.

Best advice in meantime is rest, elevate and ice and if it hurts, don't do it!
 
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Denpucc1

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Thank you so much for your response. Everything I’ve been reading seems to indicate that people with our issue had to wait a long time for the injection. I don’t want to be in pain for months. I want my life back. The summer is coming and I want to bike, golf, play pickle ball, hike, kayak, etc. Why should people have to wait when all indications point to the tendon issue? I hope I don’t have to wait a year in pain before a surgeon will do the surgery. I don’t know of many people who had the injection worked for them for very long. I don’t want to be taking 1200 mg of Advil every day, ice and elevate and not be active. I have all the signs of the tendon being the issue. After nearly 7 years of not being able to do anything because of my scar tissue issue that was diagnosed when I had my right knee replaced and years of PT, acupuncture, light therapy, heavy duty drugs, I finally got relief from having 3 of the nerves in my knee deadened. I spent the spring, summer and fall being so active and I want it back.
 

Jockette

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After nearly 7 years of not being able to do anything because of my scar tissue issue that was diagnosed when I had my right knee replaced and years of PT, acupuncture, light therapy, heavy duty drugs, I finally got relief from having 3 of the nerves in my knee deadened.

I‘m glad you got relief from the nerve ablations in your knee!

Please tell us the date of your knee replacement, and which knee it is, and we’ll add that to your signature. :flwrysmile:
 
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Denpucc1

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I had my right knee replaced in December 2013. Because of the scar tissue issue I had a significant limp and my ROM was not quite 90 degrees. The surgeon went back in to try and remove as much ch scar tissue as possible but it just came back.
 

SaraK

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Part of what I was saying was that there are two different tendon issues possible. I had psoas tightness and pain after both THRs that resolved by the 3 month mark with no injections, etc. The first never had another issue. The second was fine for a bit but then started having problems that started small and ramped up over time. Many surgeons don't seem to want to recognize this issue so it took me a while to find a new surgeon to diagnose it. In the meantime, they tried injections into the psoas near the spine, PT, muscle relaxants, pain meds, a heel lift, rest, etc.

So, while an injection might be helpful now in helping it to settle, you may just be experiencing normal issues with the muscles having been stretched and irritated that will go away without other significant intervention being necessary.

It's hard, but try to be patient and give it a chance to resolve. Even the cortisone injections can be stressful to the body, so many surgeons don't want to jump to that too quickly. If this doesn't resolve, surgery is still there. That's the big gun, though, so more conservative/less invasive/less expensive options (including letting the body heal itself) are generally tried first.
 
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Denpucc1

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I didn’t realize my issue may resolve in its own. My surgeon recommended the injection so I scheduled it. I’m seeing a different surgeon due to insurance so I’ll be getting basically a second opinion. You have given me such relief as I honestly thought my only option was to see if it was the tendon and then surgery. Phew!!! Ty so much!
 

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