Groin pain can be from hip?? Really?

[Freedom]

The OS who did my knees only does knees and shoulders. He referred me to the OS within the practice who does hips. That was this morning's appointment. I'd already looked online, not really excited w/ this guy, but decided to use the appointment to gather info. This is another OS in this area whose name comes up ALL the time re joint replacements. I couldn't use him last year for my knees, as he wasn't on my insurance. As of Jan 1 I have new insurance, and now I can see him. But as I am a new patient to him, can't get in till Feb 28th; I DO have that appointment made.

( Today's OS is age 39, and his healthgrades rating is 3.2. The other guy is age 64 and his healthgrades rating is 5.0, the highest rating possible. Both of them have over 10 reviews.)

So today I never met the OS, only his PA, who kept pushing the cortisone injection. He said I am certainly not at end stage arthritis, and they don't just jump in to surgery. First you have to try other non surgical paths: limit activity, rest, ice, anti inflammatories, PT, injections. I've done the first 4; I am now taking 3 ibuprofen 3 times daily just to get through the day. My dogs are used to a 2 mile walk, I can barely do 1/4 mile. And I pay for that at night in bed. PA today also said I don't have the right xray angles / views, because the knee man did those, and I don't have a good MRI as with no dye. They would redo xrays before moving to surgery. Current xrays show the gap is small on the front inside of the hip, but the rest of the hip seems ok. He also said this OS only does posterior surgery. He went on to say there are 100's of ways of getting in to the hip, it doesn't matter which one you use, muscles and tendons have to be cut, and then you have life long restrictions. Further, he said my hip still has life left in it. I can go on as I am, or I can get an injection. He said the injection would give a good idea of how I will feel post replacement surgery. He claimed over 75% of people get a year of pain relief from their first injection. I asked what if the injection doesn't give me pain relief. Well, then it is not a hip issue and we go back a step to diagnosis.

I asked about post op restrictions and he said the therapist goes over all those with you after surgery.

Several things he said above don't jive with what I've read online.

I said I would think on it. Not inclined to use this OS (I haven't even met him yet!), and I think if I decide to have an injection (no way!), that should be with an OS that I plan to have do the replacement surgery.

I've just read through 5 or 6 other threads including the one titled Does Risk of Dislocation depend on Surgical Approach, and I read the 3 links provided there, in post 2 by Sharonslp, Forum Advisor. So I am still gathering info.

Oh, @Jaycey in response to your comment directly above: the OS does ONE approach, so there is no "let the surgeon select the approach which fits your situation." They train in one approach, and they pay to learn to use one brand of implant. If you want a certain approach or implant then you select a surgeon who does that.

Thus, in a holding pattern until Feb 28th.

 

[Jaycey]

If you want a certain approach or implant then you select a surgeon who does that.

Sorry, that's exactly what I meant. The surgeon will have an implant they have experience with and a favoured approach. They should give you a reason for both options.

Sounds like a frustrating appointment. I hope you see better results on the 28th!

 

[leejaa]

I have had a posterior approach by my OS who also did my knees but my restrictions will be only 6wks. The PA seemed hugely under educated for what is current practice in orthopaedics. Good luck on the 28th - hopefully you will get more information and support.

 

[AWS]

He claimed over 75% of people get a year of pain relief from their first injection.

The last injection I had gave me relief for 3 days. Then pain started again and it was worse than before.

 

[RSC]

@Freedom, I wouldn't concern myself with anterior/posterior, but rather on finding a good surgeon. I started the "Does risk of dislocation" thread and ended up going with posterior. It ended up just fine. I'm about 3 and a half months out and I can walk as far as I like (at least 7 miles) without any discomfort or difficulty in the hip. The PA gave me supposedly lifelong precautions, but the OS says that actually in my particular case I would have to get hit by a car or fall off a cliff to dislocate. I was told that it would be a 7 inch scar, as I recall, but it actually ended up 5 inches and is completely hidden by briefs, although I almost always wear boxers.

 

[Freedom]

I'm glad I have my notifications on, as now I see I have not updated folks here. The appt on the 28th is canceled.

Thursday, Feb 16, I had a phone call from that office, saying the surgeon does not accept my insurance. I was surprised because I went through this with them last year, for my knees. I specifically changed plans as of Jan 1 to get a plan which has him in network. And I had checked online before I made the appt. And my PCP's office had made the referral with no issue. So I said I wanted to check w/ the insurance co and I would call back.

Called the insurance co, yes he is in network. I explained about the phone call . . . my person, who was in Member Support, then called over to Provider Support, came back on the line and told me that he definitely is in my plan. Next she put me on hold and called the office. Came back and told me it was really weird, the person kept saying no, we do not accept that insurance. She suggested I file a grievance for denial of service.

So I did that with her, on the phone. I made sure it came across as "I am a mere member, my insurance company tells me one thing, the surgeon's office tells me another. I know only one of them is correct but I have no way to determine which one. " And I also mentioned that now I feel like I can't rely on the online provider search. She said it usually takes 30 days to get a response.

After the phone call, I was very upset. I've heard so many good things about this surgeon.

Friday, Feb 17, I get a call from the woman at my PCP's office, just following up, checking if I had the one surgeon's visit (yes) and I was ready for the next one on the 28th. So I filled her in. She said "that's crazy, of course he is in network! Let me call." Twenty minutes later she calls me back and says she is completely baffled, the person insists they do not take my insurance. She wanted to do some more digging and she would get back to me by the end of the day.

She called again at 3:45 (the office closes at 4). She said she'd called network support, my health insurance provider support, and I don't know who else, she has several people working on this. She is out of the office this week, returns on Monday the 27th. She said not to worry, even though she is out of the office all these people will work on it this week, and she will check on the status first thing, then call me. She said for me to plan to go on the 28th.

I completely forgot that the other person, the one at the surgeon's office, had told me she canceled my appt. Didn't even think of it till 5 PM, lol.

I feel better knowing there is someone working on this for me.

Nothing is ever easy with health care!

 

[Jamie]

What a discouraging experience! I'm so glad your GP's office picked up the leadership to get this resolved. They will get to the bottom of it. If your insurance company verifies this doctor is in network, then he is! It sounds like you've talked with some admin person who doesn't have their act together. Good for you for pursuing it!

Please don't let this experience sour you on the surgeon. He sounds like the right one for you. I did not like what you were hearing from the other surgeon's office....was going to advise you to run quickly to someone else. But you already had that figured out! Sometimes you need to trust yourself to make the right decision.

Although your xrays are a bit difficult to see, it actually looked to me like the joint had pretty significant problems. But I'm going to tag @Josephine to have a look. She's the expert.

Hang in there....this will get worked out. Maybe you can get that appointment back if you call first thing Tuesday.

 

[Josephine]

He went on to say there are 100's of ways of getting in to the hip, it doesn't matter which one you use, muscles and tendons have to be cut, and then you have life long restrictions.

There may be 'many' ways but in no way are there 'hundreds'! And no muscles are cut. Only exception to this is in the posterior where the piriformis is cut to enable the hip to be dislocated. But it is carefully stitched up again afterwards so is rarely a problem. Other then that, muscle bodies are teased apart so the surgeon finds a pathway through them to to joint - like this - the blue line

so there is no "let the surgeon select the approach which fits your situation."

In all my career I have never seen a surgeon use more than one approach. Mostly they were posterior and lateral/antero-lateral.

I also looked at your xrays - as you can see, I cropped them a bit! The only thing I can see as an issue are the white bone areas marked with the arrows. Generally, this white bone is a sign of hardening which is osteoarthritis

 

[Freedom]

Wow thanks @Jamie and @Josephine. I didn't realize what the white areas meant. I've marked the one area which bothers me, in the blue circle. And it hurts almost constantly!''

LOL yes Jamie, the xrays were taken 'by the knee man, and aren't what we like to see' according to the PA I met. And I did try, can't make an appointment until they get everything sorted out. Just now the surgeon's office says I can't go there.

I appreciate all the help and support I get on this forum!

 

[Josephine]

I expect you'll find that any movement that involves turning your leg inwards will hurt, or turning it inwards and lifting it.

 

[Freedom]

Yes, that leg is the weak one. Considering the knee was done first, should be strong! Nope. And as I've said (I think) climbing over the tub to stand under the shower hurts; climbing over the middle bar to sit on the leg press and strengthen the quads hurts Actual motion on the machine is fine, it is the getting on and off.

 

[Freedom]

Latest news. Surgeon I wanted to see is not in my health network, so that is not possible.

Just called a new place, bit of a drive which is fine as long as I can drive, not sure how I will get there and back if it comes to me not being able to drive myself. Anyway appt is Apr 12. And as the last xray will be 6 months old, they will take a new one that day before I meet w/ the surgeon.

Meanwhile, hip continues to get worse. I still limp but now use a cane as I feel very unstable. I often have a weird feeling on my rump. Mornings are very difficult. I can't take ibuprofen on an empty stomach, so I have to get the dogs out and in, feed the cats, get my coffee and breakfast, eat, wait 15 to 20 minutes (if I take the ibup. sooner I just throw up), THEN get the ibuprofen. I am usually in tears by then. And it takes another 15 to 20 minutes for the ibuprofen to help. I often have what feels like swelling down the outside of the leg, almost down to the knee IN THE MORNING when I get up. (I am rather large, so it is not possible to see this swelling, but I feel it). In bed, moving is hard so I'm not sleeping well. I start on my back when I get in bed. I can roll over onto the left side, that is ok. But I can't roll over to the right side - that requires using the left hip, apparently. So I have to sit up, use my hands to lift and turn my rump, then lie down and complete the turn. And I have to use my right leg to move the left leg over. So awkward! And I do this a few times during the night.

Saw OS yesterday re knees; no need to return for 3 years! Hooray! Just wish I could use my 'shiny new knees.'

He again encouraged me to have a cortisone injection. I'm just not convinced we have the right diagnosis for what is causing the pain. And, I don't 'do' injections. So not going that route. He thinks I am nuts, and asked me why. I told him "fear of pain is strong." He just shook his head. Said it is very easy to get in to the hip joint and there is no pain with the injection. (Well, some folks do report pain with it!) He said as to posterior or anterior, doesn't really matter, higher risk of infection w/ anterior, and if you ever need a revision - which at my young age (58) is highly likely down the road - that has to be posterior, and so I will have 2 scars. (This was when we were discussing my keloids). And after the first 6 weeks post op, no difference between the 2. Well, that 6 weeks is when you have more limitations w/ posterior and, me having little to no support, 5 dogs and 7 cats, that is a big factor for my situation.

Just a way to keep track of where I am at, what I am doing, what I am working towards. From the Sept 12 xray, I agree w/ him that this hip is not (yet) to the point of needing replacement. From the same xray, there is not much difference right to left; so why is the right fine and the left giving me so much pain? Nope, not convinced we have id'd the issue yet. Hope to learn more on Apr 12.

 

[kayak59]

Freedom, after being told that my groin pain was from my back for a year, I'm going to have a total left hip replacement! Can't wait! Had both knees replaced for Christmas 2015 and have had nothing but back -- and hip although at the time they thought it was just my back for over a year. I've had multiple cortisone shots and a Right SI nerve ablation but was still having increasing, eventually agonizing pain in hip. Finally went to see hip specialist. Got x-ray guided cortisone shots in my hips today and when I get back from holiday in England, I am getting my left THR using the Superpath technique scheduled. Totally thrilled! Went into my knee replacements with grim determination but at this point, I can't wait to get this done. Finally, light at the end of the tunnel! So looking forward to getting my life back!

 

[Freedom]

Good for you kayak59.

I am still not sure I have the correct diagnosis. Sure my xrays show arthritis; but it is not advanced and it is the same in both hips. Why is the right fine and the left giving me so much grief?

Now a new problem: the surgeon I plan to see April 12 does take my health insurance; but he is not in the same network at my Primary Care Physician, and she is not going to give me the referral that I need for the insurance to cover the visit. Geesh!

 

[Freedom]

@kayak59 I realize just now, my comment may have sounded curt. Not intended that way! I was just so frustrated w/ my own situation. And there aren't many docs trained in Superpath, nearest one for me is about 40 miles away and my PCP wouldn't make the referral!

Hey everyone. Saw new surgeon. Will have a cortisone injection on Tues of next week. I'm not happy about that but my health insurance wouldn't approve surgery without it. And I can't go on living like this! New xrays were done today; major changes since last set 6 months ago. Definitely a LOT more arthritis, a LOT more bone deterioration, and 2 rather large bone spurs - none of which show in the Sept 12th x-rays.

A Radiologist will do the injection at the hospital, with fluoroscopy.

Nice doc, I like him, will stay with him for this round of issues.
X rays from today and w/ bone spurs marked

He also said this left is not nearly as round as the right. It is very bumpy. Again, more so than in the first round of xrays from Sept 12, 2016.

 

[Horseshoe]

Ouch! Didn't know that insurance co's could require cortisone injections before doing a thr, thought that was OS's call. Anyway, I hope it brings you some relief. I wasn't offered any cortisone, hips were too far gone!

 

[Freedom]

Thanks, @Horseshoe . The surgeon explained it this way: if the xray shows bone on bone, or hip collapsed, then surgery is approved. I do not have those situations. So the injection is a diagnostic tool. Part of the shot is an anesthetic, and I 'should' be pain free for an hour after the shot. Once the anesthetic wears off, then we see if the cortisone helps by reducing inflammation, or not. But the first hour helps determine the pain is indeed from the hip and not from somewhere else (back, sciatic nerve, torn ligament or tendon). At least, this is how I understood his explanation. I'm not happy, I don't like the whole idea of the shot, and I avoided them w/ my knees.

 

[gaulsuerou]

Thanks, @Horseshoe . The surgeon explained it this way: if the xray shows bone on bone, or hip collapsed, then surgery is approved. I do not have those situations. So the injection is a diagnostic tool. Part of the shot is an anesthetic, and I 'should' be pain free for an hour after the shot. Once the anesthetic wears off, then we see if the cortisone helps by reducing inflammation, or not. But the first hour helps determine the pain is indeed from the hip and not from somewhere else (back, sciatic nerve, torn ligament or tendon). At least, this is how I understood his explanation. I'm not happy, I don't like the whole idea of the shot, and I avoided them w/ my knees.

My surgeon also said he had to do the shots before I could have surgery, part of the progression I guess. I had such high hopes for the injections figuring it would buy me time, when I got off the table I did not think I was any better, had a feeling of fullness, and over the weekend I had a lot of cramping in my butt area and down my legs, that soreness did wear off but the shots did absolutely nothing for me. I too am dealing with insurance issues and have to jump through a certain set of hoops. All I want to do is get scheduled for surgery and get it over with and take back control of my life!


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[kayak59]

@kayak59 I realize just now, my comment may have sounded curt. Not intended that way! I was just so frustrated w/ my own situation. And there aren't many docs trained in Superpath, nearest one for me is about 40 miles away and my PCP wouldn't make the referral!

Hey everyone. Saw new surgeon. Will have a cortisone injection on Tues of next week. I'm not happy about that but my health insurance wouldn't approve surgery without it. And I can't go on living like this! New xrays were done today; major changes since last set 6 months ago. Definitely a LOT more arthritis, a LOT more bone deterioration, and 2 rather large bone spurs - none of which show in the Sept 12th x-rays.

A Radiologist will do the injection at the hospital, with fluoroscopy.

Nice doc, I like him, will stay with him for this round of issues.
X rays from today and w/ bone spurs marked

He also said this left is not nearly as round as the right. It is very bumpy. Again, more so than in the first round of xrays from Sept 12, 2016.

Ouch! That does not look good! And no problem! I got my first hip cortisone shots a week ago and it did help! The crushed glass feeling in my groin is nowhere near as bad now - if I don't do anything. Would not exactly recommend can international trip in this condition but it is so wonderful to see my relatives and just be here. Good for the soul! (And am SO glad I brought all those Lidocaine patches with me! Helping tremendously!)

Good luck!

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[Lilli215]

Groin pain is def an indicator of arthritis in the hip, i had an MRI on the hip which showed mild arthritis and a few developing spurs. I know it will need replaced sometime in the future but need to get through a LTKR next Feb first!! My groin pain has got a bit worse since my RTKR in January , physio gave me an exercise to do which helps a bit, oh the joys of getting older!!!