THR Heterotopic ossification, not what I expected

[Layla]

Hi Mr.fun,
Wondering how you're doing and how the appointment with your surgeon went?
I hope there is some resolution for you in this New Year.
Wishing you only the best!
@Mr.fun

 

[Mr.fun]

@Layla im still feeling the same. 2nd surgeon Agreed that the HO is a problem. Original surgeon wants me to wait until Feb to make a decision on how I want them to proceed. Waiting also allows the bone to mature. Im under the impression that both surgeons will be present for the HO excision. But I still have numerous questioned to be answered when I go back nxt month. I'm still uneasy about all of this. I just feel there is more to this issue then what the xray is saying. Right from surgery I swapped my old issues out for these new ones. My hip flexor area still feels very inflamed. (ANTERIOR APPROACH) It feels like it did after surgery with stiffness and inflammation. I just never turned the corner and continue with the inflammation. Thanks for reaching out.

 

[Mojo333]

Hi @Mr.fun
I can only imagine that the thought of more surgery is anxiety-producing...to say the least, but it is time to get back on a healing path so you can get back to a painfree life.

But I still have numerous questioned to be answered when I go back nxt month. I'm still uneasy about all of this. I just feel there is more to this issue then what the xray is saying. Right from surgery I swapped my old issues out for these new ones. My hip flexor area still feels very inflamed. (ANTERIOR APPROACH) It feels like it did after surgery with stiffness and inflammation.

I understand you questioning this diagnosis, but it is possible HO is the responsible party for your complications.

The fact that in your quest to find the source of the ongoing pain... pain that originally wouldn't be deemed unusual for the immediate time after your THR...then with time, it seemed possible improper cup placement or impingement might be the culprit which would also explain the symptoms...and finally Heterossification which means bone is continuously growing into the already angry soft tissues and certainly looks like it could ultimately be the culprit since the most common presentation of the presence of HO will be pain and decreased range of motion (ROM).

Patients often complain of stiffness in their joints. Other common signs to look for are local edema, effusion, erythema, warmth, and tenderness in the tissue or joint.

Waiting also allows the bone to mature

Yes, this is important for a successful outcome

According to National Institute of Health: Absolute treatment with surgery only after HO has fully matured, which can take up to 12 to 18 months.

I am sure that I would want to ask the surgeon/s " How sure are you that HO is the only cause of my lack of improvement? What do you expect my recovery to look like?
Which prophylactic measures will be employed to discourage reoccurance?
How often will my progress be monitored and when will imaging be able to assess the success of the excision?"

I do hope you stay positive and we have had members who have dealt with this and are back to their lives!

 

[Layla]

Thanks for the update. I do hope this year brings you hope, healing and peace.
Please keep us posted, we do care.
@Mr.fun

 

[myglasshalffull]

All my best on this continuing issue. Hope it gets resolved and be sure to ask all the questions, advocate for yourself. And you might want pen & pad with your questions before your appt. I did this & helped cause when I had my first appt after surgery there were a few things I forgot to ask about.

 

[Mr.fun]

As a last resort I will be starting shockwave therapy this week. Will try treatment for a month and meet with surgeon after those treatments to make a decision on how I want to proceed.

 

[Layla]

Oh...I need to read up on this.
I certainly wish you the best, Mr.fun, and hope you will share your progress so we're able to encourage you along the way. Hopefully you achieve the desired result. We're rooting for you all the way!
@Mr.fun

 

[Mr.fun]

Update
1 year anniversary last week FEB 8TH. I did 5 sessions of shockwave. Not much help. If anything it aggravated the soft tissue hip flexor area more. I'm still not able to put a sock or a shoe on the operated side. Sitting on a toilet still sucks. Any general sitting to be honest sucks. I had a bone scan jan 22 2024. Attached below. Still active HO. My pain may be a little better. ROM is the same if not worse. I'm Waiting for the HO to stop maturing before I make a decision. I go back In four months for another bone scan. Surgeon is compassionate but seems to have no answers to my questions. he does not know of anyone the specifically does HO excision. Hopefully more answers in 4mnths. Surgeon says he is actively talking to other orthopedics around but none have experience/knowledge.

 

[Mojo333]

Hello, @Mr.fun
I feel really bad that the shock wave treatment didn't provide any relief, and due to the nature of H.O., this waiting period is necessary before any further treatment may be possible.
We don't see very many members who develop this complication...and I'm sure it isn't a risk factor that you considered either.
Apparently, according to what I read, being male is a risk factor. Certainly that isn't narrowing things down.

It seems that prophylactic treatment is the accepted way to prevent but how are surgeons to know who will develop H.O?

I know I am not being very helpful. I hope that your surgeon will be able to identify a revision specialist that can do the necessary surgery...
H.O. is not extremely common, but is not rare or unheard of...so I am certain orthopedic Surgeons have had to deal with it.

I hate that just sitting causes you so much discomfort.
Hope you can find ways to make things more tolerable.

 

[Jamie]

Here in the US, there are surgeons who deal specifically with HO, but I don’t have any way of knowing if that’s the case in the Canadian medical system. It is good that your current doctor seems to be trying to locate someone.

I wonder if you would be interested in getting a review by the surgeon team at the Hospital for Special Surgery in New York City? They will review cases via telemedicine, but there is a cost….I believe it’s about $600. If they had recommendations, you obviously would have to travel there for the treatment. They do this frequently for residents of the US and have hotels and other support available at reasonable costs. This process does work for people who are willing to travel for treatment. If you had the review now, they might decide there was something they could do now and not make you wait until the ossification had stopped growing.

 

[Layla]

Hello Mr. fun
I am sorry to read this news and even more so that you have to wait an additional four months for the next bone scan. My heart goes out to you and your family as I am certain it affects you all, each in different ways. Hopefully, Jamie's idea above is something you may be able to consider. Stay in touch and know that we're here for you always.
@Mr.fun

 

[Mr.fun]

@Jamie @Layla
Paying out of pocket is not going to be possible. I could pay for the initial appointments but paying to have any surgery in the US would not be possible. We get free healthcare in Ontario, Canada. It took 2yrs of waitng for my original hip replacement. Now thar I am having complications. I have had to wait once again. The 2 surgeons I have seen for the HO Agree with my original surgeon that it is the HO. I am not so sure. The problems with groin impingment started after surgery. (Day 1) I have never improved since the 5 week marker. ROM AND PAIN THE SAME AS AT 5 WEEKS. My xrays also look like the cup is not even positioned inside the pelvis compared to what I have seen online and looks to be pointing forward and down. I'm not a doctor but complained of my hip joint being in the way as a reason of not getting my socks on. Hip does not move out of the way. Meaning slide back. If that makes sense. I complained of this before I had seen the xrays. (Attachments are in previous post for reference) I feel the HO is secondary to the cup placement. My original surgeon says he will do the surgery for HO. But I am not confident that it is just HO. He has 20yrs doing Anterior approach and has never had this outcome with HO. So essentially he is saying he has never preformed HO excision. Im still waiting for referrals out of the area. My hip flexor is so tight. It feels better to walk. If I lay down with out a pillow under my knee it just has this painful pulling/tugging sensation. If I sit for to long I get the impingment feeling and It start to go numb in the front. Also pulling and tugging until I walk. It has all the symptoms of the healing in the beginning of give it more time. Every post I have read has some of these issues. Including the deep ache at night. However I just was never able to turn the corner. Even though some days pain wise I think it's possible. The more I try to ramp up the strength training and stretching it gets worse. Hip gets more and more inflamed. I back off things for awhile and repeat. Even the elliptical for 10min will cause problems and I am over a year. Can not ride a bicycle. Impingment at top of rotation.
I don't have a problem going down stairs. pinching going up. I can step into my car from the driver's side. Right leg goes underwheel but from the passenger side it is difficult to lift/pull my leg in. It is my Right hip that has the replacement. Over all I am coping well mentally. I still workout.. upperbody mostly. I started working out as a teenager. It has become a part of my life as well as eating healthy. I am not overweight and have not gained any wait do to this disability. Frankly I am glad that I found the gym early on in life as a method of coping and not alcohol. I try to continue my life as I wait. This is not something I focus on with anyone else. People know that I am having issues. They see me limping. People that know me know that when I say how are you. All I want to hear is good. I do the same. That being said I will post here when I know more. I want other people who are going to have a hip replacement to learn from this as well. Not sure why medication is not protocol for this complication during joint replacement. Which they do have. How do you know someone is susceptible to HO until they get it. This form is a good avenue for people to be patient when healing. You girls are doing an excellent job helping people find their way through the fog. MRI 2nd week of March. I have waited 8 months for. Take care for now Mr.Fun

 

[mendogal]

It must be so frustrating. Hang in there Mr. Fun!!! We'll be waiting for your MRI update.

 

[Constanze]

Hi @Mr.fun ,
I admire your discipline and am sorry - like everybody else here - that the shockwave treatment isn't helping. To judge by the way you describe the position of the cup, however, it sounds logical to me that only a revision could help. It seems you are also right in saying that the HO is not your only problem but just one factor contributing to your pain and inability to put socks and shoes on, to ride a bicycle etc. So you will probably have to have this done, but it's so frustrating that one has to wait so long, isn't it. One has to wait for surgery in Germany, too, but not THAT long.

A good thing is that your coping strategy is exercise (even if it's mainly upper body work-outs for now ), not alcohol or overeating. So is mine, actually. Have you ever considered crawl swimming (not breast stroke, because that involves flexing your hips, and that would not be suitable). Of course that is, providing you have a swimming-pool or a lake in your area. I left my hip operation way too long, so I was in terrible hip pain pre-op, limped and couldn't run anymore, but swimming partly helped me alleviate my pain. It also helped remaining reasonably fit and strong pre-op while waiting for my surgery. There is a lake not far from where I live and I wore a wet-suit when it got colder.

Yes, and do post updates on Bonesmart.

 

[Jamie]

I understand the money issue about going outside your medical system. But I do agree with you that what you describe could indicate more problems than just the HO. I do hope you can work out a way to get another opinion on your hip before any procedures are done.

 

[newguy]

WT.....Geezee.. I feel ya. Awful and seemingly Unacceptable.

 

[Mr.fun]

MRI results.

 

[Layla]

Hi Mrfun,
I am wondering what your surgeon had to say and if there's a plan?
@Mrfun

 

[Mr.fun]

@Layla I follow up with him shortly. I am still waiting for my referal appointments to come through. My hip flexor pain out of surgery has felt that it was over stretched and just never turned the corner. I complained of Illiosoas impingment. I feel the HO is secondary to how I have felt from surgery. Even when xrays where normal I still felt this way. HO appeared and surgeon went with this diagnoses. I am taking my time and want to make sure that every possible complication is caught. I fear getting HO removed and my symptoms continue. I some times wonder if I wasn't working on my feet for 12hrs to sometimes 16hr shifts if I wouldn't feel better. I just had a week off and inflammation goes down a bit. ROM gets a few degrees better but soon as I go back to work I regress. Realistically This is not going to be a quick fix. Could be a couple years before I find a new surgeon with more knowledge. I am going to ask for an injection into the illiosoas and go from there.

 

[Layla]

I some times wonder if I wasn't working on my feet for 12hrs to sometimes 16hr shifts if I wouldn't feel better.

Wow...that is a LONG time. I am sure you would feel better if you weren't on your feet for so many hours.
Gosh I hope you're able to find a surgeon sooner than a couple years from now. Please keep us posted and let us know how your follow up visit goes. This has to be very difficult. I'm so sorry.