Hip pain

[Suttree]

Good Morning and Happy Easter. I've been lurking on this site for the last few weeks and am finding it very informative and well run.

I began experiencing pain in my right hip during August 2015. It hurt to put weight on my right leg . . walking was/is painful. I have a history of occasional lower back pain so I figured this was somehow related. I started the stretching routines and took advil. After a few months I went to family doctor. He took x-rays and it showed "mild osteoarthritis of the right hip". The x-ray also showed some disc protrusion so he referred me to a spine specialist. An MRI showed bulging discs and stenosis. I began a year of rehab (PT, needling, ART, standing desk, stretching, more stretching, etc, etc . .) but no relief. I tried three nerve blocks that each brought around a day of relief but that was it. I felt like I had exhausted my non-invasive options so in October of 2016 I had surgery (2 level microdisectomy, L4/L5, L5/S1). Followup MRI showed the surgery accomplished the physical goal of creating some space and cleaning things up . . but brought no relief to my hip pain.

One constant through the last 18 months has been muscle knots in my glut that will not release. I thought the description of 'piriformis syndrome' matched up best to what I was experiencing but there doesn't seem to be any universal treatment to jump on that was any different than what I had already tried. On a whim I went to see a chiropractor a few weeks ago and he took x-rays. He burned them to a disc and asked me to take them to my doctors.

I'm now waiting to see a new OS at the end of the month that specializes in hips. I've not received any professional opinion yet from the chiropractor's x-ray image. Obviously right side does not look like left side but my eye is not trained to make any better sense of it. I thought I would post here to see if there was anything noteworthy to gleam from the community's collective experience. I'm also attaching a pdf that compares my current x-ray to the one originalyt taken in October 2015.

Hoping I've been chasing a spine issue when the hip has been the culprit all along.
Thanks.
Ken

 

[Josephine]

Hi and welcome to BoneSmart! What a typical story! It's amazing how often doctors focus on the back, specially when there's a previous history, and totally forget that this doesn't preclude other conditions!

family doctor took x-rays and it showed "mild osteoarthritis of the right hip

Your right hip looks like it does have a bit of arthritis indicated by the white line at the top of the joint (red arrows). There also seems to be a bit of a cam deformity (yellow arrow) which goes along with the arthritic changes - see here Femoro-Acetabular Impingement (FAI)

In your left hip however, there appears to be gross changes with bone cysts (red stars) evidence as well.

The x-ray also showed some disc protrusion so he referred me to a spine specialist.

You know, many years ago there was once a small study done in the UK where they took a mobile xray machine out into shopping centres and got lots of people with no history of back issues, to have xrays of their spine. An amazing number, something like 45%, showed disc protrusions/bulging discs with NO symptoms! Food for thought, eh?

 

[Suttree]

Many thanks for the feedback Josephine.

I can typically distinguish my left from my right in everyday living but will admit that got them mixed up in my x-ray. I assumed the messed up hip would be my right since that is where the pain lives. I just figured I had been positioned differently for the first x-ray from back in 2015.

So is it normal to have structural issues on one side but feel the pain in the other? Thanks again.

 

[Josephine]

To determine side when you look at an xray, you have to do it as if you were looking at a person standing in front of you, face to face. So then the right hip in the xray would be on your left. Like this

And what I said was that both hips are bad but in different ways.

 

[Suttree]

Family was in town for the weekend and I didn't get to do a full read on your FAI link. This excerpt is so spot on that it is almost eerie

"What are the Symptoms?

FAI often presents as hip and groin pain with restricted range of hip movements.
Symptom onset can be acute, following injury, or insidious after prolonged exertion. It is generally not disabling, except in sporting activity.

‘Payback pain’ after participating in sporting activity is common

Pain is primarily felt deep in the groin at the front of the hip, more rarely it can be on the side of the hip or the buttock.

Movements can be restricted particularly high flexing and trying to cross the legs.
Pain is often provoked by these manoeuvres, by exercise, or by attempted return to sport and relieved by rest and inactivity.

FAI may occasionally present as groin pain after prolonged sitting. There is no rest or night pain."

Thanks for the quality insight.


Sent from my iPhone using BoneSmart mobile app

 

[Josephine]

It's easy when you know how!

 

[Jaycey]

@Suttree I wasted so many years going down the same route as you have - spinal issues instead of bad hips. My hip finally collapsed before I finally had an x-ray. I have lower back issues but that bone on bone pain and mobility issues had nothing to do with my back problem.

I hope you get some quality time and answers from your OS. Please keep us updated!

 

[Suttree]

Thanks Jaycey. I'm thankful I'm hopefully catching it before a hip collapse. That does not sound fun at all.

I meet with the hip specialist on Wednesday and am anxious to hear his opinions. Will be frustrating if he concludes FAI and that they missed the cam deformity on the 2015 x-ray (the one Josephine marked with a yellow arrow).

Below is the right hip from my x-ray last month (screen shot from an iPhone). I'll check back in after my appt.

 

[Josephine]

Will be frustrating if he concludes FAI and that they missed the cam deformity

Suttree, if you read the article I left you, you would have seen that a cam deformity IS an FIA

 

[Suttree]

Suttree, if you read the article I left you, you would have seen that a cam deformity IS an FIA

Correct . . I was trying to convey that back in 2015 the doctor looked at the same x-ray you did but did not conclude cam deformity / FAI . . they just noted mild osteoarthritis and I was off chasing spine issues for the next 18+ months. I will be curious to see if the doctor has a different opinion at my appointment in a few days (e.g. says "yep, you got FAI . we should have seen this in 2015").

 

[Josephine]

Well, I'm with you all the way there!

(Hope I didn't come across as being snippy because I didn't mean to be!)

 

[Suttree]

Had my appointment this morning with the OS. They took new x-rays and looks like a right hip replacement for me. The images I posted above must have been inverted or reversed (prior to my posting) because today's -showed my right hip to be the one marked above with the red stars for bone cysts. The doc found no issue with the left hip.

I'm actually looking forward to the procedure. Plan to do lots of digging on this site in past threads to answer my questions (surgeons, hardware, planning, etc...).

 

[Josephine]

What procedure are they planning to do? Because if it's an arthroscopy, I would strenuously urge you not to do it. You really do need a hip replacement.

The images I posted above must have been reversed

Yes, I thought they were!

 

[Suttree]

What procedure are they planning to do? Because if it's an arthroscopy, I would strenuously urge you not to do it. You really do need a hip replacement.


Yes, I thought they were!

Procedure will be a hip replacement. OS said it was the only viable option.


Sent from my iPhone using BoneSmart mobile app

 

[Jaycey]

Procedure will be a hip replacement. OS said it was the only viable option.

Whew! This is good news. We see far too many people here go down the scoping route only to end up with THR in the not too distant future.

Have a read in our Library. Lots of information regarding both pre and post op. We will be here for you!