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Hip problems without groin pain?

Discussion in 'Hip Replacement Pre-Op Area' started by Ramp, Mar 3, 2017.

  1. Ramp

    Ramp
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    I have had another doctor mention that unless you have groin pain that you don't have a hip joint problem. I have some joint space left but it's low and the X-ray shows some arthritis and MRI shows Labral tear. Full focal Fissuring, chrondrosis and FAI. Most of my pain is on the outside of my hips and often just behind the hip bone. Sometimes aching and burning after I walk or climb stairs and sometimes feels like someone is stabbing me with a pin or knife just laying in bed. As well as glute pain for months which I assume is the joint referring pain when I sit or sometimes walk. I had an ultrasound and all the tendons and muscles looked good. But is it not possible to need a hip replacement with no groin pain?

    I have no bursa pain or pain when I press on the hips anywhere. MRI was also negative on bursitis.


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  2. sharonslp

    sharonslp Forum Advisor

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    I was medically approved for a THR based on the stage of my osteoarthritis for several years, even though I didn't have groin pain. I opted though to soldier through with PT and Celebrex for a long time. Once the groin pain did occur....and it was a dramatically sudden onset....there was no hesitation on my part. Celebrex didn't touch that pain. I scheduled then for as soon as I could. For hip #2, I didn't bother waiting for groin pain.

    With hindsight, I limped along...literally and figuratively for several years too long, being sidelined for no good reason. Is your doc trying to stall you because you are so young? That would be a shame...it doesn't sound like this is going to magically improve on its own.

    I'm asking @Josephine our nurse administrator to comment.

    Sharon
     
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  3. Miss Muffet

    Miss Muffet Forum Advisor

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    Several years ago, in the earlier stages of my hip pain, an elderly lady (who had had both hips replaced) told me it was pointless consulting a surgeon until my pain manifested itself in my groin. I think that's old thinking as surely a simple x-ray would reveal the extent of the problem?
     
  4. Jaycey

    Jaycey Moderator

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    With all due respect this guy doesn't know what he is talking about. Of course you can have hip problems without groin pain! In fact, some people have minimal pain at all.

    In my experience waiting until your pain is significant means a longer, more complicated recovery. I waited until my left hip collapsed before having it replaced. That recovery took over a year. Fast forward to seeing the first symptoms with my right hip - it was done quickly. That recovery was a matter of weeks.

    I think you have already posted that you have a date for surgery. Great decision. Life is too short!
     
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  5. Josephine

    Josephine NURSE DIRECTOR Administrator

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    Of course it is! I agree with Jaycey - that surgeon hasn't the foggiest notion what he's talking about! I suggest you print off the form I've attached to this post and get a good idea what your situation is. The form is based upon quality of life which is much more accurate.
    That tells me all I need to know to say you most definitely need a hip replacement!
    I'm sorry - can you clarify what you mean by 'hip bone'? Use this chart

    referesrs.jpg A hips outline.jpg
     

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  6. Ramp

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    That chart is of a woman so my body is a little different heh but

    I would say my glute pain when it's bad is on the bottom when I sit at WL2B/L3B. And often when I walk at VL2B. I can press down and feel the back of my hip joint I think behind it. I don't have a butt really or much glute muscles left so it's easy to feel the bones from the back.

    But the majority of my side hip pain is coming from the VRF1 VL1B. The pointiest part of the great trochanter and just behind it. I have zero pain when I push anywhere and I've been examined for bursitis and back X-rayed.. It all seems to be radiating out from the joint. As well as a prickly pain sometimes I try to describes as like thorns or barbed wire inside the hip that even hurts laying down. Walking is the number one irritant. Even two blocks followed by stairs.

    My MRI was not perfect of course and neither were my X-rays but everyone is hooked on groin pain and making me doubt things even though some doctors have said there is not much to be done except replacements. I have always had pretty much zero groin pain and the cortisone did not do much if anything. "MAYBE" a day of relief which also makes the doctors skeptical. Having hip replacements is a huge undertaking at any age so if there is anyway of postponing it without pain then I want to explore it. If not, I need to get on with it and get living again! I've attached Xrays and MRI info ;) does my femoral ball look weird to anyone ? ;).

    ramp 1-vert.jpg

    Ramp 4.jpg
     
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  7. Josephine

    Josephine NURSE DIRECTOR Administrator

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    It's actually androgynous!

    As for your pain spots

    Ramp 6.jpg

    The blue and red are almost certainly this Piriformis syndrome.
    And the yellow is Trochanteric bursitis.
    These almost invariably go together.

    As for your xrays, the points at 1 are cam deformities as in Femoro-Acetabular Impingement (FAI). These give the top of the femur that characteristic pistol grip appearance.
    The whitened spots at 2 are signs of early arthritic changes in the rim of the acetabulum.
    And if you look at the blue circles I have placed on the femoral heads, you can see they are not the natural round shape as in the xray of the normal hip below

    Ramp 5.jpg


    normal joint.JPG
     
  8. Ramp

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    So are you saying that I should not be getting a THR?! I did read arthritis can bring on piriformis syndrome. Both sides are very similar. Did you read my MRI ? Thanks!! I have had this for 3 months now and it has been completely debilitating! I have been in bed in terrible pain.

    Most doctors are saying I need THR and the labral repair would not be successful because of the arthritis. I have no radiating pain down the leg and no sciatic indicators. I will say sometimes my IT band area is sore sometimes but it doesn't go down to the knee at all. Maybe ends 6" above it. The doctors have checked me for bursitis by applying pressure to all spots of my leg and there is zero pain from pressure. Doesn't that rule out Trochanteric Bursitis? Because of my torn labrum I am unable to cross my leg over and do glute stretches. I did have an ultrasound of my back end and they said everything looked normal.
     
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  9. Josephine

    Josephine NURSE DIRECTOR Administrator

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    No I am NOT!
    They are 100% correct. And didn't I point our arthritic changes?
    It doesn't necessarily go all the way down. Sometimes it can just be the bit adjacent to the hip and for knee patients it can be adjacent to the knee.
    Absolutely! You never told me any of this - you naughty boy! You trying to make me practice my crystal ball techniques? :heehee:
     
  10. Ramp

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    Heh. Sorry. I've just been through so much the last 3 months trying to figure out what is wrong and how to fix it. My life is a full time doctor scheduling business.

    I guess I am looking for any way out of a THR. I have been trying rolling and periformis stretches here and there but they do irritate my hips. Are the balls of my hips supposed to have that chunk out of them in the inside of the socket ? Or at least it looks like a dent or something in them. Not nice round balls. Keep in mind I have never had a joint issue until I tore my labrum last July. And my pain all came on suddenly in December after a busy day of stair climbing!


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  11. Jamie

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    Ramp, hip deterioration can come on quite suddenly after years of "getting there" and then you're in the type of pain you are describing. It doesn't get better....only worse. And the "worse" can also occur suddenly with substantial increases in pain and disability. You need to listen to your doctors and what your own body is telling you. Get your hips replaced so you can start to enjoy your life again. No one wants wall-to-wall doctor appointments and no relief.

    If there are specific fears you have about surgery, post them and let's talk. Information is power and you'll feel better if your apprehensions are addressed and resolved. This is VERY successful surgery. Remember, for every person you read about on the internet with concerns or problems there are at least 10 out there with no problems who simply went on to do the things they wanted to. This is how it works for most people.
     
  12. tgn

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    I also think this is quite wrong.

    In my case my symptoms were:
    Couldn't wash between toes;
    Couldn't put socks on easily or do up shoe laces;
    I occasionally walked with a limp and a PT friend picked up on this;
    Leg would be very stiff, especially after waking up and would require a lot of effort to get it 'started' for the day;
    Stairs were becoming difficult- could no longer walk up them 2 at a time;
    Could no longer do bush walks;
    None to minimal pain.

    When I saw OS he was very surprised that I did not have major pain as x-ray showed I had bone on bone.

    He also had a hip scoring questionnaire which had a lot of lifestyle factors built into it other than just pain. This allowed him to subjectively score my hip problem and then he used this at follow ups to confirm things were improving.

    So I think we are all built differently with varying pain thresholds...
     
  13. Jamie

    Jamie Administrator

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    Absolutely, @tgn.....there are no "blanket" statements that can be made. The real truth of the shape of your hips is in the xrays.
     
  14. Horseshoe

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    Ramp, I did everything I could think of to get out of doing my two thr's. Did all the supplements, workouts, researched, hoped my Dr would call and tell me it was just strained muscles after all. Meanwhile it got worse and worse though I'd get a couple of good days here and there that tricked me into thinking it was cured :)
     
  15. Jaycey

    Jaycey Moderator

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    The only way "out" for you I am afraid is living with the pain you are currently dealing with. And believe me it can get a lot worse. Best to get this done and get on with living. The longer the wait the more complicated the recovery.
     
  16. Ramp

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    I agree with it all. It's just that I am not bone on bone yet so I think some doctors are feeling maybe I can stretch it to age 50 and get it done. Every doctor seems to have a different opinion unfortunately, and that has been confusing for me. I guess its possible I have a few different problems because of the hips, such as periformis syndrome. It would be nice if I could sit in comfort again so I am going to try super hard to work on that. I know this is the kind of problem that doesn't get better and I am still trying to grasp how I never had an issue until one day in December, bilaterally at the same time, boom! I know i'm stuck with the labral tear but if I can get some strength and flexibility back and decrease the pain then I can keep an eye on the cartilage. If I continue to have the pain though, I know there is only one solution and they are supposed to be booking me in for May/June this week for THR. I did do 5 minutes on the stationary bike yesterday for the first time in 2 months which made me feel a little better. After 3 months doing almost nothing I am trying to get some strength back. I know this is also important for any surgical recovery. I actually have one more doctors appointment with an orthopedic specialist from the Cleveland clinic that also does fancy injections but I have heard these don't do much for hips. Thanks for all your input in this trying time for me.

    Update.

    A specialist finally looked at my MRI today in depth and said I do have some areas of bone on bone and maybe some glute damage. He's sending me for another MRI. To look at why I am getting so much pressure when I sit. He specializes in PRP and stem cell injections and says he feels because of my age I should at least give this a shot as he has lots of patients that get long term relief from them. If it doesn't work then THR is the only way to go but he wouldn't rush to that without trying something else first. Any thoughts on these new experimental injections? The PRP is your own blood and the stem cells are from placentas or something. He is considered a top orthopedic guy. My aunt has PRP on her knees and says it works for her.

    http://my.clevelandclinic.org/staff/5017-anthony-miniaci
     
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  17. Josephine

    Josephine NURSE DIRECTOR Administrator

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    It's spelled pIriformis!
    They will. I should have said, they are unsuitable for a damaged hip.
    Actually that isn't a chunk out, it's the point where the internal ligament of the hip - the ligamentum teres - is fixed to the femoral head.

    ligamentum teres.JPG

    In other words, it's perfectly normal anatomy!
    The labrum injury was only a tine part of the entire issue which is actually arthritis.
    Oh yes you are! I pointed that out to you on the xray.
    They will because they are all different individuals with different histories of training and experience. You'll rarely get a consensus when you have two or more doctors!
    Soryr, it really doesn't work that way. You'll have to stop thinking of this as separate issues which can be treated separately. There is only one overall condition and that is arthritis.
    I strongly recommend you don't go down this path. I've read lots of reports about this treatment and general consensus is that this only works in joints that are very, very early in arthritic changes, so early that the patient does not yet declare any real symptoms! How daft is that? Why would a person seek treatment for a condition that has not yet manifested itself! But the sad fact it, it really doesn't work where the arthritis is established. Not only which, I believe it's phenomenally expensive.
     
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  18. confused newb

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    @Ramp, I'm not really sure why you would want to 'stretch it' out any further than you have already. You're 42, and it sounds like the pain and discomfort is basically taking over your life... why would you want that to continue until you're 50 when the end result is going to be a hip replacement. You're searching for answers for all of the different issues, but in all likelihood... they're all caused by the arthritis in your hip. Remember the song as a kid... the hip bone's connected to just about flipping everything... I know my hip causes me pain in my knee, and my back, and my groin, and my butt, and my other hip sometimes.
    This is just my personal opinion, but I really don't think you're going to get any real relief until you seriously consider the hip replacement. You get the replacement and the arthritis is gone, the torn labrum is gone, and then you can start to rehab and rebuild muscles around the joint, and start to reclaim your life.
     
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  19. Josephine

    Josephine NURSE DIRECTOR Administrator

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    I love that! And it's so very, very true!
     
  20. Ramp

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    Yes newb you are right. It's a few of the doctors I've spoken too. They have outright said things like I should try other things first, and I am too young, and try to put it off until 50, etc. The hip replacement doctor I saw that had a year wait even referred me to another replacement doctor AND an arthroscopic guy because of my age as an option. Even though I told him the artho guys didn't want to touch me. I have some areas of bone on bone according to the MRI. I do believe my cortisone shot is working a little now as I do not have as much pain in my range of motion from the labral tear. I still have loads of glute pain and side pain and the last doctor that read my MRI said he sees some glute tearing. I guess I have started to feel better in the last week or two and a little stronger which gives me 'false' hope. Maybe it is because of the symbalta blocking the nerves, who knows. I am still going ahead with scheduling a first THR this year whenever I can get one but maybe it doesn't hurt to try the PRP or stem cells in the interim and if they don't work then I know I tried everything.

    Chronic pain, combined with hope, despair, fear, optimism and pessimism sure makes a total mess of the mind.
     

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