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THR Iliopsoas tendonitis post THR

Checking in with an update. I was surprised that my last post was weeks ago... I was back to work full time starting November 9th. And traveled to a work conference in Florida on November 14th for 5 days. When I got back to the office last Thursday, I left the cane in my car and have been without it since. Still have a slight limp that is more pronounced after sitting for an extended time, but is improving. The sleeping is not back to normal, but I average 5-6 hours nightly which is better than just 4!

I have chosen to pursue physical therapy and the sessions start next week. I want to focus on range of motion and flexibility as I have no idea at this point how I will bend my leg enough to reach the stirrup and get on my mule any time in the near future.

My surgical side is still sore at times when trying to sleep on that side. There is a very specific area that is troublesome, but I can usually adjust to get my weight off of that spot. I am sure this is normal, but it is frustrating. I am off aspirin therapy and have switched to ibuprofen every 6 hours. I started back at the ymca pools last week with very slow walking in the "river run area" where there is a current resistance and then some time in the warmer therapy pool.

I hope all of you had a Happy Thanksgiving!

Julie



Just4mules (Julie)
October 20, 2015 LTHR
 
Hi @Just4mules, wow, you are making incredible progress for only being a little over a month out! That is impressive that you were able to travel to Florida already for a conference. You went back to work very soon - are you on your feet much at work?

I hope your physical therapy goes well and helps with your ROM. Keep up the great recovery!
 
Great progress report!
Good to hear from you. You are quite the busy person, and so soon after surgery!
I started my formal PT at 4 weeks and it's been a good experience. Hope yours is too.
I would try a mounting block for a while. They make things so much easier, don't you think?
There's always a log or stump to use while on the trail. :wave:
 
Hello @Hipster Girl, I have mostly a desk job. I have to keep reminding myself to get up and walk frequently as the hip gets stiff when I sit too long. I am really happy with my recovery and realize it has been pretty amazing! @Cricket hip, I am really hopeful the physical therapy will be appositive experience and improve the mechanics of the joint. I think getting back to the gym and pool will help too. Yes I will need a mounting block, rock or stump for a while, no doubt! This is when having a shorter mule would come in handy.


Just4mules (Julie)
October 20, 2015 LTHR
 
@Just4mules as well as you are recovering, I have no doubt you will be riding again in no time!

How many times a week and how long do you plan to do the physical therapy? I am contemplating outpatient PT for myself as well but I don't know what is the norm for frequency & duration?
 
@Hipster Girl, I just completed my 4th week of PT and it's really helped to fine tune the balancing muscles. I go 2 x weekly. Then do my home exercises on the off days.
@Just4mules I understand about the talk mule. But I bet he's a smooth ride! My last horse was 16.2
My goodness, it was like scaling a wall!
:horseriding::fasthorse::fasthorse::horseriding:
 
I will be doing 2 times a week for four weeks, then we will reevaluate. I am already working on some exercises she gave me during my initial evaluation. I have noticed that the only time I am limping a lot is after sitting for an extended period, like 30 minutes or more. The hip seems to get pretty stiff when sitting. I still am very happy with my recovery, I did not expect to be this far this soon.


Just4mules (Julie)
October 20, 2015 LTHR
 
Hello All,

It's been a while since I posted. I have developed iliopsoas tendonitis, started in January 2017. Diagnosed in late March. I had a injection to the tendon in April, which provided about 60 pain free days before it came back. I am getting another injection on Monday. All the research I have done seems to point to conservative management does not work and it will likely require surgery to release the tendon. I have no overlap of the cup or other position issues with the implant. Has anyone here had this complication?

Thanks!
 
I have severe tightness in the operative groin. Is that how it manifested itself with you? I am only 8 weeks post op so hoping this is just overall trauma and it will subside over the coming months.

PS - love your picture. Were you able to ride pain free post op (until this complication developed)?
 
Hi gwenc,
Yes I was riding pain free within 6 weeks of surgery. I have had no trouble until this January. The pain is when getting into car, getting into bed, going up stairs or raising leg while sitting or standing. I literally have to lift my leg in the car or in bed to prevent shooting pain! I was told this is a rare complication of THR. Lucky me!

The reason I proceeded with THR at my age was because I could no longer ride without extreme pain. Now I can't really get in the saddle darnit!
 
Hi Just4mules,

Thanks for your posting, and I'm sorry to hear about your complication. THR recovery can be something of a roller coaster. The symptoms and timetable described in your post sounds similar to my own post-op THR experiences. I was pain-free at month 2 but now experience shooting pain whenever I move out of a sitting position. Could I ask how you were diagnosed with iliopsoas tendonitis (what kind of doctor did you see / what kind of test was performed)? Similarly, do you know what causes the pain you described? Finally, do you have any weird sensation within your leg when you step?

Thanks so much!
 
Hi Trillium,

I went back to my OS and he sent me for an flouroscopy (sp?) guided injection. The injection is meant to be diagnostic as well as therapeutic. If the pain is eliminated with an injection directly to the tendon then it is diagnosed as Iliopsoas Tendinitis. They did also xray but found nothing out of place there. The motions that elicit the pain are usually very telling for this problem- getting in and out of car and bed. Stair climbing, raising out of chair and lifting leg with or without resistance. Normal walking elicits no pain or weird sensations at all.

Julie
 
Thanks Julie,
I did get a cortisone shot (without fluoroscope) and it did nothing for the pain. My Xrays showed zero problem, too. My normal walking is usually limping and I hear clunky sounds going up inclines and stairs....weird and disappointing!!! All I want to do is stretch my hip flexor, but that would really hurt me. Come on bod, I am still your friend!!

thank you!
 
Wow Just4mules, you are lucky you were riding pain free at 6 weeks post op - even if it didn't last! I have groin pain too, but its pretty much all the time, especially when walking. Also butt pain sometimes. I do walk unaided, but with a limp. My doc told me I would be able to ride at 10-12 weeks but at this point (I am 8 weeks post op) I am a bit doubtful. I hope things improve for us all!
 
Well you could read our article on the problem Iliopsoas syndrome but you are right that conservative treatment is rarely successful. I would suggest you see a chiropractor. A very underrated form of treatment in my opinion!
 
So I had the second injection and had no relief. I swear it seems worse than before he injected it. He wanted me to call him in two weeks which will be Monday 8/14. I have no idea if he will recommend a 3rd injection or not. Frustrated! I cannot ride at all right now and summer is about over. I just keep trying to focus on the positives, like at least I can walk and for the most part walking on flat surface is painless.
 
Just4 mules, I have been on this journey for 15 months now, I struggle with stairs, leg raising and getting out of lounge chairs and cars. I remain in a lot of pain, particually weight bearing and walking. I also had the steroid injection guided under U/S (not a pleasant experience, but quick),in March. I had nil reduction of pain once the local anaesthetic worse off, but it made the whole hip very stiff for 3 months. Like a brick was tied to my thigh. The Psoas tendon was noted to be slightly thickened at the U/S. It is a frustrating process.
 
So I had a third injection, which had very little effect on the groin pain. I went back to the OS on Friday and am now scheduled for psoas lengthening on 11/30. It will be an open procedure, through the same incision as the THR. I was hoping for an arthroscopic procedure, but I trust my OS. So I will keep you posted as to the progress after this procedure.
 
@Just4mules, even though I was not officially diagnosed with iliopsoas tendonitis, I have alot of the same symptoms as you - pain going up stairs, getting into the car, etc. In addition, the farther I try to walk (even on flat ground), the worse the groin pain gets. My pain also radiates down the front of my thigh as well.

I had a CT guided psoas injection which has provided no relief. Revision surgeon #2 who ordered this followed up a week after I had this done and all he said was "let's give it more time". The day I had the injection, I saw the surgeon an hour afterwards. He said I should have gotten some "immediate" pain relief due to the lidocaine (?) they inject first before the steroid. Unfortunately I did not and my groin and thigh actually felt worse later that day than it did prior to the injection. I know he is not going to order any additional injections at this point. But, he also really doesn't know what to do with my situation.

Sending healing thoughts for your surgery and that this will resolve your pain and you can get back to riding. :praying: Please keep us posted!
 
Hi Marvy,

One thing my OS said is that he usually recommends waiting a year post op before any surgical intervention in these cases. He said since I am 2 years post op he said I have been more than patient. If he would have not moved forward with surgery, I would have gotten a second opinion. I have already had physical therapy and three injections- enough already!
 
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