Bilateral THR Iliopsoas tenotomy - any experience?

[hbl]

Hi all. 3 years after a double hip replacement and much physio (and not being able to see my surgeon because of Covid) finally I have had an x-ray (all OK) and now an ultrasound which has revealed the psoas tendon issue in my right leg which, from day, has 'snapped' and in certain exercises (leg raises etc) is as weak as dishwater. Years of physio and little or no relief and endless frustration it is revelatory that it has now been diagnosed as the acetabular cup component being a fraction too large and over time has caused a problem as it cannot pass smoothly over the top of the anterior edge forming a triangular 'peaking' as has been described in certain movements.. (I had no idea this was a 'common' problem and hadn't picked it anywhere or up on this site before. Nor had my extremely good physio heard of this. And my surgeon (also v good) did not mention it either when I went to see him with this problem 2 months back but he did refer me to an arthroscopic surgeon and for an ultrasound. The latter suggested:- Solution first stop an injection (which has worked now week 3) and possibly and inevitably if this doesn't give lasting relief then the arthroscopic surgery to release the tendon. (No mention has been made of bigger surgery to replace the cup). I haven't been in pain as others have described BUT it has definitely impacted on my physicality.

So my questions is - has anyone seen permanent relief from the steroid injection(s)?
Does arthroscopic surgery have a high rate of success!
What's the recovery time?

Any other advice/experience?

 

[Hip4life]

Welcome to BoneSmart! Yes! There are members here who have dealt with this. I’m one of them. My cup had a slight overhang and the tendon kept sliding across it so it never could heal. Ultrasound with injection was my first step. The hope is that it will take care of the issue. Mine lasted 2weeks. I’m glad you’re on your third.

If it doesn’t give long lasting relief, the decision is release the tendon or revision of the cup component. My original OS could do the revision (he was a revision specialist as well) but referred me to an arthroscopic specialist for the tendon release option. He recommended a complete release at the lesser trochanter. Another option is a partial release which lengthens the tendon up closer to the hip capsule. The arthroscopic OS said he preferred the complete to reduce the chance of the tendon healing back to a shortened length. There was no PT, the downtime recommendation was 1-2 weeks, to increase activity as tolerated.

Other muscles take over the psoas function. It took about a couple of months for my strength to return to normal because of the prior limitations the sore tendon caused. I have a slight reduction in active range of motion (putting on a sock for example) or bring the knee up past 90 degrees. It doesn’t limit me in any way. I would do it all again for the relief.

What is the best route to go? My search of the literature basically said that it depends on how much overhang you have. Larger overhang, a revision might deliver better results. Otherwise, people seem to get satisfactory results with the release. Obviously, the release is less invasive thus lower risk. The decision would be between your OS and you. The doc has the experience, can best assess your anatomy and situation.

I hope this helps a bit. Please feel free to ask any other questions. I will tag my colleague @SaraK who had a partial release. She may have other insights for you.

 

[SaraK]

Yes, this issue is not as uncommon as you might think but it affects some people more than others. Due to a bit of dysplasia, my cup apparently overhang a bit. Since the outside of the cup has a roughened surface to encourage bone growth, my psoas tendon was getting raw rubbing on it. The pain got progressively worse as I tried to get others to take it seriously.

The steroid shot gave me complete relief but only for 10-14 days. My surgeon said that some patients get relief from a single shot, some need to repeat every few months and some need to take the next step. I was one in the final group but the shot did confirm the diagnosis.

My surgeon preferred the lengthening at the groin/capsule. I opted for PT but surgeon didn't mandate it.

Within a few days after surgery, I felt better than I had in awhile. As @Hip4life said, there are still some issues like lifting the knee above 90 degrees or harder to put on pants, the limitations aren't significant. I hike and lift weights and do just about anything I want to do. The surgery gave me my life back.

 

[hbl]

Thanks both. I do not have any pain with it other than a real weakness in certain movement (leg raises) but I am very active, walking, pilates etc etc and it is frustrating that my right leg is so much 'weaker' than my left. I have to lift it to get in and out of the bath and car for example. At this stage I do not know how big my overhang is whether we are talking under 6mm or more, question for my surgeon I guess. Others clearly suffer much worse problems than I do but I would love the problem to go away but the thought of surgery is scary. My understanding is that you can't have too many steroid jabs (max 2?).

 

[Jws.]

I had both a "Lengthening " the same as Sara k and a "full release" at the lesser trocanter as Hip for Life. The lengthening did nothing for me. The surgeon said when I asked him why he didn't do a full release he said he wanted to limit my weakness. 3 months after my Hip Replacement , I truly couldn't walk . My hip was 70% restricting me from walking as normal. After the full release , I had much more flexibility and was able to significantly walk better. The cost of the total release was weakness in lifting my leg up while sitting and getting in a car. It's not terrible but it is there. I f i had to do it again , I would 100% do the total release and not a lengthening which would risk me having the second surgery. The deciding factor on the surgery is that the downside is minimal , besides the normal risks of surgery. It's a simple surgery (actually 12-15 minutes to do the full release) 45 minutes w prep and recovery and not much down time. (1-2 weeks) Hope this helps. @Hip4life @SaraK

 

[skcoj1]

Wow, this is eerily similar to what I am suffering from. With my issue, 6 weeks post surgery, while walking my foot had a slight scuff on a low dirt mound. I felt something. Now 10 weeks later, the issue is feeling worse. X-rays, CT Scan, and a recent MRI show nothing out of the ordinary. The healing of the bone and device is going very well. But this irritation, pain, weakness, just sounds exactly what I am experiencing.

 

[hbl]

I am due to have Iliopsoas tenotomy. Has anyone got experience of how long the average recovery period is after this? Am going in as a day case.

 

[CricketHip]

I will tag @SaraK and @Hip4life since they both had tenotomies.. I seem to recall from reading other members recovery threads that it wasn't a hard recovery.

You can also go to the upper far right of the BoneSmart screen and click on the search option and type tenotomy
in and read other's accounts of their experience.

Do you have a date set? If yes, please leave it here and one of our moderators will update your signature.
@hbl

 

[hbl]

Thanks

 

[hbl]

yes, sat 23rd July

 

[SaraK]

I didn't have much pain from the procedure - a bit of a burning sensation in the groin around the area where the tendon was cut. I took a couple of pain pills the first day and then didn't need anything. The main issue was swelling causing stiffness (because of fluids they use to keep visual space open). That went down in just a few days. I used a cane for those few days and then didn't need anything more. It took some time for the muscles and brain to coordinate. The brain would think it was lifting the leg more than it was (think of needing more effort to lift something off the ground if you lengthen the rope you're pulling up).

Within a week, I felt better than I had pre-surgery. I did PT for about 6 weeks but that was my option -surgeon didn't require it.

 

[hbl]

Well, had the partial tenotomy on 23rd July and due to go back tomorrow for the stitches to be removed. Am still slight swollen but generally have got good movement. HOWEVER, I still have a lot discomfort in my groin - possibly worse than before - and no relief on leg raises or getting in and out of bath and car. My surgeon said my acetabular overhang was around 3mm so not massive. Am really hoping this significant discomfort goes away but don't have any idea of the average recovery time before it can be determined as to whether it has worked or not? Don't know if anyone else has any idea? I know I'm impatient!

 

[Layla]

Hello @hbl
Lets tag @SaraK and @Hip4life to see what they have to add through their own experience.
Best wishes for your visit tomorrow to have stitches removed. I hope you feel relief soon.

 

[Hip4life]

Hello, @hbl I had a complete release but I think I can weigh in. Like any hip surgery in general, everyone is going to recover differently. When I had a consult for a partial tenotomy, the doc prepared me for a possible six week recovery with crutches and PT. Now, not everyone has experienced that but just pointing out possibilities. Even though I had fairly immediate groin pain relief, it took a while for the swelling and soreness to decrease.

You said you're going tomorrow to have stitches removed. Did you have an open tenotomy? I had mine via arthroscopic procedure so the 3 tiny incisions just had dissolving sutures. My doc said I could go back to work after 1 week. I took off 2 and then felt I needed to arrange one more before I felt ready to get back to my very physical job. Did the doc say how long he thought your recovery would be? Remember, you've got to give those tissues and that tendon time to heal (easy on those straight leg raises) until the doc tells you when it's okay. Icing really helped me in those first days/weeks. These are all things you can take up with your doc or his team tomorrow. Make a list of your questions or concerns so you don't forget. All the best for your appointment. Keep us posted.

 

[hbl]

Stitches removed (my op was arthroscopic). My surgeon says the recovery can be 6 to 8 weeks in terms of seeing the benefits so I need to be patient (not my strong card). Groin pain not unusual as tendons take a long time repair. I am very impatient and worried that I won't see the longed for improvement. going back to him in 6 to 8 weeks. I'll keep you posted

 

[Layla]

I am very impatient and worried that I won't see the longed for improvement.

Please try not to project. Think positive and give it time. Sending up a prayer and thinking good thoughts that you'll gradually notice the relief you're hoping for and experience perfect healing.
Hugs

 

[Hip4life]

Like my husband would say when I would get impatient: don’t trip yourself up so close to the finish line. Lol. He was right, in more ways than one. That healing time will be well worth it. Your body will let you know when to progress. Just listen to it and don’t push it, as hard as that might be. My thoughts after I was sufficiently recovered after the tenotomy were: THIS is what usual THR patients feel like after their initial surgery: no pain and finally able to get on with life! It just takes some of us a little longer on a more circuitous path but we get there. Wishing you patience and good healing. Looking forward to your updates.

 

[hbl]

Thank you for your kind and supportive comments, will let you know how it goes. More discomfort and pain today than 3 days ago and haven't done anything 'extra' so back on the anti-inflammatories.

 

[Mojo333]

I'm so sorry you are hurting.

I hope you are using ice which really is the best anti-inflammatory.

HOWEVER, I still have a lot discomfort in my groin - possibly worse than before - and no relief on leg raises or getting in and out of bath and car.

I hope raising your leg to get in and out of bath and car are the only Leg raises you are attempting as the surgery trauma needs to heal and soft tissue is already angry.
Please try to baby your leg a good bit.
Hope the next few days bring a marked improvement.

 

[hbl]

I am now back to anti-inflammatories twice a day and absolutely no relief in terms of very sharp pains in my groin on certain movements i.e. leg raises (impossible), legs in table top position (very difficult) and getting in and out of bath/car etc. Walking uphill is also difficult. The pain and discomfort is MUCH worse than pre the tenotomy. The op was 5 weeks ago. I'm seeing my surgeon in 6 weeks. I think I have to have another ultrasound and steroid if necessary ... and then? My surgeon did say the success rate was about 75% but NOTHING about the fact that it could make matters worse.