THR Me2 and Recovery

[Me2]

Bursitis.... Yes, I am cautiously celebrating, or at least very hopeful!


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[Me2]

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[Josephine]

Thanks for the xray but I'm afraid it's not of diagnostic quality. It's only 320x282 pixels.
To be of use, it has to be at least 1,000pixels.

I pointed out that the left side that feels so terrific looks different than right side -- on the right, the cup itself is deeper shape and hangs out a little bit on the top.

It would actually be pretty much of a miracle for two hips to be even marginally the same even when done by the same surgeon. So that doesn't cause me any concern. And from what I can see in the xray, they are near enough the same.

He acknowledged also that slight chance with how small I am the little bit of overhang may be catching the soft tissue as it rides over the joint? (the surgeon) who basically said same thing plus that with anterior approach (which he also does) a surgeon is operating inside bottle with no direct sight of joint.

I don't know if I'd put it quite as dramatically as that but there are access problems, it's true.
But I've never heard of soft tissue being caught in the hip joint! It's far to far away to be able to do that!

And THIS (OUCH OUCH OUCH OUCH says Sheryl as he causes pain almost to pass out point) is hip bursitis."

The problem with the term 'bursitis' is that there are a few bursae around the hip joint and some can be working in conjunction with other issues such as piriformis. So before I start opining on this, I need you to tell me exactly where the pains are that you are experiencing.

Can you tell me the exact site of your pain using these charts? I've added the leg one in case there is any referred pain down there.

 

[Me2]

 

[Me2]

So, uploaded better image of xray , but hear you on not likely, but certainly appreciate your input to rule that out. Definitely like the idea of ruling that out!

So, pain is at SR2B, TR1B, VR1B almost continuously, increasing with activity (walking, standing, carrying children, sitting especially on floor or resting on either side which I don't do much of because of shoulder issues.) - even swimming

So, with activity such as walking or upstairs or up hill, or sitting too long, standing from floor, pain increases in area above but also down WtoZR1F and frequently A-HRF1, occasionally DRF2 (especially down steps) and CR2F

 

[Me2]

So had consult with my much appreciated and respected physical therapist that I've been working with for year and half (6 months on back and a year now on shoulders). She says no she's not thinking bursitis but rather just not "loading" properly But, then again, she kept assuring me last fall that my shoulders were fine until I showed up with my tyrannosaur rex arms and then MRI to show that they were not fine.

BUT I don't understand how injections helped so much - absolutely no pain for about two days (other than pretty good pain from injection, I think - not only no pain but I was walking and walking up steps with ease, standing was pain free, right foot was straight without thinking about it (has been turning out again), my back, side of hip, leg, knee, calf was not hurting. I was literally crying for joy on Thursday morning that my nightmare could be so easily solved! AND then it came back -- I still am probably getting about 50% Increased a bit with Thanksgiving prep to the point where I in desperation took a 800 mg ibuprofen leftover from surgeries this year, and it did help even thru the night.

@Josephine Any ideas?

 

[Josephine]

The green and the blue are part and parcel of the same thing which starts with (red at R1B T & V) and then follows the green and blue all the way down your leg most likely into your ankle and foot, I wouldn't be surprised.

The very first thing you need to understand is that you don't get 'this' spot and 'this' spot getting problematic independently. Everything is connected to everything else and in your case, it's this
Trochanteric bursitis
ITB (ilio-tibial band) issues
Shin splints, shin pain, compartment syndrome
and so on.

And please believe me when I say I know what you are going through as I had this earlier this year. My salvation was a chiropractor. He worked on all those areas and though I have some residual aches and pain now, for the most part, it's all bee sorted. Oh and I got my GP to inject the bursa with some cortisone as well!

uploaded better image of xray

Sadly not, Sheryl. Do you see all those wavy green and pink lines? They make it impossible for me to see what I need to. Sorry.

BUT I don't understand how injections helped so much - absolutely no pain for about two days

Well that's the nature of cortisone shots, I'm afraid. Sometimes they do only last a few days.

but rather just not "loading" properly

And I'm afraid I have no idea what she means by that!

 

[Me2]

Josephine, I so appreciate your discussion. I really do, you are the best.

I've not been around BoneSmart much, and I've missed you all. At the end of last year, I was feeling pretty depressed that I'd worked so hard on getting healthy -- and hugely pleased with my shoulders, but so disappointed that right hip/back/leg still so exhuastingly, frustratingly painful. And then, as I mentioned over on my shoulder thread, I've had a pretty dramatic start to 2017. Tooth infection leading to root canal and tooth pulled over the Christmas and New Year holiday, my mom had a stroke on 15 January, went on to heaven on 12 February, and then achy left shoulder to go with my achy back/hip/knee/leg.

So, update on that achy back/hip/knee/leg. I got some pretty good relief, albeit temporary, with the bursitis injection back in November. It did give me some ability to do the brief stint of PT and that seemed to help also. When I went for the follow up on my shoulders, my surgeon was able to tell me where the pain doctor that I wanted to touch base with went to (their practice had split up, and the pain doctor went to a different practice). So . . .

I reported to him that I got significant relief from bursitis injection back in November for about 72 hours but then not so much but did couple weeks of PT. This was at the visit at the end of February, and he suggested we do another tronchitric bursa steriod injection to see what effect. And so we did, and so I got another 48 hours of almost pain free life. He gave me some options, and I really haven't had a chance to research much. I'm, of course, hoping someone here can give me their two cents -- though advice from here so much more valuable than two cents.

He suggested that perhaps he would diagnose this as chronic greater tronchanteric pain syndrome (better diagnosis I suppose than that I'm a nut case) which seems to be the new name for hip bursitis? And it seems to be that since I am only getting very temporary, but very significant relief from the injections that I may be a good candidate for either the plasma injections (not covered by insurance) or debridement of greater tronchanter? He did another injection of just the anesthetic to see how that worked -- and I got significant relief for about 3-4 hours of the six he had predicted. He suggested a couple of orthos to see to discuss the debridement, but that if I chose to do the plasma injection, he could do that in office. So what to do?

 

[Krista]

@Me2, I suffered Greater Trochanteric Pain Syndrome (Trochanteric Bursitis) after my THR in the same hip. I had to have a second surgery to repair torn gluteal tendons, so the surgeon did a debridement of the greater trochanter and bursectomy at the same time. That sharp pain at the greater trochanter is gone now, and I have no more "catching", so it was very helpful for me. I never did have any cortisone injections. Hope you get relief soon!

 

[Me2]

Yea Me2!!! Third Year anniversary of first hip replacement! This was the day I took that huge leap of faith with all the love and support from this wonderful community to get back to living!!!! I am so grateful to everybody that has supported and cheered me on through my crazy (and I do mean crazy) time, my struggles, my fear, my sorting through, and just all of this. I literally would never have made it -- I still don't know that I will -- but I've made it this far.

@Krista I'd love to hear more about what you experienced before and after --- I intend to go read your posts and see . . . I really want to not be feeling this. I don't know that Greater Trochanteric Pain Syndrome is my answer but another step. I wish I could say this syndrome started with the surgery but this pain has been one asked about since even before my first hip surgery. I got the second hip done with hopes it woud go away, I did the SI surgery with high hopes, but still it goes on and on and on interrupted only by shoulders' pain from last year. It still hurt like the dickens just not nearly as much as the shoulders did.

 

[Granny Di]

@Me2 Hi! I haven't been on the forum much at all but I popped in today and saw your post. So sorry to hear that you are having such a bad time. I have no advice or help just best wishes for a pain free life. Hope you get the help you need.
Diane

 

[Krista]

@Me2, I'll try to answer your question about my before and after. Your situation may be something else entirely. The fact that the relief from your injections was so short, and that it doesn't go away, may mean your condition is more severe than GTPS.

Here is a description of GTPS: "Greater trochanteric pain syndrome is a condition that causes pain over the outside of your upper thigh (or thighs). The cause is usually due to inflammation or injury to some of the tissues that lie over the bony prominence (the greater trochanter) at the top of the thigh bone (femur). Tissues that lie over the greater trochanter include muscles, tendons, strong fibrous tissue (fascia), and bursae." I'll message you the link to the full article.

It is fairly common in older people, especially women. Usually it only lasts a couple of months and resolves on its own. If it doesn't, then that means it is a more severe condition, and tests are needed to diagnose more specifically, such as MRI or musculo-skeletal ultrasound. I had some symptoms of GTPS before I had my THR, and I still have some after my second hip surgery. Pre- and post-THR I had pain right where the bursa was directly over the greater trochanter. It was really sore, a round, raised tender spot that hurt way worse when palpated. The other symptom that I had both pre-and post-THR, and still have, was pain running from the trochanter down the outside of my thigh. I've been told that is IT (iliotibial) band, and I had it in both of my thighs. Again, it hurts really badly when palpated.

The surgical removal of the bursa made it so that the pain in that spot isn't nearly as bad, although it's still there to some degree. And nothing was done to help the pain down the sides of my thighs. It's the same on both of them.

The other procedure I had was debridement of the trochanter, to smooth it out to prevent the "catching" of something on my trochanter, but that wasn't GTPS. I don't have the "catching" anymore.

 

[Me2]

Krista, I wrote a bunch of questions over on the PM, which I probably should have checked here first as you answered a few.

But, from the above, it sounds like you only got relief from the "catching" and the immediate pain over the bursa itself? I don't really have a raised bump but when the doctor palpates over the bursa area it does hurt like #$@%.

Generally though that specific area doesn't hurt but pain refers in all directions when I lay on side, cross legs, walk over 500' or so, stand on that leg, go up steps. My worse pain is just below the waist, on the outer back hip. From what I am hearing the pain specialist say, GTPA is the result of the muscles and ligaments being affected much like my rotator cuff was in my shoulder?

I saw your issue did show up on the MRI? The pain specialist led me to believe there was no "tests" that could be done to see if this is my problem.

 

[Krista]

@Me2, I'll answer all of the questions here! I have had 3 issues with my hip area: the greater trochanteric pain syndome (which I've had in varying degrees since before my THR and continuing now), osteoarthritis that led to my THR, and the gluteal tendon tears that led to surgical repair of the tendons. I had the hip MARS MRI after the THR, that showed the torn tendons and atrophied gluteus muscles. It didn't show anything about the GTPS.

After the buttock and thigh pain/disability that I had post-THR never went away, the first thing they ruled out was problems with my back. I had a back MRI, and a sacroiliac joint cortisone injection. They saw nothing abnormal in the back MRI and I had no pain relief from the injection, and the limp got no better. That was when my original surgeon gave up, and had no clue, even though I told him I was fairly certain that it was a gluteus medius tear. He couldn't see the tear on the MRI scan that, yes, I insisted that he order. The atrophied glute med and min were obvious, as were the numerous fatty inclusions in them, but he just thought they were "weak", not that anything was torn badly enough to require surgery. I had to find a different orthopedic surgeon for diagnosis of that, and subsequent surgery.

And, yes, the bursectomy helped with the very painful spot on the end of the trochanter, and smoothing of the trochanter helped eliminate the "catching". My other symptom of GTPS is still with me, and I expect it to continue -- that is the pain on the outsides of my thighs, going straight down along my IT band. My physicial therapist has used a roller down that area on my surgical leg. I don't notice any difference in pain level there from my other thigh. I don't think it's fixable for me.

It is my understanding that MRI does show muscle/tendon/soft tissue injuries. So does diagnostic musculo-skeletal ultrasound. I would be looking for a second opinion at this point.

The reason my surgery was open instead of arthroscopic is because they wanted to also check out my hip replacement implants and make sure everything was ok, no loosening, no infection. They wanted to dislocate the ball from the cup, and were even thinking about putting in a different ball. In order to do all of this they decided to go open. Oh, and there was also the possibility of having to pull a piece of my gluteus maximus muscle through and attach where my glute med and min attach, in case they were too degraded to be able to support my body anymore. So they were doing lots of looking around, and wanted all options available.

Hope this helps!

 

[Me2]

Thank you @Krista I did appreciate your answering so many of my questions. I still and again tonight went back to look over your explanations.

As my pain specialist recommended, I did ask the surgeon about the about debridement or "surgical" fixing of my hip/lower back. He had said I needed to explore other options.

Well, I went back to my old fashioned "back cracking" chiropractor to see what he thought. He has been doing adjustments which seem to help briefly . . . about 24-48 hours of relief. Sometimes to where I can say its about 2-3 -- I don't feel pain there unless I think about it AND I certainly can live like that! But, unfortunately, like today, pain reached the "I can't do this! What did I do that makes it hurt so bad?" And after ANOTHER visit to chiropractor, his adjustment didn't really help. Another $25 copay thrown away.

But, I also had a visit with the pain specialist today which was good as I usually miraculously feel better when I schedule appointments so I feel like a fake. Well, today, I was hurting. So, I scheduled a PRP injection for June 9. I am scheduled to be closed that day and then would have Saturday and Sunday to recover -- he says appointment will take about hour. Then, crutches for 2+ days with only touch weight bearing and rest. Anyone else with more information on the PRP injection/recovery/what to expect would be appreciated.

 

[Krista]

Sorry you are still suffering, @Me2, and I hope the PRP injection helps. I'm not familiar with that therapy, but crossing my fingers for you!

 

[Dmcfad2]

Sheryl, I got this notice in my inbox this morning and am so sorry to hear you are still suffering! My goodness, it's been over 3 years since I had my surgery and I can say I am finally mostly pain free in that hip, but it took over 2 1/2 years for my thigh pain to finally ease up some. I still get it occasionally, but I am much better. I am back to my pre-surgery workouts (mostly weights and spinning, which I can do with no problem.) My right hip gives me lots of pain now and I still don't walk that great. I have to go slow and I prefer to not walk at all! But, that's life. Having just had my 65th birthday a few months ago.......I guess I won't be young forever! I hope you can get things worked out eventually. I was sorry to hear you are still having some issues, but happy to see your name again. We had a great little group going back then. Good luck with your injection. I hope it helps.

 

[gaulsuerou]

Hello @Me2, found your recovery thread this morning and read it like a book, I am facing double anterior total hip replacement in July needed to read a positive story, I want to be you, I have horses and ride also, looking forward to getting my life back, just don't want to go through the pain and terror of the surgery, I could never be like you and stay awake during the whole thing, but your recovery was so inspiring. Thank you.


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[Me2]

Yea Me2! I quietly celebrated by the third anniversary of my second and right hip replacement . . . I guess its still doing okay -- I just so wish that it was 100 and 10% like the left! The PRP injection seems to have made a fairly big difference -- most of the time, my right hip/back/leg pain is a nuisance 2-4 which is livable.

@gaulsuerou I would imagine you are fully recovered and back in the saddle? Hopefully, your recovery and ability to ride was and is as AWESOME as I have experienced! When I first bought my barn and horses, I usually went riding with my son or husband or friend. With all the shoulder stuff and other life going on, I have not been riding nearly as much as I like but my goal this summer was to really make effort to get comfortable saddling up and riding on my own and I finally achieved that goal last Sunday. So yea, its taken awhile but I am truly getting "back in the saddle"

 

[Me2]

Yea, once again, Me2, on the eve of the FOURTH anniversary of first hip! This hip was and still just fabulous! Getting a few flash backs of the PTSD but able to breathe and distract myself through them.

AND I'm still battling right hip/back pain. Read through my posts from last year . . . I had the PRP injection and it actually worked until I went trick or treating with my grandsons. And, a steady, quick down hill slide from there and its back to hurting even worse than last year this time. I was referred to see a different pain specialist who was able to look at hip with ultrasound and do a bursitis injection with ultrasound guidance. He saw "evidence of right gluteus medius tendinopathy and partial tear near the insertion into the middle facet of the greater troch. Sub gluteus medius bursitis noted as was greater trochanteric/sub gluteus maximus bursitis. Same story as other bursitis injections: about five days relief. But, I could feel myself walking straighter, foot didn't stray outward. When I went in to my appointment, I was hurting really bad (7/8) as I had shovelled heavy snow for about an hour the day before. When I left after the injection, pain was completely bearable (2-3). Odd thing was my sacrum area ached like crazy by day 2 and kept getting really sharp kinks in left back. I go back to see the bursitits injecting doctor on Thursday and I am scheduled for a L4-5 foraminal injection as my pain doctor feels from the MRI that its possible that back is causing some problems. Not sure about that injection but what else to do?

I really miss everyone here. Hoping all is well with so many friends!