THR MoM resurfacing converted to ceramic dual mobility.

[PolarIce]

Thank you for starting your thread and posting about your recovery and keeping it up to date as you go through your recovery. I was just told that I am able to get my first THR at 36 and they are putting in a dual mobility implant, so your experience and story was very valuable to me. I hope you do continue to get better and improve and able to go back to normal to all the things you enjoy doing.

 

[ljpviper]

Glad it helped. On another topic my tooth was bothering me and I just came back from the dentist. Seems my back molar is infected and I will have to get it pulled or a root canal.

Should I reach out to HSS and let them know so I can be on antibiotics in the meantime? What are the chances of the infection spreading, till I get the tooth corrected.

Thanks,

Larry

 

[subie2021]

My surgeon told me to ask the dentist to prescribe antibiotics for any kind of work or dental emergency, and if the dentist refuses (apparently some dentists don't think infection can spread from teeth to hips) to call the OS's office and they would call in a prescription. He was adamant about it.
Good luck with the molar. Ouch!

 

[golfer67]

You need to get on antibiotics right now. I have metal in my neck and SI joint as well as my hip and I have been told to always take antibiotics anytime I have an infection or dental procedure.

golfer67

 

[ljpviper]

Thanks I just emailed HSS, the doctors PA. Who knows how long I have had that infection. My tooth really does not bother too much so I did not really bother to go get it checked out.

Thanks,

Larry

 

[ljpviper]

HSS prescribed some antibiotics till I get the tooth taken care off. They stated there is very little chance of the infection passing to your hip. Better be safe than sorry.

 

[Going4fun]

Thanks for sharing.

In my surgeon's practice each surgeon has their own protocol for dental work. My surgeon doesn't think antibiotics are necessary. But I didn't have an infection. So your post helped me keep that distinction in mind.

So if I get a tooth infection, I will call my surgeon to find out his recommendation. Thanks for sharing this episode.

 

[PolarIce]

My surgeon told me to ask the dentist to prescribe antibiotics for any kind of work or dental emergency.

I'm located in Canada and my surgeon here also said the same thing. They also said they recommended postponing surgery if I got any major dental work within 6 weeks of the surgery. In a way it's comforting to hear that regardless of where you live, it's pretty much the same recommendation across the board.

 

[ljpviper]

Hello, I had a follow up MRI this past week at HSS. Looks like I have tendonitis/tendonosis in multiple locations around my hip.

EXAM: MRI HIP RIGHT WO CONTRAST

TECHNIQUE: MRI of the right hip was performed utilizing axial, sagittal, and coronal fast spin echo techniques, as well as MAVRIC coronal inversion recovery and coronal proton density pulse sequences for purposes of metal artifact reduction.

HISTORY: Status post right total hip arthroplasty. Now with anterior right hip pain.

COMPARISON: Radiographs from 9/9/2021 and MRI from 6/10/2020

FINDINGS:
The previously seen right hip resurfacing arthroplasty has been removed, and there is a new right total hip arthroplasty. There is no occult pelvic or periprosthetic fracture. There is no osteonecrosis of the native left hip.

Dedicated images of the right hip demonstrate a well fixed femoral component. A new small area of cystic change is seen along the proximal aspect of the femur with minimal adjacent stress reaction. The acetabular component is not loose. There is minimal synovial expansion, increased from the prior examination, but without MR features suggestive of active infection or aggressive adverse reaction to wear debris. The hip joint capsule is remodeled.

There is no trochanteric, iliopsoas, or ischial bursitis. The short external rotator muscles are somewhat atrophic. The posterior footprint gluteus medius is maintained. There is mild tendinosis of the anterolateral footprint gluteus medius. Moderate gluteus minimus tendinosis is seen. The abductor muscle bulk is preserved. The iliopsoas tendon is not torn, and the muscle bulk is maintained. The rectus femoris origin is mildly degenerated, and there is bony remodeling of the anteroinferior iliac spine. No stress reaction is seen at the symphysis pubis. There is mild bilateral proximal hamstring tendinosis.

Disc degeneration is identified in the lower lumbar spine. Fat planes surrounding the sciatic nerves are preserved.

There is no pelvic lymphadenopathy. Fat extends into the left inguinal canal.

IMPRESSION:
Magnetic resonance imaging of the right hip, status post arthroplasty, demonstrates no new features of component loosening, periprosthetic fracture, active infection, or aggressive adverse reaction to wear debris. There is minimal stress reaction within the greater trochanter, adjacent to an area of cystic change.

Final Report: Dictated by and Personally Viewed and Signed by Shari Jawetz MD. Released Date and Time: 11/18/2021 8:26 AM.

 

[golfer67]

Good Luck maybe your doctor will see something that the radiologist did not see.


Golfer67

 

[Hippielife]

These reports are difficult for patients to understand. Ask for the surgeon to interpret the results and refer treatment.

 

[ljpviper]

Thought I would give an update. I am still getting swelling on my rectus femoris by the anterior scar. Maybe it’s something I have to live with as I have had 3 surgeries on that hip. I was never able to get totally pain free.

Kinda stinks but it’s reality.

Thanks,

Larry

 

[Layla]

I’m sorry. Larry. I don’t know what to say other than I hope it eases, or you pursue alternative opinions or ideas that may bring you the comfort and relief that you deserve.
Take extra good care!
@ljpviper

 

[ljpviper]

Could be the psoas rubbing against the cup. Very similar to golfer. Very hard to diagnose. Thanks Layla

 

[Layla]

If you feel strongly about this, discuss it with your surgeon, or seek another opinion. Besides golfer, @SaraK @Hip4life and @Jws. have experienced a release, if interested in reading through their threads.
Following is a article from the BoneSmart Library - https://bonesmart.org/forum/threads/psoas-tendinopathy-and-surgery.45784/

 

[golfer67]

Well darn Larry I thought most of your problems were over. Sorry to hear that the swelling has returned and since you had your surgery done at HSS it will be hard to find any better doctors than the doctors at HSS. Are you scheduled for a follower up appointment soon? Maybe they can come up with a reason for all the swelling?



Golfer67

 

[Hip4life]

Hi, Larry. I'm sorry you are still dealing with painful issues. It must be very frustrating. It's a difficult pill to swallow thinking you may have to just live with it. Since you mentioned the possibility of the psoas rubbing against the cup, have you investigated this at all? One of the definitive, differential diagnoses for this is tendon sheath injection. Just like the rectus femoris, the psoas tendon will respond when injected if it is the offending party. You'll know pretty quickly. That's exactly what I experienced. Suspected tendinitis from cup overhang with ongoing groin pain was my initial diagnosis. With the injection into the tendon, the pain was better immediately and completely resolved within a couple of days. Diagnosis confirmed. Unfortunately, the relief only lasted a couple weeks. That's when we moved on to the tendon release, done by arthroscopy.

If you're still looking for a solution, I would encourage you to at least investigate this. You're too young to live life in pain if there is a possible answer. I know it relieved my pain so I could get on with life without thinking about my hip every day. Let me know if I can help in any way. Blessings.

 

[ljpviper]

Thanks for all the support, much appreciate It. Yeah very odd that my rectus femoris is still swelling a year and half later. I have not reached out to HSS. Still just dealing with it as I am functional but still in pain.

Might try injections in both the psoas and rectus femoris this week.

 

[ljpviper]

Thought I would give an update. I went back to HSS last week as my rectus femoris is still swollen at the pelvis insertion and down my quad with pain.Had and X-ray and blood work. All seemed ok. He did not have an answer for the swelling.

I was studying the anatomy of the hip and pelvis and noticed the femoral nerve is next to the rectus femoris and psoas. When having anterior surgery the nerve is very close to the opening created and it sometimes can get pushed aside.

Anyways I had some gabapentin pills here in my cabinet. They are great for nerve pain. I took 3 yesterday and 3 today. What do you know the swelling is already down, also less pain. I will speak to the surgeon Monday about this. Could be that nerve got damaged or scar tissue is hitting it.

Thanks,

Larry

 

[Mojo333]

Hi @ljpviper
Sorry you are still struggling with pain...
And the detective work continues
Meralgia paresthetica (hit on link for our article) is the name of a disorder characterized by tingling, numbness, and burning pain in the outer side of the thigh. The disorder is caused by compression of the lateral femoral cutaneous nerve, a sensory nerve to the skin, as it exits the pelvis.

Gabapentin is mentioned as well.