THR My rehab day 1 to 1 year and 2 months - ongoing thigh/groin pain LTHR

[Layla]

Hello ledzep,
No apologies necessary. Ongoing pain is not only draining, but frustrating when you’re dealing with uncertainty. I’m sorry you’re still struggling at eight months post op.

Your thread title has been edited per your request. Possibly it will attract the attention you are hoping for and someone will share their experience with you. Many members have received referrals to a Neurologist in an effort to discover the origin of their pain. I hope your appointment leads to answers and speedy resolution. Please let us know how it goes. I wish you comfort in the interim.
@ledzep

 

[SaraK]

I hope the neurologist is able to help you. You never know - this doc might be the on that "gets it." Keep in mind that soft tissue issues can create that loose feeling. Enough have looked at the solid pieces and not found anything. It's time for someone to really look at the soft bits and how they are impacted. It is possible that you developed a back or spine issue after your surgery that's completely unrelated.

I truly understand the frustration of no one seeming to help you and what the constant pain can do to you. I was referred to a pain doc with my issues. Unfortunately, she had the mindset that looked for one thing and attributed my pain to my SI joint being out of alignment and causing a twisted pelvis. I finally had to find my own doc. I found him thru my physical therapist who'd had another patient with a similar problem. When you find that one person who really listens and adds everything up, it can lighten the load.

 

[Hip4life]

Oh, this is tough. The wheels are slow to turn in medicine sometimes, especially when there’s not something obvious that shows up. The pain however is real and obvious. It really feels like a disconnect, doesn’t it? We certainly understand. I’m surprised that no one has wanted to try other diagnostic tools to try and pin point the source of your pain or at least rule out some possibilities. Hopefully, the neurologist can help. Please don’t give up hope. It takes some dogged determination to find the right person who has the answer. We’re here for you. Keep us posted.

 

[Smh]

@ledzep (dare I guess your favorite band? ) - it can be difficult to diagnose some issues, even with MRI, x-ray and CT. I had a psoas impingement (the tendon was rubbing against the implant which has a rough texture. It caused increasing pain and was difficult to get my surgeon to listen. I sometimes had a feeling like hydroplaning - especially when I rotated on that leg with weight on it.

It took me several months and tests that showed nothing (the tests you mentioned are not great for showing tendon issues - especially right by the titanium part of the impact).

Eventually I was told to shut everything except essential movement down for 1 month and then to do PT. The pain declined significantly during that month but ramped up right after starting gentle PT. After 3 different PTs saying there was an impingement but my surgeon and his pain management colleague still saying there was nothing wrong with the hip, but maybe the back, I took myself to a surgeon that specialized in the young hip and the impingement was quickly diagnosed). After surgery to lengthen the muscle/tendon, I am pain free.

So, that's a long way to suggest that you shut things down for a month or so. That will have diagnostic value. If that doesn't settle it down once and for all (which is possible), find a physiatrist or a surgeon that deals with the young hip. They may do tests to rule out infection or metallic. They may decide to do an injection into the tendon at the groin (which is actually a treatment for and the gold standard for diagnosing psoas impingement) or elsewhere if they think it could be a different muscle or tendon causing problems.

Most of all, be the squeaky wheel. Even when PTs agreed there was an issue, the doctors (except the last one) didn't listen. I had to advocate for myself long and hard.

I'm not always looking at the hip recovery area, so please tag me if you wants to ask questions.

Sara who did your surgery
I am 53 had posterior approach THA done October 2021 unfortunately my pain much worse since and we are unsure if ileoposas impingement is the cause
Thanks Smh

 

[ledzep]

Hello to all .....I thought that I'd update my situation. I am now 11 months post op left THR. After going for numerous scans, xrays, Orthopaedic doctors, neurologist, a pain specialist, injections in back, etc etc, I still have severe pain in left thigh and left groin. I then went to see my GP and she sent me for a further ct scan and today I got the test results back, which I roughly translated from German to English as follows : -
"Findings - Narrow, semicircular resorption margin in the area of the prosthetic cup with marginal sclerosis. In the coronal reconstruction, also, the radiolucency border extends almost semicircularly around the cup"......." Suspicion of acetabular cup loosening"......"Prosthesis shaft intact and tight"....."cysts on the rim of the acetabulum"
Has anyone come across this type of description/terminology before? Does this sound like revision surgery to any of you? I am seeing an Ortho doctor again on 31 August 22 but I would like to know what these 4 things mean beforehand. I tried googling them but to no avail. Any help or advice would be highly appreciated.

 

[ledzep]

Hi folks, so I am now 1 year and 1 week post left THR and I saw the orthopaedic doc today, concerning the ongoing thigh/groin pain. The 1st thing he said to me is that he can clearly SEE that I have problems with my left hip because of the muscle wasting in my left thigh and left bum cheek! He looked at all the scans, xrays, etc and showed me in detail each and every image of my hip, explaining why he thinks all appears to be ok, whilst in the presence of another doctor. I also explained to him that when I do left leg lateral raises and left leg lateral swings there is an audible 'clicking' sound. When I tried to demonstrate this to him there was unfortunately no clicking sound!!!...just my luck. My consultation ended with another prescription for pain killers and told to see him in 3 months time again. I am worn out mentally now as this is causing me much distress. I am very down. When one is 67 yrs old, 1 yr and 1 week is a long time! The frightening thing is that my right hip is also due for hip replacement. I have read many postings but I would like to know from you good folk out there that struggled with impingement, psoas tendonitis, etc etc .... did you also hear/feel the clicking when doing any lateral leg exercises? Any advice or comments will be highly appreciated.

 

[Layla]

I'm really sorry you're still struggling. At this point the only advice I have is to suggest you consider seeking a second opinion within a different practice, not the group you're currently with. Possibly a fresh set of eyes on your situation will prove beneficial. It's worth a try. What do you have to lose, but hopefully the pain. I'm sure you'll receive more feedback here. I wish you the best and hope you soon find permanent relief from the pain you're dealing with.
@ledzep

 

[Mojo333]

Hi @ledzep

I'm sorry your post went unanswered prior to your appointment but I agree with Layla that you should seek out a completely independent opinion.

Findings - Narrow, semicircular resorption margin in the area of the prosthetic cup with marginal sclerosis. In the coronal reconstruction, also, the radiolucency border extends almost semicircularly around the cup"......." Suspicion of acetabular cup loosening"......"Prosthesis shaft intact and tight"....."cysts on the rim of the acetabulum"

Though I am not a medical professional....there definitely sounds like there is a problem with the positioning of the acetabular cup and this isn't going to resolve itself...and certainly 3 months of painkillers and your ongoing muscle atrophy is not going to be helpful.
I am sorry you have to go through this, but please let us know if you get a second opinion.

 

[Hip4life]

If your current doctor explained away what were the reported findings on your scan results, then perhaps a second opinion is warranted. It does need to be in a different practice, however. If there is a problem with the cup, it could be why you have thigh and groin pain. It could be irritating the tendon and muscles in that area (also known as impingement.) Another 3 months seems a long time to wait only with additional pain meds. I had the tendon impingement on the prosthetic cup. 3 months was a long time to have that pain and it's been longer for you. The ball is in your court. Time to try a different tactic to find a solution. Wishing you the best in finding that solution. Please keep us posted.

 

[SaraK]

I had some popping/snapping sounds during certain movements (note that psoas impingement is also referred to as "snapping hip"). During my pain journey, I saw 4 different PTs. Except for the one I fired after a single session, each went from saying "psoas impingement is rare - look for horses, not zebras" to saying "I think you have a psoas impingement" but my surgeon and pain management specialist didn't like the answer and kept sending me to a different PT. The last PT told me she'd had another patient with psoas impingement and gave me the name of the surgeon that had helped her. He started to show me a muscle on the xray - I beat him to the punch in naming it. He chuckled and said his first patient in private practice had come into his office with a 6 inch stack of paper about psoas impingement. He said it was more prevalent than many surgeons understood and that patients had usually done so much of the research to diagnose the issue before finding the right doctor. He agreed that PI was the most likely culprit in my case. We confirmed with a steroid injection into the tendon at the groin and then scheduled surgery to fix it. I had my one year check up with the original surgeon in between that appointment and the surgery. They are at the same hospital and apparently the new surgeon had made a point to discuss PI with that surgeon because he had a much different attitude about my problem at that checkup!

Moral of the story - keep advocating for yourself and find someone with the right credentials/specialty. In particular, someone that deals more with sports injury and soft tissue. My new surgeon did his fellowship studying hip arthroscopy. Your old surgeon sounds like he is in "cover your tush" mode and trying to protect himself from litigation.

 

[ledzep]

Thank you so much for your replies. Yes I am going to follow your advice and seek a different otho doc and get away from this hospital group. I do get the feeling that they are fearful of me seeking compenstation, which is the very last thing on my mind....all I want is to walk normally again and pain free. When I do find someone suitable I will definitely mention the psoas impingement.
I will keep you updated.

 

[ledzep]

Hi folks, just a quick question concerning psoas impingement, snapping hip, acetabular cup etc. I have a very clear "clicking" sound on the outside of my left hip, not on the groin side/inner side of my hip - could this be a psoas impingement? I read somewhere the the clicking/snapping in the groin area sometimes points to an impingement.

 

[subie2021]

Last year before THR I had snapping hip on the outside of my hip, not in the front or groin. It turned out to be a tight IT band and resolved with rest and some work to loosen up the muscles there.
At the time, rolling over a tennis ball or a foam roller helped, but I wouldn't do that now with the new hip unless OKed by my surgeon. And it hurt like the dickens! Nowdays I'd try massage using a cueball or something, and ice. Ugh, I hate the idea of ice, but it really is useful and effective.

 

[spaniel]

Hello- I’m also an almost 8th month anterior approach person with ongoing issues albeit nowhere near what you are describing. May I ask how the orthos explain away the atrophy? Yes, I know,lack of use but still! I do know that there is a real fear out there amongst orthos re the compensation issue. I hope you don’t wait the three months. I do see that you are from Germany. Here’s a thought until you can get an opinion from a stellar ortho outside your current practice, Consider doing a remote second opinion with Hospital for Special Surgery,in NYC. It is the number one rated ortho hospital in the US. With that said, the remote consult is about five hundred dollars I think. I hope to be heading down there in person if matters continue with me-but I’m still giving it a bit more time.

 

[ledzep]

Hello admin , could you change my header to -" My rehab day 1 to 1 year and 2 months ongoing thigh/groin pain left hip replacement"" thanks. Only for the benefit of people going through continuous pain.

 

[SaraK]

@ledzep
Sorry you're still having issues. I wouldn't think a snapping sound on outside of hip would be psoas impingement. I did also have issues with a tight IT band and, depending on location on outside of hip, it could be something like that. Once I got the psoas issue taken care of and was able to get more active, the IT band tightness seemed to resolve on its own. You might see if you can get an appointment which a physiatrist - they deal with musculoskeletal issues and non-surgical treatments for pains like the one you've experienced.