THR My second THR 9 months out

[EBond]

I had my first anterior THR on my left hip 9 years ago in August 2014 when I was 50. After 3-4 months I was good to go. My only issue was I was mad at myself that I didn't do it sooner after the great results. No pain!

I'm now 59, otherwise healthy. My second anterior THR to my right hip was done on Dec. 13th 2022 by the same Surgeon has not gone as well as my first. My femur cracked during surgery #2. The Surgeon came to my room after the surgery to tell me not to put all my weight on my hip for 30 days. The hospital policy if you don't have any underlying health issues after a THR and if the PT thinks you are good and your vitals are good you can go home on the same day. Unfortunately, I had already put my weight on it after the surgery in an attempt to satisfy the PT that I was in good enough condition to go home the same day. I failed the PT test and ended up spending the night and going home the next day. I'm glad I spent the night I was in no condition to go home. I don't know if I did any damage putting my full weight on my hip during the PT test after the surgery.

Things progressed fairly normal I would say over the next couple of months except I continued to have have pain and stiffness in my hip area. Since this hip wasn't progressing like I thought it should based on my first left hip THR I concluded that I just wasn't doing enough PT. This is when I really started to focus on PT. I've been to PT 26 times over the last 4-5 months. I purchased nearly every apparatus my PT my uses on me so that I could workout in my spare bedroom a couple days a week to speed my recovery along. Some weeks were tough to workout on my own because I was generally sore for a day or two after a PT session. I was caught in a constant state of pain and soreness from the rehab I was doing. I put up with the pain if it meant getting this behind me.

Two months ago I visited my Surgeon because of the hip pain in my right hip, persistently stiff psoas no matter how much stretching, thigh pain, and now knee pain. He took a xray and said everything looked good. He said he thought my lower back was causing my issues. He gave me a steroid shot for the bursitis pain. I guess the knee pain is from the leg length difference. My leg is much shorter. Did the cracked femur have anything to do with the excessive leg length difference by having to drive the stem further into my femur to get it to stay in?

Last week I saw the physician assistant because my surgeon doesn't want to see me anymore at this point. The PA took another xray and said he thought he saw 2-lines in my right hip bone that shouldn't be there. He ordered blood work to rule out an infection and ordered a CT scan that I'm getting done tomorrow. The blood work came back negative for an infection.

After reading several threads here, I've decided to stop the hardcore PT and concentrate on walking and resting. Walking pain-free is my goal. I'll update what the CT scan results are next week when I see the PA again. I'm am relieved I found BoneSmart. Any suggestions or guidance would be appreciated. Thank you.

 

[Layla]

Hello and Welcome to BoneSmart. Thanks for joining us!

We ask that you identify which hip was replaced nine years ago and if you don't remember the month, please at least provide the year so we're able to create a signature for you.

Your femur fracture is not the first I've read of here. If you're interested in reading threads of others that have dealt with the same, use the SEARCH at the top right of the page typing in key words such as "femur fracture" or "fractured femur" and threads where it's been mentioned will pop up.

It sounds as though you overdid the PT and exercising at home, likely aggravating soft tissue over and over again.
It is not necessary to exercise your injured hip to promote healing. The controlled trauma sustained through THR will heal on its own. Often though, we're impatient and want to move the process along. In doing so we run the risk of struggling with pain and setbacks stalling the healing process. The best therapy for recovery is walking, but not to excess.

I am happy to read you're going to step away from the exercising and PT and try rest and walking as your exercise. Hopefully with time, rest, and engaging in the activities of daily living you will notice less pain and improved mobility.

I will leave our Recovery Guidelines even though you are eight months post op. You may find some of the information useful, especially icing if you're still dealing with pain or swelling. I wish you comfort and hope you notice some improvement soon.

Also, we do have articles in our Library that may be of interest. Here is a link Library Index
Stop back often, we'll be here for support!

 

[Layla]

HIP RECOVERY GUIDELINES

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for THRs​

The recovery articles
Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Eman85]

Sounds like you figured it out on your own. The aggressive PT tends to cause more pain with no gain, usually setbacks. I was too aggressive with my first and probably caused myself problems, totally a lazy bum with my second and it's excellent. One thing is looking at realistic goals, and pain free walking is a good one. Mine was pain free sleeping which I achieved.

 

[EBond]

Thanks for your response.

 

[EBond]

I've got pain in my right thigh when I put most of my weight on it. I wonder if someone here could look at my x-ray I took with my phone when I was left alone in my doctor's office. I have no knowledge of what the implant position should be but the tip of the implant looks like it's really close to my bone. Could the reason for the pain be the implant is rubbing against my bone? Thank you.

 

[benne68]

@EBond Can you request a digital copy of your x-ray so we can get a better look at it. Photos of images on a computer screen can be misleading.

 

[Eman85]

I have no idea how to read an x-ray or exactly what I'm looking at. That said here's a pic of mine and the implants look much different. I guess every style/design will look different.

 

[EBond]

I would be grateful if any of the kind people here could offer me your thoughts.
I developed mid-thigh pain a couple of months ago on my RTHR that was done 10 months ago today. Over the last 2 months I've had X-rays, a CT Scan and a Bone scan trying to figure out the source of the pain. I met with my OS 2 days ago and he told me the test were inconclusive. He said he would have to go back in to be 100% sure, but he felt like the cause of my pain was a lose implant. He wants me to try Alendronate Sodium 70mg once a week for 3 months and then come back in to see him. After reading some of the commentary here concerning Alendronate, I am apprehensive about taking it. It seems like I'm going to have a decision to make soon and that's to continue to live with the pain or pursue a revision? Of course, neither of those options appeal to me. Thank you.

 

[Layla]

I'm sorry you're dealing with pain and uncertainty. The thought of waiting an additional three months would be difficult.
Consider a second opinion with a reputable revision specialist, totally unrelated to your current surgeon's practice. I can't promise, but Admin may be able to recommend someone in or near your area, if you'd like them to weigh in? Please let us know. Wishing you comfort in the meantime.

Until you receive a second opinion or a more definitive diagnosis, as a precaution, I would be careful not to over exert.
@EBond

 

[Jamie]

I agree with Layla. Time for a review by a good revision surgeon. If you tell me a city where you live and how far you’re willing to drive to see a specialist, I’d be happy to give you some surgeon names to check out. Let me know who your current surgeon is so I can be sure to stay away from any of his partners. You want an independent review of your case.

You are wise to be cautious about Fosamax (alendronate sodium). It can cause bone loss in your jaw. Have you been told you have osteoporosis? Frankly, at this stage in your recovery I would be surprised that you would experience bone growth into your prosthesis. There is an area on your x-ray that appears to show some slight bone remodeling, which is generally an indication that some loosening has taken place. These are just speculations on my part and you really need the advice of a good revision surgeon.

 

[Eman85]

You say you have mid thigh pain, have you changed or increased your activity? If you rest and ice does it change and lessen?

 

[Mojo333]

I agree with all the above advice and observations...I would probably be using a cane to keep the stress off of that leg (if you aren't already) until I could get a revision surgeon's advice.
IF (and perhaps not) it is loosened and is toggling at the tip which causes the remodeling, you do not want to overstress and compromise the bone.
I really hope you get answers soon.
So sorry as I know this is got to be making you terribly anxious.

 

[EBond]

Thank you all for your responses! I appreciate it more than you can imagine.
-I do have osteoporosis.
-
@Jamie what do you mean when you say "Frankly, at this stage in your recovery I would be surprised that you would experience bone growth into your prosthesis? Are you saying that 10 months since my surgery is not long enough for my bone to grow into my prosthesis? If so, how long would it typically take?
-I'm close enough to the Raleigh-Durham-Chapel Hill area to travel there and it would be out of my OS's practice.


Thanks to all of you for helping me to understand things that are so important to me and my quality of life but that I know so little about.

 

[Hippie Chick]

Nothing to add just sending good thoughts your way!

 

[EBond]

Thank you Hippie Chick.

I know it's quite a bit to ask but could someone explain to me the radiologist results of these 3 separate test? To my uneducated mind It sounds like at a minimum my prosthesis is loose?

EXAM: CT HIP W/O (RT)
DATE: 8/11/2023 10:30 AM
ACCESSION: 42812709
DICTATED: 8/11/2023 11:33 AM

CLINICAL INDICATION: 59 years old Male with right hip pain,
evaluate prosthetic loosening

COMPARISON: None.

TECHNIQUE: CT of theright hip was performed without IV contrast.
Multiplanar reformats were provided. 3 reconstructions
performed.

FINDINGS:
Right total hip arthroplasty. The acetabular component is
well-seated with mild heterotopic ossification around the
superior lateral aspect of the acetabulum. There is a cerclage
wire in the proximal aspect of the femoral component. No
significant osteolysis around the femoral component. No acute
periprosthetic fracture. Greater trochanter intact. No
sizable effusion though evaluation is limited by beam hardening
artifact from the metallic hardware.

No significant muscle atrophy around the right hemipelvis. No
organized fluid collection.

No intrapelvic free fluid or organized collection. Colonic
diverticulosis without diverticulitis. No adenopathy. Mild
focal atherosclerotic calcification at the common femoral artery.

IMPRESSION:

1. Right total hip arthroplasty. Mild heterotopic ossification
around the superior lateral acetabulum without other
potential adverse hardware feature.

Final report electronically signed by: Joshua Wallace, MD on
8/11/2023 11:36 AM

Electronically Signed By: JOSHUA WALLACE MD on 08/11/2023 11:36
AM

Component Results​

There is no component information for this result.

General Information​

Ordered by Shawn Hopkins
Collected on 08/11/2023 10:57 AM
Resulted on 08/11/2023 10:45 AM

<<<<<<<<<<<<<<< THIS IS AN EXTERNAL RADIOLOGY RESULT FROM >>>>>>>>>>>>>>>
<<<<<<<<<<<<<<<<<<<<<< EasternRad >>>>>>>>>>>>>>>>>>>>>>>


------ ORIGINAL REPORT ------
Study: Nuclear 3 phase bone scan.

Indication: Right hip pain. Rule out loosening.

Technique: For this exam, the patient received 23.6 mCi of Tc99m
MDP and a routine 3 phase bone scan is performed.

FINDINGS:

Flow images demonstrate normal tracer distribution of vascular
compartment and soft tissue. Blood pool images show no
discrete focal uptake to suggest hyperemia.

Delay images show postsurgical changes of bilateral hip
arthroplasty. There are mild/moderately increased periprosthetic
uptake of right femoral component, along the greater and lesser
trochanter and proximal diaphysis of right femur. No
abnormal periprosthetic uptake is seen in the left hip.

Impression:

Mild/moderately increased periprosthetic uptake along the right
femoral component, along the greater and lesser
trochanter and proximal diaphysis without hyperemia. Mild degree
of loosening at these sites are difficult to exclude.

Final report electronically signed by: Jay Lee, MD on 9/11/2023
8:48 AM

------ ADDENDUM #1 ------
Comparison: No prior bone scan.

Correlation: CT right hip dated 8/11/2023.

Final report electronically signed by: Jay Lee, MD on 9/11/2023
4:24 PM

Electronically Signed By: JAY LEE MD on 09/11/2023 04:24 PM

Component Results​

<<<<<<<<<<<<<<< THIS IS AN EXTERNAL RADIOLOGY RESULT FROM >>>>>>>>>>>>>>>
<<<<<<<<<<<<<<<<<<<<<< EasternRad >>>>>>>>>>>>>>>>>>>>>>>


------ ORIGINAL REPORT ------
Study: Nuclear 3 phase bone scan.

Indication: Right hip pain. Rule out loosening.

Technique: For this exam, the patient received 23.6 mCi of Tc99m
MDP and a routine 3 phase bone scan is performed.

FINDINGS:

Flow images demonstrate normal tracer distribution of vascular
compartment and soft tissue. Blood pool images show no
discrete focal uptake to suggest hyperemia.

Delay images show postsurgical changes of bilateral hip
arthroplasty. There are mild/moderately increased periprosthetic
uptake of right femoral component, along the greater and lesser
trochanter and proximal diaphysis of right femur. No
abnormal periprosthetic uptake is seen in the left hip.

Impression:

Mild/moderately increased periprosthetic uptake along the right
femoral component, along the greater and lesser
trochanter and proximal diaphysis without hyperemia. Mild degree
of loosening at these sites are difficult to exclude.

Final report electronically signed by: Jay Lee, MD on 9/11/2023
8:48 AM

------ ADDENDUM #1 ------
Comparison: No prior bone scan.

Correlation: CT right hip dated 8/11/2023.

 

[Jamie]

Although I'm by no means an expert on interpreting the results of these scans, it does appear there is a possibility of implant loosening. Sometimes it can be very slight and still cause pain. The area I mentioned at the tip of the stem does appear to show some slight bone remodeling, so that would be something to ask about. I think your best bet is to get at least one, maybe two additional opinions. The fact that you have been diagnosed with osteoporosis should be a factor to consider in the type of implant that is used. Ask about that as well. It's possible that a cemented implant would be a better option for you.

With an uncemented implant like you have, the strength of the implant depends upon good bone growth into the porous coating of the prosthesis that begins almost immediately after surgery. It takes at least 6 weeks for growth to lock in the implant. During that time, the growth process can be interrupted by a number of things. If that happens, adequate seating of the implant may not happen. This growth process usually doesn't continue past about 4 months. If the bone has not grown in properly by then, it's usually unlikely that it do so after that time.

Here are a couple of surgeons for you to check out. Let me now how they work out and, if I need to try and search out additional names, I will.

Raleigh area
Dr. Demetri Economedes
Cary Orthopedcs
Cary, North Carolina 27511
Phone: 919-467-4992
Hip revision surgery. Recommended by Aditi.


Durham
Dr. Michael P. Bolognesi
Duke University Medical Center
Durham, NC
Speaker at 2018 ICJR workshop on problem hips and knees
Does lots of research into patient outcomes

 

[EBond]

Thank you so much to everyone. Jamie, I can't thank you enough!

 

[EBond]

I saw Dr. Demetri Economedes today that Jamie recommended to me. He spent over an hour with me. What doctor spends an hour with you? It was the best experience I have ever had with a doctor! I never felt rushed. He was totally immersed on me and my issues. He methodically questioned and examined me to include or exclude the source of my problems. He reminded me of a lawyer doing a cross-examination. Here were his conclusions:

He said after looking at my x-rays from 2014 when I had a LTHR and my current x-rays of my RTHR that was done in December of 2022 he would have never operated on my RTHR. The amount of cartilage I have in my hip is virtually the same as it was 9 years ago and is no where near being bone on bone that would trigger a THR. He said when an orthopedic surgeon hears groin pain, especially from someone that has already had a THR, they automatically think it's time for another THR. He said my doctor should have done more test on me before operating like an MRI. He also said the bone scans weren't of much value this soon since it hasn't been a year since my surgery. You need 14-16 months after the surgery to gain any good information or conclusions as to my prothesis being loose.

Dr. Economedes thinks I have a back problem and not a loose prothesis.

I also have nearly an inch shorter leg length discrepancy. Dr. Economedes thinks the LLD happened when my prothesis sunk deeper into my femur when I walked for the PT department immediately after my RTHR surgery. My OS stopped by my hospital room after the surgery to inform me that my femur had cracked during the surgery and for me NOT to put more than 50% of weight on it for several weeks. He was too late, I had already put 100% weight on my RTHR for the PT departments. Dr. Economedes recommended that I purchase some orthopedic shoes. I already use shoe inserts but he wants me to try the orthopedic shoes. I've seen those shoes, not really looking forward to that.

He made me an appointment for me to come back 4 months from now. He said if I'm still having issues after trying the orthopedic shoes he will send me to a back doctor if he needs to. I do have back pain. It's not overwhelming pain. It's manageable. My OS's PA prescribed 100mg gabapentin several months ago for me. Sometimes I take it, most days I don't. I usually rely on Ibuprophen for my aches and pains.

Thanks for letting me share my story with everyone. Special thanks to Jamie for finding Dr. Economedes for me. I couldn't resist telling him about how I had found this really great website named bonesmart.org, and that he had been recommended to me (Dr. Economedes and I live in North Carolina) by a very nice lady named Jamie from Kansas that I have never met. He found it quite amusing. It's funny how life works sometimes.

 

[Hippie Chick]

I am so glad you have some answers now. I have been peeking here regarding comfortable shoes for when I return to work and saw Oofos?- hopefully you can find shoes that you like and meet your shoe needs.