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THR One yr post THR with ongoing pain - MRI report included

Most surgeons want you to be a year out from surgery before they will consider seeing you for a second opinion. This is because there is still a lot of healing that can come in that year that doctors tell you it may take to recover. It’s good to pursue whatever you can with your current surgeon to rule things out. But in the end, it may come down to you just needing to give your hip some more time. Patience is the most difficult part of recovery. Hang in there!
 
Hi everyone,

I am just under 5 months post-op THR. I started to develop groin pain at about the 12-week mark(different than before surgery). My surgeon thought I was overdoing it and I backed off activity at that time. I recently went for a follow-up as the pain has progressed. He believes it is Iliopsoas tendinitis. The X-rays look good according to my surgeon. I have an MRI coming up on March 4th. Based on that, I think a Cortisone shot will be the next step. Hoping to avoid the iliopsoas release procedure. Have any of you experienced this situation in your healing journey? I am 51 and consider myself to be in good shape. This setback has prevented me from being able to work my job full-time. I have looked up that i should be doing glute work to try and build strength around the area. Thank you all!
 
Hi @RPDX24,

Here are a couple of articles you may find helpful
Iliopsoas syndrome
ITB (ilio-tibial band) issues and treatments

Please notice that I've merged your new post into your original recovery thread. We ask that you have just one recovery thread to keeps all your information in one place. That makes it easier for us to review your history before we provide advice. Also, if you have multiple threads, you will miss posts and advice left for you in your original thread, and some information may be unnecessarily repeated. And having only one thread will act as a diary of your progress that you can look back on.

So please post any updates, questions or concerns about your recovery in this thread. You may want to Bookmark this thread to make it easier to find.

For more on how to navigate the forum, you can read through this article: https://bonesmart.org/forum/threads/how-can-i-find-my-threads-and-posts.56840/
 
Hey everyone,

I wanted to update you. The MRI shows inflammation and some fluid including mild tendonotis. I am freaking out that this could be an infection. He still feels that is not the case but ordered CRP and ESR to screen for infection. I don't know what to think at this point. I am just trying to manage my anxiety at this point. I need some hope that it's not the worst case scenario.
 
Please do keep us posted, @RPDX24. Fingers crossed that it is not infection. :fingersx:
 
@RPDX24 I'm sorry you are dealing with this. It's hard to keep ourselves from going to worst case scenarios. I guess I've tried to train myself away from this as I always made myself exhausted from worry and it wasn't anything I could control anyway. Easier said than done. Perhaps what your seeing on the MRI is just normal healing especially given the implant artifact that occurs. So, it's good that your doc is being thorough. If what you have been doing hasn't really helped and hopefully, there is no infection, the cortisone shot would probably be your next best step. It does two things. First, it is diagnostic: if your pain is relieved, then it is the tendon causing the pain. Second, if #1 is true, then you will get relief from your pain. (Kind of a "duh.") The kicker is how long your pain relief lasts. You may get long lasting, even permanent relief or short term relief. If it is short term and continues to limit your activities, then other options/decisions will be on the horizon. It can be a frustratingly slow process at times but that it is how it proceeds in the non-emergency category of orthopedics. Some of us have walked this path. Do keep us posted. Wishing you the best going forward.
 
Thank you very much! My CPR and ESR blood tests came back and don't seem to suggest infection. The ESR number was less than 1 which is alarming He said the next step if the Cortsone shot doesn't would be a CT scan. The good news today is the blood work hopefully rules out infection.
 
Hi everyone,

Update: no infection according to the blood test. Cortisone shot did nothing to help me. I got a second opinion and he thought Iliposas release was still my best option but he is suprised the cortisone shot didn’t help. I’m getting scarred that I won’t get better.
 
I've only had good luck with one cortisone shot in my experience & that was when I had my knee drained & then doctor gave it a cortisone shot, felt like I could run marathon.
Since then I've refused cortisone shots for hip bursitis & I have arthritis on top of my right foot & my ankle surgeon suggested cortisone shots but I passed.
You are 6 months into your journey and it is discouraging to not feel like you are making progress.
Wish I had more advice.
 
Thank you, he made it sound like the release surgery was our best option but he isn’t 100% positive it will help. I’m trying to remain positive.
 
@RPDX24 I'm glad there wasn't any evidence of infection. It is interesting that you didn't get ANY relief from your injection as this usually is confirmation of the diagnosis of tendonitis as well as therapeutic pain relief (even if that is short lived.) At 6 months, some docs would suggest that a bit more time in combo with anti-inflammatories might help resolve your issue. I did have one consult suggest exactly that and perhaps another injection. Actually, he said it was too early to do a release (i.e. more time was needed for it to heal.) I was at 7 months post-op at this juncture. I also had a posterior approach. I recall you had an anterior approach. I'm not sure if that affects the healing time of those tissues. Maybe another member could weigh in on that.

In any case, I remember how frustrated I was that I wasn't free of the pain like I thought I would be. It was a different pain, of course, but still pain that was with me everyday and did limit some of my activities. I definitely had a cup overhang that was irritating my tendon. So, it was pretty definitive that a release would take care of my problem once I had done the other conservative measures. There are two procedures: a partial release (some fibers of the tendon are cut to lengthen it) or a complete (the tendon is severed from the lesser trochanter. This is what I had done.) You will have to find an OS who does this type of surgery and how he does it will be up to his expertise. As you know, there are no guarantees in medicine but statistical outcomes that give the doctor confidence in his opinion. With the complete, I had minimum down time (I was quoted a week but I was good to go at 2 weeks.) Any lingering soreness was tolerable and resolved in another week. It took about another couple of months to gain back my strength but I was back to my activities before that. There is only a slight decrease in active range of motion (can't necessarily attribute this solely to the release) but it doesn't limit me at all.

A side note: I recently had some pelvic surgery that I had follow up PT for. In one of our sessions, the therapist began manual pressure releases of the muscles around the pelvis to try and help me with lingering pain. One muscle she released was my left iliopsoas which was very tight. She pressed on a particular point and my whole leg shook like I was shivering. The longer she pressed, the less it shook until it stopped. Afterward, it felt so relaxed and it did give me some relief of my discomfort. I often wonder if that would have worked for my right, operative side as an initial conservative treatment. So, I recommend that might be an option for you to try as well if you can access a knowledgeable PT.

So, the ball really is in your court. The good news is the odds of finding a resolution are pretty good. The bad news is that it will still take some more time and effort. I am very happy that I invested that time and effort. Let us know what you decide and if we can help any further. Blessings.
 
I am about a year and a half out of my hip replacement and I have had pretty much continuous groin pain at about a 2-3 level, what felt like weakness in my surgery leg, and just a general feeling that things weren’t getting back to normal. My excellent therapist did some pressure point therapy on my quad muscles at about the 6 month point which helped tremendously. But I was still working with one hip being higher than the other. My surgeon recommended a shoe lift which did help for a little while. I also got new orthotics which also made things better for a while. But nothing got my hip back to feeling somewhat normal again plus I was experiencing a pretty significant amount of lower back pain.

A couple of weeks ago, I started again with my therapist and described my feelings to her. She did some pushing on various muscles and did some manual motion exercises on my hip joint and upper leg at our sessions. Basically I was to completely relax and let her make the motions. She watched my gait as I walked and said I was leaning to the left when I walked and “tight” - indicating she felt my spine was twisted slightly. She felt sure she could help with everything. After about 4 sessions of this passive motion and pressure therapy, things were improved, but I still wasn’t there yet. So, at our last session, she tried what she termed “traction” where she wrapped a belt around my bent surgery leg and really put pressure on the joint in a pulling motion. She then did some deep massage with a therapy gun on both my quad and glute muscles. It was somewhat uncomfortable, but not really painful. When that was over and I stood up, I was amazed to find that my hip joint suddenly felt normal and loose. I could walk better and had no pain in the groin. The instability I had before was gone. I couldn’t believe it and wondered if it would last. That was last Thursday. Today is Tuesday and my hips still feels normal and loose. I can tell that I still need to strengthen some of those muscles around my joint, but I finally see a light at the end of the tunnel.

I cannot say enough good things about this type of therapy. For me, pressure point treatments and this traction have so far resolved all the problems I had. Even my lower back feels better and I’m wondering if I had an X-ray again that my hips might now be level again. I’m getting an MRI in a couple of weeks and hope it will also indicate good things for my hip.

Your situation may not be the same as mine, but my point in telling you all this was to encourage you to give this type of therapy a try. Not every therapist out there is well trained in pressure point therapy. You need to ask. If you can find the right person, they might be able to help you and eliminate the need for more surgery. To me, it might be worth a try if you haven’t been through this already.
 
Thank you for sharing. I’m doing PT now but, he is focused on tissue massage around the surgical area and exercises meant to strengthen my glutes.
 
My MRI showed inflammation in my glutes and there is a big knot that I can feel when using a foam roller. I need to ask him if he can address that. They feel like my cup overhang is only 4mm so not a clear indicator for hip impingement there.. When I try and bring my knee in towards my chest I can feel almost a snapping sensation that is super painful. They believe that is a telling sign of hip impingement. My groin pain is not constant and only bad when my hip flexor muscles are activated so climbing stairs, getting in my car, putting on shoes etc.. I’m a cyclist so getting back into a race bike position is next to impossible. I’m going to give PT and anti inflammatory meds more time. It’s just a lot to go through a major surgery with the goal of racing again and having this kind of set back. I’m trying to maintain perspective and realize there are a lot of people suffering way worse than myself. I can walk and rest mostly pain free so I have that.

The pelvic part is interesting. I had surgery in 2022 for an Anal Fissure/fistula and my pelvic area has never felt the same since. I use a pelvic wand to relax the area. I’m going to give conservative treatment another couple months. I appreciate all of you giving advice.
 
I'm growing more concerned due to discomfort I'm my glutes and I can't lay on my side of the surgery. I fear there is something wrong with the cup and they don't seem to have anything definitive to indicate if that's the case. I'm loosing trust in my Dr’s and myself in making the decision that will resolve this:(.
 
If you feel things are getting worse, you need to communicate that to your doctors. You can always go for additional opinions, but many doctors won’t see patients until they are at least one year out from surgery.
 
@RPDX24 I feel for you here. It is so disappointing and frustrating to have THR and then to continue to have pain that limits your activity. You want that same complete relief that you read about and that others talk about. Intellectually you understand that it’s a process that doctors go through to diagnose and treat an issue. You’re doing the best to hang in but when things aren’t improving you begin to feel that perhaps the treatment is missing or ineffective for the real problem.

That snapping sensation you feel really hits home for me. I experienced that when moving certain ways. It was extremely painful and my groin pain would then be even worse for a while. It didn’t happen all the time but enough for me to feel until that got fixed, I wasn’t going to get relief. Coupled with an overhang on xray (not huge for me, either) it seemed we pretty much had narrowed down the diagnosis and treatment.

There was an interesting article I read at the time from the AAOS that reviewed patients with impingement that failed conservative treatment. It compared the amount of overhang and relief from surgical intervention. The best results were with tenotomy in patients with <8mm overhang.

A Review of Iliopsoas Impingement in THA Patients

During the AAOS 2019 Annual Meeting, Robert T. Trousdale, MD, professor of orthopaedics at Mayo Clinic in Rochester, Minn., discussed diagnosis, management, treatment, and prevention of iliopsoas impingement after total hip arthroplasty (THA).
www.aaos.org www.aaos.org

You may have to either advocate for yourself to move forward or find another ortho. You may even ask your doc to refer you to someone who specializes in this surgery. I had to keep being the “squeaky wheel” when one consultant doc said it was too early and then nothing happened. My OS wound up finally referring me to a colleague outside of his practice (not the usual way things work.) It is frustratingly slow but again, worth the persistence and effort. Remember, we are the outliers and the doc’s are usually going to want to move more conservatively in this gray zone. Hopefully, it will become evident what needs to be done. Sooner rather than later would be the ideal, right? Keep hanging in and let us know how you are doing.
 
Here is a quick update: the suregeon who would perform my release surgery is not my Suregeon who did the THR. I had a follow up appointment today after more PT. He still wants to do a full release procedure but due to me having some sharp pain near the surgical site and pain when I lye on my surgical side he thinks I may need a second procedure to take care of scar tissue and Bursa pain?!? I’m getting towards the end of my rope emotionally and having a tough time seeing light at the end of the tunnel. I’m trying to see another hospital and surgeon but, they are still” reviewing my case”. Nothing in imaging suggest I have an implant issue. The MRI shows Tendonosis and some thickening. Anyway, thank you for the advice and input. I wish I never had THR. It’s ruined my life
 
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