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

[Hip4life]

@RPDX24 I'm so sorry you're so discouraged. If you could get the tendinitis taken care of, it might change your perspective on the THR.

Rarely, are the original OSs the docs that take care of this release. Many of these procedures are specialized training or a skill set that another ortho has honed. As far as needing a second procedure: is the doc talking about doing it at the same time as the release? That wouldn't be uncommon. If all of that is inflamed and causing issues, I would welcome getting all of it taken care of in one surgery. My understanding of those procedures, is that they are fairly straight forward and technically simple in skilled hands.

Just an observation, if you have bursitis/tendinitis, I would be very cautious about PT. Certain things that they might be doing could be continuing to aggravate angry tissues. It's that vicious cycle that can have you feeling like you're not getting anywhere even though you're trying to do the recommended thing. I could've done PT until the proverbial cows came home but it was never going to fix the actual problem.

The other "complicating" factor is that you are still "only" 7 months out in a recovery that can take a year or more to to complete. For some docs that is a crucial time consideration. You're younger and ready to get back to life. All that needs to be taken into account and modulated with a whole picture kind of perspective. What was urgent for me was not so much for the doctors weighing invasive procedures against the tincture of time in doing what they deemed most appropriate for me. It is frustratingly slow and discouraging as you see all your hipster friends annoyingly getting back to all their activities free from pain. It is a real possibility for you, too, if a doctor can tie all this together for you. It's the waiting that is hard. One begins to understand the saying, "Patience is a virtue" in a circumstance like this.

I hope you get some answers soon. Keep us in the loop.

 

[RPDX24]

Thank you for the well thought out input. My original THR Surgeon referred me to a specialist. PT took a turn for the worse when he incorporated stretches for the psoas area. He wants to do a full release first. I made a follow up appointment on June 25th. They are trying to get insurance approval for the surgery. I think I would schedule it for early fall around the one year mark to see if I can somehow improve my situation. I’m 51 and raced and rode bikes my whole life. I’m kind of lost with my new normal limiting me so much. I just want to get back to having age appropriate mobility.

The troubling part is while I have symptoms of temdonotis, the injection did not help me. While he said that can happen and is dependent on the skill of the person doing the shot. I also have pain right along the muscles/tendon along the surgical site. Anterior approach was used btw. I also have discomfort when I lye on my side. If he is going to address the surgical site I would want that done at the same time as the Psoas release. Although he only said he would do that if the release did not solve everything. To your point, I can’t deal with that many surgeries. I want so much to trust them but, I’m scared of making the working decision and somehow ending up worse off. He assures me it is not the implant and says it’s strictly a soft tissue issue. If I’m standing and try to bend and lift my leg towards my chest I can only lift a little bit before it feels like something is going to snap. The pain is around the Psoas area. But, laying down straight leg raises hurt more near the scar area.

Thanks again. It’s such a relief to hear from someone that has gone through this and is in a good place.

Eric

 

[Hip4life]

@RPDX24 Eric: Everything you keep describing are the same symptoms I had. I had posterior approach so the pain in the same site as the incision didn't apply to me. However, it did occur to me that perhaps you could do some gentle massage around your incision to help you distinguish the different pains you are experiencing. My PT suggested some Vitamin E around it and to use some small circular massages around the incision. My understanding is that it can help break up some adhesions that can make the site uncomfortable. It seemed to help me.

The waiting game is a tough one. Avoiding things that aggravate the pain is difficult, too. It seems most things we do to be active seem to rely on those muscles and thus aggravate the tendon. In my process, another injection was suggested as an alternative to surgery. Had you considered getting another one while you're letting some time pass? Just throwing some things at the wall here. I was at the 9 month mark when I had my release. I remember being more than ready to get that done and back to it. I think it was the fact that nothing was improving my situation that made me push for it. Also, it was that deep knowing you have about your body when something isn't quite right or lining up with what the docs are saying. Anyway, I'm in your corner. Keep us posted. Blessings, Pat.

 

[Nini]

@RPDX24 @Hip4life when yiu speak of release what do you mean? I really hope you get relief. I know it’s hard to wait! Seems so much of our day is focused on that one spot of our body! Prayers for healing!

 

[Hip4life]

@Nini In my case, post THR, the iliopsoas muscle (2 hip flexors that basically merge together so they’re referred to together) kept sliding over the acetabular component and was being irritated causing tendonitis. If the tendonitis doesn’t respond to conservative measures (time, PT, meds, or injection) a release is considered. This is either a partial release, where some fibers of the tendon are cut to lengthen it or completely severed (released) from the lesser trochanter. The latter is what I had because that was the technique preferred by the OS who performed it. It was done arthroscopically and there was limited downtime afterwards. I hope that answers your question.

 

[Nini]

@Hip4life yes. Thank you for explaining this. I have a bit better picture now. I’m glad you were able to get your doc to listen to you for a diagnosis. Sounds tricky!

 

[RPDX24]

Hi,

So I’m still wrestling wi try this. I can’t help
To think something more is at play. Just because I also have discomfort laying on my surgical side and glutes. I just can’t bring my bent leg up past a certain point then it feels like it’s going to snap. I’ve gone ahead and ok’d them to seek insurance approval. May I ask again your list of symptoms?
It just feels like I’m in a high state of inflammation but the fact that the MRI revealed a partial tear and thickening of the Psoas seems revealing. Although there does not appear to be any issue with implant impingement. I am now trying acupuncture which makes me a bit sore after but,it feels like my last ditch effort to exhaust conservative care. I keep asking about infection and they act like I am crazy. None of my blood work is indicating that but, I do t understand how the Psoas could cause this much of an issue all over the area/ if I move my surgical leg quickly I can feel a sharp pain in the Psoas area. Even light motions that involve my hip flexor can cause bad pain. I just want to be sure I am chasing the right thing if that makes sense.

The Surgeon would do a full realease and said he would clean up debris while in there. He also felt if all goes well I would be back on my bike within 3 months. He stated crutches maybe for a week and a cane for another week with PT starting right after the procedure.

Thank you for all your input!!

 

[Jamie]

I encourage you to trust the experts you have chosen to help you with this problem and try not to overthink things. It is very common for pain from an injured area to migrate to other areas, so don’t get too concerned that pain may travel and be in different places at different times. I’m glad you’re continuing to seek assistance from your doctors to get this resolved. It can take a while to eliminate things and pinpoint the exact problem. But it sounds like you are on the right path.

 

[Nini]

Thanks for your update! Have been thinking about you. It can be so hard to get someone to listen to you! @Jamie gave some really good advice!

 

[Jamie]

Thank you, @Nini. We always love to hear that we’ve helped one of our BoneSmarties!

 

[RPDX24]

Thank you everyone!! It’s just hard to let them do another surgery where they say “it may not help” and seemingly have very few other options. If I was 75 I would live like this but I’m 51 and just want to be able to do age appropriate activity.

It’s so confusing this day and age that they can’t definitively say what is going on. I have an appointment for another opinion at the end of September but, I don’t think I can continue to accept my current state. I am approaching my 8 month mark from THR and this began around 8 weeks post op. Anyway thanks again! It feels very isolating when seemingly everyone on the planet has THR without any complications.

 

[Jamie]

I understand. And so do your fellow BoneSmarties. We're always here when you need to blast off a few sentences to express frustration and to give you support as you continue to search for the right doctors and solutions. It can take some time, unfortunately, and I'm sure you are VERY tired of that part! Hang in there.

 

[Merrill]

Thank you everyone!! It’s just hard to let them do another surgery where they say “it may not help” and seemingly have very few other options. If I was 75 I would live like this but I’m 51 and just want to be able to do age appropriate activity.

It’s so confusing this day and age that they can’t definitively say what is going on. I have an appointment for another opinion at the end of September but, I don’t think I can continue to accept my current state. I am approaching my 8 month mark from THR and this began around 8 weeks post op. Anyway thanks again! It feels very isolating when seemingly everyone on the planet has THR without any complications.

I share your frustration. I'm experiencing the same issues (although post hip pinning) you've described. The pain started about four months post op. Very debilitating. Is there any way to get the second opinion timeline moved up? Seems like four to five months is a quite long time to wait.

 

[RPDX24]

Thanks for the response, I'm on the cancellation list. I am doing acupuncture and he believes since I was diagnosed w Pelvic Floor Dysfunction that this could be a contributing factor so I am seeing someone at the end of the month. If I could improve this situation by 50% I would love with it. I want to avoid surgery if possible. I also need to work on mindset so I can better deal with the mental aspect of this. I wish you well and will keep folks in the loop.

 

[RPDX24]

Hey everyone,
I also have discomfort around the bursa l(side area) Glutes and lower back. We are going to do a fluid aspiration of the hip to completely rule out infection. In my mind the Psoas tendonosis would not cause pain/discomfort around my side/glutes etc… I’ve lost trust in my decision making ability around this issue and I am skeptical of my surgeon as well. It’s not a great place to be;) I can’t shake the fear of infection. I have an appointment with pelvic PT on Thursday and he does think that is a good idea. Does anyone have any thoughts on course of action?!?

 

[Jamie]

When you’re chasing a problem, sometimes you must explore a range of potential problems. Especially since you are worried about an infection, I believe it’s good to get this done and know for sure that you’re dealing with another type of problem. I’ve been going through an extended problem following my hip replacement two years ago since this past March and I’m finally seeing some progress. These things can take time and lots of exploring options plus talented diagnostic doctors and therapists. The body is SO complex!

 

[Nini]

@RPDX24 I was going to ask what tests you had but didn't have to read back very far and saw the post about the MRI and what it found. So from that diagnosis they still say the surgery may or may not help? That has got to be so frustrating! I'm so sorry by all of this you are going through!

"I also have discomfort around the bursa l(side area) Glutes and lower back."​

I will say that when my hip muscles are hurting (I do think that at 5-1/2 months I'm finally on the right track with PT) my back and bursa area will hurt as well. I guess they call it referred pain?

 

[RPDX24]

Hi,
So my surgeon said the bursa pain and back pain may be that the tight hip flexors may be causing issues where my glutes/back and bursa are trying to compensate and all of it is changing my gate and exasperatinng the issue.

I have a Pelvic floor PT appointment on Thursday morning. I’m looking forward to getting there thoughts. In 2021 I had surgery for an anal fistula and fizure. Unfortunately, it became infected two weeks later which resulted in a second surgery. I was then diagnosed with Pelvic floor dysfunction. So it makes sense that since all of this is part of the pelvis bowl that could be a piece to the puzzle. This also sheds light onto my fear of infection. Although I was in horrific pain and felt unwell so infection was clear upon my visit to the Dr. This situation didn’t feel like an infection but it weighs heavy on my mind.

 

[mendogal]

Hang in there!

This is definitely a situation that's easily demoralizing, but I'm also reading here definite steps forward towards a diagnosis.

The bottom line is, diagnosis of soft tissue problems is a combo of art and science, testing and proving by trial and error, plus a tad of intuition by those practitioners with skillful hands on assessment skills.

 

[Jamie]

You might want to take a look at my recovery thread. After a couple of years I’ve experienced something similar to what you’re describing and am having success with my therapist and her treatments. She dealt first with my hip muscles and now is moving to my spine and core. All these areas are connected and interrelated and it’s amazing how out of kilter they can get fairly quickly when you’re injured or have hip surgery. The most pertinent posts are those from 2024.

THR - 19 Months Out - Weak muscles causing problems

I am so heartened by your PT's very focused approach on your overall structure. It's wonderful you're feeling improvement. Curious to see what the MRI shows.

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