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

[Jamie]

Surgeons are very good at the surgical process to replace a faulty joint, but often fall short when there is ongoing pain following the procedure. I went through a somewhat similar situation with my hip replacement. It has taken over 2 years to get a proper diagnosis and get to the point where things are improving. So, please don’t give up hope! It just means you have to keep searching for the right person to help you.

The good news is that your implant seems to be fine. That’s huge because it means you likely don’t need a surgical solution. Soft tissue issues are treated through gentle manipulation, pressure point therapy, and targeted exercises. But….not just any therapist is experienced, trained, or equipped to diagnose and treat whatever might be going on.

I suggest you try a different approach by getting a consultation with a pain management specialist and start a search for a therapist who has dealt with muscle and joint imbalances following hip replacement surgery. You’ll need to ask a person you’re seeing that exact question and make sure they are going to be able to diagnose what is going on. It is possible that a pain management doctor or nurse practitioner can recommend someone on the therapy side who has this expertise. It’s possible that your gait needs work too, if that’s not been done.

In my case, I had ongoing hip joint pain that moved around to some degree. Unknown to me, I had completely altered my body mechanics over the years resulting in a twisting of my SI joint in the spine (the pain management NP discovered this) and a gluteus medius muscle that was not engaging at all (the therapist found this). My gait was horrible, but I didn’t realize it at all. It took 9 months with my therapist to get things back in place. Now it’s my job to work to regain strength.

Please let us know how things go. We’ll help as much as possible to get you to the right person to help. It is important to address this now. The longer you let it go, the more difficult and time consuming it will be to get things back where they should be.

 

[RPDX24]

Thank you for the response, yes. My Pelvic floor PT person is trying to get my glutes firing as well. I’ll look into your suggestions.

 

[RPDX24]

May I ask if has pain/discomfort elsewhere?

 

[Roxi]

Thank you for the response, yes. My Pelvic floor PT person is trying to get my glutes firing as well. I’ll look into your suggestions.

Not sure if your PT has covered this already, but one trick to make sure the right muscles are firing is to tap them repeatedly. I am working on my left glute medius right now and for the first minute or two of every exercise I tap my glut medius. It helps to tell your brain 'this muscle, we are working on this one, no don't cheat and use the other one that is easier, it is this one'. After repeated reminders like that it gets easier to do. You have to fast tap though. Like once or twice a second to really focus your brain.

 

[RPDX24]

I like that. My glute started hurting soon into walking and just stopped and did that mid-walk. What kind of PT person did you have?

 

[mendogal]

I also use the fingertip pressure or tapping technique; I was taught it by a certified myofascial trigger point therapist.

 

[msart]

Have u tried a massage? I had one this past week & it was a game changer in groin pain for me. As she explained it, my muscles were so tensed up from being in “trauma” mode that it was causing me pain. I honestly can not believe the difference the massage made in just 2 days time. Of course, get the ok from your surgeon. Also, she did not massage my surgery site per my surgeons advice. Really surprised me how much relief I got in my neck, shoulder, groin & legs. Hope this helps!!!

 

[Roxi]

I like that. My glute started hurting soon into walking and just stopped and did that mid-walk. What kind of PT person did you have?

My PT is a Dr. of PT and a certified orthopedic manual therapist. She is great!

 

[RPDX24]

My Dr just ordered a 3-phase bone scan to check for cup loosening. My x-ray shows a small
gap between the hip socket and the cup. If that comes back ok, we are going to try another Psoas injection.

Has anybody here had the Psoas release surgery? He still believes a lot of this is psoas-related but, the first injection I had 6 months post-op did nothing in terms of pain relief.

Thank you for the ongoing support.

 

[Layla]

Hi RPDX,
We've had many members that experienced Psoas Release over the years. My colleague @Hip4life is one and I've tagged her so she may stop by. She's recovering from shoulder surgery, so a tad more sporadic here currently.

While waiting for responses, I linked a search for you of all threads where Psoas Release was mentioned, if you want to check them out.

Search results for query: Psoas Release

bonesmart.org

I hope you receive a firm diagnosis soon and a plan of action to bring you relief. I am sorry you continue to struggle. Please keep us posted.
@RPDX24

 

[carolinef]

Hi everyone,

I am a (50M) active and was fit going into the Anterior approach THR. I was so excited about the notion of being able to ride 50 miles a week again and doing Yoga. I felt like I was healing well then around the 8 week mark had some groin pain when doing certain PT movements. Around Dec 20th I got the ok to start doing Zwift(indoor cycling) It did not bother my groin but fatigued my hip. The pain has progressed and seems to be growing as far as the area of pain involved. I now feel it climbing stairs, getting up or getting in my car etc..I went in to see my surgeon yesterday and he thinks I have something going w my Iliopsoas tendon. I pointed to the area and he came up w that. He said my X-rays look good and he wouldn't change a thing in terms of the head placement?!?. I am feeling super depressed and anxious that this will not resolve itself and could end up w another surgery. He put me on an anti-inflammatory medication and told me to stop PT and just rest the area. Is anyone familar w this and have they found a resolution? What are the steps involved? He said the next step is a cortisone shot. We didn't go beyond that in terms of the next steps. My inner dialogue is telling me that I will never be pain-free. I welcome all feedback and appreciate all of you!! I am in the "why me" phase at this point.

Hi there
I am in your same shoes at age 54. Onset of pain was 11 months post op. I’ve been dealing with it for 5 months. Have you made any progress ?

 

[RPDX24]

Hi, I wish I could say I have. I recently had a 3-phase bone scan and the radiologist wrote “concerning for infection or cup loosing” my Surgeon refutes their findings. He still believes it is related to my Psoas. We have ruled out infection. I am repeating an MRI on Jan 20th. This ordeal is tough on my mental health. I feel like I will never be the same. I cannot bring myself to do the Psoas release without a clear diagnosis and the Psoas injection did nothing for me. I feel like it is a cup and hip socket issue. I’m not sure who to trust at this point.

 

[Jamie]

It’s disappointing that your surgeon would order this test and then refute the results. The area of non-union of bone and the cup would be concerning to me. Before you have any type of procedure, I suggest you take the results of this scan or at least one and maybe two other surgeons for additional opinions. The fact that the injection did not give you any relief would be a red flag for me and would seem to hint that it’s not the Psoas muscle that’s the problem. Don’t give up, though. Sometimes it takes a while to discover what is really going on.

 

[RPDX24]

Thank you,
I saw another surgeon a couple of months ago. He said he didn’t have a “surgical solution” for me. That was before this latest scan. I may try to schedule a follow up. I am getting to my wits end with all of this. I also am questioning why he ordered an MRI vs doing a CT scan which would be better for looking at the bone and cup. I’ve been entering my results in Chat GBT and getting better info than from my Surgeon.

 

[Annekin]

Hi, I wish I could say I have. I recently had a 3-phase bone scan and the radiologist wrote “concerning for infection or cup loosing” my Surgeon refutes their findings. He still believes it is related to my Psoas. We have ruled out infection. I am repeating an MRI on Jan 20th. This ordeal is tough on my mental health. I feel like I will never be the same. I cannot bring myself to do the Psoas release without a clear diagnosis and the Psoas injection did nothing for me. I feel like it is a cup and hip socket issue. I’m not sure who to trust at this point.

I had a THR just under 18 months ago and like you also began developing groin pain around the same period. My GP prescribed anti inflammatory which initially did the trick. However the pain then moved to my glutes & TFL ( later diagnosed as tendiopathy). It may be that the symptoms you have are masking other problems and I totally understand your frustration. I am 53yo, & was previously an active walker. Now I struggle to walk down the street without feeling exhausted. Like you, I have also been told the implant looks good with no concerns. However my consultant has now ordered an MRI to look at the hip and my lumbar spine. I'm also having a first "dose" of shockwave therapy for the tendiopathy tomorrow whilst I wait for my MRI appointment. I think the problem with post op issues is medical professionals are very reluctant to admit anything might be wrong. Whilst it is not directly their fault if you have developed an infection, for some reason it seems to put them on the defensive. I have been fighting for a long time to get some answers, & despite the ongoing battle, I have no intention of giving up. All I can suggest is you keep advocating for yourself & don't let them tell you how you feel. I really hope you get some answers and that things get better for you sooner rather than later

 

[PolarIce]

Reading the report you posted has been very concerned that with what the imaging showed, that he does not think any of it is a concern or answers to the issues you are having. If I were in your shoes, I would definitely those results and get a couple more opinions. I am not a doctor, but to me his feedback to you sounds way off.

It's a true mental struggle sometimes dealing with a chronic injury, go through surgery and then run into trouble. I've gone through that myself and it's really mentally taxing.

I would not settle with the feedback he gave and go elsewhere to see what another opinion would give you.

 

[carolinef]

Hi there
I am really sorry to hear about your situation. I can totally relate. I’m a fit 54 year old who hd left anterior than in Sept 2023. I had a fall off my bike in July 2024 and haven’t been the same. My MRI shows the same fluid collection as yours. Nerve conduction studies show my medial cutaneous femoral nerve is not firing. Have you had nerve conduction studies ? I have pain, subtle weakness and numbness/burning etc. Mostly groin but also medial thigh and glute. My left iliopsoas is also way larger on MRI. I’m not waiting on a CT scan to investigate how much impingement there may be. I don’t want a revision but don’t want to live like this. It’s exhausting. My therapy helps short term only.
Keep advocating for yourself. I really hope you find answers and support and relief.

Caroline

 

[RPDX24]

Hi, I wish I could say things are sorted out. My Surgeon firmly believes there is nothing wrong with the implant. I have tendonosis in my Psoas, glutes, and hamstrings. PT makes things worse as does walking more than a couple of blocks. I was better off before THR. My insurance is limiting my ability to get another opinion, and at this point, I am praying somehow the inflammation gets better.

 

[Debru4]

I'm really sorry to hear what a rough time you have had, and continue to have following your hip replacement. Are you able to try a complete reset and go back to rest, icing, regularly taking acetaminophen and doing the things that we typically do right after our hip replacement surgery, as well as stopping your PT for awhile? Sometimes with severe inflammation it really is hard to settle things down. Have you had any steroid injections?I can imagine how frustrating in must be to be limited in your ability to see additional doctors.

 

[RPDX24]

Hi everyone,
I am coming back at a time when I have tried everything in terms of conservative care for my issues. This is what was found in the mri taken from AI interpretation:

• Psoas impingement likely: The iliopsoas tendon appears to be contacting or rubbing against the anterior rim of the acetabular cup, suggesting mechanical irritation.
• Signs of psoas-related inflammation: Possibly contributing to tendonosis, hip flexor tightness, and glute/hamstring dysfunction.
• Gluteal and hamstring tendonosis: Likely secondary to altered biomechanics from psoas tension or post-surgical compensation.
• No clear instability of the implant: Cup position may be causing tendon friction, but the implant appears stable.
• Edema/inflammation noted near psoas region and/or affected tendons—indicative of chronic soft tissue irritation.

I am left with psoas release surgery at what seems to be the only option. Can someone please help
Em get clarity of what to do. I am so scared to let them do anything else but, I can't stand or walk for any length of time without pain. It is in the groin, glutes and lower back. Part of me wants them to redo the cup. I've read horror stories about issues with a full Psoas release. I don't want to live like this. Has anyone out there had this done successfully? I can't shake the feeling it is more that the psoas. Thank you! I am 18 months post op and hanging on by a thread.