THR Pain after THR

[Smh]

Hello Pat ,
I am posting here after 2011 for the first time I had groin pain that started in 2009 extensive work up with no diagnosis we initially thought it was core muscle injury / sports hernia at that time Dr Myers has suggested it maybe a labral tear after arthrogram -I had surgery by Dr. Byrd in 2011 for anterior labral tear and the fibrillated ends were trimmed that gave me about 35% relief.
The constant pain and limitation improved I continued to have groin pain and could never exercise or walk long distance in 2019 my symptoms got much worse after increased activity with preparations for my child’s wedding and I had a total hip replacement posterior approach presuming that they may be some localized cartilage loss based on my arthroscopic finding that was causing my pain though imaging was OK
However my pain worsened much much more after the replacement in the groin and lower abdomen sitting at 90° was always a problem and got much worse after any torquing movements and even walking as affected
I have taken many opinions and my prosthetic implant is reportedly good I don’t seem to have the classic symptoms of IP that some of you do but I was suggested that this may be the most likely cause the steroid injection into the tendon sheath did not help.
I am almost 3 years out from the replacement and my life is miserable compared to pre-replacement.
Please let me know if y’all have any suggestions and after looking at these posts would it be possible for Pat and Sarah for you to share your surgeons name.
I am 53 years old and not particularly athletic
Thanks
Smh ( Seema )

 

[Hip4life]

@Smh Hi, Seema. First: Welcome back, if I understand you correctly. I will ask a moderator to retrieve your original postings or create a new thread of your own. Then we will be able to address your concerns quickly and specifically with some reference points. It also keeps this member’s thread specific to them. No worries.

I know at this point you’re desperate for answers. It’s interesting that the injection didn’t give you any relief which may point to a different cause than impingement. Let’s get the logistics of your thread fixed and then we will have access to a much bigger brain trust to help. Hang in there.

 

[Jaycey]

@Smh - I moved your conversation with Hip4life here so that you can get more input from our members. What was the date of your THR and which hip. We will put the information in your signature for you.

 

[Mojo333]

@SaraK
I think Smh was wondering about your surgery and surgeon...
Smh perhaps Hip4life and Sara can give you some info and guidance here.

 

[SaraK]

@Smh

I'm sorry you're having such problems. I'm not sure whether this is the psoas impingement - did the injection bring any relief? Did they use lidocaine as well as cortisone? The lidocaine gave me instant relief (lasts only 30 mins or so) and that was an almost immediate proof of the problem.

There are other muscles that can cause some of the same issues. Have they checked out the sartorius (Tailor's muscle)? Have they done a spinal study or nervestudy to see if something is compressing a nerve?

You asked on another thread who my surgeon was. It different for THR and psoas release. I'm assuming you mean the latter. Andrew Blackman did the release. He was in St. Louis at the time but moved to Great Falls, Montana shortly after.

Best of luck as you try to find an answer!

 

[Smh]

Thanks Jaycey and Pat ,
I had my R hip replacement posterior approach October 2019.

 

[Smh]

Sara thanks for the reply so you had a partial Psoas release by Dr Blackman correct ?
I had lidocaine and steroid injection in the Psoas tenodon sheath .
I thought I had temporary relief on the day of the injection atleast no worsening- so kind of inconclusive I guess .
But the steroid for some reason irritated it and I was way worse for at least 3/4 weeks .
MRI no spinal etiology.
Nature of pain very much points to something peri articular to the hip joint .
My quality of life is very limited ,I am in pain daily but I am scared to go in for Psoas release especially when my joint was fine at the hip replacement and that happened in hindsight to be an unnecessary surgery and way worsened my symptoms.
I have been suggested though by 2 orthos that this may offer me reeling and by surgery that additional sports hernia tightening of rectus and adductor at the insertion may help -however I prefer to try one muscle group alone to start with maybe ileoposas arthroscopic approach.
My pain is in the right groin and right lower abdomen with prolonged standing beyond 15 minutes unless I lean on something for support and sitting particularly at 90 degrees- and with repeated torquing in daily activities or exercising with extreme pain episodes sometimes laying on my stomach gives relief.
For with successful IP release do any of these symptoms sound familiar?
Sorry for the long message.
Smh ( seema )

 

[Smh]

Pat , would you please share your orthos name who did the complete IP release and was this done arthroscopic/ endoscopic or as a open procedure ?

 

[Hip4life]

Finally catching up. You bet: the orthopedist I was referred to (my THR ortho did not do release procedures) was Dr. Charles Burt, OrthoNebraska, here in Omaha, NE. His specialty is arthroscopic surgery. I know when I was dealing with this, it was also suggested that I could try another injection if I wasn't ready for surgery but I had gotten only two weeks of relief. That confirmed it was the iliopsoas and the short term relief suggested that further injections had a smaller chance of helping. Since you didn't get any significant relief, it makes one wonder if the answer lies elsewhere. I understand your reluctance to jump into a release surgery. However, an arthroscopic specialist could evaluate you and decide if there might be another indication to go in and take a look for another cause.

Have you been evaluated by a physical therapist? This may sound strange but including an evaluation by a pelvic floor trained physical therapist? I had recent need for this and she pressure-released several muscles, including my left iliopsoas and it was amazing how much less discomfort and tightness I had in my pelvis and back. She was also very good about addressing scar tissue. My point being is that all these muscles in the hips, pelvis, and back are interconnected and what affects one group can affect the others. It's worth exploring the possibilities if your regular docs are running out of suggestions.

As you are finding out, it takes a lot of patience and determination to get to the root cause of your problem. In the mean time, you are hurting and just want your life back. Try not to get too discouraged. We understand what you are going through. Please keep us posted and return for support as you navigate this twist in your journey.

 

[Smh]

Thanks Pat and I have been seeing a PT for almost a year .
She is good she is not a pelvic floor PT specifically but does do some of that work which provides temporary relief unfortunately if anything out of the ordinary regimen is done it can sometimes aggravate me but most of the time she can atleast provide temporary relief which I am unable to achieve on my own .

 

[Newme21]

Hi SMH I had an ileopsoas Tenotomy (release) after my right hip replacement and I had a great outcome. I have since had a left ileopsoas tenotomy and will be having my left hip replaced in Aug. both my releases were at the lesser trochanter so nowhere near the prosthesis. Both my tendon were calcified and were never going to improve , and this had nothing to do with the hip replacement surgery. I hope this gives you some hope

 

[Layla]

Hello @Newme21
Thanks for stopping by to share your experience with, Smh, and the rest of us. We’d lIke to encourage you to start a thread and share a bit of your story for the benefit of others wondering about, or going through the same procedure. Also, we‘d love to support you as you move closer to your Left THR next month. I’ll leave a link and if you have any questions, we’ll be happy to help. Please join us!
https://bonesmart.org/forum/threads/starting-a-new-thread-and-posting.57719/

 

[Smh]

Hi Newme,thanks for the response.
Who did your complete release on the right that you had good results with .
And was calcification noted on imaging ?
Also on the right though you had the release I presume you have underlying osteoarthritis so that is why needing a replacement in spite of the release ?
I apologize in advance for the multiple questions.
Thanks

 

[Newme21]

Hi SMH
I am in Australia and it was a hip/knee orthopaedic surgeon ( I have used the same surgeon for my hip replacement and the releases and he is fantastic and I totally trust him) the release is a relatively simple procedure that is done endoscopic (not arthroscopic as it’s not near the joint). The calcification isn’t some that is noted on imaging it like the tendon has got brittle from overuse (I was in the military until earlier this year!!!)

and yes I have osteoarthitis in both hips I had my right replaced in Apr 21 and I am now booked for my left on the 09 Aug 22 the ileopsoas releases have been very successful and reduced my pain but the arthritis in my left hip is painful and my range of movement poor, so the best course of action is to proceed with a total hip replacement. My right hip after the replacement then the release is fantastic, all the imaging is great and looks rock solid!

Good luck and trust your team

 

[Smh]

Thanks so much Newme this is all so helpful to hear everyone’s experiences .
I guess in the US most replacement surgeons don’t do the release at least mine does not and has referred me to arthroscopic doctors who Would do it endoscopic like you said .
Unfortunately there was not much Osteoarthritis on the hip that was replaced so not only the problem did not get fixed but got a lot worse keeping me in constant pain and one arthroscopic ortho suggested maybe from metal impinging on ileoposas which could have been the original issue.
Since there is not clear evidence and the shot did not help me I am just nervous to go for the release after the tremendous negative impact on my quality of life with the sadly unnecessary hip replacement.
Thanks
Seema (Smh )

 

[Smh]

Pat and Sarah and Newme - was it ultimately the complete release of the ileoposas that gave you complete relief of pain and is there residual weakness from the release that effects your activities of daily living ?
Thanks
Seema (Smh)

 

[Dcm1241]

Hi SMH I had an ileopsoas Tenotomy (release) after my right hip replacement and I had a great outcome. I have since had a left ileopsoas tenotomy and will be having my left hip replaced in Aug. both my releases were at the lesser trochanter so nowhere near the prosthesis. Both my tendon were calcified and were never going to improve , and this had nothing to do with the hip replacement surgery. I hope this gives you some hope

Was your release a full tendon release or partial? How is your flexor strength now?

 

[Hip4life]

@Smh Sorry, I missed your post. I find it surprising that a surgeon would replace your hip without evidence that it needed replacing. In any case, I had a complete release because that is what the ortho doc always did for any post THR patients. His reasoning: it would prevent any future surgeries if the tendon wasn't released enough or healed back to a shorter length again. It also had less down time and should not affect strength as other muscles compensate for the IP. My experience: I have a slight decrease in active ROM in certain circumstances like raising my leg past 90 degrees when standing and bringing my leg up when putting on socks and shoes. Those activities do not impact my quality of life or any physical activites in any significant manner. The surgery has allowed me to return to a very active lifestyle that the pre-op pain was limiting. I hope that answered your questions. How are you doing now?

@Dcm1241 Hopefully this answers your questions as well.