THR Pain developed after 14 months<

[Sunnysept]

Hi, this is my first post. Right hip replaced due to Perthes damage, last July 2017. Recovery uneventful really. All good. Occasional feeling of an ache where I perceived the end of the stem to be but really nothing much.

Until last month. Maybe a coincidence, maybe not, but I had a back spasm from carrying something the wrong way and groin pain started around the same time. This was front of groin pain, hurt to lift leg, hurt to turn over at night. Worse in the morning first thing and got better throughout the day. Didn’t particularly hurt to walk. Saw consultant, got an xray and he’s happy. I asked about a slight shadowy bit at the top of the neck of the stem but he said that most Exeter stems show this??

Anyway, I an osteopath for some deep tissue massage and some checks and after that the groin pain cleared up for a few days.

Then last week I was picking something up, twisting from right to left, nothing out of the ordinary, and I got the most incredible searing pain from the inside of my groin this time, around my hip joint and into my buttock. I could barely stand and the hip felt unstable. I was petrified I was going to dislocate. Went to A&E and they examined me (all passive ROM was absolutely fine with no pain) and xray showed no sign of being close to dislocation. So, huge relief to know that but I really am worried about what’s caused this sudden change?

Pain started to improve again over the past week but I just had to do an emergency stop in my car to avoid a pedestrian and I got the same shooting pain again. And now it’s sore (not unless I move it) and feels unstable again (unstable in the way that sudden movements and lifting now hurts, rather than the joint feeling unstable). Walking is ok as long as I tense my muscles and go carefully rather than my old fast walking. My buttock area is now tender as is the area over the outer side of the joint.

Has anyone else had this?

@Josephine do you have any insight?

Thanks in advance as I’m so despondent about this.

 

[Layla]

Hi, I'm sorry you're struggling so far out. I hope you find answers and relief.
I'll look forward to Josephine's response.
Wishing you comfort and resolution.
@Sunnysept

 

[Sunnysept]

Thanks . I have some more info about the pain should that help anyone to give me any insight into what might be going on. I can make the pain worse by standing straight but with most pressure on the replacement hip side and leaning slightly backwards. This in itself doesn’t hurt but when I release the pose, the pain shoots from low down middle of my buttock, right around the hip joint near the scar and about half way down my front thigh.

No pain in my knee and no numbness or odd sensations. No pain really when climbing stairs or getting out of a chair and only a little pain if I walk carefully. I can’t walk fast at the moment. I can lift my leg with also only a very small amount of pain.

If I hold the inside of my knee and push inwards it hurts a lot. Holding the outside of my knee and pushing against it doesn’t hurt. Sitting doesn’t hurt either. No pain on no movement.

 

[Josephine]

Seems to me like you've pulled a muscle or developed some tendinitis.

Perhaps you'd show me where the pain/pains are using this chart

After that, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Sunnysept]

Yes please. The pain is R2 andR3bS, R1FV&W, R3FW and X, R2FX.

 

[Josephine]

So like this?

I would suggest the red is ITB (ilio-tibial band) issues but more likely Trochanteric bursitis
The blue is Psoas pain
and the green is scaro-iliac pain


Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Sunnysept]

1. I had anterolateral 11 cm scar on side of thigh

2. Nothing when sitting quietly. 0 . When I get the pain it takes my breath away and I’d say it’s a 6 and when I do the heavy pressure and release thing it’s briefly a 9 I certainly couldn’t stand it if it was like that all the time.

3. No pain medication. Have reflux so avoiding nsaids at present and sick on codeine based products and paracetamol is like taking water

4. Not icing. Massage seems to help a little. Never got on with icing. Only ever used ice the first couple of days after THR. Mostly I’ve used heat to help me including now when I use wheat bags and also a tens which seems to help.

5. Not elevating.

6. still doing all housework except gardening which I’ve had to stop. It’s all a bit slower than normal,though

7. Haven’t done many exercises for months except a lot of walking. Until this it was 10000 a day minimum brisk walking.

No physio. Googled trochanteric bursitis and I don’t think it’s that. I know my ITB band pings from time to time (it has since straight after the replacement) but I can lie on that side and it’s not uncomfortable. More of a sharp pain on Movement that goes across that area, not constant or from pressure.

Main place I feel most pain is in the rear now I think. It’s difficult as it radiates and there’s definitely some groin involvement.

Clamx20 x two levels)
Side leg raise x15
Bridge x5
Walking currently about 7000 or 8000 steps but it was more before all of this

 

[Sunnysept]

I've quoted and filled in the answers above.
Interestingly, today it's hurting to walk, about a 3 and niggly like my own hip used to be.
No throbbing, no warmth, no pins and needles, only a mild dull ache from the upper thigh when I'm driving, particularly but I'm conscious of it at other times.
Also the groin pain and sacroileac pain are more today with some pain coming from side of hip.
The pain does seem to be moving around a bit.
I don’t have start up pain. The pain gets worse the more I do, just like my native hip did. It’s so depressing and I feel thoroughly miserable.
The is just consultant about this 3 weeks ago when I just had groin pain and before it all got worse. He was unconcerned and said some people do get groin pain after and they don’t know why. He said if the groin pain got worse I could try an injection but this isn’t just groin pain now.
Thanks @Josephine . Hope I've done all this right.

 

[Layla]

Hi @Sunnysept
Josephine is away for a couple days but I'm sure she'll get back to you upon her return.
Please provide the exact date of your Right THR in July 2017
The info will be added as your signature. Thanks in advance.
I hope you find relief soon.

 

[Sunnysept]

Thanks.

 

[Sunnysept]

One more thing which surprised me today. Went for a short walk and the leg was bothering me a lot. Weirdly, when I tensed up all my muscles big time while walking, the pain decreased somewhat. Then I decided to support my joint by pressing in hard on it with the palm of my hand when I walked, and there was no pain. Just odd. And very worrying. So scared it could be a loose cup. Mind working overtime and very stressed about it all.
Osteo yesterday said all my muscles were very tight, especially adductor, quadratus lumborum and the sacroilleac muscles.

 

[Layla]

Big hugs....try not to worry, you'll get answers and there will be a solution.
We're here for support.
Wishing you a peaceful weekend!
@Sunnysept

 

[Josephine]

I'm afraid I need this extra detail

When I get the pain it takes my breath away
when I do the heavy pressure and release thing it’s briefly a 9

Define what you mean by these?

also a tens which seems to help.

How long and how often are you using the TENS and what kind is it? Can you use two pairs of electrodes or only one pair?

still doing all housework

Which includes what?

Walking currently about 7000 or 8000 steps but it was more before all of this

You have a Fitbit then?

Googled trochanteric bursitis

You GOOGLED it? Didn't you read the article I left you?

Main place I feel most pain is in the rear now

Then tell me where! Use the references on the chart I left earlier!

 

[Sunnysept]

Define what you mean by these?

I did mean the R2 and R3bS particularly but It’s all calmed down again a bit now. I’ve been for a couple of osteopath sessions which incorporated the massage and it seems to have helped a bit. Heavy pressure and release thing was where I leaned backwards while standing and tipped slightly to the bad hip side and when I released the pose I got the shooting pain. Again that seems to have calmed again now.

How long and how often are you using the TENS and what kind is it? Can you use two pairs of electrodes or only one pair?

Using this tens once or twice a day. Yes I can use two pairs.

Which includes what?

Not done vacuuming but probably could now. I couldn’t have done earlier in the week. Cleaned kitchen floor with a steamer, very carefully and slowly. Standing cooking and pottering around the house not bad at all at any of the stages. The most pain was when walking more than about 500steps at a time and trying to walk fast which is my normal walking style.

You have a Fitbit then?

Yes I do.

You GOOGLED it? Didn't you read the article I left you?

So sorry...was doing that on my phone and didn’t see that they were links. Have read them now Good articles.

Then tell me where! Use the references on the chart I left earlier!

R2 and R3bS
My mid back area seems to now be joining in however. I did a 1500 step walk yesterday...just 10minutes and I walked slowly without any pain except a little mild groin pain in R3FV

Thanks...

 

[Sunnysept]

@Josephine This morning I’m a lot better and seem to be left with the very first problem I had before it flared up big time. I have groin pain. R3fv And r2ft. Not bad on stairs but difficult to put socks on. Bit niggly in the night but not waking me at the moment.

I had no pain like this for 14 months and then all of this happened. What is your gut telling you? I do have my xrays if you’re interested.

The shading at top of shaft was explained to me as pretty normal in Exeter stems (I’ve googled and there are a few showing normal Exeters with that, so I believe him) and the bit at the end of the stem has been like that since day 1. Again apparently a peculiarity of Exeter stems.

I haven’t been happy with the position of one of the screws but consultant says it’s at worst in my muscle wall and is ok where it is. Although I don’t like it, I’m not going to want a revision just for that! On the lateral view it looked more like it was in bone. I had two large cysts in the acetabulum but they are now starting to fill in by the look of them.

Any clues? Would be grateful for your trained eye opinion. This sudden onset of groin pain has really taken the wind out of my sails and have made me very uncertain once more about what I’m capable of doing with this new hip. It had given me freedom but I’m now feeling restricted again.

 

[Josephine]

2. Nothing when sitting quietly. 0 . When I get the pain it takes my breath away and I’d say it’s a 6 and when I do the heavy pressure and release thing it’s briefly a 9 I certainly couldn’t stand it if it was like that all the time.

Okay

3. No pain medication. Have reflux so avoiding NSAIDs at present and sick on codeine based products and paracetamol is like taking water

How often did you take the paracetamol? It should have been 4 times a day at least to get any benefit.

4. Not icing. Massage seems to help a little. Never got on with icing. Only ever used ice the first couple of days after THR. Mostly I’ve used heat to help me including now when I use wheat bags and also a tens which seems to help.

Okay

6. still doing all housework except gardening which I’ve had to stop. It’s all a bit slower than normal,though

Okay

7. Haven’t done many exercises for months except a lot of walking. Until this it was 10000 a day minimum brisk walking.

Okay

Clamx20 x two levels)
Side leg raise x15
Bridge x5
Walking currently about 7000 or 8000 steps but it was more before all of this

Clamshells are THE worst exercises to do!
So are bridges.
As for the steps, do yourself a favour and put your Fitbit in the drawer! And forget it!

Using this tens once or twice a day. Yes I can use two pairs.

I never found it helpful to use it so sparingly. I put mine on and leave it. Most have a 30min timer and I restart mine each time it times out. I can use my TENS all day like that and the pain relief is great!

I haven’t been happy with the position of one of the screws

That screw is fine. Mostly because it's a specially designed bone screw with no sharp edges. And it's sitting under both the intra-pelvic periosteum and the peritoneum. Trust me - and your doctor - it's well protected!

 

[Sunnysept]

Thanks @Josephine So you’re effectively saying that the xray looks good and that I should stop doing the clamshells and bridges?

Interesting about the tens. It is helping so I’ll just use it more. I feel it does more than just relieve the pain. It almost feels like it’s giving my muscles a massage.

Do you recommend any stretches or exercises? What do you think is causing my issues?

Your info links were really helpful but I’m not sure that what’s happened fits any one of those scenarios quite. Bit of each perhaps, but why, and what can I do about them?

 

[Josephine]

So you’re effectively saying that the xray looks good and that I should stop doing the clamshells and bridges?

Yep!

Interesting about the tens. It is helping so I’ll just use it more. I feel it does more than just relieve the pain. It almost feels like it’s giving my muscles a massage.

O-er! You shouldn't use it to that degree! It should just be a gentle trickle of pulsing. Shouldn't make your muscles work too much.

Do you recommend any stretches or exercises?

Nope. I believe that our legs/bodies will recover perfectly well on their own if given half a chance!

What do you think is causing my issues?

Over activity.

I’m not sure that what’s happened fits any one of those scenarios

What scenarios? I read through my posts and don't see any references to 'scenarios'.

 

[Sunnysept]

So two weeks on and the pain has morphed again. It's back to what it was like before I had the flare up. Persistent front of groin pain, very uncomfortable lifting my leg in and out of the car, putting socks on etc. Walking hurts a bit, especially after about 10 minutes.

Also get pain from somewhere I can't figure out and pin point. I get it when I'm walking boldly rather than pottering. It feels like it's between where the stem ends in the thigh, or in the joint - I just can't figure it out because its so momentary but easily reproduce-able.

Was at a concert last night and was sort of dancing, you know, the side to side type which means all weight on one leg then the other, and when all the weight went onto the replaced side I could feel the same pain - not bad at all, but if it was more than momentary than it would be.

Surgeon says all ok but then he did tell me he'd put a 28mm head in (at least three times, each time I questioned him over the past year). This made me rule out the fact that the implant could be too large until I got my National Joint Registry details and he's put a 32mm head in!!

Is that a big one and does it look big on the xray?

So now I'm not sure I trust his judgement on the fact that he thinks there's "nothing wrong" and "some people get this type of pain and they have to live with it or maybe get injections".

This is so upsetting for me because until August I was doing so well and really getting my life back. Doing normal things, no sport because that's not me, but gentle walks with my husband with no pain.

And now I'm questioning distances again and feel unsure about committing to things because I'm not sure if I'll be ok. It is making me rather miserable. And I'm certainly not over active. No way am I doing anywhere near what all my fellow 55 year old friends are doing. And I was just about getting back to a moderately active normal between 3 and 12 months after the op - to no ill effect until August.

So, to summarise:
Groin pain which started at 13 months post op - hurts to lift and walking after about 10 mins
The "difficult to pinpoint" pain - started at about 5 months.
Scar- still a bit tender to the touch- on the side

Question for anyone in the know

IF the size of my cup is irritating the psoas/other, is there anything other than revision that can lessen the irritation permanently, other than not moving and going back to my pre-surgery immobility?

I understand that sometimes a steroid injection can reduce inflammation, but surely that's only a temporary fix?

 

[Marvy]

@Sunnysept I'm sorry you are going through all of this. I had groin pain after my initial THR and I kept complaining to the surgeon about it. The x-rays looked "textbook perfect" as I was told. But, I knew that something wasn't right. Once a CT was done, it was discovered that one of the screws was protruding into my psoas - not alot, but enough that my body was definitely not happy with it. After many tests, injections, a MARS MRI, I finally had the screws removed. The longest relief that I had after one of the injections was 2 weeks. So I knew I was headed to surgery.

Like you, I did not want a revision, but I figured it was the only way to remove the pain.

Is there another surgeon that you can go to to give a second look?

I hope you can find a resolution to this and get back to doing the things you love.