THR Pain developed after 14 months<

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I've replied to your PM.
 
It’s me again. Latest update.
My psoas pain is still pain and restricting my movement but I’m now being troubled by a lot more pain on the side of my leg, near the trochanter. Psoas pain affects walking up hills, leg lifting into car and dressing etc and steep steps. Unfortunately the latest pain, which started in about March of this year, is now bothering me walking on the flat and is overtaking the pain from my psoas.
I initially thought this side of hip pain was trochanteric bursitis as I do have a little bursitis there. However, I went to a physio today who is trained in ultrasound and he had a close look at all the tissues in that area. He found a distinct thickening of the ITB, so much so it feels like a little fat pad when massaging the area. Lower than the trochanter in location, no fluid present there. It’s certinly the area that hurts when I’m walking and tender to the touch.
My question is, what can I do about this? Really what I need is a consultant who specialises in the tendons and tissues and not just the joint mechanics and who really understands the area holistically. It may be that the psoas issues have caused this or my tight ITB (was pinging within days of my original thr) May have caused the psoas - who knows? But I’m worried if one area is focussed on without a whole hip approach then I’ll never get right. I certainly can’t cope with this level of pain and lack of range of movement until my hip is ready to be revised.
Does anyone know who in the country (UK) preferably Birmingham, London, Bristol, Oxford, Coventry etc that I could go to see who thinks in a whole hip way and not just “lets try this, and let’s try that “in isolation?
Any other ideas? Is there anything I can do for myself to break down this scar tissue ? Just fed up. I see all these people, friends etc who have their hips replaced who have a new lease of life and I’m going backwards fast. Soon I won’t be anymore mobile than I was before my replacement. @Josephine do you have any insight or suggestions as to who I can see or what I can do? I have saved some money so I can get a third opinion privately. Thank you so much in advance.
 
Hi @Sunnysept
I'm really sorry you're still struggling with pain. Josephine is away from the forum recovering from knee revision surgery and won't be back for several weeks. I'll tag @Jamie for you and also @Jaycey who resides in the U.K. and see if either of them have advice or possible contacts for you to pursue.
Hopefully it will be first steps in finding the help and relief you deserve. Wishing you comfort and a pleasant weekend.
 
@Sunnysept , ....I am 3 weeks post psoas release/tenotomy and trochanteric bursectomy . Prior to the release I had groin pain, difficulty getting in and out of car, (car sign), and walking was becoming progressively worse. I felt despondent as hell as I was 15 months post thr and increasingly getting worse not better. I had done PT (extensive) (never helped), had the psoas shot with cortisone (helped two days), and quite frankly was at the end of my rope.In fact i was miserable. I researched the hell out of google, seen at least 15 OS's , pain management docs, etc. -nothing! My prosthetic was fine on xray, no infection , no loosening, so since this was a soft tissue problem the OS;s couldn't and wouldn;t help....
I finally googled tenotomy, and read the posts here especiallt @SaraK and @Josephine (clear,concise and direct) and knew I wasn't going to get any better unless I took action and got the release.
I had docs and PT's that would tell me that I would end up with permanent weakness in my operative leg and why would you risk that.
Well it's just NOT true. I had weakness ONE DAY post op and then my strength in the leg started coming immediately back. By the second or third day I was close to normal again.
The end result I am still waiting for, as I am only three weeks and can't yet see all the improvements. I can get in and out of cars, I walk better with no pain (most of the time), ..basically I look to being pain free when the " surgical pain" all heals. I don't have any significant pain .
I can tell you the surgery was easy, the rehab is relatively easy and other than a revision which for me would have been a nightmare...this was a simple solution. You should find a doc who has done a number of releases as it's important. In addition I absolutely do NOT recommend this surgery being done "OPEN" as there are the possibility of too many complications.
I can tell you , I am at least out of that horrible funk of emotionally losing hope and am on the other side of having hope...EMOTIONALLY, it is like night and day! and a lifesaver. I know the heartache involved and I am more than willing to answer any questions you may have. Josephine I am hoping you are well with your knee surgery and will be back here soon.
 
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Thank you so much for this message of hope. I wish it was easier to find surgeons in the UK who do lots of these procedures . I really don’t know where to go next .
 
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Sunny, Jaycey may have some guidance for you as she is in the UK herself. Sometimes you have to do quite a bit of research for these specialized problems, as Jws. indicated he did. That means search for a Center of Excellence near you, make some phone calls and start asking questions about doctors who have dealt with this type of problem. That's pretty much what you have to do in the US as well. Keep looking and don't give up!
 
Hi, I am back, trawling through the internet for answers. My hip now feels “odd”. A new thing.
I have a horrible feeling my hip is becoming unstable . I think it’s something in the cup/ball but not sure. So it‘s a COC implant only 3 years old. Has anyone else had a hip become unstable and what are the signs? It’s becoming squeaky/grindy on slow controlled movements (or standing on one leg balancing trying to strengthen it I felt it pop or squeak and it felt really weird - no pain but with my hand on it I felt it too) . No problems walking although I occasionally have been having a bit of what I thought was trochanteric bursitis over the past year. Ongoing psoas issues since the end of year 1.
It also has been feeling a little shaky/ uncertain when I lean forward or put most of my weight on that side for the past few days. Has anyone had similar and did you ever find out what it was? Could I be about to dislocate as I can definitely feel something shifting (painlessly) when I lean on it. Walking feels normal really. I keep telling myself it’s just snapping hip syndrome and it’s the IT band, but I feel a bit sick inside when it makes the movements or grinds/vibrates.
With all this covid I’m not going to be able to get it looked at for an age and concerned by then I’ll have no bone left (not got much as it is as I had perthes). Does anyone one know of a good revisionist for complex cases in the south of Uk ? I hate to say it but the surgeons locally are not very proactive and leading edge of research and i think my biggest mistake was the choice of my surgeon for primary replacement as I had a complicated hip from perthes and I just don’t think he was prepared for it by the meagre one X-ray he took prior to surgery (is that normal?)
 
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@Sunnysept The only way to confirm if you have issues with this implant is an x-ray. You may be able to do this privately to avoid any general hospital visits. Note that commissioning groups have just this week started opening up orthopaedic procedures so you may not have a long wait.

If you tell me what hospitals are near you and who did your THR I'll try and make some recommendations for a surgeon.
 
@Sunnysept The only way to confirm if you have issues with this implant is an x-ray. You may be able to do this privately to avoid any general hospital visits. Note that commissioning groups have just this week started opening up orthopaedic procedures so you may not have a long wait.

If you tell me what hospitals are near you and who did your THR I'll try and make some recommendations for a surgeon.
Should I tell you this privately? I have had an X-ray since the first time I felt this vibration (X-ray in September 2019) but not since it’s been doing it more regularly and the feeling of weakness. All was “normal” apparently.
 
Should I tell you this privately?
Up to you. Whatever way you feel comfortable communicating. Although we do name surgeons on this site frequently.
 
Hi @Sunnysept I'm sorry you are still having issues. Unfortunately, you are experiencing the difficulties in figuring this sort of thing out. That’s why it’s important to be persistent to find an experienced revisionist OS. I was blessed that my original OS was also an experienced revisionist and stuck with me to find a solution (which eventually was an experienced arthroscopic OS to release the tendon.) I know not everyone is so lucky. And it still took some time to get it sorted out. I did have a sliding, faint snapping sensation with my IP (iliopsoas) impingement. It didn’t hurt so much at the time it happened (although it felt kind of creepy) but it would get pretty sore afterward. I never had any noise associated with it. The process to assess your issues can be time consuming, frustrating, and disheartening. My advice is to hang in there and not give up. Let us know how we can support you. ❤️ Pat.
 
It was in front in right groin area. It seemed to happen mostly when I would rotate my hips toward the right. I noticed it more in a sitting position but it could surprise me at other times with other activities as well.
 
Mine feels like it’s right on the trochanter or deep in that side of the hip
 
Yeah. I know various things can crop up with all of the different muscles and tendons. People can also feel pain differently. It can even be from somewhere completely different, like the spine and the rest of the joints compensating. There are so many muscles all around the hip capsule like the glutes group, Piriformis, IT band, etc that can get irritated. This is why you need a specialist to way in. They’re so adept at moving the leg just this way or that to help figure things out. Then you start with the most likely culprits. The specialist can also give you a more comprehensive approach: x-ray, prescription anti-inflammatory, PT, injection, MRI, even a different specialist consult. This is too daunting for you to try and figure out on your own and is a constant source of worry. Try the stretches and icing or heat as you find helps (don’t stretch after icing however) in the meantime. I sincerely hope you find someone who can help you. It just takes perseverance. Keep me posted. ❤️
 
Thank you so much for taking the time to reply. It’s really difficult as most surgeons are only doing video consults at the moment.
im trying to weigh up who to see too. Do I see someone who does a lot of revisions but doesn’t have a record of as manyunder age 60 nor with anything more complex than osteoarthritis, or do I go to someone who has done fewer revisions, (but still a decent amount) but who deals with many who are under 60 and many more who have other issues other than osteoarthritis.
I obviously needed a replacement because i had arthritis but it was brought about by Perthes and so the anatomy and bone condition very different from a standard older age replacement (or so I’ve been told recently). Apparently many people who had Perthes as a child get post impingement after a replacement because their native hip socket is so shallow. That’s what my last consultant told me.
 
Hi @Sunnysept I am so sorry,, I can feel your worry and frustration..
For what it is worth, I would think that you would want someone who is very experienced in revisions and most likely has seen some cases similar to yours, my thinking is if they've been in practice very long and doing revisions, they've seen their share of shallow sockets, etc.

Please keep us updated? I'm sure many of us will look forward to hearing about your journey.
 
Hi everyone. I thought I’d take the opportunity to update you all with some progress I have finally made. With all the restrictions because of lockdown I managed to find a consultant who someone had recommended who has experience with psoas issues in the UK. He was happy to give me a video consult this morning. He isn’t someone who I probably would go if I needed a revision but a revision is the last thing I want.

I paid for a private consultation and had half an hour with him. I asked him all the questions I wanted to ask and he thoughtfully considered them. He looked at my x-rays he said they look good (I have had a recent one). I asked him about my psoas and he told me that a lot of people who have had dysplasic hips get tendon and muscular issues after a hip replacement; it’s not usual but quite common. He also said that for people who have had very long-standing issues like I have had all my life after perthes that muscular and tendon issues post operation operation are quite common also.

He assessed what I had had done with regard to my previous steroid injection and lidocane and he felt that he would personally do the injection rather than giving it to radiologist to do and he would put a long lasting lidocane rather than the short lasting lidocaine that I had and he would make sure there was enough steroid to saturate the tendon. He would also do this under x-ray guidance rather than ultrasound guidance. So quite a few differences from what I have already had done with regard to a steroid injection to test the source of my pain there. After that he would like to have a look at an MRI of all the soft tissues because I also have problems in my ITB area and he would look at it all holistically. He would then consider a CT to look at the positioning of the cup on the psoas. He does do a psoas release and he has had good success with it and he uses an open surgery in the groin area at about 6 cm but he did say that after four months recovery he had good results with no loss of strength as other muscles start to work better too. After a couple of years it may need redoing as it tends to grow back. The ITB is what he feels is my grinding and pinging and not my hip failing. There can be treatment for that surgically but he felt physio regime would be better, certainly initially.
if I remember anything else, I’ll update. Not sure when I can have all of this under lockdown rules, but it’s a start. Hope this info helps others too.
 
That sounds like a great place to start and I’m glad you found someone who listened to you and had some thoughtful answers. I had to go to a different specialist with each of those procedures (arthroscopic for the tendon release. Complete release due to the same issues your doc pointed out in them sometimes healing back.) You have a one-stop shop! Lol. You’ll probably have a better understanding of what, if any other step there is after the diagnostics are done and post second injection. Mine was so short lived without a strong opinion that another would help my situation, that we then proceeded with IP release. I wish you the best in getting relief. Please keep us posted with your progress. ❤️
 
It sounds like you have a very detailed consult with this surgeon. I like how he addressed and discussed options for both sides of your hip.
I imagine that you are feeling a bit of reassurance after speaking with him.
Thank you for updating us..this could indeed be helpful to others who possibly feel some of your symptoms.
Please stay in contact, I'm sure many of us would like to follow your treatment and progress.
 

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