THR Post Op Struggles

[Annekin]

Hi all. I'm here looking for advice & support having followed the forum for some time. You all seem like knowledgeable folk!

It's going to be a long thread. So get a drink and a comfy seat.

Im 53 and live in the UK. I have hip dysplasia which was diagnosed in 2007. In 2018 I had my right hip replaced with a straightforward recovery. In August last year (2023) I had the left hip replaced and the recovery has been difficult.

I noticed quite quickly post op that my left operated leg felt tight when I was walking & I struggled going upstairs/inclines etc without getting breathless.

After a few months of this I went back to my surgeon who said he wasn't concerned (they never are). He checked my leg length was even (it was) and sent me away without any follow up.

Because my mobility difficulties continued I decided to pay for private physiotherapy (the NHS one was too basic for my needs). My new physio (who I saw for about a year) immediately suspected gluteal tendiopathy and gave me some straightforward exercises to do.

This helped a lot. So much so that I went on a long walk (this was 6 months post op) which resulted in terrible glute pain.

Despite being given further exercises, the glute pain continued, & my physio also observed issues with my SI joint. He suspected these were present pre op, & were likely caused by the dysplasia & then exacerbated by the operation.

Frustrated that my rehabilitation had essentially plateaued I returned to my GP who referred me to an NHS MSK pain clinic. The practitioner I saw told me my mobility seemed fine (news flash. It wasn't) & that I may have to live with the pain. I am 53. I like to walk. I don't want to live with untreated pain! He said scans wouldn't help diagnose the issue.

I complained to my GP about my experience and I was offered another appointment at the pain clinic with someone else. They were more helpful & observed I had trouble weight bearing on the operated leg and there were signs of pelvic tilt

They referred me to see a consultant. Unfortunately the waiting is list is very long and after 5 months I Still haven't seen anyone.

In the meantime I paid for an ultrasound which found trochanteric bursitis beneath the incision scar. Unfortunately a cortisone injection did not provide any relief. I was told an ultrasound wouldn't help identify SI joint issues

I am getting increasingly frustrated with my situation. I struggle to get around without being in pain (although I look mobile, every movement is difficult). The issues I am having are all near the area of the new hip; gluteal tendiopathy, SI lower left back pain and pain near the iliac crest. I would like to see a private consultant to discuss getting an MRI to look at the soft tissue (an XRAY a few months ago showed the implant to be fine) but struggle to find anyone suitable when I look on Google (I live in Sheffield). Particularly as I'd really like to see someone who is familiar with hip dysplasia.

Sorry for such a long post. I'm aware others on this forum have had similar issues. But I was wondering if they had ever gone away (I am 15 months post op). Or if you had found a medical professional in the UK who had been able to help?

Any advice would be most welcome.

 

[Gloucestergal65]

I’m sorry to hear about what you are going through. I can’t offer anything other than sympathy and a friendly ear. I’m sure you will get responses from the many knowledgeable people on here. I found the forum to be enormously supportive.
I’m in the uk too so I understand the frustration of the NHS and its waiting times. I paid for my hip replacement to be done privately for this reason. Good luck.

 

[mendogal]

Welcome to BoneSmart @Annekin

I'm so sorry you're struggling. It does seem that many ortho surgeons don't pay proper attention to soft tissue issues.

Due to a variety of pre op and post op structural adjustments, folks with hip replacements do experience a variety of soft tissue problems. They are treatable if diagnosed properly.

Was your second (left) hip this August 2024 or as you wrote "last year" 2023? If you provide the exact date we'll create a custom signature for you.


HIP RECOVERY GUIDELINES

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these
BoneSmart philosophy for sensible post op therapy

5. At week 4 and after you should follow this
Activity progression for THRs

The recovery articles
Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Annekin]

I’m sorry to hear about what you are going through. I can’t offer anything other than sympathy and a friendly ear. I’m sure you will get responses from the many knowledgeable people on here. I found the forum to be enormously supportive.
I’m in the uk too so I understand the frustration of the NHS and its waiting times. I paid for my hip replacement to be done privately for this reason. Good luck.

Thank you. I do think it would be less frustrating if I didn't have to grow old waiting for an appointment with the consultant. Particularly as I imagine a lot of things will need ruling out once I do get to see him or her. So actually getting the appointment will only be the start of the journey unfortunately, & may not even lead to a satisfactory outcome.

 

[Annekin]

Yes. Sorry. Bit of a typo. The operation was last year - August 2023

 

[Layla]

Thanks Annekin,
No worries, no apologies necessary.
We edited (2024) in your initial post and created a signature for you reflecting 2023 as the year of your surgery after reading that you were fifteen months post op.

Thanks for joining us. I hope you have a good Sunday and week!

 

[benne68]

So actually getting the appointment will only be the start of the journey unfortunately, & may not even lead to a satisfactory outcome.

I'm so sorry for your pain and your struggle getting this problem properly diagnosed and addressed. But, please don't give up. You are too young to live the rest of your life in pain. It's sad, but sometime we must advocate for ourselves long and hard to be heard.

You know your body best; you know when something is wrong. Go to your appointments with a list of questions and details of your recovery. Don't let anyone brush you off. Be persistent.

We are here to support you, so please keep coming back.

 

[sadie1001]

Might it be worth seeing an osteopath? They are whole body practitioners and might get to the bottom of your problem. i see one who does massage and acupuncture as well as adjustments. It’s a gentle treatment so you wouldn’t lose anything while waiting for NHS appointments. Important to do research into finding a good one - preferably personal recommendation.

 

[Annekin]

So actually getting the appointment will only be the start of the journey unfortunately, & may not even lead to a satisfactory outcome.

I'm so sorry for your pain and your struggle getting this problem properly diagnosed and addressed. But, please don't give up. You are too young to live the rest of your life in pain. It's sad, but sometime we must advocate for ourselves long and hard to be heard.

You know your body best; you know when something is wrong. Go to your appointments with a list of questions and details of your recovery. Don't let anyone brush you off. Be persistent.

We are here to support you, so please keep coming back.

Thank you for your responses. I have finally been offered an appointment with my consultant. My physio is going to do a summary of my issues, & talking points to help me stand my ground!

I also had an ultrasound today which confirmed gluteal tendiopathy as indicated by my physio. So gluteus minimus, medius & TFL all angry (to use a technical term!). What they couldn't tell me was whether the implant was aggravating these issues. Or if I have just been really unlucky with my recovery. So that's something I really want the consultant to establish.

I don't really agree with chiropractors because the science regarding their efficacy is limited. But thank you for the suggestion. A recent sports massage also made no difference. This is probably because the greater trochanter is so tender because of the tendiopathy.

My physio has suggested shockwave therapy as an option. However I don't know anything about it (& can't really find any studies). So I was wondering if anyone had tried this as an option for tendiopathy/greater trochanteric pain syndrome?

 

[Annekin]

Might it be worth seeing an osteopath? They are whole body practitioners and might get to the bottom of your problem. i see one who does massage and acupuncture as well as adjustments. It’s a gentle treatment so you wouldn’t lose anything while waiting for NHS appointments. Important to do research into finding a good one - preferably personal recommendation.

I tried an osteopath some months ago, but they didn't seem to do anything apart from touch the base of my neck and hip etc (sorry I'm not explaining this very well!) Suffice to say, it felt like a lot of nothing. So I left feeling quite deflated. I don't think it's really for me. Though I understand it does work for some people.

 

[benne68]

Glad you have an appointment, @Annekin! And it's great that your physio is preparing that write-up for you.

Here are links to some threads that mention shockwave therapy. Perhaps you will find some helpful information:

Search results for query: shockwave therapy

bonesmart.org

 

[Annekin]

Glad you have an appointment, @Annekin! And it's great that your physio is preparing that write-up for you.

Here are links to some threads that mention shockwave therapy. Perhaps you will find some helpful information:

Search results for query: shockwave therapy

bonesmart.org

Thank you! I'll have a read

 

[Annekin]

I've received my ultrasound report. It confirms greater trochanteric pain syndrome as I mentioned yesterday. Within this, the report also refers to;

"Cortical irregularity measuring 0.34cm length deep to the tendon noted on the lateral facet of the greater tubercle at insertion of gluteal tendon."

I vaguely remember the radiographer saying something about this at the time. But I'm not sure I understand what it means. Does anyone on here speak the lingo?! I've tried looking it up but it's a bit confusing. I'm assuming it's just part of the tendiopathy diagnosis?

I'll ask the consultant next week. But it would be useful to go in with some knowledge as to what I'm taking about!

 

[Layla]

Hi Annekin,
I wish I could help, but I'm unable to, I am sorry. Possibly someone will stop by that truly has knowledge in this area. I do understand wanting some clarity on the topic, but the consultant isn't expecting that of you. Sometimes in researching the lingo we misinterpret terms that can lead to unnecessary anxiety or a misunderstanding of our condition. I hope you're able to avoid that.

I am sorry you're dealing with pain and wish you comfort as you await next weeks appointment. Hopefully it leads to a plan that resolves your issue.
@Annekin

 

[Annekin]

Hi Annekin,
I wish I could help, but I'm unable to, I am sorry. Possibly someone will stop by that truly has knowledge in this area. I do understand wanting some clarity on the topic, but the consultant isn't expecting that of you. Sometimes in researching the lingo we misinterpret terms that can lead to unnecessary anxiety or a misunderstanding of our condition. I hope you're able to avoid that.

I am sorry you're dealing with pain and wish you comfort as you await next weeks appointment. Hopefully it leads to a plan that resolves your issue.
@Annekin

Thanks Layla
I think it's more about not wanting to be fobbed off by the consultant. So making sure all questions are answered and any issues taken seriously.

Unfortunately I had a situation in June where the pain clinic dismissed my issues stating a scan wouldn't help with a diagnosis. This led my getting a second opinion (a referral to the consultant). But in the meantime a scan did show the issues I have mentioned here.

My concern is that the consultant also minimises my issues, despite the evidence. My aim is therefore to make sure I go in armed with as much knowledge about my condition as possible.

Obviously that doesn't mean misinterpreting the report I've been given. But as you say, if there is anyone on here with musculoskeletal knowledge, it would be helpful if they could translate this part of the report into layman's terms!

 

[Annekin]

I saw the consultant today. The cortical irregularity is just an odd shaped protrusion where the gluteal muscle is connected to the bone. So nothing to be concerned about.

They are going to order an MRI to check my lumbar spine and the SI joint. It will also cover my left hip. Although he thinks I've just been unfortunate with my recovery, they want to make sure there isn't anything else going on.

Unfortunately the NHS doesn't cover shockwave therapy, so I'll have to pay for that privately. However I think I'll wait for the MRI, just in case something else is found which the NHS can treat.

Feeling relieved that I'm finally getting the MRI I've been chasing for a year. All I want is reassurance that everything is okay with the implant and that it isn't causing any serious problems. Hopefully a scan will help put my mind at rest and I can then get back to my rehabilitation.

 

[benne68]

Glad you are finally able to get that MRI, @Annekin. Do let us know what it shows.

 

[Annekin]

So a brief update-I got through my MRI appointment. It won't be until April. Apparently this is because the type of MRI ordered can only be done on one machine in Sheffield, for which there is a long waiting list. Just my luck!

I felt quite deflated when I found out the date & searched around for private MRI options. Unfortunately 3 body part scans (which have been ordered) cost about £1000 privately. I would probably pay this if I thought there was a guarantee something would be found and a solution offered. But this is not a sure thing. So it seems a lot to pay when I could wait four months and get the scan for free. So it puts things into perspective!

In the meantime I've had my first shockwave therapy session. There will be 1 per week for 5 weeks. It won't help with my back issues (which are really playing up at the moment, despite being given new exercises to do by my overly enthusiastic physiotherapist). However my tendiopathy does feel a bit better, so I'm hoping at least that will be helped by the shockwave therapy.

Obviously it doesn't help having all this snow & ice in Yorkshire at the moment. I feel like an old lady trying to get around without falling over. Just a slight slip and my back spasms. Fortunately the temperature is meant to be going up next week so at least then I'll be able to go for a walk (short walks are my new plan, if only to lift my mood!)

So things are moving forward, just slowly. So not such a brief update after all!

 

[benne68]

Thanks for the update, @Annekin. I'm sorry you have to wait until April to get the MRI. That is so frustrating!

Glad to read that your tendinopathy seems to be improving after your first treatment. I hope you will keep us posted as you have additional sessions.

Please be careful with the snow and ice. No falling allowed!

 

[Annekin]

Thanks for the update, @Annekin. I'm sorry you have to wait until April to get the MRI. That is so frustrating!

Glad to read that your tendinopathy seems to be improving after your first treatment. I hope you will keep us posted as you have additional sessions.

Please be careful with the snow and ice. No falling allowed!

Thank you. Thankfully the snow has now gone, so now feeling more stable going outside!

The physio who is doing the shockwave therapy also gave me a really straightforward exercise to do to help build my core which has helped my lower back a lot. It's hard to explain but involves hanging a resistant band over a door hook (where you would hang your dressing gown for example) and then pulling each end of the band down toward you & past the waist, bracing your stomach whilst doing so.

When I started doing this I couldn't feel a thing, so thought there is no way this is making a difference. But low & behold; my back feels so much better afterwards. I do combine it with some light bridges, but the resistant band exercise has really helped. Suffice to say I'm now wondering if I've been doing rehabilitation the wrong way around, & should have been building my core first before working on the other issues. I also think it's because this exercise doesn't involve flexing my hip, which always causes me pain during physio.

This, combined with the shock wave therapy, is definitely helping. I still feel pain, but at least I am now more mobile. I really hope it continues. But I know I mustn't get carried away and overdo things. So fingers & toes crossed things are getting better.