THR Psoas tendonitis post-THR

[Sashimu]

So I just talked to my surgeon about my CT scan results. The good news is he doesn't see any issue with the prosthesis itself. He thinks that I have a very irritated psoas muscle, possibly tendonitis, and that I need to basically stop doing everything, except activities of daily living, and then increase my activity very very very slowly over the next few weeks. No more exercises; take Ibuprofen on a timetable. I asked him about an MRI but he said it was too soon after the surgery to be able to tell much; maybe in a couple of months if my problem persists, though he thinks it "should settle."

Just to recap my problem: I did two or three sets of the 6 exercises they gave me, seven or eight reps of each, and walked 10 or 15 minutes, for 3 days in a row. The fourth day I woke up with groin pain at a five or six, which I've had most of the time ever since, except for after I've taken ibuprofen. So that's where I'm at, after almost 9 weeks.

I've mentioned that my hip was angled backwards and that during the surgery he removed some bone that was covering the front of my hip socket in order to place the cup. He said that the psoas muscle ran over top of that bone that is now gone, so that where bone used to be there's now a hollow, and that the muscle is trying to adjust to this. Hence the irritation on activity.

Still digesting this news. Not what I had hoped for my recovery, but I know I'm not the only one in that boat.

 

[Layla]

Just to recap my problem: I did two or three sets of the 6 exercises they gave me, seven or eight reps of each, and walked 10 or 15 minutes, for 3 days in a row. The fourth day I woke up with groin pain at a five or six, which I've had most of the time ever since, except for after I've taken ibuprofen.

It looks like you began the exercises on March 30th...is that correct?
You mentioned after four days you woke up with groin pain...did you stop the exercises at that point then?

Also you mentioned the intense groin pain you experienced after slipping on the zucchini, I wonder if the fall further aggravated already angry healing tissue? Your THR sounds like it was a bit more involved. Given that, one would expect your recovery to be a bit slower than others.

 

[Sashimu]

Hi Layla, I got my first set of exercises from physio on March 29th. I did them once or twice a day, five reps each exercise... They were all done standing--hamstring curl, marching on the spot, sidestepping, calf raise, and hip extension. I also walked 5 minutes a day with the four wheel walker, gradually increasing up to 15 minutes.

The second time I went for physio, on April 15th, I got another set of exercises. Still doing the hamstring curl and the hip extension, but also doing marching while walking, mini wall squat, standing abduction, and step up onto a step. They also gave me a standing hip flexor stretch. I continued the walking, though I've never gotten past 15 minutes a day. I cut back after the slip in my kitchen and when I talked to the physio on April 23rd he said to cut back on my activities and to continue with the exercises as long as they didn't cause pain.

After 6 days or so, I felt so much better that I started ramping things up again, which led me to the point I'm at for the last 2 days, where the level of groin pain is such that I'm doing nothing except moving around the house.

Even though I had a list, I totally forgot to mention the slip in the kitchen to the surgeon... But yes, that couldn't have helped matters any.

I'm going back to the physio tomorrow even though I'm no longer doing the exercises just to get answers to a few questions like should I still be using the cane or walker around the house... I'll be sure to mention the slip as well. Also who knows, maybe he can do some kind of treatment to relieve the inflammation.

 

[Layla]

He thinks that I have a very irritated psoas muscle, possibly tendonitis, and that I need to basically stop doing everything, except activities of daily living, and then increase my activity very very very slowly over the next few weeks

I agree and hope you take your surgeons advice over the PT‘s. Also consider icing the groin area several times a day as long as it’s hurting. Hopefully with stepping away from the exercises, limiting activity for a time then slowly rebuilding, you’ll notice a change soon.

In case you never made it through the Recovery Guidelines, check out The Big Tip -

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.

I hope you have a nice week!

 

[Schaargi]

Oh, @Sashimu ,

I'm so sorry this has taken a down turn. I injured myself early on in my recovery from my first hip by being too enthusiastic with my exercises and it took about 3 weeks for it to calm down. Now, at 11 months out, those 3 weeks seem like nothing. It's a setback but not a game changer.

You seem to be doing everything right. Now it takes some patience. You might be able to have some treatment to help calm it down. Your physio should have some ideas. Hang in there!

 

[Layla]

Forgot to wish you a....Happy Two Month Anniversary!!
Stay in touch and let us know how you’re doing....we care.
@Sashimu

 

[Sashimu]

Oh, @Sashimu ,

I'm so sorry this has taken a down turn. I injured myself early on in my recovery from my first hip by being too enthusiastic with my exercises and it took about 3 weeks for it to calm down. Now, at 11 months out, those 3 weeks seem like nothing. It's a setback but not a game changer.

You seem to be doing everything right. Now it takes some patience. You might be able to have some treatment to help calm it down. Your physio should have some ideas. Hang in there!

Thanks, @Schaargi. I just read your recovery thread...a lot of similarities in our recoveries, even though we don't have exactly the same problems. I also got a couple of good tips from it! This was back near the beginning of your recovery, in the first nine weeks, which I'm now coming up to. Riding the recumbent bike, and dry needling! You thought the dry needling really helped your hip flexor (aka psoas?), so I'm definitely going to ask about that when I'm at the physio tomorrow.

I've said this before, but it is SO helpful to read about your and other people's experiences. Thank God for this forum; this has been a rough ride and it's a lifesaver. ❤

 

[Sashimu]

Coming up to 12 weeks out....psoas tendonitis is sure not what I expected or wished for, but it's what I've got.

Still struggling with the surgeon's direction to minimize my activity to essential ADLs, and to increase my activity very very slowly. I've been getting out to local parks with friends, which is great, but I'm finding it SO hard not to walk around. We were in a lovely garden on Friday and I walked a good 20 minutes--probably more than I should have even with two rest stops. Saturday we visited another park and I deliberately didn't walk around at all. Though the weird thing is, I didn't really notice any difference in my groin pain whether I walked or didn't walk. It seems to be a five when I get out of bed in the morning, regardless of what I did the day before.

The last time I talked to my surgeon, on May 4th, he said we would talk again in 2 months. What I'm getting from that is that he expects it to take at least 2 months for this tendonitis to resolve. I've made another appointment with him on June 1st though, because I have some questions.

First of all, I never told him about my slip in the kitchen, and I want him to take another look at the CT scan to see if there's any evidence of a tear. I would think a CT scan would show it if there was one, and that if there was he would have noticed, but I'm going to ask anyway.

I also want to confirm that he thinks there is tendonitis but not impingement. He said a couple of times on May 4th that he didn't see any need for revision; at the time I wasn't sure why he said that, but now I'm thinking that he meant that there was no sign of impingement, even though he never mentioned the word.

I also want to ask him if he thinks I need to continue precautions past 12 weeks, given the situation. I sure hope not. Would love to be able to touch my right foot again!

As far as I know all the orthopedic surgeons in this town are in the same office. That's going to really complicate things if I decide I would like to get a second opinion. I have an appointment with my family doctor next week, after I speak with the surgeon, and I'm going to ask him for his take on this whole situation.

Wondering if anyone here can provide a bit more information about tendonitis versus impingement. My understanding is that impingement causes psoas tendonitis, but not all tendonitis is the result of impingement... Does that sound right?

Once again, can't say this too many times... This site is a godsend!

Added note: @SaraK and @Hip4life I've read both your threads and I know that you have had a lot of experience with psoas issues... Just wondering if you would be willing to comment on my situation, particularly my question about the distinction between psoas tendonitis and impingement. I'd greatly appreciate any advice you can give me!

 

[Sashimu]

Forgot to mention... Wondering if the title of my thread could be changed to, Psoas tendonitis post-THR

 

[Celle]

I've changed your thread title, @Sashimu .

 

[Hip4life]

Oh, @Sashimu, I do feel for you. I read back through your thread. Our recovery timelines are interesting in that our surgery dates are just a few days different even though a couple of years apart. It seems similar as well in that at this time in my recovery, I was still having significant hip pain with activity, especially with walking after a mile or so (I worked up slowly to this BTW.) This was concerning since the job I was trying to get back to required me to walk for most of a 12 hour shift. I met with my OS for another visit on that May 14 and he suspected iliopsoas tendonitis from impingement on the cup prosthesis. He wanted to see if it would “settle.” We eventually progressed to an ultrasound guided IP tendon steroid injection in August. It is both diagnostic as well as therapeutic. I got relief for 2 weeks. So definitely IP tendonitis. Unfortunately, the impingement made me seek further resolution with tendon release. In your case, since your doc is not thinking it’s impingement (my cup had a slight overhang that you could see on X-ray) the steroid injection might be a really good next step for you. It is the hope that when a patient receives it, they will get good, long lasting results from it. Once the inflammation settles, the tendon won’t get aggravated by normal activities. Then you’re on your way back to your life. It certainly is something you can discuss with your OS when you see him next week. When recovery runs a bit “longer” the hardest muscle to exercise is the patience muscle. The wheels can be a bit slower to turn than we would like or hope for. Hang in there, keep us posted, and let me know if I can be of any further help.

 

[Sashimu]

Thank you so much for your input, @Hip4life! As I mentioned I talk to my surgeon on June 1; the last time we talked was on May 4, when he suggested that it should settle.

Sounds like you got your injection about 5 months post surgery. I'm at 3 months now, but the way the system works here in Canada, it could easily take 2 months before I actually get the injection, even if the wheels start turning next week.

The groin pain has actually subsided a bit, but I can easily reproduce it just by lifting my leg a little when I'm seated. On the other hand, I now have a constant dull ache in the area of the actual joint. I'll mention that to him as well next week.

 

[Hip4life]

Yes, part of the delay getting the injection was me just thinking that if I kept trying stretches and slowly building the exercise routine it would get better. Like I did before getting seen for THR. LOL. I’m anxious to see what your OS says. It would be wonderful if that could be a solution for you.

 

[Sashimu]

I talked to my surgeon this morning.

It was clear that while he's pretty sure it is tendonitis, he doesn't really know what's going on. He started talking about the extra bone he'd removed and how it might be contributing to the problem. He even said that maybe he took too much, but that the area would fill in with scar tissue.

He said things should get better if I don't aggravate the soft tissue, but he wasn't able to give me any indication of how long it could take, except to say that improvement is possible for up to 2 years after a THR. If there's no improvement in the short term, he could order an MRI. He also mentioned the possibility of an injection of PRP, platelet-rich plasma, which I hadn't heard of before.

He said again that the cup was well placed and shouldn't need revision. I guess I have to take his word for it, unless I want to pursue a second opinion.

And of course today my groin pain is worse again. I just canceled an outing with a friend, figuring that since I'm already in pain I should just stay home and ice and elevate. I'm feeling really depressed today, I have to admit.

 

[Schaargi]

@Sashimu

I'm sorry you are down. I developed tendinitis on a while with my first hip, as a result of overdoing my activity The hip flexors take on a lot when you are recovering. My PT told me to back off from any movement that aggravates the hip flexors for a week or so, and then SLOWLY add it back in. For instance, she said to start with one march. One. Not marching in place for 5 or 6 steps. Just one.

That's pretty slow. It tool several weeks for my pain to subside.

I hope you get some rest and can slowly move back to a situation where you can move a little bit.

 

[Sashimu]

Right now I'm not actually doing any exercises, but with them it seems really straightforward; yep, start with one and very slowly increase. But what I'm really having trouble with is figuring out how not to aggravate things with walking and ADLs, which is basically all I'm doing. Since I'm still having pain, I'm clearly doing too much a lot of the time, but my judgment seems to be really poor when it comes to knowing how much to do. It's like I have a mental block somehow and I'm really floundering with this. It's really frustrating.

I feel like I need a timetable, like what we got at the very beginning; be on your feet 5 minutes out of every hour.

 

[HelenaM]

I hope you will be feeling better soon. I had some burning pain around my scar - OS said it was nerve or soft tissues still healing, while my internist said tendinitis. I think that walking with daily activities and no pt is working for me, gradually. i have found it hard to know how far or fast to walk, and when to rest too!

 

[Schaargi]

@Sashimu

We are in the same boat!

My surgeon and PT say, "Don't do anything that aggravates it." And I say, "Like walking to the mailbox and making the bed?"

That's a tough one. I tried being a complete couch potato for 3 days and then keeping track of how long I was on my feet before I rested.

Right now, I concentrate whenever I'm on my feet, taking short steps and avoiding pivoting, shifting my weight, and turning to the left. It's excruciating.

I'm so sorry you are struggling.

 

[Hip4life]

I’m really sorry you are feeling down. I’m not sure how you can keep from aggravating the tendon when it’s involved in so much you do. I would go crazy not doing anything. I’m surprised he didn’t discuss an injection for a future treatment. My doc discussed future options although he wanted me to give it a chance to resolve on its own. He really didn’t give me any restrictions. It was up to me to let him know. It seemed to improve for a while but I did contact him 3 months later when it was started getting worse not better. Try your doc’s recommendations but follow your instincts. Don’t wait too long before getting back to him. A second opinion could be useful but difficult if there are not a lot of docs outside a practice. I wish it wasn’t such a long drawn out process. Try not to get too discouraged. We’re here for ya and understand all those feelings you’re having. Keep letting us know how it’s going. Blessings. Pat.

 

[Layla]

But what I'm really having trouble with is figuring out how not to aggravate things with walking and ADLs,

Hi @Sashimu I‘m really sorry you continue to struggle with pain and uncertainty. When you mention walking, I’m assuming you mean walking outdoors and if so, how far and for how long are you walking? Also, how active are you around the home? If you don’t mind sharing possibly we can pinpoint something that’s causing the aggravation and discomfort.