THR Psoas tendonitis post-THR

[Sashimu]

Hi @Layla. Yes I mean walking outside. For example:
Friday I went to a doctor's appointment, walked a block to the appointment and back and went into two stores, for a total of maybe 1O minutes.
Saturday I walked in a park with my poles for at most 25 minutes, with 2 rest stops.
Monday I met a friend for coffee and walked through a store with her, for a total of maybe 15 minutes.
I drove to all those places.

Sunday and today I stayed home and didn't go for any walks. When I stay home, I make things to eat a few times a day, and I wash the dishes or run the dishwasher once a day. I make my bed. I hardly do any housework. I sit a lot, often with an ice pack on and my legs up, though I haven't been keeping track of how much time I spend sitting versus on my feet. And because I have stairs, I go up and down 8 or 10 times a day I'd guess. One leg at a time though.

My pain level was pretty good from Friday up until yesterday, when I started getting some groin pain on and off during the day. And for some reason today it's been a steady 5-6 from noon on. When I look at what I've been doing, it's hard for me to understand why the pain is so much worse today, unless I'm paying on Tuesday for the walk on Saturday. For whatever it's worth, it's getting close to bedtime now and my Fitbit says I've walked almost 2,000 steps.

 

[Sashimu]

Schaargi, HelenaM, Hip4life, thanks so much for your good wishes. It really does help!

@Hip4life, my surgeon did mention the possibility of an injection today, though he was talking about platelet-rich plasma rather than cortisone. Before I go there, I'd like to feel that I've really done everything I can to resolve this problem through rest and slowly increasing my activity level. I certainly don't feel that way at this point. I keep thinking the problem is that I'm still doing too much, not that this approach doesn't work.

I've contacted the physio to see if I can get more explicit direction from him as to how to manage my ADLs etc. so as not to aggravate things. But regardless, if I see no sign of improvement in the next three or four weeks, I'm going to ask for an injection. I'm with you on that one!

 

[Sashimu]

One other thing re my activity levels... I live alone, so I need to do most ADLs myself. I can get friends to help with grocery shopping, though I sometimes do it myself anyway.

 

[HelenaM]

I think it is hard to manage ADLs. I have found some less complicated recipes, and I have been able to order some groceries for curbside pick up which has been instituted due the pandemic. They put things in my trunk. When I get home, I transfer most items to canvas bags and don’t carry anything too heavy. I am hoping that I will eventually be able to carry more, but I am not pushing it now. Hope things start to improve for you.@sashimu

 

[Sashimu]

Thanks, @HelenaM. I think I need some less complicated recipes too... I just made a pasta dish that I like but I realized that I was on my feet making it for like 45 minutes. Probably not ideal! I've also been doing some online shopping and actually getting it delivered, since that only costs $3. Just have to plan ahead since there's a $50 minimum.

Hoping things improve quickly for you too!

 

[Layla]

I've contacted the physio to see if I can get more explicit direction from him as to how to manage my ADLs etc. so as not to aggravate things.

I hope this helps. I understand your frustration, but remember we all heal at different rates. Others passing you up is difficult to ignore, but don’t lose heart. It’s only been three months. Happy Three Month Anniversary! (One day early) I wish you were feeling better about your recovery on this special day. Patience dear Sashimu, it will come.
Sending a hug and wishes for a good day!

 

[Sashimu]

I talked to my family doctor yesterday and I found that very helpful.

He thinks I should log another 4 weeks on celebrex, with minimal activity (e.g., no more walking unless required by ADLs), before I go back to the surgeon to talk about next steps.

Contrary to what I've heard from other people on this site, he seems to think that cortisone is not an option for a tendon injection, that it's been debunked as a treatment. Not sure where he's getting that from; I'm going to have to research it. As I mentioned, the surgeon is suggesting PRP instead, but that's not covered by our medical system and is pretty pricey. I'd want to ask the surgeon if there any alternatives he can suggest.

Re getting a second opinion, he said "it was my right", but he obviously didn't think I needed one. He said the radiologist has a good reputation and had already provided an independent opinion. I was right that all the orthopedic surgeons here work in the same office, and we agreed that it would be really awkward, at the least, to ask one of them for a second opinion.

The obvious place to go for a second opinion would be to a surgeon in Vancouver. However, I live in the Island health authority (there are five health authorities here in BC), and it turns out that the way our medical system works, he would have to make a very strong case for the system to pay for a consultation with a surgeon in Vancouver, which is in a different health authority. Don't think that's going to happen, just based on wanting a opinion from a different office.

 

[Pumpkin]

@Sashimu,
Just throwing these options out there for you,

Hospital for Special Surgery (HSS) in NYC reviews difficult cases, you send them your records, then an orthopedic committee reviews you case and offers their opinion. It costs about 500 US.

You could also consider a same day cash pay opinion from a surgeon in Seattle. Some give a pretty good discount, you would have to call around for cost.

 

[HelenaM]

@Sashimu,
I am wondering how things are going since it has been awhile since you starting resting your Psoas. Hope you are seeing some improvement.

 

[Sashimu]

Thanks for checking in, @HelenaM. I am doing a little better, just a little. This is such a slow process, and I can very easily slow it down even more just by doing too much. But I think I can do a little bit more with a little less pain than I could a couple of weeks ago, which is encouraging.

I've been thinking I should get in touch with my surgeon again, at least to try and get some further imaging to pinpoint what the problem is. I haven't done anything about it because the last few days here we've been battling intense heat (40 degrees C/100 degrees F), which we never get here in Victoria. It has really sapped my energy, and trying to stay cool has taken all my attention!

Hope you're doing well.

 

[HelenaM]

@Sashimu,
It looks like your weather is improving! Good to hear that you are able to get around a little more. I have not be offered anything more than an X-ray, so I will be interested to hear if you find out about another diagnostic tool.

My husband had a knee replacement today, and he was already up and walking with a walker when I left the hospital. I am exhausted though and he is probably coming home tomorrow.

Hope you have a good weekend, and feel better every day!

 

[Layla]

Happy Four Month Anniversary, Sashimu
I wish you were more pleased with your progress at this point. I think your idea to check in with your surgeon is a good one. It can’t hurt to have a discussion with him in regard to your concerns. I hope you’re able to do that soon.
Wishing you a safe and happy holiday weekend!
@Sashimu

 

[Sashimu]

Thank you for the good wishes, @HelenaM and @Layla!

Yes, the weather has been really pleasant since the heat finally broke, but unfortunately it sounds like the next scourge is on its way--smoke :-(. The BC interior is ablaze :-(

This morning I discovered that I am finally able to lift my right leg off the bed, but it hurt quite a lot, so I won't be doing that again anytime soon. At least it can be done, though; it was completely impossible for months.

I'll be talking to my surgeon tomorrow about getting further imaging. I'd really like to know what's actually going on in there! It may well be exactly the same as what he thinks is going on, but still.

@HelenaM, I hope your husband is doing well post TKR!

 

[Elf1]

Hope you get some insight as to what is going on when you see the surgeon tomorrow. While it hurt a lot at least it's progress that you were able to lift your leg off the bed. Just keep taking it slow and steady. Ice today if your leg is still hurting from this morning.

 

[HelenaM]

@Sashimu
Do you mean that you did a straight leg raise or partial straight leg raise? I found that very hard for to do for many months. I could do it, but it hurt. About four months after my surgery we rented a place at the beach with a shower in the tub. I had trouble lifting my operated leg over the 14 inch side. So frustrating it was! I can now do a straight leg raise although I would not try many! And I can lift over the side of a tub.

I used ice early on and was bothered by heat, but when my internist recommended heat at some point I tried it and it did help in the hip flexor area. She said it helps heal tendons, but everyone is different.

My husband’s new knee is good, but he had a setback due to pain meds or anesthesia. Today he was able to do pt very well, but it has been really upsetting.

Again, I am hoping you will get some answers and/or helpful suggestions from your doctor.

 

[Layla]

I'll be talking to my surgeon tomorrow about getting further imaging. I'd really like to know what's actually going on in there! It may well be exactly the same as what he thinks is going on, but still.

Good news! I’m happy to hear it. I know you’re troubled by your progress so I hope you receive reassurance, or a plan to help you move forward without pain.
Please let us know how it goes.
@Sashimu

 

[Sashimu]

I spoke with my surgeon yesterday. He talks a lot, so it's hard to get a word in without interrupting him, but bottom line, I got what I came for, which is an MRI requisition. This being Canada, it could take a while to get (months?), but we'll see. I asked him about ultrasound, but he obviously thought an MRI was a much better option.

He started talking about revision and changing the positioning of the cup, which I found quite disturbing, even though he said we'd need to wait at least a year before considering it. Eeek.

Otherwise, things are much the same, except that my left leg seems to be acting up more and more. No big surprise there...

@HelenaM, I did a full-on straight leg raise, but no, I won't be doing one again for a while. Haven't had to maneuver my leg out of a tub. I've tried heat on my hip, but ice still feels SO much better.

Hope things are going well for you and your husband.

 

[Layla]

Hi Sashimu,
I hope you don’t have to wait as long for the MRI as you’re anticipating.
Wishing you comfort and hope you find more strength week by week.
@Sashimu

 

[HelenaM]

@Sashimu
When he mentioned revision, did he say he saw something in your X-ray that might indicate that? Three surgeons have explained to me why my X-ray looks good (my husbands knee surgeon is also a hip surgeon and I think he was curious, so he pulled my X-ray up and looked and explained just To be helpful?)

Did he explain why He chose MRI?

Sometimes doctors assume we understand their thinking or don’t fully communicate their thinking.

Sending you good wishes for healing.

 

[Sashimu]

@HelenaM, I'm really not sure why he talked about revision, except that he thinks that maybe I'd be having less of an issue if he'd done something better/different with the cup? Not exactly what I want to hear but. The xrays to date show no issue with the prosthesis.

That was nice of your husband's knee surgeon to explain your xray to you!

He said MRI would produce the best view of the soft tissue. I don't doubt it.

Best wishes to you too!