THR Psoas tendonitis?

kain

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I had a left THR four+ years ago age 69 - needed not due to age/arthritis but undiagnosed Perthes disease as a child. Took almost 60 years to get the op, left leg being shorter. Surgeon lengthened the leg 2 and half cms and until past year it had been semi-satisfactory as in no pain but still same rotation limitations as past 60 years.

For past year have had pain firstly in outer thigh which when finally got to speak to surgeon - diagnosed (on phone call only due to Covid) as Trochanteric Bursitis and physio recommended.

Physio achieved nothing - managed a face to face appt. by going privately when a full examination was diagnosed as a problem with the psoas tendon and an ultrasound guided injection as treatment. Had this done - again privately but 6 weeks later proved useless.

In addition I have ongoing sciatica in my right leg- well I call it sciatica having had several similar flare-ups for past 20 years. In 2018 I had an epidural steroid injection - which was of no use but then had a Facet Joint Injection which gave me 16 months pain free. Flared up again at start of pandemic so now at the mercy of NHS waiting list for further similar injection or denervation.

It has been suggested by various physiotherapists that lengthening my left leg during THR could have caused an imbalance as my body had adjusted for over 60 years to that shorter leg.

My worry is that each consultant only deals with their own speciality when there could be a spinal cause for both sides - on previous sciatica flare-ups the pain has been down the leg and into my foot - this time it is mainly in my back/ankle and I can pinpoint the source of the pain - the exact spot where the Facet joint injection was done.

The hip surgeon says (from x-rays) the implant is fine and he couldn't do it better today but I feel a more holistic approach may be beneficial.

MRI scans - over 2 years ago show spinal stenosis, lower 4 lumbar discs degenerate with some disc bulges, L5 nerve roots impinged. Several other findings but appreciate that most people my age will have many similar characteristics.

I have reached a point now where I don't know which side hurts more and am becoming more and more housebound as unable to walk very far, plus my balance is shot, otherwise no other health issues but I just want to be able to do normal things - like go for a walk, take my grandchildren out.
 
@kain ,
Welcome to BoneSmart, glad you joined us!
You are correct about imaging not being correlated with pain, most people our age are walking around with bulging discs, impingement etc with no pain.
Since your pain (that you can point to) is in the same place as your previous successful injection, my best guess is you would benefit from an injection in the same area.
My worry is that each consultant only deals with their own speciality when there could be a spinal cause for both sides
A physician that specializes in physical medicine (physiatrist in the US), looks at the whole body, and may be a good choice for a consult. @Jaycey or @Roy Gardiner are in the UK and may able to better advise about which type of doctor in the UK practices in this specialty.

I agree with the PT, your body had adjusted to the leg length difference (LLD), and may be struggling to adjust to the new leg length. The PT may be able to help with a small lift in one or the other shoes to help your body adjust.


Please post your surgery dates, a moderator will add it to your signature for you. Having the exact dates will help us properly advise you. Thanks!

Keep us posted on how you are doing,
Chris
 
Thanks for your response Chris - re surgery dates, LTHR was September 2016 - ultrasound guided steroid injection into Psoas tendon February 2021 - ineffective, attempting further consultation with surgeon for next move
Right side sciatica -
First attack 2003, lasted 5 months - eventually given nerve root block - effective
Second attack 2015 -some chiropractic treatment no medical intervention
Next attack 2017 - eventual epidural steroid injection -ineffective followed by
August 2018 Facet Joint Injection -pain free for 16 months!
Current attack started December 2019 - unable to achieve any face to face consultation due to Covid only by phone - on waiting list for further Facet joint injection or denervation. Phone conversation with consultant last week after complaint- asked how do we know that is the best course of action when had no examination and current pain source not identical to previous. Finally have face to face on Friday so we shall see. At least further 3 month wait for treatment.
 
I had psoas issues after my second THR - also a feeling almost like hydroplaning inside the hips on rotation sometimes. Surgeon said "looks ok to me.". Finally referred me to pain management. She was all about back pain and the rotation of the pelvis. She had PT do manipulations to straighten rotation (couldn't listen when I tried to tell her the tilt (very minor) was different each time. She did injections into the psoas muscle thru the back and it helped some but only worked for 7-10 days each time.

I finally went to another surgeon who very quickly realized I was right when I had asked to be evaluated for psoas impingement (same thing I told the pain mgmt doc). An injection into the psoas tendon gave me complete relief but only lasted a couple of weeks. He said that proved the diagnosis and, having already tried rest, meds, PT and an injection, surgery was the next step. He didn't do that sort of surgery but referred me to someone that did. I had the psoas released over 2 years ago and am so glad I did.

You may not need a release but it is one possibility if it's the psoas. It's a question of identifying whether it's the psoas or facet syndrome or both. I think both could be caused by lengthening the leg and stretching the muscles on that side.

Take care!
 
@kain
did you have the facet joint injection in aug of 18 for continual groin pain after THR? and you are saying the facet shot gave you complete relief of groin pain for 16 months ? thats great results? better ROM as well..no groin pain? thanks
 
No the facet joint injection was for sciatica on right side - unrelated to groin pain four years after LTHR.
Had several sciatica attacks over previous 17 years - other treatment including epidural steroid injection useless. Sciatica pain radiates from buttock down outer thigh to ankle. Apparently 16 months pain free after FJI is good - now awaiting further one with possible denervation, very long waiting list.
 
@kain How did your appointment go? Any further clarification?
 
Had further x-rays, blood tests and double MRI - lumbar and pelvic - hip implant is sound, no infection found via bloods - although still painful especially during the night. But MRI indicates multi-level facet joint disease coupled with potential nerve root entrapment. Suggestion of repeating injection into psoas as small amount of fluid surrounding psoas tendon shows on MRI but as first one unsuccessful am a bit dubious...
Referred to spinal surgeon - appointment tomorrow so will await verdict there
 
Hello,
I am sorry you’re dealing with pain. Thankfully the implant is sound and there is no sign of infection. Wondering how your appointment with the spinal surgeon went if you’re interested in sharing...we do care.
Wishing you comfort and speedy relief.
@kain
 
Hello
Thankyou for your interest , my hip surgeon was concerned about my recent MRI - as I have left hip pain and also right side back and leg pain. Several anomalies on MRI point to possibility of spine being root cause of both. However appointment yesterday did not go well, this consultant disregarded all the info he was sent by my hip surgeon - who has all my history and I am unable to describe this person as my language would be moderated. Suffice to say he was obnoxious and the total opposite to my hip surgeon who is a lovely man. I will have to wait for a letter from him with his 'opinion' as I was so angry that I didn't take in much that he said as he spoke to me as if I was a five year old and was just desperate to present me with the bill - which was like salt on the wound, I knew I was going to pay but felt I had just poured money down a drain.
Will follow up when I know more.....
 
I’m so sorry you had a bad experience. We’re here to offer a listening ear and support if you need it. Wishing you all the best as you try to get to the bottom of this all. Stay in touch.
@kain
 

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