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THR Psoasis Relief

Hi everyone ...@saraK, @Hip4life
Haven't been here for awhile....so it has been 5 months since my psoas release. A lot of the issues I had before have been cleared up...wish I could say ALL but that isn't true.

Simply put , I have been having groin pain (swelling) from 2 months post op (august 23rd ). It generally comes when I work out spin or walk. It doesn't hurt the day of ,only the next day when it swells (i can feel the swelling ,it starts in my inner right thigh , the area gets larger and then the swollen "thigh tissue" kind of gets (sorry for the graphics) attached and stuck to my rI saw my OS from NY (HSS) and he actually flew to california to see me for a consult at my home .(incredible nice guy).

He suggested I had athletica pubgalia (sports hernia-not regular hernia different) where the nerve gets wrapped or pulled by the tissue. He said 95% resolve on their own. It wasnt resolving so I went to see a "sports hernia " specialist who only does surgery for athletes with this problem.The OS physically examined me for a SH and said it's impossible that I have one as clinically I did not respond to where i would resond when he palpated. More importantly, he said that his athletes who hav SH CANNOT SPIN ON A BIKE FOR MORE THAN 10 minutes as they would be in great pain and certainly not for one hour with no pain like I do.
He said it should resolve on its own "whatever I have " and to try different shoes, orthotics etc.

It did not resolve so I saw an Arthroscopic OS whom I heard was really good out here in California.
He did a physical exam and he palpated and found two ares that I was tender. He concluded that I have
OSTEITIS PUBIS which causes groin pain particularly after THR and he has done and created approximately 25 operations for it, has a success rate of 70 % and has PUBLISHED his results.

He said that first I should try a cortisone shot in the Pubis area and for dx and relieve see if it clears the problem...then we can discuss surgery .(HERE WE GO AGAIN).

So I am back to not being healed...facing another surgery. Admittedly , the groin pain occurs more pronouced if I walk up steps (like college gym steps) or for long distances (5 miles) or spin for an hour. It swells up ,pushes on my groin and testicle and makes me nauseous.

I also still have trochanteric bursa pain which was "removed" at the same time as the psoas release but has never really gotten better.

I am trying to lose the 25 lbs which I gained after the THR and the Psoas Release surgery as I think it is a major contributer to the swelling of my groin tissue.

Any thoughts would be certainly welcome from all you wonderful "mavens' out there.

(I know your first comment is going to be DON"T WORK OUT..but I am 5 months post op and both my OS's said I could do the 5 mile walk and the spinning for an hour even if it is swollen the next day as it still should subside with time ..but it isn't!)

I am really saddened that I am going through this still...would love help..

Has anyone heard of Osteitis Pubis? or had a similar groin like problem in this area?


I think I am posting in the wrong place again...
 
Hi @Jws.
I really am sorry that you are still struggling and I will be the first to say that I cannot imagine that with this newest problem, you wouldn't cease that spinning ASAP. It certainly can't be helping matters considering where this problem presents and the position of sitting on a spin bike.

Here is a thread that Josephine weighed in on some time ago regarding Osteitis Pubis
She also contains a link to a site you may find useful.
 
You have to be healed before you can maintain or develop fitness, let alone optimize it. First things first.

The biggest objection I've heard to the suggestion to rest thoroughly is the fear of “going to pot” or becoming permanently out of shape. This fear seems most often expressed by the most fit people, who are actually in the least danger.
Healing should almost always put physical conditioning on the back burner, especially at first. Worry about healing first, and then concern yourself with restoring any fitness you have lost.
  • You certainly will go to pot if you never heal. Chronic pain is a much greater threat to your fitness than resting. Your soft tissue can't heal if you constantly stress it.
  • Top condition is vulnerable, but the bulk of your fitness is actually quite stable. You won't go completely to pot in 3 months. Or even six. And even if you do get out shape, it’s really not that big a deal to get back into shape.
  • If you’re worried about gaining weight, there are many experts saying loud and clear that calorie intake is by far more relevant to fatness than exercise. Just eat less when you’re not exercising.
 
Hi, @Jws. Mojo333 has given you the advice you need to hear. I hope it makes sense to you and you can give her suggestions a try.

You don't have to stop being active completely. That's never advisable. But for at least 6 months or so until things settle completely, it would be wise to cut back on the exercises. Try a 30 minute bike ride and 2 1/2 miles walking....half of what you now do and see if that lets you enjoy the exercise without the swelling afterwards. If not, then cut back to a level where you don't get the swelling. You might need to do different types of exercise - perhaps walking in a pool or some water aerobics.

Even though the surgeon told you it was okay to do these things, he's speaking from a perspective of the implant and the fact that it's correct and functioning well. Any time you have an action (activity/exercise) that is followed by a negative reaction (swelling/pain), you need to pay attention and not continue to cause your body to remain in an inflamed state.
 
Hi, there! Nice to hear from you but not nice to hear what you’re dealing with. I’m so sorry. It must be frustrating to be at square one with another problem and having to jump through the same hoops. In the meantime, you’re suffering from pain. I don’t have any first hand knowledge of osteitis pubis but I think it would be wise to ease back on the physical activity that aggravates the issue and get the injection for possible relief and definitive diagnosis. At least then you’ll have done the things most likely to help and your doc will then offer you other options. It gets old though, doesn’t it? Also, if I’m not mistaken, the bursa can grow back after a bursectomy. Mine was “debrided” with my release as well. I wonder, if it did grow back, if it is not aggravated by all of this as well. Best wishes for finding an answer and getting relief. We’re here for you. Keep us posted. Pat.
 
So sorry you're still having problems! I hope this new doctor has the solution. I don't wish more surgery on you or anyone else, but do want you to find a solution. This has gone on long enough! Let us know how things go.
 
Sorry this continues for you. I felt encouraged all was well because we haven't heard from you. I'm sorry that's not the case. I hope you find answers and complete relief soon.
@jws
 
@Jws. Hi, read your post but didn’t want to hijack okie’s thread. I’m really sorry you are still going through this. Yes. My IP release completely took care of my groin pain. My arthroscopic OS said that release at LT is what he did for all his THR IP impingement patients. His opinion was that 1. Then it didn’t have the chance to heal back to a still shortened length and you’re right back to square one 2. That other muscles take over the flex function and there should be little to no loss of strength. Both those have proven true. Fast surgery. Fast recovery. No PT. It took a few months for everything to settle into its new normal. Some minor stiffness/decreased ROM with the motion like putting op leg up on opposite to put on sock but it doesn’t really bother me otherwise. Still slightly weak going up a lot of stairs but I’m putting that on deconditioning because it’s gotten so much better. Walking, hiking, swimming, cycling all on my menu without issues. It’s so good to not think about “can I do that and how much pain will it cause?”
Total release might be your answer. Does the doc think your pain is still the IP impingement? Has he done any other diagnostics?
Like you said, an experienced OS is the key. My first consult was not, and it showed. My IP release doc was and it was evident in everything he did, asked, and said. Sorry this is so long but I wanted to be honest about everything. I so want you to get to where I am now. Aches and pains can be a part of life but that groin pain-no! I wasn’t willing to accept that as part of my life. Please feel free to tag me or PM me anytime. I’m on the forum regularly (except for 10 days from this Thursday when I’ll be mostly away from Internet on vacation.) I’m happy to support you however I can. Pat.
 
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Hi @Jws. I’m sorry you’re still experiencing some challenges. I hope in working with your surgeon you‘re able to achieve the complete relief you’re seeking


Hip4life said:
Please feel free to tag me or PM me anytime. I’m on the forum regularly.
Click to expand...

Hi Pat, I’ve edited your tag to Jws as it wasn’t showing, you were missing the period after the initials.

We ask that you please keep the conversation on the forum, as opposed to PM, for the benefit of others going forward that may be dealing with similar issues and searching the forum for answers. After all, that’s how you two discovered one another leading to your conversation.

The stories shared here can be such a comfort to those experiencing the same and members often recall issues they’ve read about on the forum, prompting another
suffering the same to check out a particular thread. So please continue to document progress here for the benefit of us all who are continually learning. Thanks in advance! :)
 
Thanks @Layla I must have accidentally taken the period off. Yes, I prefer the posting, as well, for the benefit of all. ❤️
 
Have had psoas lengthening ( tenotomy) at central compartment still have groin pain. OS suggests NOW 1 year later to have another release at lower trochanter and instead of just lengthening cut the tendon off at the lesser trocanter to give me much more room for psoas not to rub against implant therefore stopping groin pain.
Will my leg and hip become weak and unstable because I had a psoas lengthening at central AND a psoas release at lesser trocanter. (one psoas lengthening at central compartment and NOW cutting tendon off at lesser trocanter to give groin more space)
Will appreciate all input. Thanks. have been dealing with the groin pain of this for 3 years now..
 
@Jws. you will notice that I have merged your 3 threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.

Please keep all your questions and updates on this thread. If you would like a new thread title just give a shout.
 
@Hip4life ...Who was your Psoas release surgeon and where was he located...are you fully recovered now...full range of motion....NO INSTABILITY AND NO GROIN PAIN? best jeffrey
 



@SaraK @Hip4life if you had a psoas release at central compartment and it didn't relieve groin pain can you have another release at the lesser trochanter without making the leg really weak. all replies are welcome!
 
Hi, Jeffrey. I’m not a doctor but I don’t see why it would make a difference if you then had the tendon released at lesser trochanter. It is just the more distal tendon on the same muscle. As you know, I had that done (complete release of the tendon/muscle) with very little significant residual weakness 9 months out and back to all of my desired physical activity. The only hesitation I could see is to rule out any other cause to your pain. If it is definitely tendon impingement, with no relief from a previous tendon release, then total release may be a good viable option. It’s just finding an OS to help you. All the best, Pat.
 
Pat @Hip4life ..My thoughts exactly....
.Who was your Psoas release surgeon and where was he located...are you fully recovered now...full range of motion....NO INSTABILITY AND NO GROIN PAIN? best jeffrey
 
@Hip4life, @SaraK @arroyo65

Just spoke to OS and he said because I already had a Psoas Release (tenotomy) that didn't work (at central compartment) , he only gives me an 80% chance to get rid of my groin pain if I have a second psoas release at the lesser trocanter.
He says that the adhesions (Scars) from first psoas release will lower my chances of another psoas release (full release at lesser trochanter) being successful....In fact he went on to say even if I have a full revision, the chance will still be 80%.
Meaning there is a 20% chance I am stuck forever with this horrible groin pain....is he right??
Are there other alternatives I am missing? Is he just being a jerk because I didn't use him for first psoas release?
I really thought I finally had the solution at the lesser trocanter. Any help would be appreciated...three years of this pain and all the life being consumed by looking for an answer and ??? would appreciate any constructive ideas please..
 
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@Jws. I know you're frustrated. I'm sorry you've had to go through so much and still have significant pain. My suggestion would be for you to schedule a virtual appointment with broken link removed: https://www.starortho.com/. He's in northern California and possibly he might be able to offer some suggestions.
 
I agree that a second or third opinion might be warranted. I’m not a doctor but I’m having a hard time wrapping my logically thinking head around why releasing the tendon completely at the lesser trochanter would continue to keep tension on that tendon to have it continue to cause groin pain. That’s one of the reasons why my doc did it that way on THR patients referred to him because of the scar tissue at the capsule site. I realize no one can give a 100% guarantee but is he trying to talk you out of trying anything? Is he a revision specialist or arthroscopic specialist who has the experience to make those judgments? I cannot imagine the frustration and disappointment you are experiencing. Best wishes to you. Keep us posted. Blessings, Pat.
 
I am still having groin pain after the last psoas tenotomy , had cortisone shot in psoas two weeks ago and for 6 days it took away all my pain, so 99% sure its psoas being to tight still. I had the last psoas tenotomy cut in the central compartment now I am having more aggressive release at lesser trocanter. My surgeon said he can do ANOTHER tenotomy at the lesser trocanter ,but it will be arthroscopic with an "OPEN " assist.
My concerns are these: Doesn't any " open" surgery increase your risk of infection and other complications?
Secondly , before when I had my psoas cut at the central compartment ,when I asked OS's about a release at the Lesser Trocanter , they all said it was a "COMPLETE RELEASE" of the tendon only at the lesser trocanter. (that it is why it loosens up the psoas so much). I have talked to two now and asked them can they cut ALL the tendon arthroscopically and they have told me that they only can do 50% of a release at the Lesser Trocanter because arthroscopically they cannot see "around the whole" of the Lesser Trocanter.

Does anyone know whether it is possible to release all the psoas tendon at the lesser trocanter arthroscopically?
 
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