THR Psoasis Relief

[Pumpkin]

My concerns are these: Doesn't any " open" surgery increase your risk of infection and other complications?

Recommend you speak to your surgeon about the risk with open vs arthroscopic. Both carry risks, but with proper preparation those risks are low.

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

You may want to seek a third opinion to confirm the opinions you have received.

 

[Hip4life]

All I can tell you, Jeffrey, is that my op report states after the surgeon did a debridement of the IP bursa: “we had excellent visualization of the lesser trochanter and iliopsoas tendon. This was released. The tendon was completely detached from the lesser trochanter and retracted approximately 2cm.” All this was done arthroscopically under GA. It took about 30 minutes in totality and I went home about 2 and a half hours later. That was my experience with my surgeon and that’s all I can speak to. Like Pumpkin says, your answer lies with your second or third opinion from that corresponding surgeon. It’s difficult when you’re having pain. I hope you get your answers.Keep us posted. Pat

 

[Jws.]

I had a cortisone shot in psoas and doc hit the femoral nerve and it's been two months now with this meralgia paresthetica...has yours gone away? any suggestions from any hippies who have had this? does it go away in time? does walking,massage ,rollers, help?

thanks for any help as to therapies and time it will last..I hear it goes away on it's own...thanks

 

[Layla]

Hello @Jws.
I‘m sorry you’re still struggling with issues this far out from your initial surgery. As you wait for responses on your thread, may I suggest that you search for posts in regard to Meralgia Paresthetica by using the Search bar at the top right corner of the page, if you haven’t done so already. With any luck you’ll find the answers you’re seeking and gain some hope through updates of others that dealt with the same.
Wishing you comfort, relief and brighter days soon.

 

[Jws.]

I hope I am posting in correct place. So in my search to have my second tenotomy (psoas release ) at the lesser trocanter it has basically come to these last three options. @arroyo65 , @SaraK @Hip4life

1. Prior surgeon at HSS who did psoas release a year ago at central compartment (cut)..says he can be more aggressive and do a psoas release at the lesser trocanter and cut all the tendon off the lesser trocanter EXCEPT at that point he would do it as an "open" surgery. He would start arthroscopically and look at the central compartment for any bone spurs or adhesions, (that may interfere with the psoas release ,clean them up and then go to the lesser trocanter and through "open" surgery (much more visibility cut the tendon off the lesser trocanter and any peripheral tendons he sees. He says very simple surgery 10-15 minutes HOWEVER he hasn't done it for 10 years but is exceptionally qualied at HSS and I don't think he would take it on if he couldn't do it right (However , that is my most concern with him).
2. Second OS who is world famous for writing and doing all the research on psoas tenotomy (took me two months to get telehealth appt- he is a "big" data guy and very straightfoward OS (not empathetic at all) says he would NOT go up and look for spurs and adhesions at the central compartment(there is no data for it) but would do a full release at the lesser trocanter only ...10 minutes- and says that if I was his brother I should find any qualified OS in Los Angeles as it is a simple surgery not worth the trip to the Mayo Clinic. (says the "DATA" says there is no more risk doing it "open" than Arthroscopic. I said what about infection risk higher for infection for open , he says there is no data that that is true.
3. Third OS in florida does about 20 per year , all the same way and has been doing it for 15 years. He says he will do the TOTAL release at the Lesser Trocanter (where he always does it) arthroscopically (no open) and will also arthroscopically go up to the central compartment and clean adhesions and spurs than release all tendon at theLesser Trocanter. He has been very suceesful doing it this way. HOWEVER, and I am still confused by his last comment, he says he ACTUALLY goes into the COMPARTMENT and cleans out spurs and adhesions , then keeps you on antibiotics for 24 hours (because he went in the "joint" ) to prevent infection.(what adhesions or spurs are in the original joint that would effect the psoas release? He also says rehab is six weeks with restrictions on certain types of walking until the joint heals up again to protect against DISLOCATION. His procedure is the only one where dislocation and instability is an issue as he is actually going in the joint and needs six weeks of healing (I have almost three years of solid healing and don't want to lose the protection that gives me for instability.(don't know why he is opening up and going in "joint".

PLEASe , I am confused and would love your input..My perfect scenario would be my past surgeon "having experience with the Lesser Trocanter Release, the Mayo Clinic guy going up to the central compartment and looking for adhesions and spurs and the florida guy is perfect if he STAYS OUT OF THE JOINT. I would like the lesser trocanter all arthroscopic , looking up to central compartment for adhesions and bone spurs and full release at lesser T and 20 of them suceessfully per year.

I do not want another surgery after this. HELP??!!

 

[Pumpkin]

@Jws.
You have a lot of decisions. Sounds like your first and third surgeon are going to clean up bone spurs, the second one is just going to do a release.
Bone spurs can be seen on x rays, MRI, or CT scan. Do any of those types of imaging show bone spurs?
If in fact the bone spurs are part of the problems you are having you should seriously consider surgeon #1 and #3.

Ask the Expert , recommend you sign up for our Ask the Expert webinar tomorrow (Nov. 21).

Let us know if you would like to update the title of your thread, to better reflect what is going on with your hip currently.
Just post what you would like here, and a moderator will update it for you.

 

[SaraK]

I'm not able to evaluate which is best but, if it were me, i'd agree with Pumpkin. I'm not sure I'd want them just poking around for bone spurs - I'd want imaging showing them. MRI (in my case) seemed just about useless because of the metal affecting things. Personally, I'd be less concerned about the "open" procedure than the restrictions from them using enough traction to go in and look at the bones. One question for FL guy is whether, if you tell him not to go into the compartment and just do the release, he'd still impose the same restrictions.

From your perspective, splitting time btwn LA and NYC, isn't surgery in 1 of those two areas better for follow up, etc? I wouldn't want to travel more now than necessary. Is one less likely to shut down for electives (almost all hospitals here have already shut down to electives again).

 

[mer123]

Jws,

My situation sounds very similar to yours. I talked to several doctors at HSS, Mayo and DC to expore my options to address this nighmare with my psoas after THR. Please let me know what you decided to do and the outcome. Thank you!

 

[SaraK]

@mer123 - I don't see that you've started a thread of your own yet. I'd love for you to start one so that we can better communicate with you on your issue. I and few others who are more active on the site have has psoas issues after our THRs and some of us had the psoas released. When you start your thread, tag me like I did you - just put a @ before anyone's screen name and it alerts them that you have mentioned them in a post.

 

[MoveOn1]

@Jws. I would love to hear how thing re going now. You articulate my biggest concern will hip replacement help my back?

 

[MoveOn1]

@honeybeast thank you for the article you provided all those years ago. I’m just wondering if you went through with the THR and if so has it made a difference in your back pain? I am nervous that my quality of life will not improve after hip replacement because I will still have back pain. I have seen back docs and they each have said that my inflexibility is due to my awful right hip, but I think my back plays a part in that as well.

 

[Jws.]

@Mojo333 ,@Hip4life @SaraK Well...time has come again....I have my covid shots...I am having more severe groin pain than ever and I have decided today that IT MUST BE DONE AGAIN....I feel like "Tiger"..now going in for my third surgery for this Psoas Release.
This time I am going to have a FULL RELEASE at the Lesser Trocanter and hopefully the "third time will be a charm".
The problem is , it's not enough that I worry about the surgery but the real issue is that I am scared as hell that this is the last chance before a major REVISION, if this doesn't work out and even then no one has told me that a complete revision would work, so it comes down to if this doesn't work...I am going to be depressed as hell and will be lost again searching to relieve the groin pain..
So one step at a time, THIS WILL WORK, I have researched the hell out of it and I know the major part of this is the psoas..so if the surgeon is good, the stars are aligned, and whoever it is that watches over us is looking...than I should be ok..say a prayer kiddos and fingers crossed..will keep you updated..@djklaugh please check if this is posted in correct place. @Mojo333 is this posted in new posts.ty

 

[Mojo333]

@Jws.
Here in your thread is where your post will go so admins will move it here.

This time I am going to have a FULL RELEASE at the Lesser Trocanter and hopefully the "third time will be a charm"

Glad to hear you have found a surgeon and I have no doubt, through this long journey to try and be rid of pain, that the "what ifs" creep in.

I am scared as hell that this is the last chance before a major REVISION

This is the one big What If but as this new year brings hope and progress on all fronts, I am going to lend my positive mojo and this does the trick.

So one step at a time, THIS WILL WORK, I have researched the hell out of it and I know the major part of this is the psoas..so if the surgeon is good, the stars are aligned, and whoever it is that watches over us is looking...than I should be ok..say a prayer kiddos and fingers crossed..will keep you updated.

Do you have a date for the surgery yet?
Please let us know so we can add it to your signature and so we can collectively get good vibes headed your way.
I think you have been dogged in pursuit of answers, and I'll be looking for your updates.

 

[Jws.]

@Mojo333 thanx mojo

 

[Mojo333]

You're welcome.
Do they have you a date for the procedure?
Looks like we have several members who have what they suspect are similar problems and I know I know more about these different tendon release procedures since I've been following your story.

We want a happy ending for you.

Maybe one day, telling of your struggles and how you overcame them will serve as someone else's survival guide.

 

[SaraK]

I'm so sorry you're still having problems with this but glad you are taking a step forward. I know from experience what that constant pain does to the psyche. I wish more surgeon's understood how common this issue is after THR (I've heard it may be more than 4%) and just what the pain is like. Then they might be willing to recognize and treat this more quickly.

I'm going to keep my fingers crossed that this does the trick for you! I hope you get to the point that you don't even think about it very often - forgetting the hip ever had an issue can be a wonderful thing!

 

[Layla]

Hello @Jws.
It is unfortunate you continue to struggle with pain three years post op. It is easy to understand your worries and fears about the possibility of an additional procedure not bringing you the desired result after your hopes were dashed twice. I know you’ve put a lot of time into researching the procedure and choosing a surgeon. I’m sorry you have to go through it all again. Lets hope the third time is the charm.

 

[Jws.]

@SaraK @Hip4life Well, here we go again...Having complete Psoas Release from the Lesser Trochanter.

I am really hopeful that THIS IS IT!!!... I have researched the hell out of this psoas tenotomy and decided to go forward...There is no way I can live the rest of my life with the groin and other pains this tendon is causing me now for three years....
The OS's say that it's 80 % successful , the other 20 % is body position, pelvis position or the unknown that will make this tenotomy fail.
My doc who is doing the surgery says the cortisone shots into the psoas and the subsequent relief trumps all of the 20 %.
but.......
(the hell with but !)
Will update you as I go on with this one...
JWS

hope I posted in the right place..

 

[Hip4life]

What’s the date for your surgery? There are so many “what if’s” in life especially with a major event. Honestly, for me, getting rid of the pain and getting on with life kept me from dwelling on the 20%. I don’t know how you have dealt with this for 3 years. 9 months was long enough for me. Even though I have some minor ROM deficits which I consider insignificant, it has been so worth it and I am so grateful to be back to all my previous physical activities. As always, I wish you the best and blessings for a restoration to an active life with less pain. Pat

 

[SaraK]

I'll be keeping my fingers crossed that this one works for you! You've been dealing with this for so long. Please do me a favor, though, and don't push too far, too fast this time. Gradually work up to normal and back off if anything causes pain at the time or within 24 hours. Your body has been through so much and it will need time to get back to normal. Even my gait had been significantly affected and, while there was marked improvement within the first couple of weeks, I had to unlearn bad habits and re-strengthen muscles that hadn't been used properly.