THR Psoasis Relief

[Jws.]

@Josephine Hi, I hope I am posting a new post in the correct place.

I am now about 5months post op. I was doing fine. In the last two weeks I developed groin pain with an accompanying tight band on my top right thigh. I am depressed. I feel like this whole replacement is like a "mine field". I am still scared of indolent infection. I had my blood taken, whites and reds normal. My c-reactive was normal, my sed rate was slightly elevated 32. I am worried that the new groin pain is the beginning of the indolent infection trying to break through.

Talked to another OS and he said indolent infections can hide and not show up for years. I am concerned that this new groin pain (less than 1-2) may be the beginning.

As I posted in my other posts I had chills 8 weeks post surgery at night and no fever, went away next day. Again, one month later had severe chills at 4am in morning with 100.03 fever, went to pcp, given course of augmentin, had blood cultured (no bacteria).

Then , about a month ago in 60 degree weather got out of car and again had chills. This was in mountain area 6000 ft elevation which could account for it. That's three times chills but no bacteria but still never had them before. Do you have to worry about this infection thing 24/7?

I met with my OS and and I have GTB for sure not a problem, had it before I had THR. He DX me with tendinitis in the groin and thigh pain.

I was walking fine a month ago one hour a day, no limp, and going forward. Even was doing staitonary bike for 45 minutes.

Now I have this groin and thigh pain and I am going backward. I was told not to exercise, he RX, PT but for ultrasound , Iontopherises and Celebrex for 10 days. No walking or exercise.

Sorry to sound like a wuss, but this has been 5 months and I don't have the freedom to travel. Don't want to get stuck in third world country with a significant hip problem, worrying at each new development, groin and thigh pain, back on meds, no exercise. Sorry running on.

Please advise what this new groin and thigh pain is? It feels like my right leg is like a peg leg walking, stiff, heavy at thigh and "webbed " together with my groin.

After taking celebrex (100mg bid) for two days groin pain dissipates but my walking is not "free' like a month ago. The celebrex took away the groin pain but the right leg is stiff, heavy and has thigh band tightening around top of thigh

Josephine ..to pinpoint the band or pain in my thigh it is right where the "yellow dot "was on one of your posts with the "body" diagram , the pain is in the front of thigh where the femur ends (I think).

Josephine and others, please give me any of your thoughts on this new groin pain, indolent infection, tendinitis, therapies and actions I should try to get rid of the groin and thigh pain and walk "freely" again...thanks...

 

[Josephine]

Hi, I hope I am posting a new post in the correct place.

You did it correctly this time!

I have GTB

What is this?

Talked to another OS and he said indolent infections can hide and not show up for years. I am concerned that this new groin pain (less than 1-2) may be the beginning.

I can tell you that it's not. There are plenty of less worrying things that it could be but it doesn't sound like an infection to me in any way whatsoever.

He DX me with tendinitis in the groin and thigh pain.

That would be my guess

Sorry to sound like a wuss, but this has been 5 months

So what? 5 months is hardly any time at all. You're worrying unnecessarily.

Please advise what this new groin and thigh pain is?

First I need you to show me the site of these pains using this chart

And then I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Jws.]

@Josephine...
you are the best...you give concrete , solid , no hedging advice and it's very much appreciated.
To answer your questions ( which I am happy to do)..
GTB is Grand Tronchoteric Bursitis.
The groin pain is located at R3FW
The tightness "band" on my thigh is W or X - and runs through R1F,R2F, and R3f.

I am on the third day of 100mg celebrex bid and yesterday I tried walking "heel toe" on the right leg and two things happen..
1. my right thigh will occasionally buckle if I "fight" the tightness and try to do heel -toe walking ( not drastically but it will buckle for a second) instead of letting the tightness force me into a lazy limp.
2. pain in groin and thigh is much less with celebrex but tightness in those areas is still there and it limits my walking distance because I am fighting to walk without a limp and when I do that there is increased pressure on the groin area and thigh area, and if I continue to walk..I get buckling and close to getting groin and thigh pain (1-2).
I don't know if I should do any walking at this time to strengthen the muscles or help the walk or go the 10-15 days of celebrex and do the normal walking for work and getting around and nothing else.
I was also recommended to rest the area for 10 days and see if the inflammation releases and the groin and thigh pain goes away.

3 months ago I took 200 mg celebrex bid, and walked absolutely normal for two days so I know it is possible (only 2 days)..
than was dx with GTB by a friend who is OS and she gave me tips to relieve GTB...( SLAM- Stand like a man- Keep your legs always spread open , when getting up , stand front first , then turn and walk . Same with getting out of car.. Additionally, she advised getting a 3" foam mattress on bed so you don't put pressure on the bursa . (that works as well) My GTB is significantly improved. (she also says that she started the SLAM program because most women get bursitis because of the crossed legs and tight leg position)

Thank you for helping to allay my fears as to infection. I am still concerned , but feel better. Will get new cbc after this course of celebrex and hope that the sed rate of 32 backs down to normal , and the c-reactive stays at.3 normal as well as white cells.
Thanks again for being so responsive and so direct and straightforward.

As I am sure you are aware being a litigation attorney , I always have to "battle" to get un hedged opinions from the docs. They will always give me "ambiguous ,broad answers " . I am not looking to sue them , but it what it is and I never get a direct true opinion from most of them as they don't want to be tied down to a specific answer. (I believe it's worse for me , but I think it 's just the current state of affairs for everyone with the docs.)..

Thanks again for being a direct resourse. I feel much better reading your responses.

Josephine, today the tightness in groin is back (no real pain 1-2)...no pain when sitting, sleeping..(slight "annoying" tightness)...it feels like a "peg leg" when walking..stiff.

 

[Josephine]

GTB is Grand Tronchoteric Bursitis.

LOL! I think what you mean is Greater Trochanteric Bursitis!

Is this where your pain is?

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Jws.]

Absolutely...go for it...TY

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Jws.]

@Josephine
1. Posterior
2. Taking celebrex 100mg bd so that may have some effect on pain levels but in general, I have never had pain when sitting, lying down, just tightness. When walking, only have a tight band on thigh like peg leg, no actual pain, and 1-2 groin pain.

More concerning is my operative right leg buckling at my thigh when I walk forward and it is heavy and difficult to move my right thigh and groin while walking any significant distance. Where before it was freer and easier to walk for an hour. Now it's like battling uphill.​

3. celebrex 100mg morning and night for 5 days. So far was told to take for two weeks or so.

4. No icing

5. no elevating

6. do my office work, household chores, go out to dinner, no extensive walking.

7. no home exercises for two weeks now

8. no PT for 10 days now

yes your diagram is accurate where the pain is...
I am really afraid that this will never end with a pain free hip and a constant search for OS's opinions, shots, therapies, and drugs, and overhanging all this is always the Damocles sword of infection.

 

[Layla]

Hi @Jws.
I'm sorry for your situation. I feel you're agonizing over this and I find it really sad. I wish you could
receive some reassurance, get a diagnosis and remedy for the pain so you're able to move forward.

I think infection, dislocation, revision lives in the recesses of all of our minds. There are no guarantees with THR. These aren't our natural God given hips. But we took a chance for a better life. If you find the origin of your pain, work on resolving it and try really hard not to entertain infection I believe you can have your happy ending!

We're here for you, we understand your fears, stop back often and we'll try to encourage and support in any way we're able. I look forward to Jo's response.
Hope today is a good day!

 

[Josephine]

2. Taking celebrex 100mg bd
7. no home exercises for two weeks now
8. no PT for 10 days now

Okay, so please tell me what the answers to these questions would have been for the weeks between Feb 1st and 2 weeks ago!

 

[Jws.]

between feb 1 and two weeks ago answers:
2 no celebrex
7. walking an hour a day in my house as exercise (once in awhile switched to half hour-45 minutes stationary bike)
stretches in house...after walking for hour

runners calf stretch 3x count of 20 each leg
standard quad stretch 3x count of 20 each leg
supine piriformis stretch 3x count of 20
hamstring stretch w towel 3 x count of 20

During that time
only had the trochanteric bursa pain 1-2
no groin or thigh pain
no "buckling " of thigh when I walk
(Josephine this really concerns me now as my leg will actually give way with the thigh and groin pain when I walk forward for a few seconds.)

thanks
hope you have answers

want to exercise (gentle walk) or easy biking..
saw OS yesterday and he said I could walk as long as I don't have pain
at PT should do tendinitis stretches with ultrasound, ionophoneses,
said psoas tendon is really tight and have to stretch it
consider cortisone shot as well.

 

[Josephine]

between feb 1 and two weeks ago answers:
2 no celebrex

So you had NO pain meds at all from the start?

runners calf stretch

What is this?

 

[Jws.]

@Josephine
no sorry from surgery date Feb 1st until two weeks ago had following pain meds...

February right after surgery had :
Tylenol 3000mg for about a week than off and on 2 Tylenol per day(sorry whatever normal dosage of one pill) for about two -three more weeks.
Tramadol 500mg couple times beginning of post surgery first couple of weeks (stopped, not a fan)
oxycodone 2 per day for about 3 weeks, than one per day, for 3 more weeks , than one every fourth day for the next month

from May Advil and Tylenol , once a day as needed..(off and on)
then OS prescribed Celebrex 200mg bd beginning of 4th month when bursitis and flexibility wasn't getting better for 10 days

then things really got better, was able to walk with no limp, no groin or thigh pain, only pain when getting out of car and after sitting too long and only in great tronchanteric bursitis

then mid May - no meds, was walking fine for hour, switching next day to stationary bike, mild stretches

then all of sudden mid May the groin and thigh pain happened and continued

then started again by OS on 100mg Celebrex for relief of groin and thigh pain and tendinitis until today.

saw OS yesterday and he said to do stretches at PT for the tendinitis and said I can walk again for an hour as long as no pain. Suggested at some point after 6 months to get cortisone shot in psoas tendon.

runners calf stretch - find wall, perform pelvic tilt. Take one step back with either foot, maintain your heel down down to floor and toes facing forward. This will stretch the back of the leg and calf.

Josephine,
It seems one thing gets better, than there are a series of another chronic things that go wrong (groin and thigh pain) and I have listened to your advice and generally have not overdone it with exercise and PT.

My dilemma now, is my OS correct with my thigh and groin pain, can I walk gently for 45-60 minutes or must I do nothing for 10 days but PT stretches and the Celebrex to have the tendinitis and poas calm down.

Thanks for any and all help you can give, it's now going on 5½ months.

 

[Josephine]

is my OS correct with my thigh and groin pain, can I walk gently for 45-60 minutes or must I do nothing for 10 days but PT stretches and the Celebrex to have the tendinitis and poas calm down.

You seem to be between a rock and a hard place! I think you'd be better seeing a chiropractor.

 

[Jws.]

@Josephine
are you saying that my OS is not giving me appropriate advice, that he is not helping at all....
should I get second opinions ???? please clarify...ty

 

[Josephine]

I wasn't actually saying anything - just observing that you are in an impossible situation.
Though you're right - a second opinion wouldn't come amiss

 

[Jws.]

@Josephine I am really down. I can't get straight answers from four top OS's as to why my hip is not healing after 6 months and why my groin "discomfort" (not pain - feels like a web from my thigh to my groin, like extra tissue is there or swelling but no noticeable swelling)

My primary OS left it at tendinitus, tronchoteric bursitis. My second opinion, the classic "it takes time". Third opinion "it takes time". From what I understand, this is really not true (default answer when they don't know) but most hips heal within two months and there generally is some sort of problem after 6 months ... sorry frustrating.

Tried bicycle but after 20 minutes burning sensation in groin so stopped (was able to do this for 45 minutes two months ago with no burning sensation). So in the last month my OS had me on 2-300mg Celebrex per day. Pt 2-3 x per week (just light stretching for hip flexor and tendinitis). Week ago got really bad stomach pains from celebrex (wasn't helping anyhow ) and stopped.

Next day got up and said with feeling "good" no pain. And walked for an hour (felt great - normal gait no limp, no pain, slight webbed feeling and thickness in groin but not bad. Went out with my fiance and walked at malls for about 6 hours no pain..(thigh sore but no big deal)..got home tired slightly achy but no big deal.

Next day woke up ... achy not terrible .. walking mostly fine (no real overdoneit pain).
Went to PT, told story of this "miraculous" recovery and after one of the supervising PTs stretched me Pilates, hip flexor, etc.) my joy was deflated as it caused some regression (groin thickness, limp,etc.). The therapist pulled me aside and said "don't come back here, the body works in strange ways. You are doing fine on your own, stretch and keep doing what your doing.

So I started walking an hour a day ..stretching before...during walking. No pain, webbed groin disappears and I am fine. Afterwards still fine except for slight groin thickness.
However, still unable to bend down and tie my shoes and put my socks on, even with the stretching (the basics)

Finally, called the fourth OS and asked her what's going on here, why am I not rid of this tightness, thickness in my groin and after 6 months, how come I can't do basics like tie my shoes and put on my socks.

Here's where I got nailed and depressed...she said (board certified OS)...
"after 2-3 months generally all tissues, muscles are healed from a hip surgery and what you have is what you are going to end up with. You have to maybe come to terms that you can get a cortisone shot in a bursa but for the groin thickness and discomfort and the bending down to tie your shoes and put your socks on, this just may be the way it is". She also indicated that I shouldn't try and bend down to tie my shoes as dislocation is a real problem always!...REALLY???

I believe I have my trochanteric bursitis (which I will get a cortisone shot for)..

I am still worried that I may have an indolent infection (latest CRP 3 and ESR 32)..but can't equivocate the ability to do all of that walking and no pain with having indolent infection.

I am hopeful that the forth OS is completely wrong and for whatever reason I am still healing...

Josephine, need your help. Really confused and these hip changes are taking up my "life" (I am 70 and don't want to waste another NY second depressed and worried about this or confused as hell with where I am). I got grand kids I want to enjoy..etc. I was fit and really active before hip surgery and as I said before OS wasn't sure he wanted to do the surgery as I was not bone on bone and not in severe pain (just bursitis).

All thoughts are welcome please

 

[Josephine]

Oh you are in a twizzle! Well it sounds like you have trochanteric bursitis for sure and the only sure fire treatment is a cortisone injection.

Mostly these TBs are activity related so you may need to assess and readjust your activity and PT.

You OS was correct in part about the ongoing risk of dislocation. I have this chart that shows none of us are completely free of this risk even if healthy and fit.

But is is just a risk, not an inevitability.

I also don't agree with her opinion that 'this maybe what you're stuck with". That's too easy to say.

So did you give any thought to seeing a chiropractor?

 

[Jws.]

@Josephine ...saw two new OS last week. One said I may have a small leg differential (2.5 mm) measured from xray combined with contracture and my natural pelvic tilt on right side. So with all that put together thought I should put in lift. Other OS says if you start with lift you have to wear your shoes all the time even at home at night or you will get worse.

Other OS said that it might be psoas tendinitis and wants to give me cortisone shot there and then other OS said there is not that much contracture. Felt the psoas tendon and said he wouldn't give a shot there. He didn't think I had psoas tendinitis.

I am terribly confused with all these docs diagnoses and depressed and thoroughly frustrated. Can't after 6 months put my socks and shoes on.

So I carried on forward and walked for 45 minutes exercise, normal gait and no pain. HOWEVER again three hours later (yes I stretched) had groin pain and was limping. slept and next day pain was gone.

Next day went on bike for 40 minutes, had tightness where pelvis meets groin on side of right hip when started. Ended up ok., loose, stretched, 4 hours later had "BURNING " pain in groin. Slept and next day burning pain was gone.

I feel great after bike. Would love to keep working out. Burning pain in groin is it caused by slight tears in tendon or possible infection. This is the pain that scares me the most.
I know I am all over the place but that's how these docs made me feel. They were not conclusive about anything. Some said you are still healing other said you're healed and these are residual effects. See a pain management guy.

Please help if you can. I will answer your questions and diagram my source of pain.
Your directed questions with the diagram of where the pain is helps A LOT to clarify the main issues. Please get back to me. Thanks

By the way they want me to get a cortisone shot in trochanteric bursa. My crp is .3 and sed rate is 32. Is it ok with these to get cortisone shot.

 

[Josephine]

You poor thing! What a muddle they have left you in! There is one thing I can tell you though - if you put a group of 5 surgeons in a room to discuss something, you will inevitably end up with 5 opinions!

As for the cortisone shot, I would get it with all speed. I've had such shots for TB three times, all with good effect. (They were three different incidents of TB)

I also suggested you see a chiropractor - have you done anything about this? Because what you really need - apart from the shot - is some deep tissue massage on the IT band around the upper thigh.

 

[Jws.]

@Josephine ...thank you for your quick response. My main source of pain is in two places.

The first is at TR2F in your schematic (right in the crease of your hip and pelvis as you are sitting...pain level 1-2)...(what is that area called?) ...

Before I go on that bike it is tight there. If I ride for 30-40 minutes it loosens up.
The second area is in my groin WR3F. The pain is more of an irritation rather than shooting pain. When I walk, or more troubling three hours after I work out, my groin begins to have like a BURNING or tearing pain.

I am concerned that the riding of the bike triggers "pus" from either the first area or second area and I have a purulent or indolent infection. I guess it could just be inflamed tendon as well?

Quite frankly I keep having thoughts that it is an indolent infection and that is what is holding back my NORMAL healing process and keeps giving me pain (groin) 6 months post surgery..

Please advise re: infection thoughts and infection theory

Would love to fly you over here and pay you as my advocate with all these OS's and watch you cut through the BS and get the issue resolved.

Thank you ever so much for being there with your knowledgeable and wise replies.
Jeffrey