THR Question - One year after thr

[Mojo333]

This is not a reply but a new question. Has anyone had any luck with steroid phonophoresis for scar tissue and sore muscles lingering

Hi @HelenaM
Phonophoresis is ultrasound therapy using topical analgesics (usually anti-inflammatory or cortisone-type medications) within the ultrasound gel. It is thought the ultrasonic waves can drive these medications across the skin enabling penetration to the site of pain or injury. Topical analgesics are generally thought to have better side effect profiles compared to taking medications orally.

Haven't heard of many members that have been prescribed this protocol.
Topical analgesics applied could certainly help with muscle soreness but at less than one month out, tenderness and tightness are normal.
These symptoms actually can be helpful in my opinion as they can remind us to restrict our movements while we heal. My quads were super sore for many months.

Regarding the scar tissue, we need scar tissue (combo of skin cells and collagen) to repair our wound. Internal adhesions in the hip would be extremely rare and are unlikely to be a potential problem.

I am a fan of my anterior replacements as my surgeon was trained in this approach and I am doing great with my new hips.
But the process of recovery, regardless of the approach, just takes time and these are early days, my friend.

Keep that patience muscle toned up...all temporary unless you push too hard and end up with self induced tendonitis or other issues that can take months to resolve.

 

[HelenaM]

@Mojo333
Thank you for the reply. Actually I am approaching the 13 mo. mark and still experiencing some soreness, although my routine is getting back to normal. I may have aggravated some muscles early on with physical therapy or on my own, since I was told by some sources that I would be better in 6 weeks or 3 months. My surgeon indicated pt should be mainly walking and should not irritate the hip flexors, but I don't think the pt I used was clear about this.

I have had enough confusion pertaining to the recovery timeline that I went to see a second surgeon, thinking that something was really wrong. Probably not. As the first surgeon, he stated that I had some soft tissue issues but added names such as it band, bursitis, etc. (I don't think it is anything specific since it moves around the scar tissue). He is a youngish surgeon, and was trained (medical school and residency) at a major orthopedic university/hospital fairly recently. So, his view is that now some specific therapy and modalities like this ultrasound might help me strengthen and gain flexibility. I can walk miles, but have some weakness on the operated side that he observed. I am also walking and moving in the pool, and trying not to aggravate my hip flexors, since I had some tendonitis type pain or nerve pain in that region that has improved. I am relatively short, so I think that the stairs in my home have been an extra challenge for me. They are full size standard, but I find slightly shorter stairs much easier.

I had some numbness, and still have a little, but consider that insignifcant.

So, I think I will give the ultrasound a try since I am now into my second year of recovery. I will be cautious about any repetitive pt actions that could aggravate muscles.

 

[Mojo333]

Thank you for the reply. Actually I am approaching the 13 mo. mark and still experiencing some soreness, although my routine is getting back to normal.

Well, duh.... Could've read your thread title but I was off by only a year
I certainly understand why you are getting frustrated...
I was still able to aggravate things with certain activities well up to 2 years post-op and still can, I think...
Hard to tell what is due to BTHR, and what muscles might be complaining anyway when I do repetitious labor intensive tasks.

 

[HelenaM]

In the case where three surgeons all state that the X-ray looks really good after a year, but have some different explanations of what is causing soft tissue pain (hip flexor tendonitis, it syndrome, nerve Issues, scar tissue), does anyone know if there might be a reliable imaging method (such as ultrasound?) to find a more specific answer @Pumpkin @Sashimu@Hip4life

 

[Sashimu]

I'm planning to ask my surgeon that exact question, @HelenaM. I could be wrong but I think the main options are an MRI or ultrasound. Not sure if a bone scan is an option. I've heard the MRI is complicated by the presence of the metal implant, but there is a technique that can be used to counter that.

 

[HelenaM]

Thank you @Sashimu. It seems complicated to pinpoint the Issue or issues and also whether it may have been triggered by pt that aggravated things or by something else. I hope you are seeing a little improvement at least. I think I am, but it is so subtle that I am not totally sure.

 

[HelenaM]

Fourteen months after my thr, I still have some hip pain. After climbing some stairs I developed right knee pain in addition to the right thigh or hip pain. I went to see a knee os who tried some rom tests, etc. and said that he thought it was referred from my hip. I also went to see an orthopedist who is a pain specialist and sports medicine person. He did X-rays and ultrasound and thought my knees looked good. Since several doctors seem to believe I have meralgia parenthetica, which I have mentioned earlier, my next step is to begin pt to strengthen my quads on Thursday. I also have an option to have an ultrasound guided injection which might calm everything down until it settles down naturally. It Is interesting but confusing how pain can be referred.

 

[Mojo333]

I am sorry you have still be dealing with pain.
Don't know if you saw this article in our library

Meralgia Paresthetica

Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — a nerve that supplies sensation to the surface of your outer thigh — becomes compressed, or "pinched." The lateral femoral cutaneous nerve is purely a sensory nerve and does not affect your ability to use your leg muscles...

bonesmart.org

Glad your Knees look good, and referred pain can certainly be hard to diagnose.
It caused over a year delay for my hips....

the injection brings relief!

 

[HelenaM]

Thank you, Mojo. Hope the pt and/or the injection and/or time will help!! @Mojo333

 

[Nyc1961]

Helena,
I just finished reading all the posts on your thread and I must say, enlightening is an understatement! I can relate to almost all of these posts, particularly the posts from elf1 and one talking about winding up in the ER after his prednisone injection. I can certainly relate to that! All these posts are so reassuring and really brought my stress level down this morning.
Best wishes for a very good and hopefully, pain free day!

 

[Eman85]

You can see it's been a while since my first and my second THR. I can do most anything I can think of, some I shouldn't do. But I have some weakness in my right and soreness and stiffness with both. My right was always my stronger hip as my left had the pins and always hurt more. After over 3 years on my left I've come to attribute a lot of it to the severe strain that is put on all of the soft tissue in order to disassemble us and then reassemble us. It's not a pleasant thing to watch but if you watch the actual surgery or even the animation you'll come to realize just how much trauma our bodies go through. Try dislocating a chicken leg to get an idea of the trauma you go thorough before the new joint is put in. Through the years I've had my fair share of injuries between sports and work. In all of those my bones stayed inside my body and yet some of them still give me pains and stiffness after decades. For me getting rid of the deep bone ache was a win and the nagging soreness and stiffness is just part of the price. I don't think it will all ever go away.

 

[Sashimu]

Hoping the new PT brings you relief, @HelenaM. Keep us posted!

 

[HelenaM]

Does anyone know anything about the mini-hip anterior approach? I have read that it is less widely used, but the recovery is easier. It is possible that the recovery issues with this approach might be a little different.

 

[Elf1]

Can't tell you about that, I had the lateral-anterior or whatever it's called. I know some folks claim that one approach is easier than the other, but from reading on here for the last 2 1/2 years it kind of sounds like its mostly hype. Maybe someone else will have some knowledge of this approach.

 

[HelenaM]

@Sashimu @Nyc1961
I just completed my fourth session of pt and feel that I have improved - glutes and quads are stronger - meralgia paresthetica is less, my gait looks better. I did a lot of research and found what I think is a really good pt group. They use massage, tens, hot and cold, etc. in addition to the usual activities. I don't know if this would have helped me earlier as opposed to just walking, but it is helping me 14 months after surgery. I am continuing. I have even joined a gym to spend more time on the bike and the quad machine. I did have some added ache/pain for the first two sessions, but that is better. I think this pt is skilled at adapting her plan for what will work. Hope you are having some improvement. So, I know that hips don't need anything but walking to heal, but after a year, it is working for me to add some other types of exercises.

 

[Jaycey]

I know that hips don't need anything but walking to heal, but after a year, it is working for me to add some other types of exercises.

Sounds just fine @HelenaM ! You gave yourself time to heal and now it's time to build more strength. Well done!

 

[HelenaM]

I am continuing with my physical therapy (my 10th session is tomorrow) and feeling stronger in the quads but still having some mild pain in my hip and thigh. I consider this pt to be a success at 15 months after surgery.

But, I just spoke to someone who is really a "ten week wonder". She is younger than I (in her forties), but back teaching school with no problems after an anterior hip replacement.

I am continually frustrated that it is impossible to understand if the range of recovery times is longer than usually presented by the os, and also that the quality of recovery may not be exactly perfect, and I wonder if the long recovery means that something was wrong about the surgery/surgeon. If function and rom are good, but there is lingering pain, how abnormal is that, I wonder. I don't know how we define a success. Even though I think I am on the mend, it is so troubling that the timeline was really off!! I had another type of surgery years ago, and the timeline was about right. However, when I had a relatively simple break of a bone in my foot 20 years ago, I was told by another orthopedist that the bone healed in 6 weeks, but the soft tissue might take up to two years. Hmm....

I know others have had a similar experience too, and I thank people on this site for having shared their thoughts and experiences.

 

[Jaycey]

I wonder if the long recovery means that something was wrong about the surgery/surgeon

A longer recovery MAY mean the surgeon had more work to do during the procedure. Perhaps there was more damage to the joint than originally seen during the diagnostics. However, this is not necessarily the case. Everyone reacts differently to surgery. Some of us just take longer to recover.

it is so troubling that the timeline was really off

Ah - but there is no timeline. It took over 12 months for my LTHR recovery and at 6 weeks I was back in the office post my RTHR.

As we always say - never compare your recovery to any other recovery. Literally every recovery is different - even on the same person.

 

[HelenaM]

@Mojo333 i am confused about the opinion of Josephine regarding scar tissue in the hip. I have not figured out how to copy an excerpt.

My surgeon and internist both said that I had scar tissue that might be irritating nerves. I looked back at Josephine’s post and think the context was whether scar tissue could cause impingement. My internist also said I had layers of scar tissue in my six inch scar which was hard and painful for a long time. For me, it is a nerve issue related to scar tissue, not related to impingement.

is there anyway to get clarification on this? Thanks!

 

[Mojo333]

Yes, I think Josephine was referring to in the hip....not referencing the incision.
Scar tissue is the collection of cells and a protein called collagen the body uses to close the wound.
Certainly my incision was and ,when jabbed by a sharp object, still can be tender.
As was my appendectomy scar for many years.