THR Seeking Psoas Release Information

[Mr.Clean]

I’m 18 months after THR on left side, 20 months for right.

Left is still very painful in the hip flexors.
All muscles are strong, pretty good flexibility, rom still working.

I’ve tried everything I can read or learn. Been to two therapist, Chiro & surgeon says all is good, no suggestions for pain but meds & therapy.

Any suggestions ?

 

[Mojo333]

Hi @Mr.Clean
Welcome to the forum.

I’m 18 months after THR on left side, 20 months for right.

Could you please leave us your dates for your surgeries...at least the month, year as this information will go on your signature and helps folks to know where you are in your recovery.
.

Left is still very painful in the hip flexors.

I am sorry you are having pain and a hard time finding answers but can you elaborate on this... where is the pain and is it constant or particular times with activity?
Wondering how your recoveries went (PT engaged in...?) and if the left always acted like the problem child or did it act up later?

 

[Jamie]

I would be curious to know if anyone has mentioned Pressure Point (sometimes called Trigger Point) Massage Therapy for you? It can be very helpful following a hip replacement when there is continuing muscle pain or tightness.

 

[Hip4life]

We could not get the pain in my right (op leg) hip flexors to calm down despite various treatments. The culprit was a slight overhang of the acetabular component which the muscle/tendon was sliding over. I then had a tendon release for that. However, if your xrays are showing everything is in order, the pressure point release massage is really worth a try. I was having recurring low back pain after a non-joint surgery and among other things, a tight iliopsoas on my left side was contributing to that. The PT did the pressure point release on it and it helped so much! She just found the right spot on the muscle and pressed with her fingers into it while I was lying on my back. It's straightforward and simple. It's a bit uncomfortable at first but one of those good discomforts.

 

[Mr.Clean]

Layla,
Any info on psoas tendon issues with acetabulum edges?
Second & third opinion say that’s the problem.
One wants to remove and replace acetabulum, other wants to cut(tenotomy) the psoas tendon.
I am concerned with both but really don’t think psoas tenotomy is a good long term.
THA was 7/21. I had both done right is ok, left is problem.

 

[Layla]

Hi Mr. Clean,
Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. Please post any updates, questions or concerns about your recovery here. Let us know if you'd like your thread title changed to better reflect your current issue and we will edit accordingly.

Here is an article on Iliopsoas Tendon Release - Psoas Release for Psoas Impingement

I will tag @Jamie from Admin for her opinion as I am not certain how to advise on this.
Best Wishes in whatever you decide. We'll be here for support if you need us.

 

[Mr.Clean]

I’m not following where I need to go to continue this conversation?

 

[djklaugh]

@Mr.Clean you are in the right place to continue your conversation and/or ask other questions ... just keep posting here on your thread.

 

[Mr.Clean]

Thank you, still looking for info on Psoas release.
How does the back, hips, pelvis respond to no psoas connection on one side and a connection on the other ?

How well does the joint stay connected, not displace with no psoas crossing it?

Long term stability ?

How does hip flexion work missing the major flexor?

Why is recovery longer than THA ?

Sports was possible after THA, what about after psoas cut?

Thank you for the resource !

 

[Mojo333]

Hi @Mr.Clean
I don't have all the answers, but I am going to tag the two staffers I know that have had a psoas release and they could give you first hand information.

@SaraK @Hip4life

I do remember the short term recovery was very short... not at all like THR recovery.

How about we also change your thread title to Info on Psoasis Release ?
This may help get right folks alerted to your thread.

 

[Mojo333]

I changed this for you @Mr.Clean
Hopefully some other members will weigh in...
Please check back to see when staff weighs in.
Also, if you type Psoas Release in search, you should come up with some other members' threads.

 

[Mr.Clean]

Thanks Mojo

 

[Mojo333]

 

[Hip4life]

@Mr.Clean Hello, again. I'll try and answer your questions with my experience with a complete release at the lesser trochanter. It has now been almost exactly 4 years since my release.

After conservative measures for my tendinitis due to acetabular prosthesis cup overhang, I had arrived at 2 options: revision of the cup or IP tendon release. I decided for the release as it was minimally invasive (all arthroscopic) and had little down time. In fact, I had my surgery on a Tuesday and my OS said I could go back to work on the following Monday if I wanted. I took 2 weeks as I had a very physical job and some good friends willing to fill in. My OS pointed out that he did a complete release for all of the THR patients that came to him as they found that it eliminated the possibility that the partial cut might not be enough or would heal shortened again and have to be repeated. He also allayed my fears in telling me that, once recovered, I shouldn't experience much, if any, muscle weakness. There are other muscles that fill in for the iliopsoas. That has proven to be true.

I only have a slight decrease in active range of motion in lifting (flexing) my leg past 90 degrees when standing. I have no issue with passive range of motion. None of this impacts my quality of life in any way. As far as I know, there have been no other physical impacts from the release. However, the tenotomy has positively impacted my quality of life by removing the daily pain I had, allowed me to get back to my favorite physical activities (no restrictions there except for what I already had from my THR-no jumping. marathon running, extreme sports.) It was so nice to be able to walk straight upright again and feel the complete relief that I had been anticipating with my THR. It took a few months for the strength to completely return to my leg but it had been down a long time from my arthritic hip and then the tendinitis. I still did not need to go to PT but that was always an option if I had decided to.

Someone from the forum was very helpful to me as I tried to decide which course (revision vs tenotomy) to take. Their observation: if the tenotomy doesn't work, you can always proceed with the revision. There are no guarantees here, as you well know. Every body reacts differently and recovers differently. You have to find an experienced specialist in arthroscopic hip procedures that you are comfortable with and then they have varying approaches as well. That being said, all things being equal, I would do it again without hesitation. I hope that was helpful. If you have any other questions or concerns that I can help you with, please don't hesitate to ask by tagging me. Blessings.

 

[Mr.Clean]

Thanks Hip4life,

I know a lot of low back issues are from one psoas tight or weak.
You have experienced no back issues from having the imbalance of one side connected and one cut loose ?

Also no diaphragm issues ?

No dislocation or stability issues ?

I am a martial artist and athlete, so concerned, even though less invasive it is very permanent disconnection of muscle tie in so any issues will be forever. Any thoughts in that regard ?

 

[Hip4life]

@Mr.Clean The only back issues I have are age related and arthritic. I also had a 40 year career which involved a lot of standing and lifting. That’s hard on everything. Lol. But none of it I can relate to the procedure and I have no limitations in movement or strength. I continue with walking, hiking, lifting kayaks and bikes onto the car, fishing by climbing up and down steep, rocky embankments, etc. You get my drift. I definitely have no diaphragmatic or balance issues. I did have that tight psoas on my non-operated side causing just some nagging low back soreness (nothing debilitating by any means.) The manual release by PT took care of that.

If you’re worried about the permanence of disconnecting that muscle and don’t want to go the revision route, perhaps you should pursue the partial release where they cut some fibers to lengthen the IP. Then it has the ability to go over the cup without the tension that causes the irritation and tendonitis. I’ll re-tag a colleague who has had this procedure done. @SaraK

It always is a big decision. You, with the best advice from your surgeon(s) are the one that knows your body and your goals. I know you just want to get this hip thing behind you and get on with your life. You may have a stint with PT with the partial but it still is a relatively short time in the scheme of things. As athletic as you seem, I would think your chances for success and a good recovery would be good if you follow recommendations. Keep us posted as the decision making process continues.

 

[SaraK]

I had pain in the groin from the psoas rubbing against the rough part of the acetabular cup. I’ve read that the larger implants (both diameter and going from 160 degrees to 180 degrees ) reduced dislocations but increased the risk of psoas impingement). Surgeons seem to think this is rare but it actually affects about 4% of patients from what I’ve read.

I had a partial release at the groin and was very happy with the result. I had it the morning of 12/31 and (with my cane and the surgeon’s blessing) went out dancing with friends that night. Pain was minimal - I stopped painkillers the same evening.

I felt better a week after surgery than I had in months. It is still harder for me to lift the leg past waist high but I declined the extra work that would have helped with that.

I liken it to the opposite of a kid going through a growth spurt and getting clumsy. You need to retain the brain for the longer muscle because it’s not moving as much as the brain thinks it is.

As @Hip4life said, I preferred to do the release (and my surgeon suggested that first) because it was less invasive and a faster recovery than a revision but a revision was still there if needed.

I lift weight and do Pilates with no problems. I did have some instability issues after several weeks of inactivity after rotator cuff surgery at the beginning of Covid but no issues since.

 

[Mr.Clean]

Hip4life & SaraK, God bless you and thank you both for the feedback !!!
You’re both awesome & caring.

 

[Kingster23]

This is all quite interesting and helpful. I had my right hip replaced about 3 years ago. I had immediate pain lifting my leg from a seated position. It continues to this day. I’ve had multiple PT attempts, a diagnostic cortisone shot and meetings with PAs. Today I met with the original surgeon who does massive numbers of THR’s (top 3 in the US) and is highly regarded. Contrary to what I suspected, he doesn’t think there’s an impingement, but clearly is tendinitis. He’s recommended I consult with one of the few surgeons on the FL Gulf Coast who does Tenotomy surgery. The thought of that worries me a great deal as I am very active (tennis and table tennis and long walks) and don’t want to lose strength in my leg. The posters give me hope that things will turn out okay. Thanks!

 

[Jws.]

Sara and Pat were g-dsends when I was going through my impingement..The Psoas Release at the LESSER TROCANTER hit the nail on the head for me...I had a prior Psoas Relief at the joint and it wasn't enough (at HSS) NY.
I could not walk without significant pain before the LT Release . With Pat's generous help and recommendation to Dr. Charles Burt , (one of the most caring ortho's I ever met! and competent) I can walk ... It's not perfect but nothing is..I too am a blackbelt and sensei in Shotakan Karate..I don't think full out training in martial arts is still in my future and u should check with your doc on this...best of luck to you..