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[THR] Still hurting 1½ yrs post-op<

Discussion in 'Hip Replacement Recovery Area' started by GrammieRee, Jan 31, 2019.

  1. GrammieRee

    GrammieRee new member
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    My right hip was bone-on-bone with a large cyst and a bone spur. I had that hip replaced (mini-pos) at Dickson-Diveley in KS in July of 2017. I had the surgery done in KS so I could stay with my daughter afterward, but am back home in FL now.

    I did 6 weeks of PT after surgery, returned home to FL and put in a pool for exercising. Now it's 1½ years later and I have to admit the pain is MUCH MUCH less than it was prior to and just after surgery! But it still hurts so that I have to take 800mg of Motrin a couple times a day to make it tolerable so I can walk (limp) on it. But I want to know WHY it still hurts!

    I recently saw an ortho doc here who took xrays and said everything looks fine. Did blood work, no sign of infection or inflammation. He gave me a shot in my hip (cortisone?) that did nothing but make me feel like I'd been kicked by a mule. He had me do a couple more months of PT but that didn't help it either. He says he has no idea why I'm still in pain so he wants to replace the hip. NOPE!! If he can't pinpoint the problem and know that my hip does indeed need to be replaced again, I'm not letting him do it!

    I've contacted the ortho doc in KS to ask WHY I'm still in pain, if this is normal or not, and if there are any tests he would like done. But the only msg I got back from him is asking why I want a revision done if the pain is tolerable. The PT here says it appears that my leg (with new hip) looks like it might be longer than the other leg but the ortho doc says it's not.

    I'm hoping someone here can give me some idea of what's wrong, what I should have them check for, or if this is as good as it's going to get and I just get used to living on Motrin.

    Thank you for any input or advice you can offer.
     
  2. desertrat

    desertrat junior member

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    Sorry you are going through that. I'm no expert, someone who knows more will answer you soon, but it doesn't sound right to be in that much pain that long after surgery. The forum moderators and other users are very helpful - I'm surprised no one has answered you yet. The forum nurse and expert is in the UK so on different time. I wonder if the problem is coming from your back or something else. Hang in there and check back often - someone who knows more will help you soon.
     
  3. alexthecat

    alexthecat MODERATOR Administrator

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    I'm sorry you're still having trouble with your hip. That's really not typical. I agree that you don't want to keep taking Motrin forever. That can have some unpleasant side effects in the long term.

    I'll tag @Josephine for you, since she's the best person to advise you. Have you ever tried taking a break from all that PT for a few weeks or more? Sometimes the hip just needs a chance to rest. Too much exercise can actually set back your recovery.
     
  4. Debru4

    Debru4 graduate

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    Glad you checked in here for support, and hopefully some helpful suggestions. If it were me, I also would be concerned.

    If you have good insurance, perhaps you could follow up with a completely different doctor who might have fresh eyes. If it were me, I'd also take an exercise break and restart with the icing and elevation--it might help settle things down.

    And as Desertrat said, it also could be related to your back or some soft tissue. Either way, it sounds like you need some relief. Hang in there......
     
    Last edited: Feb 1, 2019
  5. Jaycey

    Jaycey SUPER MODERATOR Moderator

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  6. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Good Morning GrammieRee,
    I'm sorry you're still struggling a year and a half post op. It has to be frustrating.
    While I have no answers I see the forum Nurse Josephine was tagged. I look forward to her response.
    Wishing you comfort and answers soon. We're here for support if you need us.
    I hope you have a pleasant weekend.
    @GrammieRee
     
  7. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I think it seems like you've done a might too much for your own good!

    Tell me where your pain is using this chart

    aa hip-references-horz.jpg


    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?
     
  8. GrammieRee

    GrammieRee new member
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    Thank you all so much for your concern and replies! :) I will try to address all the questions and comments. I forgot to mention the Ortho Doc here in FL thought I might have a pinched nerve in my lower back (where I have degenerative disc disease) and ordered an MRI but said that didn't show any pinched nerves.

    As for PT, I did 6 weeks right after surgery in mid-2017, then none until Nov 2018 through Jan 2019, so I did have a long break in between. The PT I did just recently was all stretching exercises. The therapist thought perhaps my pain was due to swimming and exercising in the pool without proper stretching. But the stretching PT did not help the pain at all.

    I do have good insurance and, because this has gone on for so long, I saw the Dr here in FL this year to get a fresh perspective. He's the one who says he has no idea what's wrong so wants to do a replacement. >:(

    The FL doctor didn't give me a copy of the recent xray but I have one from after the surgery in KS which I will try to upload here.

    It's difficult to give coordinates from the chart because my pain isn't in just one particular spot. It's from down in the front - around the side - and down into the back. I'll try to mark it as best I can and upload that pic too.

    When sitting on a hard seat the pressure on my right "butt bone" (the ischium - had to look that one up) causes pain in my hip. Same with sitting on the commode and pressure from my right thigh bone. It's not severe but I can definitely feel it.

    And of course I would be more than happy to answer any and all questions! I am extremely grateful for any help or insight you are able to offer me!

    grammie 2.jpg

    chart.jpg
     
  9. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    As you can see, I have resized your xray. Thank you for posting it. But can you tell me how long after surgery it was taken?

    As for the pain spots, they look to me like Trochanteric bursitis but it is unusual to get this on both sides when only one hip has been done.
    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?
     
  10. GrammieRee

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    Oh gosh, I guess I'm not very good at this lol I actually enlarged the xray photo to what I thought your instructions said the pixel size should be. And I meant to mark only the right side (front & back) on the chart. Please forgive me for not doing things properly, I'm trying lol
    The pain is all on the right (THR) side, from down in front, around the side, and down into the back.
    The xray was taken exactly 2 months after my hip replacement surgery.
    The Ortho doc here thought it might be bursitis but blood tests showed no inflammation and the (cortisone?) shot he gave me in my hip did not help the pain any.
    Please feel free to ask any questions you have and I will do my best to answer them clearly.
    Thank you so much!
     
  11. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    GarmmieRee, there really is no need to keep apologising. Most new members have these difficulties and we are very accustomed to giving advice on how to do things! In no way is it meant as a chastisement! :friends:
    THAT'S what I wanted to know. Have you had a more recent xray?
    No, I don't agree with that.
    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.
     
  12. GrammieRee

    GrammieRee new member
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    1. Mini-Posterior

    2. When I get out of bed the pain is a strong achy 8. Very stiff in the morning and MUST use a cane to walk at all. After I take Motrin and move around more it's usually a 1-2, where I feel mild pain with each step but I can get through it. I get occasional sharp pains now and then (maybe a 6) but it doesn't last.
    Sometimes my pain is more in the groin, sometimes it's more in my backside, deep in like behind incision area, and sometimes it's on the side just above the bone.

    3. The only thing I take for pain is Ibuprofen. I take four 200mg pills at a time = 800mg.
    I do this once in the morning and again in late afternoon.

    4. No, I haven't iced it for about a year now.

    5. No, but I do sleep with a pillow between my knees.

    6. I do all the cooking and housework but, because I have degenerative disc disease in my lower back, I only do a little at a time and then I have to sit a while. Like I can sweep a floor but then I have to sit until my back stops hurting before I mop it, then I have to sit again.

    My activity level goes way up in the summer because I'm in the pool most every day. I had intended to use the treadmill during the winter but my physical therapist told me not to. He said I should use a recumbent bike instead so I've been shopping online but haven't picked one out yet.

    7. Exercises done at home
    Stretching exercises prescribed by physical therapist, one session per day:
    Sit up with left leg out straight, right bent out to side, lean forward to count of 60 - Repeat with other leg
    Sit up with legs bent out to side, feet together, lean forward to count of 60
    On back with left leg out straight, right leg bent up. Lift straight leg to height of other knee, hold for count of 10 x10 - Repeat with other leg.
    On back with knees bent up, lift butt and hold for count of 10 x10 times.
    On back with left leg straight out, pull right knee up as close as possible to left shoulder, hold for count of 60. Repeat with other leg.
    On back with knees bent up, elastic strap around knees. Open knees out to side, hold for count of 10. x10
    On back with left leg straight out, right leg bent up. Place right foot over left knee, pull right knee to left side, hold for count of 60. - Repeat with other leg.
    On side with legs out straight, lift top leg, hold for count of 10 x10 Repeat with other leg.
    On side with bottom leg straight out, top leg bent, grab ankle and pull foot up to butt. Hold for count of 60. - Repeat with other leg.

    Anything done at PT
    The Physical Therapist said it wasn't helping like he thought it would and did not set up any more appointments.
    While I was seeing him I mostly just went through the exercises he had me doing at home (listed above).
    He also had me lay with a heat pack on my hip for a while, often did a massage of my hip/thigh, and a couple times he had me use a recumbent bike for 8 minutes.
    I was seeing him three times per week.

    NOTE: I had messaged my surgeon in Kansas (or actually, his nurse) to see what he thought of all this. His first reply was simply to ask me why I wanted a revision if the pain was tolerable with Motrin.

    I wrote again and explained that I do not want or intend to have a revision - that is just what the Dr here wants to do it because he can't figure out what's wrong. I asked if he wanted any other tests done or if he thought my pain was normal this long after surgery. Finally got the following response:

    "Dr Wingerter does agree that proceeding with revision without an identifiable need is not a great idea, especially if pain is controlled with anti-inflammatories. It is not uncommon to still need anti-inflammatories following joint replacement. He also sees patients who continue improvement even 2 years or more after surgery.

    We have done all of the tests that I recommend to rule out loosening and infection. He recommends continuing with anti-inflammatories as needed and working with PT or activity modification on your own."

    So I guess he's saying that pain a year and a half later is not abnormal after all and I should just keep taking Motrin and hope it continues to improve.
     
  13. Debru4

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    Boy, it sure seems like you are in a lot of pain for there to be "nothing wrong". Have you tried doing no exercises at all and just icing and resting to let things settle down? And perhaps adding in Tylenol--alternating with the ibuprofen?

    Or perhaps your pain is back related, and you need to see an ortho for further evaluation of your back? Just tossing out ideas.

    I'm sure Josephine will have a better understanding of what it all means. I don't think I could manage if I had pain with each step, or had to sit in between doing most things, so you really are a trooper. I hope you get some answers, and some relief. :console2:
     
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  14. GrammieRee

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    Thanks so much for your reply!

    I've tried taking two 200mg Motrin with two extra-strength Tylenol but that doesn't seem to work as well as four 200mg Motrin. Had blood work done to make sure my kidneys and liver are still okay, but I worry about the future toll of taking so much Motrin every day.

    The ortho doc here thought it might be a pinched nerve in my lower back and did an MRI to check, but it didn't show any pinched nerves. Of course, I was laying down in the MRI machine, not standing upright so....??

    Thanks, but I'm not really a trooper, I just don't have any choice lol It gets very frustrating not being able to do things or having to constantly stop in the middle to sit down. But that's the only way I can get anything done. My left hip (the "good" one) often hurts and pops and the physical therapist said that's from overworking it by limping and that I should ALWAYS use my cane. But did you ever try to clean your house one-handed?? lol

    I should have added to my previous message that I also have pain down the front to outside of my right thigh. The physical therapist thinks it's just muscle strain, that the muscle tightens up and tries to spasm. The muscle does get very hard and I try to massage it or use a roller to make it relax. The PT said I need to sit more but I already sit too much! The more I sit the heavier I get. The heavier I get the more strain on and pain in my hip. The more pain in my hip the more I sit. - It's a vicious cycle...
     
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  15. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Before I get to responding to your answers, can you show me the site of your pain using this chart?

    aa hip-references-horz.jpg
     
  16. Debru4

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    It can feel like a bit of a vicious cycle with the lack of activity/expenditure of calories, and potential weight gain, which then can stress our hips and backs as you mentioned,

    But in truth, the most important thing we can do for ourselves is to not push, especially with activities or exercises that cause us discomfort. Sitting, resting, walking, eating well, and sleeping plenty.....it feels kind of decadent, but really is what we need. And when your PT tells you to sit more, listen to them:):)

    I have to disagree....the idea that you continue to do housekeeping, and everything else, knowing it is going to hurt, and will take you much longer, but you keep at it.....yes, you are a trooper:)) But you are right....so often we do things, because we have to. And that's not all bad if we can do them without damaging anything, as it keeps us engaged and active. :flwrysmile:
     
  17. GrammieRee

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    Thank you both for replying! :) I already posted the graph photo showing where the constant joint pain is. I'll post another here showing the muscle pain in my thigh - if that's what you were looking for?
    graph.jpg
     
  18. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Wow, that's a large area. I hope you find answers and relief soon.
    Wishing you comfort :console2:
    @GrammieRee
     
  19. Debru4

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    Have you been trying to sit and ice more recently? Has it helped any? Do you do any gentle stretches....not sets of exercises but just some gentle stretching? Just a thought.
     
  20. GrammieRee

    GrammieRee new member
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    Thank you, Layla!

    And yes, Debru4, I have been sitting at my desk a lot or laying on my bed to watch tv.

    The physical therapist said he thought my pain was due to exercising in the pool without doing any stretching and from limping instead of using my cane. He said my muscles are good and strong but they tighten up and try to spasm and he believed the stretching exercises would cure the thigh muscle AND joint pain. It did not.

    I've stopped doing the daily regimen now since it isn't really helping, except a couple exercises that I felt are helping with range of motion of the new hip. I may get back into the stretching more once I pick out a recumbent bike so I'm exercising again - or when my pool water finally gets warm enough that I can get back in it. That day can't come soon enough for me!
     

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