THR Symptoms of infection<

[Josephine]

The square a bit closer the outer part so it touches the border of R1F and R2F

Well it's near enough! It's still a psoas issue.

I also notice that in TR2F there is feeling that trochanter can’t move forward

The trochanter would be at R1FV so nowhere near that. And it doesn't behave like that either. It's just a bulgy bit of the femur (thigh bone), that's all.

How do you think a single dose of antibiotic would make a noticeable difference in pain and stiffness within 2 hours of taking?

When did you have that and for what reason?


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?

 

[M_Mar]

Yes, I'm willing to answer your questions.

I went to a dentist for a filling and cleaning that's why I took antibiotics as prophylaxis. Is there any way to rule out the infection other than hip aspiration? I got very paranoiac.

Also I did CT scan, US and and another set of xray (GP ordered them not the surgeon) and everything looks good according to the reports. US didn't show any problem with Psoas tendon and didn't show any fluid however I'm not sure how much you can trust US.

The pain is always in the front with every step. The area feels very very tight despite I do regular stretches.

 

[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.

 

[M_Mar]

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

Hi Josephine,

Here we are.

1. Anterior approach. The area under the scar is still tight. Also the area is still looking a bit swollen. This is 7 months after the surgery

2. pain is 2-3 when sitting. Sleep is OK however I can have pain in the morning around 5-6 am at around 3. When I start working in the morning there is stiffness and pain comes at about 5 straight away. I need to walk it out a bit to loosen up. Pain is aching type and front under the scar and a bit high is very stiff

3. I've been on celebrex for a couple of months recently that helped a bit. Haven't been taking anti-inflammatory for the last 2 weeks and take Panadol 4 x 500mg

4. I don't ice much. Probably twice a week after a walk when pain hits more. I ice for about 45 minutes

5. I never elevated my leg

6. I take my son to the school in the morning. This is about 3500 steps. The pain starts pretty much straight away and stay with me for the whole walk. Some days are not that bad and sometimes it's pretty exhausting. I don't have problem with cooking, cleaning and general housework
Shopping is worse as it involves walking

7. No exercises other than walking and I've never done PT.

My last feeling as the pain moved from my groin more close to the lateral aspect of the hip. I looked for an anatomy a lot and looks like my pain comes from the area of rectus femoris attachment. This area is very stiff. I would say in the morning I need to massage and stretch a bit otherwise I can't do proper step. However I'm not a doctor so who knows.

The pain now is exactly there. I can stretch my leg back. But under the load it's painful.

 

[Josephine]

take Panadol 4 x 500mg

The question was "how much are you taking (in mg please) and how often?"

 

[M_Mar]

Hi Josephine, this is daily. Two times per day, each time 2 x 500mg = 1g. So daily four tablets 500mg each

 

[Josephine]

2. pain is 2-3 when sitting. Sleep is OK however I can have pain in the morning around 5-6 am at around 3. When I start working in the morning there is stiffness and pain comes at about 5 straight away. I need to walk it out a bit to loosen up. Pain is aching type and front under the scar and a bit high is very stiff

5-6 eh? After 35 weeks?

3. I've been on celebrex for a couple of months recently that helped a bit. Haven't been taking anti-inflammatory for the last 2 weeks and take Panadol 4 x 500mg twice a day

I'm glad to hear you are not taking Celebrex (NSAIDs) any more. Very wise. However, you could take more Panadol, 1,000mg 4 times a day at 6hrly intervals. If that doesn't improve your pain management, I suggest you ask your GP for something else such as coceine or Tramadol. Those could could take once or twice a day in addition to the Panadol (paracetamol)

4. I don't ice much. Probably twice a week after a walk when pain hits more. I ice for about 45 minutes

I suggest you ice whenever your pain escalates to the 5-6 level.

6. I take my son to the school in the morning. This is about 3500 steps. The pain starts pretty much straight away and stay with me for the whole walk. Some days are not that bad and sometimes it's pretty exhausting. I don't have problem with cooking, cleaning and general housework. Shopping is worse as it involves walking

Obviously it's the walking that is the problem. Are you limping or walking badly, do you know?

7. No exercises other than walking and I've never done PT.

Good! Hips don't need it anyway!

Another thought - have you discussed this pain with your surgeon? Perhaps it's time you had some investigations into it, like a bone scan. The site of the pain you declared has me wondering if there might be an issue with the cup or something.

 

[Layla]

Happy Monday to you
Wishing you comfort and hope your pain eases soon.
I hope your week is a pleasant one.

 

[M_Mar]

Hi Josephine, I discussed my issues at the 3 months appointment and then at 6 months and the surgeon advised that the soft tissues are still adjusting.

I’m going to see him in a couple of weeks and ask for some more investigations like bone scan and probably MRI. I’ve done 3 xrays so far, one CT and three times ESR and CRP. Blood is good.

I personally think my cup looks a bit too ante-verted based on xrays and CT. This is my personal view based on other xrays and CT from the internet. I may be totally wrong. However I’m not sure if it can be a problem. The surgeon says that the cup is inside the bone and he doesn’t leave any edges that can potentially irritate the muscles.

He also advised he leaves the joint capsule and doesn’t take it out. And I may think it can be a bit scarred and still inflamed? I had shoulder acromioplasty that left me with frozen shoulder for the a year. I have not had inflammation phase. The shoulder just healed and could not move after 4 weeks. The surgeon was surprised as at two weeks I was very good. I lost 50% of movements and it took me one year of stretching to get it back (I refused of manipulation and another surgery)

Do you personally think I need hip aspiration to rule out the infection? Are there any other tests for that?

My blood is good. However I came across a couple of articles when patients didn’t have any fever and blood was ok. However it turned out to be acne bacterium. And the only symptom was pain. I have a feeling of chills when the hip is more painful but temperature is fine. I know I sound a bit paranoid but not sure what to think...

Thanks

 

[M_Mar]

Layla, thank you. Try to stay positive which is hard. Hope you had a great week

 

[Josephine]

There are just three tests to be done to indicate/rule out infection

Blood tests ESR and CRP
Bone scan
Aspiration to get joint fluid to send to the lab.​

 

[SCaprae]

Good morning, just read your posts after answering your message. You are in good company w/ these folks. From your description of symptoms, they sound somewhat familiar & I would not hesitate to have aspiration done if for no other reason than “peace of mind”. If infection is present a single dose of antibiotic will not do the job. As I was told: very little circulation in the pelvis & femur, infection can “micro-encapsulate” to the prosthetic parts. Even if controlled by antibiotics, will more than likely “bloom” back. Hence revision. Best of wishes.

 

[Layla]

Hello @M_Mar
Please know we’re here for support if you need us.
Wishing you all the best.