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tiona Hi, I got your message and have taken a quick look at all the posts. My situation was different from yours in that I didn't have any impingement; I had actual tendon damage from working too hard in physical therapy after the THR.
I had pain and decreased ability to do things with my leg from the first PT session at the hospital. I was pretty snowed by the meds, so I didn't put 2 and 2 together until the 3rd day I was there (discharge day) and I had already participated in twice daily PT sessions. I rested when I got home and backed off on the exercises a lot. Things did improve, but they never got truly better and were chronically problematic.
When I saw my OS for the 6 week f/u, he assured me that some people just take longer to recuperate from THR and that things should quiet down. I don't think he believed there was anything really wrong at that point. He wanted to see me back in another month and expected I'd be much better by then. When I still had significant pain at that point, he became concerned because it was clearly not the norm. He thought it might be a psoas problem, because that's the most common tendon problem he sees after a THR (although it's still not that common, but I can understand why your hip in particular has done this). He injected the psoas (under fluoroscopic guidance) and when the marcane/lidocaine settled in I only had a bit of relief of the pain and the steroid didn't really do much of anything. I asked my surgeon about the chance of rupture and he said it VERY rarely happened and that was more of a problem with other tendons that work super hard, such as Achilles tendon. He's pretty experienced with injections into the psoas, so it wasn't difficult for him to do it. It was much like what I experienced when I had hip joint injections before the THR. Mine was done primarily as a diagnostic tool to try to narrow down the source of my pain.
It became apparent over more time that it was primarily my adductor longus tendon, although I had some problems with the flexors too. At the 6 month point he started talking about doing an adductor longus tendon release. And, he also wanted to do an arthroscopy to have a look at the joint and the other tendons around the hip. I did both. Surgery was done at 11 months post op THR. He found some damage and excessive scar tissue on the psoas and to a lesser degree on the rectus femoris tendons. He released the adductor longus completely and released some of the psoas and rectus femoris. I developed a hematoma from the adductor longus surgery site (that was a direct cut and not part of the arthroscopic procedure needed for the other two), but that shouldn't happen to you if you are having just the psoas released. So don't let my experience influence your decision whether to have the psoas released--my situation was unique.
I'm pretty sure the psoas release will need to be done arthroscopically, so you will need to find someone experienced with hip arthroscopy. There aren't a lot of orthos around me who do arthroscopies. They are trickier than a more accessible joint, so they tend to be done by hip specialists. My OS happened to be a hip specialist and does a lot of arthroscopies, so I felt very comfortable having him do it rather than seek out a different surgeon.
Looking at what you have for test results and the length of time since your THR, I don't see how you are going to get any relief unless you do have the psoas release. You have actual impingement--it's not going to just go away and stop being impinged. The tendon callus idea makes sense to me, but if it hasn't calloused by now how likely is it to do so?
You said your surgeon doesn't do the procedure. That means you have to find another surgeon anyway. You'll get a second opinion when you do that. It is true that you will get many opinions depending on who you ask. You are a nurse (I am, as well, although I no longer practice and have a desk type job now doing disability reviews) and you also have your husband the PT--you have good foundation of knowledge and experience to draw on in making your decision. If you do decide to explore this further, look into OS that do hip replacements AND arthroscopies. That way they can check out the joint while they are in there. The reason I say that is that there is a sports medicine OS in the same practice where my OS is who doesn't do joint replacement but does do hip arthroscopies for other things. I think it's better to have an OS who also does hip replacements looking in there. The psoas release is maybe not a common procedure, but it is the most common tendon release done to the hip, I think, so hopefully you can find an OS in network. My insurance is the same way as yours. I was lucky that my surgeon was in network.
As far as recovery and any residual impairment, I had more done than just the psoas, so again my situation is different than yours. But, I think you will have some weakness for quite a while after surgery until your other muscles over-strengthen to pick up the slack. Luckily the psoas is not the only hip flexor. I still have weakness in my leg (surgery done May 2013). It's really hard for me to do a straight leg raise compared to the other side. But it doesn't bother me with normal walking. It's a little tougher to do stairs foot over foot but I don't feel much weakness if I'm climbing a small hill. It's certainly nothing that stops me from doing moderate hiking, biking, or horseback riding, which are my primary recreational activities. My surgeon told me that since I had quite a bit of tendon release work done, it will likely take a year or even up to 18 months to get my strength back--the other muscles really do have to hypertrophy to pick up the slack. But, again, you shouldn't have as much difficulty with just the psoas done. I also had a very tight IT band after the arthroscopy. That is just kind of working it's way back to normal.
You have to make the decision for yourself. From everything I was told by 3 orthos that I saw while trying to decide whether to have my surgery done and what my OS told me, the psoas release isn't really that difficult to do or recover from if you have an experienced surgeon. I guess you just have to decide what you can live with and what you can't. I don't regret having my tendon surgery done. I do wish I wouldn't have had the hematoma, of course, but there is risk with anything and living without the tendon pain now is so much nicer than when I had the pain.
Best of luck and do tag me when you decide and let me know how things go if you do have the surgery done. I'm not here a lot, so make sure to tag me so it shows up on my email.
Dorothy
United States
Good grief - was it gold plated or something?
