THR Tendinitis after THR

[calikat]

I have just learnt that there is a three to four month wait for a cortisone injection.The Trust is probably short of money and they are waiting until the beginning of the financial year before sending appointments

Kim I am so sorry.

 

[tiona]

@Kim22..Wow, 3-4 months for an injection! I guess many of us here in the USA are fortunate...at least those with employer based health insurance...You'll be first to know if/when I get an injection (I could probably get one within 24 hours once I decide) a 30% chance of long term relief sounds mighty tempting. I'd feel better if my OS said he'd do it with the aide of ultrasound...he uses "landmarks."

My PT is going well, I'm making progress, but my PT does acknowledge that I seem to have a mechanical impingement between 30-60 degrees as I raise my leg. I have plowed through and forced myself to work through the pain, as he also thinks that 50% of my issue is the "pain-brain" syndrome. I was able to lift my leg while sitting on a stool yesterday. My left hip also hurts, I will need a THR on that side eventually.

A walk depends upon the weather...we are finally getting some rain, but the experts say we would need significant rainfall daily until June for real drought relief.

I think I mentioned that my hubby and I are going to a "Total Joint Replacement" seminar next month, hoping to learn something there.
T

 

[Kim22]

@calikat Thank you.I was feeling a little down when I replied to Tiona about the long wait until I can have the injection.I am just guessing about the reason being financial and it could be due to the amount of patients waiting for the procedure. Like the rest of the western world we have a growing ageing population with joint problems and our public funded health system struggles to keep up with the demand.I have decided to take a philosophical attitude as I think things sometimes happen for a reason and it will give the physio exercises more time to work.I must admit I am not that hopeful but who knows at least I will have tried my best by the time I move on to the next stage.My husband used to say that I was one of the most impatient person he knew but boy have I been tested I have had to learn the art of patience over the past three years.I am sure you will know all about that.I hope that your situation is improving

@tiona I meant to ask you if you are in the same situation as me in that when I get up I am relatively pain free but as the day progresses so does my discomfort levels which are at the worst in the evening ? Also have you considered consulting a Chiropractor ?

 

[calikat]

My left hip also hurts, I will need a THR on that side eventually.

It is never ending right?! I am hoping my left hip will last until I can get my right hip sorted out. Are you in Southern California? The drought comment had me thinking so.

 

[Kim22]

@calikat Me too! My left side feels arthritic but the last X-ray showed adequate joint space so no THR on the cards just yet for me and anyway like you said I really need to sort the operated hip out first.

 

[Kim22]

@tiona You and your hubby will be looking forward to the seminar and I hope you learn plenty.I wish I was coming too.Great news that your PT is helping which is very encouraging.I know what you mean about "brain pain".The anticipation of pain causes me to tense up and racks up the pain levels.

At my hospital cortisone injections are only performed by radiologists and there are only two of them.According to my OS that's all they do all week so they are very skilled and experienced in the procedure.When I had my diagnostic ultrasound the radiologist stressed that the injection should be done under ultrasound and my OS confirmed this at my last appointment.As your PT is helping you you can afford to put the injection on hold for a few more weeks perhaps ?

I hope the weather improves this weekend for your walk but equally its good news that you have had some rain at last in California to help the drought situation a tiny bit at least.The rain keeps on falling over here in the UK.Many areas are now flooded but mainly in the South and we are up North.Bizarre weather on both sides of the Atlantic Have a great weekend.

 

[Josephine]

Regrettably I won't be able to let you if the injection works as I have just learnt that there is a three to four month wait for a cortisone injection.The Trust is probably short of money and they are waiting until the beginning of the financial year before sending appointments or maybe the demand for them is just really high

That's quite usual. Nothing to do with Trust being short of money or anything like. Last year I had to wait 6 months for a shot in my shoulders because a) the surgeon was on extended leave and then b) he was terribly over booked. When I saw him he said I should have phoned and pestered him but I know he works so hard - how could I?

 

[tiona]

Hi @Kim22 @calikat,

I don't mean to be a "downer" about the long wait for injections/treatments and such in the UK, Australia etc. It's just that in the USA we have never had that issue. It's been quite an eye opener to hear your stories here on this site.

However a huge portion of our population has been uninsured and/or under insured so they are (or have been) well, basically screwed. Our system is changing now, and we have many confused, frustrated and ticked off physicians, institutions etc. It's a confusing mess here and will be for quite some time. As a nurse I believe that all people need access to decent medical care. So, I'm for "Obamacare" in many ways....but it's a mess right now.

@calikat, I'm in Northern CA, but the entire state is in a major drought situation and Southern CA receives their water via a huge aqueduct which means that they rely upon Northern CA for their water. We can't deliver. Central CA is our "bread basket" in terms of agriculture and they will have no water. It is an emergency on many levels for our entire country really.

But that aside....back to our bones: I will have my final PT session next week. I have an impingement, it's official. Now what? I don't know.

@Kim22...I'm not going to be in a hurry, this is not an urgent complication. My PT warned me off of a steroid injection for now, (he is afraid it would weaken the structures). A tenotomy? Maybe. I need to do further research. For now, we plan to attend a seminar, find and write to specialized orthopedic surgeons etc. At this point my insurance company has to preauthorize everything...but I am a fighter and we think we can push back if denied.

On a totally different level, I've been offered a director level position at work and don't want to mess that up by going out on medical leave (insert scream here). But still, I'm fortunate to be able to be active, though my hip fatigues. Today I worked, walked during my break and my PT session was a challenge...my left hip was screaming at me too. (sigh). I'd love to know if ANYONE has had long term success in this situation with steroid injection!!

This has been long and rambling. Sorry...I've had a couple of pale ales;)
T

 

[Kim22]

Hi @tiona First of all I would like to congratulate you on your promotion. I certainly see why you wouldn't want to take any more sick time just yet which could mess things up. Well done,you must be very highly thought of to be offered a post at director level. When is the seminar? If you find the time it would be of great benefit to us other hippies if you could share any relevant information regarding tendinitis.

I have been trawling through the internet and I have not found any studies which provide evidence that a cortisone injection can bring long term relief from psoas tendinitis either. From what I have read it can provide temporary relief and my physio told me that it would be appropriate to increase the intensity of exercise during this window of opportunity. Maybe @Josephine has more information on the value of these injections?

At the moment I am listening to my hip and just doing those exercises which don't cause pain. I find the worse one is the ROM heel slide exercise as when my leg returns to an extended position it feels like one muscle is rubbing against another and is very uncomfortable.

I am so glad that you are getting on with your life but it's a shame that your left side is uncomfortable (mine too). I find that my right hip feels weak on occasions. My life is more restricted than yours as I have been told to restrict walks to ten minutes out and ten minutes back and no inclines. I have tolerated this to a degree as unlike you we have had the wettest winter since records began in the UK and the idea of getting out for a walk is not so appealing but for the past couple of days it has felt positively spring like and it is a lovely sunny morning. I know that as spring progresses I will get very frustrated yet again.

Take care Tiona and keep us posted on how things are going. I always look forward to reading your posts.

 

[tiona]

Hi @Kim22,
There is an article that you may be interested in the "Journal of Bone and Joint Surgery" out of the UK. It is titled "Pain related to the psoas muscle after THR." You can find it at boneandjoint.org.uk. Most of the studies and articles I've read are out of the UK. Let me know what you think....

Question: Is your tendon/muscle tight? Mine is not, so it really doesn't "need" to be stretched.

 

[Kim22]

Hi @tiona, thanks for highlighting the study. Well at least one of the patients benefited from the cortisone and seemed to get a complete cure. The weakness of study is the small numbers included but as the condition is relatively rare compared to the number of successful replacements then this is not surprising. The way I see it if you have an impingement which is irritating the psoas then the injection will only offer temporary relief at best as it won't eliminate the cause.

I have been told that impingement is not my problem but as yet I have not had a CAT Scan. I really need to know why I have tendinitis in the first place if not due to impingement. Am I just unlucky or perhaps it pre-dated my THR or was it a result of the arthroscopy I had to repair the torn labrum in 2012. It has been stated on here that most cases of tendinitis are caused by patients doing too much in the early stages but all I did was walk which is encouraged and in fact I did a lot less than many in terms of activity.

To answer your question about my hip flexors being tight well no, I don't believe that they are. I can do a kneeling psoas stretch and was doing them until they seemed to cause pain so stopped them. The physio has not given me that stretch as part of my routine and I am being very careful to do only what she has told me to do. I think that the tendon is very inflamed and this is causing the muscles to rub against each other during flexion and even worse during the end of extension that move can feel very sore at times.

I am seeing my OS again on the 25th March when he will order X-rays to check on the left side again as the last one showed adequate joint space despite feeling very arthritic. He did say that if the pain continued and the X-ray was unchanged he would order an MRI scan to see what is going on in the left hip but to tell you the truth I feel I have to get the right side sorted first. Do you think that our painful left hips are making the right sided tendinitis even worse? Just a thought.

Have a great weekend Tiona and I am sure that you are entitled to a few more pale ales to toast your success at work.
Kim

 

[calikat]

I've been offered a director level position at work and don't want to mess that up by going out on medical leave

Congratulations!

 

[Josephine]

I have not found any studies which provide evidence that a cortisone injection can bring long term relief from psoas tendinitis either. From what I have read it can provide temporary relief and

and usually that's all it does! it will never give permanent relief of itself, only if one is lucky enough to have the condition reverse itself during that temporary relief. I was lucky enough to have that happen in a bout of trochanteric bursitis a couple of years back.

my physio told me that it would be appropriate to increase the intensity of exercise during this window of opportunity

Which we all know doesn't actually exist!

And increase the intensity? I think not!

I really need to know why I have tendinitis in the first place if not due to impingement. Am I just unlucky or perhaps it pre-dated my THR or was it a result of the arthroscopy I had to repair the torn labrum

it most like pre-dated your THR being a left over from the original hip problem. It's not at all uncommon for these things to bubble away beneath our radar for years only to have some significant event make it pop to the surface. Back pain is a prime example. People often speak of having a 'bout of sciatica and in between times it's perfectly fine". In between times, the primary problem is always there, just bubbling below our radar. Then we do something like lift a heavy box or reach too far and BAM! we are struck down by this sudden pain of sciatica! I would opine that this is the case with your psoas tendinitis. And further that you will never actually find a cause for it. Only that it's there.

Do you think that our painful left hips are making the right sided tendinitis even worse? Just a thought.

Of course they do! Here's a phrase I haven't used in a while - "everything is connected to everything else"!

 

[Kim22]

@Josephine You say that a cortisone injection can only ever bring temporary relief but that you were lucky enough to have permanent relief following an injection. With all due respect how do you know that this permanent relief was not due to the cortisone rather than the condition just reversing itself coincidently following treatment ? I realise that statistically the odds are stacked well and truly against the injection bringing me a permanent cure but I was trying to hang on to a little bit of hope that the injection combined with physiotherapy may improve my situation enough for me to start to get more benefit from my new hip.

Of course I am aware that "everything is connected to everything else " but my issue is whether or not the discomfort in my unoperated hip is related to osteoarthritis in the hip or to a muscular imbalance caused by the pathology in the operated side.

 

[Josephine]

Well of course, I don't know that it wasn't fully the injection that cured the TB but I do know that usually cortisone injections are just another form of pain medication. So it's highly unlikely they will resolve anything. It could be that the shot made the inflammation in my TB decrease to such a degree that the condition cleared up of its own accord which they will do anyway. Most of these inflammatory conditions are "self limiting" anyway, meaning they will - or may - resolve without treatment eventually.

whether or not the discomfort in my unoperated hip is related to osteoarthritis in the hip or to a muscular imbalance caused by the pathology in the operated side.

And I doubt you'll ever get a definitive answer to this until or unless you have your other hip done.

 

[tiona]

@Kim22, @Josephine...Just finished my final PT session yesterday...my hubby was present. So, while I have made some progress, the bottom line remains the same. Impinged between 40 and 90 degrees. And 40 degrees is painful. I've kicked up my exercise regiment a bit, at the most 6 miles a couple of days ago...this including work plus my walk after work which is aerobic. Problem: my knee hurts. Bad. Especially going down hill. I pointed this out to my PT, and he absolutely thought it was related to my hip issue and Illiosoaps impingement and changed angle and gait.. He recommend a revision. So now, I'm creating a "medical file" ...I can't believe this is me, since I still think I'm a "young and active woman." Ha! But I picked up his report (to add to my medical file), because I've decided to seek a second opinion. His report is a paragraph long, acknowledges the impingement but states I'm within "NFL" ..."Normal Functional Limits"... This is just to cover everybody in case of potential litigation I'm sure. I'm not litigious, but his assessment, for which I paid a lot of money is way too brief....Just venting.... Does anybody know of an exceptional orthopedic surgeon specializing in THR revisions in the Sacrament CA region?
Thanks, T

 

[Kim22]

Hi @tiona as you know I live in the UK but there must be someone on here who can recommend a revision surgeon in your area ? Sorry to hear that your knee hurts and it is most likely related to your hip problem.I know that as most of my pre op pain was in the knee but it resolved after surgery and has been by enlarge trouble free since but I have noticed the knee aching at the end of my exercise session but it doesn't last very long.Its good to hear that you have made some progress as a result of the PT.When you say you managed 6 miles is that all walking ? I am impressed if that is the case.All I do is 20 minutes a day on level ground.I know I could do more but I am following the physios advice to the letter.Have you decided to not pursue the tentotomy route now in favour of a revision ? I am still waiting for an appointment for the injection and doing the exercises.My ROMs seemed to improve a little last week but the pain seemed worse yesterday after a 2 hour car journey.I find this situation so frustrating as I am sure you do as well.I have no knowledge of creating a medical file but it sounds like a lot of work as well as expense.I am so sorry you are going through this experience and I hope you find an excellent revision OS who can advise you on how to put things right.

 

[Josephine]

I think a second opinion it very much the thing to do, tiona.

exercise regiment

However - and this is me the pendant! - I'd just like to point out this to you
Regiment : Military - a unit of ground forces, consisting of two or more battalions or battle groups, a headquarters unit, and certain supporting units.
Regimen: Medicine/Medical - a regulated course, as of diet, exercise, or manner of living, intended to preserve or restore health or to attain some result.

 

[Kim22]

Hi @tiona I have tagged @Jamie for you as she is in the US and may be able to give you some advice on finding an excellent OS specialising in revisions who practices in your area.

 

[C Mac]

Hi Tiona,

Sorry that your PT evaluation came out not only shorter than you'd like, but with the bleak recommendation for revision. While I am not in the medical field, I wonder if the tendon release wouldn't be a less invasive more conservative approach that would be the next step to try before a revision - especially if there are no problems with the hardware and installation. Your MRI doesn't show any problems with the cup placement and it's relation to the illiopsoas, does it?

I'd also suggest that you get your knee checked out. I ended up with a torn meniscus after my surgery and PT added to the problem.

Try to remember, you are still a "young and active woman" you are just hitting a crappy speed bump that is slowing you down at the moment… The first year out is much about healing from the surgery and your body's adapting to that change in alignment of everything with the new hip hardware.

Like Jo said, "everything is connected to everything else" -- dysplasia seems to show this in a loud, loud scream!!

Take care,
Cardie