THR Tendinitis after THR

[tiona]

@C Mac, @Josephine..I hear you Josephine. Cardie, I've read all the studies about tenotomy and thought that may be the answer, but have been highly discouraged by my PT, my PT friends and my OS. Once a tendon is cut, there's no going back. My acetabular cup does extend beyond the edge of my acetabulum and is interfering with my illiopsoas tendon. I'm not quite ready to sign up for a revision, but I am gradually coming to the conclusion that I may have to risk a revision in order to have the potential of "normal" function. No easy choice for sure and I'm starting to feel some anxiety and depression about this mess I'm in. It's a grieving process I suppose. Meanwhile, I'm planning to research specialists and send out some sort of brief letter to see what kind of responses I get. Plus I still plan to see what can be learned at a joint replacement seminar on the 15th of this month. Thanks all.

 

[Josephine]

I don't know where you're getting your information from but it's misleading you hugely. The psoas is actually one of a group of muscles in that area so won't matter a jot if it's cut. The adjacent muscles will quickly take up the slack.

 

[Jamie]

@tiona.....here are some surgeons in your area for you to check out. Get one or more additional opinions....better to have more than less.

Dr. Michael Reis- University of California, San Francisco Professor and Vice Chairman of the Arthritis and Joint Replacement Department.


Dr. Joel Matta - Santa Monica, California

St. John's Health Center
Orthopedic Center
2001 Santa Monica Boulevard, #1090
Santa Monica, California 90404

Specialties: Orthopedic Surgery and Hip/Pelvis Reconstruction, specializes in Anterior Approach

Clinic Phone Number: 310-582-7475
Dr. Matta's Contact Number 310-582-7473

You can contact Dr. Joel Matta and request that he look over all your films, reports, and a brief history written by you. He will review everything and give you his opinion and advise.If he sees a problem, he will likely offer for you to make an appointment with him and have him do the surgery, or go to whomever you preferred. He takes on complex cases, and is well known as one of the best revision specialist. He does not charge a fee to review, give his opinion and recommended treatment.


Surgeon near Los Angeles:

broken link removed: https://www.orthopaedicsurgery.uci.edu/faculty/schwarzkopf.html - hip and knee primary and revision

 

[tiona]

@Jamie, @Josephine,
Thanks Jamie!
Josephine, cutting the muscle a jot may not be a big deal, but the tendon is a different matter...isn't it? Do you know of anyone who has had a tenotomy for this complication? If so, I'd love to talk to him/her...thanks for your replies!!

 

[Josephine]

Well, the psoas it actually a muscle though it's commonly referred to as a tendon. In medicine, the terms are interchangeable.

As you can see in the first image, the muscle is comprised of two bodies which are responsible for adducting the leg (drawing it to the midline as when you cross your legs). One is called the psoas and the other the iliacus.

But there are several other muscles that perform this action too. I've marked some of them here with blue stars in the second image. So the loss of one muscle here really doesn't matter that much. If it did, the surgeon's wouldn't do it!

We've had a few members that underwent this but I don't think they come here any more. As I recall they did pretty well with it.

 

[tiona]

@Jamie, @Josephine...Good news! Jamie, one of the surgeons you recommended from UCSF has recently moved just up the hill from me in South Lake Tahoe!! That would be Dr. Michael Reis. I have an appointment with him April 28th. Even if I have to pay cash he will offer a 40% discount! I've decided to pay cash to consult with 2 super specialists, then I'll decide what to do. I've also decided to reveal to my co-workers my situation, and I think they will be supportive no matter what I choose. My greatest fear is about my career! My appt is April 28th. Josephine, I will absolutely ask about conservative options such as a tenotomy, and will keep you posted about what these "super specialists" have to say! I'm nervous about having to make a decision. I'll keep ya'all posted.
T

 

[Josephine]

That's good news, tiona. REALLY good news.
And I hope and pray you will find the answers you are seeking.

 

[tiona]

Just got back from my appt with Dr. Reis...loved him. There are 3 possibilities...Impingement, Nerve palsy or tendinitis. He is going with tendinitis and suggests an image guided cortisone injection. He feels as if the injection may be the remedy especially since my issue is relatively "fresh'...less than a year since my THR. It will at least be diagnostic. If the injection is ineffective, then "nerve palsy" should be considered. His "gut feeling"is tendinitis...he was more thorough in 10 minutes than anyone else has been ...ever. I feel in good hands. I'll keep ya posted. My OS has offered injection but does not use image guided technique...so, pray that my insurance will pay...because without image its not a sure diagnostic. A confident physician=a confident patient. Feeling hopeful. He thinks that injection could solve the problem. It will at least guide him as we move forward. T

 

[Jaycey]

Sounds like a real result @tiona ! Do keep us updated!

 

[Kim22]

Hi @tiona I am so pleased that you have found a very thorough surgeon who has filled you with confidence about your situation.Have you had your cortisone injection yet ? My situation seems to be improving slowly after over three months of doing the exercises prescribed by my physio as they have helped improve both the strength and the flexibility of my hip which was very weak before I started them.I still have some discomfort in the groin and upper thigh but not as much as I did.The last OS I saw diagnosed psoas tendinosis instead of tendinitis which is chronic condition and recommended increasing the hip flexor stretches which I have done but very slowly.I hope you are ok and please post when you can.

 

[tiona]

@Kim22 @Josephine...Injection today. Normal range of motion 5 minutes later. Great radiologist, knowing I was a nurse he involved me in the process totally. The lidocaine/marcaine offered immediate results. The diagnosis confirmed...the tendon is scraping on the cup. This is likely a band aide...revision may my only long term option, 6 weeks will the the tale. Josephine, The specialist and the radiologist told me that a tenotomy would cause permanent disability, but would relieve the pain. Not an option for me. My left hip is deteriorating fast, I may have both done at the same time if I choose to go with revision.
Keep ya posted;) T

 

[calikat]

Hi Tiona. I am glad you finally have an answer. I discovered that I have a misaligned acetabulum cup also. I have an overhang but it is to the back (?) rather than the front. The whole thing is so disappointing. I am trying to see if the level of pain is something I can live with.

 

[tiona]

@calikat, Me too calikat....My hip is great right now, but the chances that the injection will work long term is about 10%. Pray. If it doesn't work I'm going to ask my specialist if he can do the revision and my left hip replacement at the same time. Sounds crazy I know...but I have researched and have chosen a couple of great guys. Might be possible. The lidocaine wore off as expected, but the Kenalog (cortisone) is kicking in..so aside from the pain secondary to the injection (not a small procedure) my hip is still better over all. I could lift my leg into my pants and into my truck today...ha The guided CT showed the tendon impinged over the cup for sure. The radiologist suggested that I asks for a posterior approach on the left side. Anterior approach destroys the capsule....but greater risk of dislocation overall with the posterior approach. Ugh!
T

 

[calikat]

I would not do an anterior approach again. I have some nerve damage also, and I think this approach is a lot of hype. I had a guided steroid injection in my psoas when I had the CT scan. I had some relief, but the overhang for me is to the back so my symptoms are a bit different. If I take an NSAID along with an ultracet daily the pain is manageable, but I am pretty uncomfortable if I don't take it. I hope the steroid gives you lasting relief. For me they only seem to last 4 - 6 weeks which I guess is pretty typical. Maybe your body will adjust. One OS I saw for a second opinion thought I should wait a year before doing anything. My left hip is going too. It is always something! LOL!

 

[Kim22]

Hi @tiona I am just catching up as I have just returned from a lovely holiday in Italy.So you had your cortisone injection over a week ago now and it certainly seems to have helped.I do hope this relief is permanent for you. My left side side is also deteriorating fast and I will also need another replacement sometime soon.Keep us up to date with your progress.
@calikat Sorry to hear about your impingement and that the positive effect of the injection only lasted for 4-6 weeks.The injection that I had before any hip surgery only lasted 4 weeks but I must admit I felt like I had got my life back for those few weeks.Thinking of you both
Believe it or not I have just received the appointment for my psoas injection on 12th June but as I have seen some improvement I may postpone it to see if the improvement is maintained but if the pain returns I will remain on the list and will go ahead.

 

[dickinson]

@tiona and @calikat . so sorry you're still having such a hard time. I had the anterior and did fine but I guess it's the luck of the draw. I sure hope things get better for you both. very soon.

 

[55beachgirl]

I also had anterior right THR and initially did amazing. Six weeks later, I had left TKR which was a hundred times more difficult of a recovery. Thought the hip was the least of my concerns until January, when I started having pain in my groin (the exact pain that caused me to be a candidate for THR). That pain has since gone away, but for the past couple of months I've had pain and weakness (to the point I can barely walk) in my quad muscle. It does work itself out, but sometimes it even hurts during the night (to the point it wakes me up).

I'm in very good shape and walk a lot, do yoga, swim, and garden (a lot). The only med I take is Lodine 500 mg 1-2/day.

My question: is this to be expected? As some have commented, the anterior approach is almost too successful, in that patients do too much too soon (guilty!). Will it work itself out in time, or should I go back to my OS? At my six-month follow-up he diagnosed it as illiopsoas tendonitis. Therapeutic massage seems to help, and my massage therapist says my IT band is very tight.

Thoughts? Thanks!
Beverly