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THR Thigh pain post-Total Hip Replacement<

Josephine

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So that first one I reviewed was taken on February 16 then? Only 8 days after surgery? I was unaware of that.
In that case, I take back all I said in post #4 as it was far too early for loosening and remodelling to have taken place. Sorry if I worried you with that misinformation.

In the May 22nd xray, there is clear evidence of bony ingrowth all down the left hand side of the stem.

They look the same to me.
 
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nlt99

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Sorry to have misled you Josephine! At the time I first posted, I didn't realize that the X-ray had been taken so early in the process. Those were the frog-leg X-rays.... I am still curious about the frontal ones. When I look at the time-sequence of the ones I have (below), I can't really see any difference or bony ingrowth.... can you?? Your experienced eye might see things that I would miss.

Frontal X-Ray Sequence.jpg



The other thing I am still curious about is the bone scan (below). What could the heavy black area down by the end of the prosthetic stem be? (arrow)

Bone Scan of R Hip 2.jpg
 
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Josephine

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When I look at the time-sequence of the ones I have (below), I can't really see any difference or bony ingrowth.... can you??
Well first do remember that bone growth can take around 12 weeks to occur which is why surgeons who use uncemented hips tend to impose nonweight bearing for a period of time. But I think I can see some evidence of it in the enlarged version. The arrows are pointing at a slightly fizzy area which is what I think is bony ingrowth. However, I'd be happier if this was occurring all round the stem and not just in a couple of places.

stem end.jpg


troch end.jpg


The other thing I am still curious about is the bone scan (below). What could the heavy black area down by the end of the prosthetic stem be?
Well aside from the fact that I previous said I never learned to read MRI scans, I would imagine that those areas are the result of the surgery as they are all over the place and just where the surgeon would have been with his scalpel!

Mind you, I could be wrong!
 
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nlt99

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WOW... thanks for the blow-ups and explanation....... I can see what you are saying!

Actually, the last image I sent was from a bone scan, which is difficult to read too. They are fuzzy and indistinct. I think the dark areas are where there is bony activity, which would explain why it's all around the implants. I did find two images similar to mine online:
Bone scan history.jpg


Bone scan history 2 inverted.jpg



The radiologist's report didn't specifically mention that spot in my scan, and I am wondering why. I will ask the surgeon for his opinion at my next visit, although I think I have learned that surgeons can be very good at the surgery they perform, but not necessarily good diagnostic doctors.

I will also ask the new surgeon I will be seeing this month for a second opinion this and of my problems in general.

I had a very strange thing occur yesterday & today: Yesterday morning my pain suddenly increased markedly, and for no specific reason, making it very difficult to walk at all. I had to use two canes all day just to barely get around the house... I was miserable. Even with two canes, and trying to put as little pressure as possible on that leg, it was still extremely painful and nearly impossible to walk. Then, in the middle of the night I had to get up to go to the bathroom, again needing to use both canes. It's a fair distance, and I suddenly realized I might not make it in time, so I started moving very quickly (still using the two canes.... very awkward!). When I left the bathroom to return to bed, I realized that my pain had greatly reduced, and I was able to walk with only one cane (still trying to keep some of the weight off my leg). All day today I have not needed to use both canes, and though still painful with each step putting weight on that leg, it is nothing like yesterday! It is like it has been normally recently. For the life of me, I cannot figure out what made my pain suddenly increase so drastically, nor why it so suddenly went back to the way it has been before! It is very frustrating because I can't figure out what's going on, and neither can the surgeon it seems.....

Sorry to bend your ear for so long! Thanks for 'listening' Josephine!
Nick
 

dougie0216

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@nlt99 watching your story unfold with interest. I have no similar experiences or advice other than hang in there. You have some good people above looking out for you. Good luck.
 
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nlt99

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Thanks Dougie!
 

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@nlt99 Just a note to say hang in there first of all. You are doing a great job of taking care of yourself.

Next, if you have access to a teaching medical facility for your 2nd opinion you might try that. When I was looking for a 2nd opinion with a different surgery (broken nose in a car accident) I found out that specialist doctors can be a bit chummy and not want to rock the boat with another peer. University doctors are not working in the same for profit environment and have less allegiance to their peers and more to the recovery of their patience.

Meanwhile, you're really on top of it - providing your images and advocating for yourself so I'm sure you'll find the answers you deserve. I hope your feeling better soon.
 
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nlt99

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Thanks for that suggestion StayStrong.... I'll have to check it out. I'm sure you're right about some docs being "chummy". Thanks for the support as well.... it's been a rough trip so far........

Nick
 

Josephine

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Well, what can I say? It comes and goes, it seems. My only thought here is that it's coming and going would not indicate a loosening. But I could still be wrong!
 
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nlt99

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Thanks Josephine.......
 

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@nlt99 Following your story with interest!
@Josephine - I am wondering if you can answer a question for me. If a stem becomes slightly loosened at 3-6 months post op, will it definitely require surgery to correct, or can it heal and tighten up again with complete rest (basically starting recovery over)? Obviously if its VERY loose or causing extreme pain this would not be an option, but just curious if bony ingrowth can restart and rectify a loose stem if its not too severe? I find this whole subject of joint surgery and recovery fascinating, and want to learn as much from you as I can!
 

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@nlt99 I am also starting to follow your very-well-documented story. I feel for you, and I'm thinking I may have to stop looking at your xrays so I don't become that hypochondriacal patient who thinks she has everything somebody else does!

I will tell you what makes my right leg's pain skyrocket suddenly (the hip is doing fine but I have S-I joint issues and piriformis pain, all giving me shifting pain and muscle cramps up and down from above my waist to my ankle, grrrr) (for which ibuprofen is the only thing that works, so I'm with you on that!)--- my soft tissue is a GREAT meteorologist! I get suddenly increased pain about 48 hours before a change in the weather, and it's dropping barometric pressure that is the worse and more frequent culprit. When the pressure levels out, so does the pain. I've been having that for years, but it took me quite a while to figure out what was going on. So-- how's your weather today?
 
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nlt99

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Thanks for your comments! I do notice the weather affecting things, but not nearly as much as you.

Nick
 
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nlt99

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To kind of wrap up this thread, at least for now, here is a little (or a lot) more info....

I went to see another surgeon to get a second opinion on my situation. Here is the info I presented him with, in an attempt to get him up-to-speed on the situation as quickly and easily (for him) as possible:

- My right hip was replaced on February 8th 2017. Recovery was going very well until about 3 wks to 1 month post-surgery

- On a Monday, I walked 1 mile in the morning, exercised in the pool for about 1 hour before lunch, then had PT at 4:30pm (think I overdid it – I was afraid I had damaged something, or loosened the prosthetic implant because I was experiencing crippling pain in the right thigh)

- During side-stepping exercise at that PT session I suddenly had such pain that I had to stop. At a subsequent visit, the surgeon agreed with me that I should stop PT since it seemed to be hurting more than helping… which I did

- I have still not recovered full function, frequently experiencing sharp pain upon putting weight on the right leg and walking

- I have no pain when sitting or lying down, only when putting weight on the leg

- It seems like twisting (torquing) on the leg sometimes makes it worse

- It seems like “side-stepping” (like moving sideways down the kitchen counter) sometimes makes it worse

- It seems that carrying a weight (maybe 25 lbs) can cure it for a day or two, like it is driving the prosthetic stem tighter into the bone (this has occurred multiple times)

- The pain can come or go immediately, with no notice

- I have had an EMG study done 6/28/17 with negative results. The Dr said the nerves were fine, with only some peripheral neuropathy in the lower extremities

- I have seen a spinal surgeon who found no fault, saying that surgery was NOT suggested at this time. He recommended a bone scan

- I have had multiple spinal Steroid injections at Right L3/L4 & L4/L5 by with some positive results. The Doc did NOT suggest continuing them at this time since the last one had little effect

- The surgeon injected steroid into the outer trochanter bursa sac on 5/22/17, based on painful palpitation at that location. Had some short-term relief, very similar to the relief provided by the earlier spinal injections

- I had multiple X-rays of the hip replacement which the surgeon each time said looked normal

- I had an MRI of the hip on 6/15/17 which radiologist report shows nothing significant (I had requested a CT scan to show any bone damage, but the surgeon ordered the MRI instead because he said it would give him more information). In looking at the MRI myself, I was disappointed that parts of it did not extend far enough down the prosthetic implant to see the area of activity I have seen in the bone scan.

- I had an MRI of the spine on 5/23/17 which showed some abnormalities, but nothing considered critical

- I had a CT scan of the right knee 6/30/17 which found no significant change in the fractured kneecap. The prosthetic ‘button’ appears to still be in place

- I had a bone scan of the entire lower part of my body on 7/24/17 which the radiologist report says shows nothing very significant. Some activity around the Greater Trochanter and hip prosthesis, as well as the R knee.

- Based on the bone scan & X-rays, the surgeon injected steroid into an area of heterotopic ossification at the outside of the greater trochanter on 8/7/17. This had a limited effect on my pain symptoms (seemingly taking effect in about 7 days)

- On the bone scan I personally see a ‘hot’ spot at the outside of the tip of the stem that I am curious about. (not specifically mentioned in the radiologist report)

- At my 9/11/17 visit, the surgeon suggested that the problem may be difference in flexibility of the femur Vs the implant (I’ve read of this online). He said to give it more time and see him again in 6 weeks

During my 9/12/17 PT session, pressure from the foam roller showed a specific area of sharp pain about half-way down the outside of the femur



When the second surgeon read the info above, he agreed that the 'hot spot' at the tip of the implant stem was of concern to him too. Not being overly familiar with reading bone scans, he immediately called a radiologist friend of his, who read the scan himself and said that for 6-months post-surgery it did not appear alarming to him.

We went over everything in depth and the second surgeon said that while there was enough evidence from the scans, xrays, and my personal experiences to support the possibility of a loosening implant, it was not clear enough or concrete enough to cause him to consider doing revision surgery at this time. He wants me to return in two months for another X-ray so he can see if there is any clearer evidence of loosening.

I asked him if it made any sense to use my crutches to totally keep the weight off that leg. He immediately said 'No, I need to have pressure on the bone to stimulate more bone growth'.

I asked him if there was any other way to proceed (than revision surgery) if the implant was loosening.... he said 'no', that was the only option.
I would really much prefer to avoid revision surgery if at all possible for at least three reasons:
1- I don't recover well from major surgeries (couldn't eat for 2 weeks following the hip replacement)
2- That would mean starting rehab all over again, and I've lost 7 months so far with this one
3- I've read that in general, revision surgeries are less successful than the primary surgery

Realizing that neither surgeon has any real solution to my situation at this time, I started thinking of the adage: "Physician, heal thyself". Thinking back to the multiple times when carrying a heavy object seemed to relieve my symptoms for a while (up to a day or more), I decided to purposely carry a heavy object whenever my pain symptoms seem to be worsening, thinking that it might force the implant more tightly into the femur, hopefully helping the bone to grow and secure it permanently. So far, after following this procedure for a couple of weeks, it DOES seem to be working in general. I still have occasional periods of increased pain, but have been walking with no cane most of the time. I truly believe that my problem is that I caused the implant to become loose by overdoing it so much that Monday about 3-4 weeks post-surgery.

So, there you have it..... this is where I'm at for the moment. Hopefully, following my own procedure with be successful, but if not (or even if so), I will see what the new surgeon has to say after seeing the X-ray in two months.

Thanks for your time in reading all of this! Nick

#heterotopicossification
 
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nlt99

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Hello Josephine...… I am back again with an update.
I am still struggling with this problem, now nearly 3-years post surgery. I have had epidural injections, nerve ablations, steroid injections, IT-Band stripping (at PT), some providing temporary improvements, but no help in a permanent sense. I have a later set of X-rays on CD, taken March 11 2019 (about 2-years post-surgery, showing frontal and frog-views. I copied the files from that CD to my PC hard-drive and could copy them up to my Drop-Box if you would care to give me your opinion. That way you can display them just as the Dr does, enlarging and changing contrast etc to get the best view possible. I would need your email address to give you permission to view/download it.

Hope you are doing well and enjoying the holiday season! Nick
 

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@nit99,
Josephine is currently on leave. You are welcome to post your x-rays in your thread for staff to take a look.
Sorry to hear you are having continuing challenges with your hip.
You may want to call imaging facilities to see if they have a radiologist specializing in reading images of joint replacements for another opinion.
 
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nlt99

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Here are the Frontal and Frog X-Rays. At the top of the Frog image it says "Weight-bearing"... not sure if that applies to both images......

Appreciate any insight.... thank you! Nick

X-Ray 3-11-2019 Frontal.jpg
X-Ray 3-11-2019 Frog.jpg
taken 3/11/2019
 

Jamie

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@nlt99 .... it appears you may have cropped these images quite a bit. Can you repost them and back off a bit? I'm sorry about Jo not being available right now to review your x-rays. She is off recovering from a knee revision and we're not exactly sure when she will return. Since she is the expert with x-rays, the recommendation to see either a radiologist or some additional surgeons would seem to be the next step. However, if your implant is loose, the only option to fix the problem is a revision.
 
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nlt99

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Hello once more!
Just an update: I saw another surgeon two days ago, and his opinion, based on the bone scan and X-rays is that my stem implant is loose. He just ordered a new bone scan and CT scan, and if his opinion is the same after reviewing them he will recommend revision surgery. He also commented that in his opinion, the stem implanted is shorter than he would expect based on my height and length of my femur.
I will update further once I know the results.....
Nick
 

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