THR Unexplained onset of pain 2 years after successful THR

[Jaycey]

He feels a diagnostic aesthetic injection would be a good idea to eliminate or confirm bursitis.

Did you have this injection?

 

[jean1702]

Hi Jaycey, I didn't because my GP and another physio said they were adamant it wasn't bursitis because I have no tenderness to touch (although I can't sleep on the bad side as it feels sore but not tender / like sleeping on concrete if that makes sense), also the fact I have groin pain too combined with the outer hip and glute pain. My husband and I were chatting about it today though and think maybe I should to at least eliminate it as I have no options.

 

[Jaycey]

think maybe I should to at least eliminate it as I have no options

If it were me, I would push for the injection if only to rule out bursitis. Everyone's symptoms can vary.

 

[helenium]

Hi @jean1702
I'm so sorry to read about your ongoing problems. Like Jaycey, I was wondering if you'd had the injection. And have you asked your surgeon about it?

He even referred me to another surgeon colleague who specialises in revisions and he agreed the hip itself is fine.

I realise you must have spent a great deal already on your private consultations and tests. But there's a piece of advice I read regularly here on the forum - to find a good revision specialist not associated in any way with your current surgeon. I wonder whether yet another opinion would be an option for you if all else fails?

It's a piece of advice that resonates with me. My RTHR was showing signs of loosening on x-ray, and about 2011 my original surgeon (NHS) transferred my care to his colleague who specialised in revisions. I'd had problems on the left side for some time, but both surgeons told me there was nothing wrong with that THR. Time went on, the pain on the left side got worse, I was told it was coming from my spine. I was convinced it was my hip. I was seeing an osteopath regularly and he was sure it was a hip problem. Eventually I sought another opinion (privately). It was indeed my LTHR.

Another thought, have you considered seeing a good osteopath?

 

[jean1702]

@helenium & @Jaycey Thank you both for your replies.

Re. the trochanteric bursitis injection, I haven't asked my surgeon about that directly but at this stage I expect he would say try it.

In terms of seeing a revision specialist, unrelated to my original surgeon I agree that makes sense. The 2nd surgeon I saw though was thorough in that he did the CT Spect Scan on top of the MRI, X-Ray and bloods that my surgeon has done. They said there are no other tests they can do which I find so devastating. Do they really not have any other investigations that they can do?

I saw a neurologist last week who specialises in the spine, he looked at my MRI and has said that he does not think my pain can be coming from the back as the MRI looks great, the pain is too widespread to be due to a single nerve compression etc. etc. I believe him as I just know this is coming from my hip itself.

He has requested another MRI to include the upper back but said it's not going to show anything different and 'not to get my hopes up'. I did ask if they could include the pelvis and hip again as it's over 2 months since my last one and the pain has got a million times worse. Perhaps something will show now? I know most people want clear scans but I am praying something will show that is fixable.

On a separate note, I got my GP to redo my blood tests. My infection and inflammatory markers (ESR & CRP) have always been really low since this started last November and I have been tested twice, once in January and once in February. Last week my ESR was the same (low) but my CRP was raised a tiny bit from < 0.1 to 6.5. Normal range is < 5. My GP & the neurologist said this is not the sign of an infection and not to worry as it would be in the hundreds by now but may show there is inflammation somewhere. I also wonder could anxiety raise it as I am in such a state. Anyway, they reran the bloods and I get the results tomorrow.

Sorry to ramble on but is there is any other scan, test, investigation anyone can suggest I ask for I'd be most grateful. If it is not infection and the hip replacement has not moved then are there any other things this could be? I am honestly at breaking point now and even find myself regretting having had a hip replacement despite successful surgery, 2 years of absolutely no issues and being thrilled with it until this started in November. The mind takes you to very dark places when you are in pain and have no diagnosis.

xxxxxxx

 

[helenium]

Just wondering, who would put the injection into the bursa? I think my current surgeon would want to know about it, and most likely do it himself.

Sorry to ramble on

No need to apologise, not rambling at all, it's all very helpful and gives us the full picture. I've been in a similar situation, but I learnt the hard way that x-rays and tests don't always give a definitive diagnosis.

If it is not infection and the hip replacement has not moved then are there any other things this could be?

I sincerely hope that you've overworked something, that everything else has come out in protest, the injection will help, and that it will all calm down.

To put it mildly, I've not had the best of luck with my hips! I'm not suggesting that you have the same problem as I had, but my initial LTHR looked fine on x-ray to many, very well fixed. But the actual alignment was completely wrong. I suspect the first revision specialist (the NHS colleague) might have suspected this, probably hoped my aches and pains would resolve without intervention. I felt like a hypochondriac.

That's why I suggested that another opinion could be beneficial when you've explored your current options. The eye of a good, very experienced, revision specialist might spot a problem. And if unrelated in any way to your original surgeon, is more likely to say if he/she thinks your original surgeon's work is not as good as it could be.

 

[Stellamac]

I too have the same issues after having my RTHR in Jan 2019. I have had many different injections for diagnostic purposes which eventually from what I have read causes fatty atrophy. I recently had an MRI that is a special MRI because of the hip replacement. It is different from a regular MRI. It di focus on my pelvic area and muscles, tendons, and soft tissues. It showed that I had Tronchanter Pain Syndrome and Tendinopthy Of gluteus medius and Maximus. I also had a EMG of muscles and nerves which did not show I had any nerve issues. I too have the pain in glutes, hip, and groin. The recommendation is an injection and physical therapy that focuses on the tendinopothy. I feel frustration just like you and can not understand that I am in worse pain than I was before my surgery. I would like to keep up with your progress and hope that I can get any ideas of what they do for you. My symptoms and pain are so similar to yours and it is debilitating pain.

 

[jean1702]

Hi Stellamac, sorry to hear about your ordeal. Did you recover successfully from your operation and have a period with no issues or have you had these symptoms ever since? My symptoms started suddenly over a couple of days last November. Before that I had two years of absolutely no issues and was fit and well, doing daily exercise and enjoying my new hip. It's hard to understand how you can have all of those things, there must be an underlying cause/reason they have all kicked in and started to cause you issues? Have you found anything that works? I am very happy to have physical therapy and injections but just want to get a diagnosis and understand why this has come on so suddenly when I was in perfect condition before. xx

 

[Hip4life]

I feel so sorry that this is going on. It’s not only frustrating but demoralizing. I had ongoing tendonitis from cup impingement. What I learned from that was it’s complicated to figure out the what, why, and the how. You’ve discovered that as well. I see you’ve gone back and forth on the injections. That’s the one thing I would recommend to you. Beside the procedure being fairly simple and straightforward, it could give you much needed relief and it would tell you if that was, indeed, the cause of your pain. An injection is twofold. It is therapeutic as well as diagnostic in that the steroid helps the tissues to “calm down” (the inflammation part) and if that pain subsides then those are the tissues causing the pain. If it doesn’t, then you move on. I got my injection. Yes, it was the IP tendon AND I got GLORIOUS pain relief. How long the relief lasts can vary. Example: for my shoulder, it was one and done. For my post THR groin pain: it was short lived which then told us that we needed to move on to other options but we had our suspect. As you have found, the process of hunting down the cause can be daunting especially when you’re suffering and all you want is to get back on with your life. Prayers for finding a solution soon. In the meantime, we’ll be here.

 

[jean1702]

Thank you @Hip4life, that was such a nice message. It's lovely to have the support, I feel so worn down by the pain and especially by the thought that it may never go away. Not having a clear diagnosis is soul destroying. I got the results back from a 2nd MRI today and there was nothing conclusive, it did state "possible mild bilateral gluteus minimus and gluteus medius tendinosis" though. I have been googling it and the symptoms are very, very similar except for the fact that it is anything but mild, it's constant and I have groin pain too although a bit more sporadically. I do think it's worth an injection into the the trochanteric muscle as you say to at least narrow down the possibilities. I am perplexed as to why it has been getting worse though. Since last November I have stopped exercising other than walking the dog, this is after going to the gym, fast walking or cycling every day so surely it should've been getting better weeks ago rather than worse. xx

 

[Hip4life]

I think once things get irritated, it’s sometimes hard to get them to settle again. I found that was true with both my shoulder and my IP tendon. It’s kinda hard to not move those major joints/muscles even with lessened activity. Sometimes less activity makes things so stiff it hurts. What’s a person supposed to do? I don’t know what the answer will be for you but I do want you to know you’re not alone.

 

[Zmak]

Gabapetin

It's a nasty drug but given time it will start to work and becomes easy to tolerate. I'm on it high doses for life but the the more Powerful version (Lyrica)
Did you give it long enough time to work? It needs time to build up gradually increasing dose over time until the right dose is found . Many stop taking it due to side effects
If nothing else is working then nerve pain being invisible is all that's left. Once you have exhausted all options go and see a neurologist IMO

 

[Stellamac]

@jean1702 I wanted to check in to see how you were doing and if you had gotten any definite answers? I was reading an Article that I felt like might be something that is being overlooked. Try looking up Trochanteric Impingement. Tell me what you think? I too have the glute issues, the lateral thigh issues and wide spread pain that is hard to explain to doctors bc it is in different places at different times. The groin pain is more often than not and feels very deep pain. I am seeing a sports medicine doctor this month, not sure why but will be having a diagnostic injection. I too have a lot of tests that really show nothing and doctors are stumped. So frustrating and it makes you to give up and not try. I hope you are doing better and let me know you think about anything you learn.

 

[ritabell]

@jean1702 I empathize with you because I feel lost in my quest for a diagnosis. Some days I just give up and say I will lean to live with this. Other days I feel this is my last chance to try to figure it out. Following this thread about trochanteric bursitis pain 1+ year after surgery. I had a steroid shot which didn't help, restarting with a new PT because I, too, am at a loss for what to do next. Side of hip always very sore to the touch, can't lay on that side, feel like I have a leg discrepancy when I walk, can't tell if that's related to the bursitis, paradoxically completely numb around surgical area so I suspect some kind of nerve problem as well. I had the anterior approach and this is one of the "complications" but I wonder if this is contributing to the bursitis or if there is more than bursitis going on.

@Stellamac what is a tendon release? Who decided that procedure?

Surgeon says the implant is perfect. I have grow not to like him. He is a man of few words and never says... Let's get to the bottom of this.

 

[Going4fun]

So sorry to hear about your ordeal.

One thing I want to share is that it's probably best to consult more surgeons ... So many times on this board, the issue isn't that the new surgeon (the one who figures out the problem) ordered a different tests than the old. It's that the new surgeon (the one who identifies the problem) somehow "reads" the results of the MRI or x-ray and the reported symptoms very differently than the previous surgeons who couldn't identify a problem.

So keep consulting. I know it's a pain. You're doing everything right here.

 

[jean1702]

Hi all, I haven't been on here for awhile as to be honest, I have not been in a good place. My mental health has suffered hugely as a result of not being able to get a diagnosis and being in constant pain for 6 months. I am completely sleep deprived and very low. I am now scheduled for an aspiration in a few weeks even though my blood markers are normal. At this stage, my hip consultant has said he has to rule infection out in a hip that just isn't right after so long (this has been going on for 6 months following 2 pain free years after a successful hip replacement). I am not sure I even want to ask the question but has anyone ever heard of a hip being infected when the CRP and ESR results are normal? Thanks as always.

 

[Schaargi]

@jean1702 I'm sorry your mental health is suffering. It's so hard to keep going when you can't get a diagnosis. I am almost a year out from one hip and still have pain when I try to turn out my leg, and my other hip is failing (no diagnosis yet). It feels like you don't have options to fix it if you don't have a diagnosis. How frustrating!

I'm glad your consultant is still working on it and trying to rule things out. That's a little something, right?

Hang in there.

 

[helenium]

Sorry I've nothing useful to contribute @jean1702. I've been thinking of you, and when I noticed you'd posted on your thread I was hoping for better news. No wonder you're feeling so low . Good to hear your consultant is still looking for answers though, and hope a solution can be found soon.

 

[jean1702]

Hi all,

I have posted another message some time ago under the thread "Hip Pain 2 years after successful surgery….". Unfortunately my issues haven't gone away and I am scheduled for an aspiration in a couple of weeks to rule out infection. I don't want to have it but have run out of options as the consultant tries to find a diagnosis.

My specific questions are
a) how does infection present itself (i.e. other than elevated bloods and fever)?
b) how long does it take to show symptoms once an infection has set in (e.g. can it take months)?

I appreciate elevated CRP and ESR blood tests and fever are classic but are these symptoms sometimes absent even when infection is present. I'd be grateful for any insight into unusual presentations.

Thanks.

 

[Jaycey]

@jean1702 You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

Please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we will get it changed for you.

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