THR Weight bearing concern - 6 months out

[Onna123]

Hello everyone - thank you in advance for any guidance and for your support & understanding.

My LTHR was 7/2016. Anterior approach by a very reputable and experienced surgeon. I am 56 years old and was in good shape prior to surgery with the exception of my left hip and leg, of course. MRI findings were numerous including advanced osteoarthritis, moderate sized joint effusion containing chondral loose bodies, torn and detached labrum, grade 2 tendinitis of the gluteal cuff abductors, and more... Prior to surgery I could barely lift my leg and I know my left leg area was weak for quite some time and my gait was very off. Left side was compensating as best it could for pain and lack of function.

I am now 6 months out from surgery and walk with a continued painful left side and I limp due to this weight bearing pain. (mostly in the posterior top leg area and top left side). I am not overweight but do carry my extra pounds in my lower body - pear shaped! My leg does also tingle some and does not bend as freely as my right side. I have been faithful with my exercises, previous formal PT after surgery, and now just love having discovered pain free movement in the pool! I believe everything else is fine as I can easily perform all my exercises with the exception of the SLS (single leg stance) on the operated leg. My body tilts way left, my groin is so painful and I cannot stand on this leg for more than 5 seconds - unless in the pool.

I am walking without a cane, quite often as needed during the day, unfortunately with a bad "hobble." Aleve, Advil does not help. I only took Oxycodone prior to PT or when I overworked in the few months after surgery.

I plan to meet with my surgeon. I have been in contact, occasionally with his PA, who has advised me not to overwork, this takes time, healing is different for everyone, etc. but due to the 6 month time frame he felt it is reasonable to now meet w/my surgeon.

I am wondering if I am being too impatient as I know my leg was very compromised prior to surgery but feel after 6 months I should be rather pain free and walking smoothly without this awkward gait. I want to understand the why's but also fear they will want to send me for much testing. An MRI I do not mind but bone scans and/or CTs worry me as I have had many CTs and PET and nuclear medicine scans w/radiology in the past and actually that is one reason I delayed seeking help for my hip pain.

Has anyone experienced anything similar after 6 months out ?

May I ask how you managed this situation and what your outcomes were ?

Josephine - I believe I read you are away from this forum for a bit (maybe not?) but certainly would value your expertise I this area when you can comment. MUCH APPRECIATION

 

[Jamie]

Welcome to BoneSmart. I'll tag @Josephine for you so she can comment when she returns to the forum from her vacation.

It is definitely not normal to be experiencing the type of pain you're describing at 6 months out from surgery. I'm glad you're going to meet with your surgeon.

Do you have some other underlying medical conditions that might be causing you problems? You mentioned having had CTs, PET and nuclear scans.....what were those for?

 

[Onna123]

Thank you, Jamie. Scans years ago were from the discovery of a large liver tumor and elevated tumor markers. Benign results after a major cancer center ran these numerous tests.

I am thinking that additional tests will want to be run for my hip vs only gait training for my limp (which would develop muscles not recently been used.). Since Josephine has been involved in hip issues for so many years I was wondering what, if any test, she would think they would be running and what they might think the issue is.
Also, the pain is not as bad with more elevation and rest. That is why I was thinking/hoping overuse causes this.

 

[Onna123]

Hello - wondering if Josephine has seen my post and would be able to comment with her expertise.

An update is that I met w/my surgeon's PA as my OS was in ER surgery at my appt time - he practices in a large hospital. My x-ray, they advised me, was fine however my opposite side pelvis is now tilted, also, as I saw on the X-ray.

PA examined me and the problem is in my leg he believes. He has me taking Diclofenac 75,
doing IT Band stretches and asked me to really try to rest the next 2 weeks and do daily massages (2 times). He stated in his office visit notes I have severe bursitis (he did a thorough manual exam)
and very tight IT band. One week since my visit and it seems better but far from perfect.

He texted me that he spoke in detail to the surgeon (he is a Castle Connolly Top doc who is also a revision specialist - but very busy). He said the OS agreed w/the above and suggested an injection if symptoms don't improve and that he believes the tilt will improve by working on eliminating the pain in the trochanteric bursa and ilio-tibial band. If it does not he suggests a spine consult.

Josephine - I'm trusting that I was in good hands - I am 7 months out. I trust the THR went well and that I am experiencing this pain as my leg/hip was very bad prior to my surgery. More time to heal that others - I never could really apply any weight without pain prior to surgery or anytime after. Don't want to over-react but don't want to wait too long. In your opinion does this sound like a good plan (bursitis / IT band issues) or should I seek a 2nd opinion at this point. I certainly do not know what I am looking at w/my X-rays. And while I have seen others post their photos to you - I am not technically savvy and wondering how I can get these on line to you.

Thank you very much

 

[Josephine]

I'm sorry I didn't see your post earlier but I was indeed away for a couple of weeks.

He stated in his office visit notes I have severe bursitis (he did a thorough manual exam) and very tight IT band. (He) suggested an injection if symptoms don't improve

This was my opinion as I read your first post - ITB (ilio-tibial band) issues and Trochanteric bursitis.

I have been faithful with my exercise

This can be the primary cause of these issues - too much and too aggressive exercising or gym work! Do read the articles - save me writing it all out again!

 

[Onna123]

Thank you, Josephine.

I did read the attached articles and will continue my stretching (most of these were given also by PA!), rest and ice more and continue massaging. The article on acupressure massage was extremely helpful as I was not doing it properly (w/knuckles, etc) or often enough throughout the day. Thank you for this -what a difference doing it properly makes - I really feel the tenderness now. WOW.

I would like to keep you posted in the weeks ahead.
I will remain positive and continue to focus on doing all I can to get better.
You are appreciated.

PS - hope your time away was for good things

 

[Josephine]

Fantastic! I'm so pleased I could help you.

 

[Horseshoe]

I'm six mos out from my first thr too, my quads took a long time to recover (are fine now) and suspect I was overactive by bopping around, going to stores several times daily, etc. I had developed tendinitis in the front (quads) and side of thigh muscles, very painful, but don't recall any weight bearing pain, just aching when I walked or got up from a chair.

What did help was lying down, resting and icing my legs for a few weeks although it was boring. I did not do any PT.

If you don't see much improvement, it would likely be useful to see a revisionist OS from a different practice and/or ask to see your OS directly, not the PA, and have him to read your xray. Josephine is very good at spotting things in xrays if you're able to post it on here.

 

[Onna123]

Thank you, Horseshoe - I just read your response.

Doing a bit better w/stretching and massage. Not too much, though.
I will find a friend who can possibly help me post my X-rays as I am not technically savvy at all.

I believe my situation is similar to Karla's as I read her story.... In her story it seems an injection once helped Josephine with similar pain. My plan is to keep stretching, massaging, icing and heat - try and load my x-ray for Josephine's review - try an injection in a few weeks if no relief and see where we go from there. I can walk unaided - just somewhat painful and limp. Never was able to balance on operated leg like Karla either.

Hope your healing is going well

 

[Celle]

I will find a friend who can possibly help me post my X-rays as I am not technically savvy at all.

This article may help:
A few tips on posting xrays

 

[Onna123]

Thank you, Celle - very much.

Great instructions - now to find someone to help

 

[Pewaukee]

Hello, I am almost 6 months out and felt the same way you do. I was so discouraged that I have not progressed faster. I used my cane still and had a bad limp. Could not balance on one leg either.

I also discovered the pool. It felt like heaven and I was contemplating becoming a mermaid so I would be pain free. I went to see another surgeon to get a second opinion. Known to be the best in the Midwest. He does 400 knee and hip replacements per year and knows his stuff. My surgeon said my legs were the same length, the new surgeon said they were off by 3/8 of an inch. So he recommended a shoe lift. I put the whole 3/8 in at once which was a huge mistake because it freaked out my body. So I started with 1/8 for two weeks, then added another for two weeks etc. It has made such a huge difference in the way I walk but my thighs still ache.

I feel we all recover differently and this was MAJOR surgery. I cried ever time someone said, my aunt or whoever had that done and they were out and about with no cane after 6 weeks. This is not very encouraging and those people should not say anything at all. We will heal and we will be so much better, but the journey can be rough. Prayer has helped me!


Sent from my iPhone using BoneSmart mobile app

 

[Krista]

@Onna123, I had an experience similar to yours. My THR was in July, 2015, and by December 2015, I was seeking help because I could not do the single leg stance (even for a second) on my operative leg, and when I tried my leg collapsed from under me and sent me off to the side. I had a severe limp when walking without aids, and pain in my buttock. X-rays of my hip showed nothing wrong. Physical therapy didn't help. Problems with my spine and sacroiliac joint were ruled out. A tip from a person on a different hip replacement forum got me thinking that perhaps I had a torn gluteus medius and/or minimus tendon, since they are essential to being able to hold your hip steady when on one leg, like you need to do when walking without a limp. My original surgeon was stumped, so I sought out another surgeon who did gluteal tendon repair surgeries in addition to joint replacement. He saw my tendon tears on a MARS (metal artifact reduction sequence) MRI that were bad enough to require surgery for repair. X-rays don't show soft tissue damage. I had the surgery to repair them in Oct, 2016. The bursa on my greater trochanter, which was horribly inflamed, was removed, and my greater trochanter was smoothed out because of impingement. My IT band was very tight as well, from the year+ of overworking it when my glutes weren't doing any work at all.

I am well on the way to recovery. I can now balance on the surgical leg, for up to 20 seconds. I am slowly regaining the strength in the repaired glutes. They were in sad shape after doing little work for a year and a half. From my story and others I have read, it appears that many doctors who do hip and knee replacements are mainly concerned with the bones and the prostheses, and they may not be aware of all the soft tissue issues that can cause problems with walking correctly. You need MRI or musculoskeletal ultrasound, coupled with a skilled physical exam, to see what's going on with soft tissues.

Wishing you the best in getting properly diagnosed and treated. I hope your current efforts and plan will get you to recovery, walking without a limp and no pain!

 

[Onna123]

Thank you Pewaukee & Krista


Krista - I am glad to hear that you are doing better
I had read some of your posts and noted similarities. I appreciate you sharing your situation.
I hope to be in contact in the future w/you to share our progress.

Pewaukee - I hope your lift is helping your pain. I must say the stretching/massage I began a few weeks ago is helping me - far from perfect - but better. I don't know if you do any stretching - while I would never advise you please know how this helps me.

May I ask how your 2nd surgeon determined the leg length difference ? Exam only or scan/test?

I plan to continue my stretching, etc, get Josephine a copy of my X-rays (when I get someone to assist me with this), get a cortisone injection if needed and in a month or so if things aren't improving w/my gait and the pain I will see another surgeon for his opinion. With me, my operated leg is the one that feels shorter (I hear it typically is the opposite). I wonder since I compensated for the pain for so long prior to my surgery that maybe the tightness, pain in the operated leg, etc. is what is causing my gait to be off. I will do whatever I need to improve - it is just getting the proper diagnosis. I had the anterior approach and still also have some numbness in the front which also doesn't help when walking. My leg just seems off - but my hip seems great! No arthritis pain which I am so thankful for

Much appreciation to all.

 

[Jaycey]

I wonder since I compensated for the pain for so long prior to my surgery that maybe the tightness, pain in the operated leg, etc. is what is causing my gait to be off.

That and the muscles in the leg atrophy as you try and stay off that op leg. Sounds like the gentle stretches are helping.

With regards to leg length - they can do a measurement on your x-rays. You can also have an experienced PT measure you. Here is an article from our Library on LLD including how it is measured.

 

[Onna123]

Jaycey -

Thank you.

1) with regards to LLD - typically, should I have had an x-ray of my entire legs (that was done at one time?)
I have only been getting copies of hip/pelvis.
Possibly prior/after surgery they did a full leg x-ray to measure? I was not awake if it was done ! The only results on the hospital "My Chart" and copies of the discs I have are hip/pelvis. Should I try to obtain additional ? If I decide to get a 2nd opinion what should I bring in addition to hip/pelvis x -ray, 3T MRI I had prior to surgery, MRI lower spine, etc.

2) with regards to your site - how can I tag someone to read my response to them ? Once I just "post reply" does it go automatically to them ? Thank you.

 

[Jaycey]

Don't worry about more x-rays. Surgeons typically like to have them taken pre-consultation. And no, they only need a straight on x-rays of your hips. They check and see if both hips are lined up. This doesn't mean there isn't any LLD. But they can see if you have any tilting of your pelvis. Ask the surgeon's office what you should bring before your appointment. My surgeon's also checked to see if both knees lined up.

If you are posting in a reply to the member who just posted on your thread they will get an email notice that you have posted. This is assuming they have check that they want a notice when someone has posted on the thread. To tag someone use the @ sign followed immediately by the members user name (no space between @ and the name). If the tag is working a drop down menu will appear. Click on the members name and the tag should turn blue when you post the reply. Like this @Onna123

 

[Onna123]

@Jaycey - Thank you again. Trying the tag - your name did appear in a drop down box.

I do appreciate your knowledge - I feel like a bother but you have been helpful w/information I have confidence in. I appreciate knowing your surgeon measured your knees - I mentioned this to the PA as my operated knee definitely appears higher (I do not know if it was off prior to surgery as I never noticed it but never really paid attention to this) - and my pelvis is definitely tilted more as we saw on the X-ray. This operated leg does feel shorter (I will try to get the x-ray uploaded here in the weeks ahead for any advice.) but this is the leg w/the IT band issue and bursitis pain - getting better w/stretching but does feel tight and doesn't bend great. I mentioned the higher knee issue to the PA and he said "they measured" and my legs are fine. The PA said my OS (who was not available at my appt) said that if we can work on the eliminating the pain it will hopefully resolve the tilt. If not he recommended a spinal consult. I don't want to get anxious about all this. I am grateful and would be fine just knowing that time and my stretching/massaging/building atrophied muscles/etc. will eventually even things out. It has been 8 months and I am trying

I understand OSs are busy and dedicated to current issues. I just feel that I do not understand what is causing my current situation. While I hate to now look into seeking another opinion - possibly in the next few months I should.
I thought I did all my pre-surgery legwork so well to find a good team to go to - I know they have a great reputation. Possibly a 2nd opinion will reassure me that all is fine or let me know my issues and what they feel my next steps should be.

I have a surgeon in mind if I move forward w/a 2nd opinion. I believe I read in a post that Josephine has a list of surgeons she would possibly recommend. Is your group comfortable w/providing recommendations ?
@Josephine

Much appreciation FOR SURE - may kindness return to you all in the beautiful way it is given.

 

[Jaycey]

The tag worked just fine!

We are happy to help in any way that we can. Unfortunately Josephine can't recommend anyone in the US as she is in the UK. Our other admin @Jamie is in the US so I tagged her. But I am not sure she is familiar with your area.

The other option is trying the clinic finder on this site.

Depending on how long you limped around before your THR it may take awhile to resolve all these issues. Did your surgeon suggest an injection for the bursitis? Josephine swears by these.

 

[Onna123]

Jaycey - Ok - I will wait to hear from Jamie - I do have a surgeon in mind - if 2nd opinion.

Yes - surgeon did recommend injection if stretching/massage did not provide good relief.

Have a good weekend.