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Discussion in 'Hip Replacement Recovery Area' started by Jws., Apr 6, 2018.
I don't believe I ever received your xrays
@Josephine @SaraK. I have gone back to my four OS and internist and they "reversed" on their opinions. (what else is new?).
The one "sage" doc went from trochanteric impingement to psoas impingement and the way he would treat it would be to OPEN the posterior area and free the tendon ALL along the lower trochanter. He says that there are other muscles there and the "freeing of the whole tendon" - "full release" would not make the leg weaker.
I have read up on tenotomies for the last two days and all have said that the idea of a full release is never a good idea, that a multiple cut or fractional release is the way to go. They also indicated that an open surgery for the tenotomy is not a good idea rather it should be done arthroscopically (i.e.less risk of infection, dislocation, etc.) and the fractional release (lengthening) will eventually allow the tendon to grow back and you will not lose much muscle power in that leg. He did agree that a cortisone shot in the psoas would be a good diagnostic tool to see if it is actually psoas but said he was not hopeful it would take away the groin pain for more than a week.
My primary OS surgeon without much manual testing issued a prescription for a cortisone shot in the psoas and came to that suggestion as well - psoas impingement. He said there is a possibility the cortisone shot could be "a one and done".
The third OS I saw came to the psoas impingement as a possibility and said no harm in taking the cortisone shot as diagnostic as well. He does do arthroscopic psoas tendon fractional releases and he indicated "I would be real lucky " if the cortisone shot worked for more than a couple of weeks but there is always a possibility of a shot being "one and done".
My fourth OS who I actually scheduled for the psoas shot in two weeks under ultrasound said there is a possibility of "one and done" as well but said after that arthroscopic fractional lengthening tenotomy would be the last chance.
I talked to a very credible patient who had the multiple cut arthroscopic tenotomy done and she was generous enough to spend time with me and her result was great. She indicated that it should be a fractional release and the cuts should be "proximal to the acetabular cup near the lesser trochanter.
@Josephine my concern is this; before the diagnostic cortisone shot this Friday - I have read that there is a OS doc who does these regularly and he has indicated that the cortisone shots given with u/s don't work and that the shots given under fluroscopy give 70 % accuracy and pain relief.
Jo I have two questions;
1. Do you or anyone on the forum know whether the fluroscopy shot is that much better than the u/s and should I only do it under fluroscopy? If I did it under u/s this Friday I would have to wait three months before I could do another one under floroscopy.
2.IS it realistic that the cortisone shot could be a "one and done situation"?
Any help on this would be greatly appreciated. Any other thoughts on the risks and dangers or suggestions on tenotomy would be welcome as well
thank you all.
To be honest, I am alarmed at the thought of you having a full release for this problem. Certainly as a first shot scenario anyway. I've never seen such a procedure done, not ever. And I think the recovery could well be equivalent to the original hip replacement! Horrendous!
I once worked with a great ortho surgeon who used to say "always use the little guns first"! And he was right! And then work your way up the bigger treatments.
So in terms of guns, I'd list them
1. cortisone shot - maybe repeated in 3 months
2. closed (meaning no incision) or arthroscopic tenotomy with or without u/s or fluroscopy (which is actually just xray using an image intensifier which shows an active screen shot rather than a static one)
3. closed or arthroscopic release or Pie crust (dry needling) release
4. thinking time
5. more thinking time!
6. full release - perhaps, maybe, maybe not!
I've had cortisone shots in my shoulders every 3-6 months for years and they do work pretty well but they don't last forever. But I also had a cortisone shot in a right trochanteric bursitis twice and both times it was a 'one and done' situation.
Whilst reading though your thread, I cam across a post where I asked you for your xray which you appear to never have supplied. That would be helpful, you know
@Josephine..I agree from all I read I will not be goining in at any time for a FULL release.
In reference to your "little guns list"...I agree whole-heartedly...
I am starting off (hopefully finishing) with a cortisone shot to the (hopefully) bursa of the psoas.
My major issue here is the OS wants to do it under ULTRASOUND and from all I read Ultrasound shots can miss the mark and not relieve the pain, whereby shots under FLOROSCOPY are much easier to see and have a 70% higher rate of success. I need a "true" diagnostic shot that can tell me if it is psoas or not and if U/S is not accurate I may never know if it is my psoas or not.. Josephine , is the above true..this is important .. as I can cancel the shot using the U?S and there is another qualified OS here in LA who does the shot under floroscopy.. I like the OS doing the U/S shot but not that much that I get a poor result..Pleases advise on this asap as I am scheduled to get the shot friday.(along with a shot again (wore off) in my trochanteric bursa).
No one suggested "pie needling" ...Is that a surgical procedure done by OS's or ?? do they do it to psoas as well as IT band? does it work well to lengthen the psoas muscle? Is it relatively simple like acupuncture?
Are you saying "thinking time" , that I just give this more time (it's been 12 months post op, having constant groin pain sitting now and when walking)...ABSOLUTELY MISERABLE...
A unique thing happened yesterday, I had my PCP measure from bone to bone the way you described and he came up with a 2" lld (a lot right)whereby my right operated leg was shorter...two of my other OS's from time to time also dx a "short hip" as the problem , and a 2-3cm difference caused by the surgery and my natural pelvic state which was slightly shorter but increased with the surgery.
As a result I went to my podiatrist (friend) who said it wasn't 2" (says thats a lot) but did give me cloth lifts (1/2 inch) to put in my shoe about half inch. I walked with the lift yesterday and my pain was better , my gait was better...could the shortness have been causing my groin pain and could this be the "miracle-smallest gun cure ever ) to alleviate the groin pain from whereever (psoas, it ,) and give me relieve.. (from my lips...)..
Please advise ...I will send you the xrays as soon as i figure out how to or have my it guy do it...(all my OS's looke at it and said it was fine except the one who said my primary OS didn't leave enough room with the ball and lier and that's structurally causing the impingement...
Thank you for always responding so quickly ..you have been a g-d send..Jeffrey
Anyone else who may have suggestions please reply...
See if this helps -
Hope you have a good day!
My surgeon sent me to a pain management specialist who kept thinking that the sacrum was akilter and or the two sides of the pelvis were tilted in different directions (pelvic torsion) and that this was causing the psoas to spasm and cause all of my problems. None of the therapies her PTs did (including giving me a heel lift to use for a while) helped me (actually caused more pain) and one PT told me the imbalance was very slight and in the range of normal. The back and LLD are definitely items to rule out before surgery. My injection, that diagnosed the impingement, was under fluoroscopy and into the tendon, not the bursa, since an MRI had ruled out psoas bursitis. My injection was done by radiologist not surgeon. I asked about U/S v fluoroscopy and she said both could give good results by someone trained and experienced and more an issue of which method the person doing the injection was comfortable with. Josephine might have more/better info, though.
The correct term is pie crust OR needling. Did you look at the article? As far as I know its use is pretty wide spread.
I would agree that 2" is a lot! Probably the biggest LLD I've heard of! But you seem to have had quite a good result from the lifts.