THR Psoasis Relief

[dapplega]

@Jws - just my 2 cents (which is probably worth less than that)... If there is an impingement issue couldn't it be clearly shown/demonstrated and not be subjective. If the impingement occurs during sitting you'd think an xray could be taken in that position validating the diagnosis... I hope you get some positive news...

 

[Josephine]

maybe I didn't explain it correctly....so I am including a short abstract of the physicians who did the study...

I'm so sorry - it seems we were both understating the information! That article (and more, the xrays in it) were VERY helpful.

Trochanteric Impingement

I incorrectly jumped to the conclusion that this referred to the greater trochanter when in fact, it was the both the lesser and the greater trochanters! You can see in the xray here

The reference to the cup exchange would be about the greater trochanter coming into contact with the rim of the cup. Likewise the lesser trochanter can make contact with the ischial tuberosity but I think that would be unlikely unless you were in the habit of crossing your legs a lot! But it should be noted that the lesser trochanter is also the attachment for the psoas tendon, as you can see here.

The Os rx "Trochanteric Impingement" .
You said "I never heard of that before"

I think you might find this article helpful when wanting to quote snippets
How to use the quote feature

 

[Jws.]

Josephine, are you saying now that you have heard of "trochanteric impingement" and IS it a viable theory. More importantly have you heard of it "mechanically" causing groin pain and is the "fix" (changing the liner) one which is relatively easier to do than a full revision. I really value your opinion, after I received that diagnosis. I asked two OS's and they say that in theory it makes sense but they have not come in contact with a case.

Have you come in contact with a case similar to this and would you go ahead and do it if you were in my position.

Others have said to first try the intra-articular shot of cortisone in the groin as the more conservative treatment (is there a possibility of infection with shot?) and give it until a year (it's been 9 months) and see if it gets better. (they believe I will still be left with some pain).

What recommendations do you have for conservative treatment? or ??

I know you speak directly and don't hold back and that's what I need...I keep getting the runaround from the OS's here in LA.

 

[Josephine]

Josephine, are you saying now that you have heard of "trochanteric impingement" and IS it a viable theory.

I'm saying it is possible in theory.

More importantly have you heard of it "mechanically" causing groin pain

I'm afraid not.

is the "fix" (changing the liner) one which is relatively easier to do than a full revision.

Changing the liner would never be easier to do than a full revision. Changing the liner IS a revision.

I asked two OS's and they say that in theory it makes sense but they have not come in contact with a case.

Well me neither!

Have you come in contact with a case similar to this

Never

Others have said to first try the intra-articular shot of cortisone in the groin as the more conservative treatment (is there a possibility of infection with shot?)

There is a phrase in medicine which goes "little guns first" which mean, always try the simplest treatments first. I'd say that was a pretty good maxim to use here.

Is there a possibility of infection with shot?

Not if the injection is carried out under strict sterile conditions. There shouldn't be any more risk that with the original surgery.

 

[Jws.]

@Josephine I am now 11 months post hip. I still cannot tie my shoes and put my socks on but I have no pain sitting or standing. In just the last month my groin pain went away (miraculously) and most of my limping went away. I am able to spin for an hour and a half with no pain (love spinning) where I couldn't go 10 minutes without groin pain, and walk right after for an hour NO PAIN

However, even though all was getting better, the last two days my right leg is stiff as heck and my leg and hip are like "peg leg" without any pain just the whole area hip top thigh ,peg leg ...(not exactly a limp when walking but difficult not "free flowing".)

Josephine my concern is, even though things are improving, am I still healing or am I stuck with this stiffness and "peg leg " syndrome. It took me 11 months to heal this far. Don't know if that's it or could this tightness work itself out or is it a psoas thing that I can get a steroid shot for.

Please, your thoughts. I don't want to go back to that miserable emotional and physical place I was 2-3 months ago. Anybody else. Thoughts would be appreciated.

BTW it generally happens with soled shoe (not sneakers and more restrictive jeans)

thanks

 

[Layla]

Hi,
Sorry you're struggling somewhat and have questions. Josephine is away from the forum
for a few days but she will see your tag and address your concerns once she's available.
Please check back periodically.
Wishing you comfort and a pleasant weekend.
@Jws.

 

[Mojo333]

I still think at 11 months out...and with your issues prior...an hour and a half spinning is too much and may be causing some of that stiffness.
It never hurts until we stop.
If there is an issue...impingement or otherwise...then it certainly would have to aggravate it I would think.
I know you want to be well and fit..but can still be a matter of overdoing it.
I'm sure Jo will have thoughts but please do take it easy in the meantime.
Hope today is a better day!

 

[Harryn1]

Hi @Jws. Sorry to hear you’re having issues.

My own personal experience with spinning classes (especially the 90 minute ones) is that they were too demanding on My new hip. The violence of the sprints, the constant standing and sitting, and compliance with the demands of the instructor just put me into pain - it was too jarring at the time (I was about 4 months post op).

I have no issues at all with just cycling, whether indoors at home or outdoors; it is very forgiving and wonderful. I ride most days but Sadly, have stopped spinning completely for the time being. Maybe forever.

Also, here’s another thing. A month or 2 ago, I just felt weirdly lazy. Normally, I come home from work and ride my bike, mostly indoors. But for 2 weeks or so I hardly exercised. It was after that fortnight that I realised that the last of the twinges of post operative hip pain left me. I ascribed it to arriving at the 6 month milestone, but in retrospect, I think my body also just needed a break from exercise.

 

[Josephine]

I am able to spin for an hour and a half with no pain
the last two days my right leg is stiff as hell and my leg and hip are like "peg leg" without any pain just the whole area hip top thigh ,peg leg

I think you see here cause and effect. How often have I said that over-activity will result in aches and pains.

am I still healing or am I stuck with this stiffness and "peg leg " syndrome.

I can do no more than refer you to this oft posted comment of mine:
Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

 

[Jws.]

Josephine, Mojo333, Harryn1 - 12 months I am still having groin pain and thigh pain around the top of my thigh. It has localized to when I get up from sitting I will have the groin pain like a tight band by the groin as I am getting up, will stand and walk a couple of steps and the groin band will transfer to a tight band around my right thigh (operated side) and feel like peg leg, and stiff as hell, like I am fighting through to walk.

I saw my OS and he said he thinks it's the psoas and suggests a cortisone shot in the psoas. I saw another credible OS here in LA two months ago and he thought it was trochanteric impingement and said it wasn't the psoas at all (Lawrence Door) and he wrote the paper on psoas impingement. My OS talked to the two surgeons who wrote the paper and did the surgeries on the trochanteric impingement and they said "nope" wasn't that.

So here's the thing... I have found that if I am having "groin " and thigh pain...if I get on the stationary bike and ride for about an hour ... I have no pain while riding and after the tightness band around the thigh dissipates and my walking is better..(no residual pain after)...

When I went on the bike a month ago I was fine for two weeks and no groing pain and no thigh pain and could walk. I stopped the bike for two weeks and the pain came back.

I know my body pretty well and I believe the biking actually is stretching the psoas or whatever and relieving the pain.. since there is no pain, none, while biking . I am not spinning hard just regular biking in place sitting up and no pain after. If I don't get on the bike for a day or two my whatever muscle or tendon contracts and I have groin and thigh pain again. Very localized and always the same groin and top thigh band of pain.

I am really depressed as I am going through it with this roller coaster of pain/no pain and OS differential diagnosis.. I am at my wit's end after a year of this.

I am going to have the psoas cortisone shot in the psoas muscle or tendon or bursa?

Does that area communicate with the hip and am I risking infection? Could I get lucky and is it likely a "one and done " shot that could cure this on and off pain? Could hard or heavy stretching relieve the pain? Is psoas tenotomy a reasonable option??

Please Jo, any help here would be really appreciated. Any thoughts or similar experiences would be welcomed. As you can see from my posts this has been a horrible journey for me. I just feel at times like I want to rip it out - sorry but that's what I feel.

Any help or insight would be appreciated!!!

 

[Mojo333]

So sorry you are still struggling!
@Josephine
Any thoughts about this?

 

[Josephine]

I was going to post my pain chart for you but it seems I did that before. Your answers gave me a description like this - is it still the same?

However, though I never said it outright before, I did muse with the possibility that you have a loose stem. You can see quite a distinct shadow all around the femoral stem. And the pain sites you declared are all focused on that site.

 

[prairienut]

Josephine's musings would be worth looking into. I have read that it is not always easy to diagnose a loose prosthesis from the X-ray. It at least should be ruled out.

For what it's worth, I will tell you my experience. I had a loose femoral stem for many months and possibly years before it was revised. I self-diagnosed my problem before seeing the local OS back in November by noting three common symptoms of a loose prosthesis: 1) "start-up pain" which in my case meant that in the morning, my hip was very sore, and I limped badly. By the end of the day, I could walk around almost normally with no assistance device. Apparently, the prosthesis can move slightly out of position while sleeping (or sitting), then has to re-seat itself once you are active again. 2) "pain on straight leg-raise" When lying down on my back, trying to raise my straight leg off the bed was painful. 3) "giving way" At times the joint would feel as if it were collapsing. This caused me to suddenly fall three different times. Surprisingly, these episodes didn't hurt. The hip just felt very unstable. So by the time I went to the OS, I was prepared for the bad news. They confirmed the diagnosis with a MARS-MRI.

 

[Josephine]

Josephine's musings would be worth looking into. I have read that it is not always easy to diagnose a loose prosthesis from the X-ray.

Problem is that an awful lot of surgeons these days, don't know how to spot a loose device on an xray! Even my own darling surgeon whom I trust above all, couldn't see mine on the xray! But I was trained to spot them back in the 1970's by a surgeon who was Charnley's right hand man for many years until he moved to the hospital where I worked. He was an amazing surgeon and made the most complex revisions look like a primary. I doubt many surgeons these days have had the benefit of such a illustrious education in a single subject!

 

[prairienut]

@Josephine, You have had an amazing and long career in the field of joint replacement. I doubt there are any other ortho nurses around with your depth of experience and a sense of how the technology and techniques have changed over the decades. You are right about many OSs not spotting a loose prosthesis on an X-ray. I went for years diagnosed as "bursitis" with an Rx of PT when I know now it was the gradual loosening of my femoral stem over a very long period. It is hard to describe the wonderful feeling of having a solidly fixed femoral stem. Actually, it's a lack of feeling -- i.e. lack of pain. It does scare me how long the stem is compared to my original one, but if that's what it takes, I will just have to get over my qualms.

 

[Josephine]

Thank you, pairienut. Your words are very touching and I appreciate them.

 

[Josephine]

This is not my xray right?. This is the xray in the article I sent you. So the person in the xray may have a loose stem. If I send you my xrays can you tell if it has a loose stem. Given your years of experience reading these and finding your own loose stem. Will you be able to tell if I have a loose stem.Thank you, please help. Jeffrey

Jeffrey. You sent me this pm. I'm just wondering why you haven't also sent me your xray. But in here, NOT in a PM.

 

[Jws.]

@Josephine I saw my fourth OS today regarding my groin pain. 12 months to the day of my THR Not being cute here, I need that many to get consistent answers. It's frustrating and depressing. My primary OS talks very little and the rest don't really want to take on his work but you can eek out some corroborating second and maybe even third same opinions.

Josephine I will be sending you my xrays here. He suggested that I have some HO and that as per other OS 's suggestions he recommends having one cortisone shot to the psoas (as it "MAY" be the problem). If the cortisone "takes" and relieves the groin pain from two weeks/4 months he would give it another try with the cortisone shot and if that worked even for two weeks or more than he would recommend doing a psoas tenotomy.

He then said if the psoas shots only work 50%, he would recommend arthroscopic removal of some stray HO and scar tissue and at the same time he would "nick' the psoas tendon because he believes it is not only a psoas problem but also a "scar tissue around the capsule problem".

My fears here even with the shots in a surgicenter is the "infection " possibility because 15% of all patients, their psoas communicates with the capsule.

He also indicated that if some cortisone happen to get into the capsule "it wouldn't be a terrible thing as it may help to break down the "collagen" and help with the stiffness and range of motion".

I saw my primary OS a week ago and he just thought it would help with a psoas shot and didn't mention scar tissue or HO.

The third OS concurred with my primary to try Psoas shot then would try arthroscopic tenotomy.

It has been now one year post THR and I am at my lowest ebb. As you all know the ups and downs of this is heart breaking, especially when you see people heal and be on their way in 3 months pain free.

Jo, I need your insight regarding the above and any of you others who have had the cortisone shot to the psoas and groin pain and/or a tenotomy and groin pain.

Please, please reply with your story and opinions as to good and bad and your suggestions. I don't want to be a gymnast. I just want to be free of the groin pain, walk pain free and see my grandkids. Thanks.

 

[Mojo333]

@Jws.
I can only imagine that this is so frustrating and Josephine Would be the one qualified to comment on the information you have received.
I just want to say, I am hoping this gets you closer to being pain free.

try Psoas shot ...then would try arthroscopic tenotomy .(slight Nick).

I believe this is the route @SaraK had to take and if it is to be...she had a release done one month ago so she could relay how recovery is going.

 

[SaraK]

@Jws. - I posted on your thread on October 16 telling you that your symptoms looked a lot like mine. I had groin pain that continued to get worse even as I reduced activities. ROM also decreased. After several months of PT (4 diff PTs) and 2 new docs, I was finally diagnosed with psoas impingement (the diagnosis I'd been fairly certain of for several months). As Mojo said, I had tenotomy a month ago today. Recovery from surgery was quick and that pain when trying to do anything went away within a week or so. Because it lengthens the muscle, full recovery takes a while but I'm already so happy I had the surgery. The cortisone shot was amazing but gave relief for less than 3 weeks. My doc (not orig OS) said that confirmed diagnosis but didn't bode well for further shots and referred me to the surgeon who did the "nick." Just like THR, there are different approaches - where they cut it and full cut v many small ones, but end result should be similar.

If you want more info, look at the last few pages of my thread or tag me again here with questions.

Good luck!