9 months post THR and still suffering. Any suggestions?

Bones, joints and muscles
1

I had a "successful" THR in August 2017. Did plenty of physical therapy, obeyed all doctor's orders, had a very well respected surgeon. But, I have continued thigh stiffness and pain. All my follow up x-rays and CT Scan showed a hip implant that looked perfect. I was eventually after much pestering told that some people experience thigh pain due to "a mismatch between the rigidity of the stem and one's own body" or something like that. This stiffness isn't the kind of stiffness that goes away with warming up, with heat, or ice, or stretching. It's just there all the time. Walking never feels natural or very pleasant and my gait does not feel natural. To call it stiffness is probably misleading it's more a stiffness/pain. Not excruciating pain, just always there. I feel like I am dragging a lead weight around when it's actually lightweight titanium ! It has affected my back too and it feels as though my back doesn't quite know what to do with my new hip ! That's a subjective description, but it's the best I have.

After 9 months of working hard to be normal, I am so discouraged and sad because some days despite trying to be positive, I realize I am in a way worse off now than before. Have not found the surgeon to have too much interest in me after the surgery, which i think is common, especially when everything looks textbook -wonderful on x-ray. The pain is mid thigh, some stiffness and pain on the hip too, but the thigh stiffness/pain is the worst. It goes all the way down to my knee. My knee also hasn't been happy since the surgery but it's not my top complaint. My knee was swollen for months afterwards, although I had zero knee issues before. It now bothers me when I walk but my main concern is the thigh and the fact that I can NEVER forget I had surgery. I'm always in some discomfort. I walk at most 30 minutes a day because sadly that's my limit at the moment   I can do most chores around the house and shopping, cooking, some socializing etc. but walking is so limited when it should be better with a new hip. It has definitely affected my sense of well-being and changed me for the worse. Has anyone else experience this and has anything helped? 

2

Dear Margot

What bad luck you have had, but you could not have just left it and done nothing so it was reasonable to have expected a good outcome to the surgery.

I appreciate that you cannot turn the clock back but did you check on what the hospital records showed for the success of your surgeon's surgeries!

I don't really believe the story you have been told about a mismatch between between body and stem to be honest. I can well understand that perhaps the positioning of the cup and or a mismatch size wise could be the problem but I'm only speculating.

If I was in your position I would want to check up on the hospital records for your surgeon to be aware of any issues and would find a top hip revision surgeon at a different hospital and see them ASAP to evaluate you and look at your X rays.

Good luck. Richard

3

Margo,

I have the exact same symptoms with my first THR done last August! I have now had my second hip done and quite honestly it is feeling better at four weeks than the first one. I spoke with the home PT person today and she has said that it could be the IT band that is tight. The reasons for this are unknown but it happens. Anyway, she has recommended that I try the KT tape. Go to Youtube and check out KT tape thigh and you will see what it is. Apparently this tape is now available at pharmacies, including Walmart. She is dropping some off for me this evening to try it out. You can keep it on for about five days and then replace it. I am hoping that it helps me. Let me know if you give it a try and if it helps.

4

Thank you Richard. Both the doctor and the hospital have excellent outcomes which is why I chose them. My arthritis was supposedly not the worst but my pain was bad and it was limiting me and so that’s one reason I am so upset about this outcome. I actually now question  if a THR was the appropriate solution for my particular pain.  I did see another surgeon 5 or 6 mths post op . He looked at my X-rays and CT Scan and agreed that it looked perfectly fine and hopefully this would settle down in time. The only comment he made was that “I see you had some lengthening “. I should try to find out how much lengthening occurred although I assume he would have discussed it further if the amount was a problem. I can’t imagine having to go through a revision as this has been a much harder journey than I ever imagined, only to end up worse off. Thank you very much for your thoughts.

5

This sounds like sciatic nerve injury.  Your problems are very similar to mine.    I had a MRI neurography done just 2 weeks ago and it showed stretching of the sciatic nerve, and one part was stretched to the point of no return and scar tissue was present.  The part of the nerve that has scar tissue will never regenerate, but the other parts will take 2 years or more to regenerate.  You might inquire about this and see if this is your problem.  

6

Gina,

This is very interesting and I have a suspicion you could be correct. Thanks for sharing your experience and for the idea. I will definitely inquire. And sciatic nerves only show up on MRI’s or MRI neurography, not the X-rays or CT scans that I had done. I had not considered sciatic pain at all since my pain was a stiffness/painthat makes my leg feel heavy to move. I associated sciatic pain with a more sharp pain or pins and needles. Clearly I need to consider this.

I sure hope you are improving.

7

Dear Margot thanks for the additional information. Have you any idea what approach you had?

BTW your surgery would not have gone ahead unless it was really necessary if you are in the UK.

Cheers Richard

8

Get a LONG-LEG-XRAY, your regular Dr can order it in Australia, but finding aclinic that does it is the problem, I was lucky, GP had no idea which clinic did it, I had to ring around, 3rd phone call, and they knew what I was asking for and yes the did the x-ray. 

I have a 22mm difference, and surgeon even when I complained said repeatedly there is nothing wrong with the surgery,I also have/had that heavy feeling and stiffness.

​I also asked my physio to measure my leg length, she went and got and most senior physio rathe than try herself, and they also came up with 22mm difference, were amazed that it had not been picked up earlier, but not for lack of complaining from me, but nobody took any notice. 

No of course not, just a lot of extra leg.  10mm naturally below knee, which I never knew about as I had it my entire life, apparently most of us have some difference, but 10mm is unusual extra natural length, this not recognised prior to surgery to my belief, and then 12mm added during surgery, prosthesis could have been knocked in another few mm I was told months and months later.

​I wear a shoe lift under my right heel, which gives me enough lift to correct most of the 12mm the surgeon gave me, the 10mm natural can be ignored.

​Try a slipper or flat shoe on the opposite side to the potential long leg, and see how that feels walking around the house, that's what convinced me, no shoe on left leg and when shoe on right I felt so much better, but you cannot live like that, needs to be identified correctly if it is an issue.

​Mine became complicated but trying and trying to walk with the extra leg, as advised by the surgeon and his juniors, you will get used to it, I ruptured S1-L5, bulging L5-L4, and bulging L4-L3, the amount of pain from my back was extreme, and sciatica down the long leg, felt as though I was not recovering from surgery. same amount of pain as during post surgery, just never got better. 

After never having back pain this was a shock, and then to be told there was no link, do they think I am stupid, of course there is a link, but proving it becomes an issue when your x-rays and scans shows a lot of arthritis in spine as well as every joint in body.

 

9

Richard, I had something called mini-posterior approach. This means the incision was just a few inches shorter than regular posterior. Hi tech approach in the US with computer guided navigation system and robotic arm assistance. Highly rated here and everyone has had very good results .....except me! Hospital and doctor both rated well. I think I was probably a borderline case for THR if you know what I mean. Yes, I most definitely had arthritis but not end stage arthritis.  Since I had trochanteric  bursitis also prior to surgery, and since I still have it, my concern is that surgeon was too quick to jump on this arthritis as the true or major source of my pain. Sorry for the long, detailed response ! However I am overdue for pain and disability relief after all this time and I’ll take any thoughts or suggestions from the forum. Unfortunately the surgeon I chose is a few hundred miles away in another city, otherwise I’d be pounding on his door a lot more! Cheers back.

10

Of course Richard, it does me no good to wonder about something that cannot be changed. I must simply deal with my situation as is. I can’t go back and undo surgery for example so why think about that. But I am not a happy camper with things as they are.

11

Dear Margot

Thanks for that, much appreciated. It is interesting to read up medical analysis of the different approaches and how their outcomes compare one with another!

Cheers Richard

12

Dear Margot

Absolutely however knowing what method was used, surgeon, hospital, etc and outcome gives members information that they can use when making decisions regarding their own situations so it is valuable stuff.

I hope that will hear a positive outcome to your situation soon.

All the best Richard

13

Hi margot

I'm 12 weeks post op and u too have these issues. I've been told by my surgeon that he had to fit a size 3 larger hip rather than the size 2 orginally planned. This has caused stiffness to the point I struggle to stand up sit down and even walk. I have to use a crutch continually I also have a massive limp as my tendons and maybe ligaments are damaged. My knee looks out of place like it got moved, I can't bend it. I also have a leg discrepancy of 1.5inch. I ice daily but I end up in bed a lot. I have my first Physio next week. I've seen a few people now with the same issues. I'm UK.

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Hi Lyn, you have certainly had an awful lot to deal with and I'm so sorry. Thanks for the info on this long-leg x-ray as I'd never heard of it. I too may have read that up to 10 mm difference can be tolerated and adjusted to, but beyond that it can be a problem. I should know what the difference is in my leg lengths so I'll try to find out at my next doctor's appointment. It could be a contributing factor in my problem. Of course there is a link between the hip and back as you say ! Good luck....to both of us.

15

Hi Penny, that's too bad. Yea, my knee was sore and swollen from the moment I woke up from surgery and it still bothers me a little. But the thigh bothers me so much more. I'm sorry to hear of your stiffness and pain, it's awful to have surgery and still be hurting, I know how that feels. I do hope your physio helps. They are often much better listeners than the surgeons post-op and they helped me so much in the beginning months after the op. Good luck.

16

If the pain is on the outside of your leg, not the front, not the back, or inside but the outside of your leg, and the pain starts at the hip and goes down to the knee and stops that is classic IT Band Tendonitis. I had it real real bad, and it seems like it is coming back just a little bit lately. When I had my THR the surgeon must have done something (I sure complained to him about it) because after my THR for 3 years that pain was gone.

You can actually feel the IT Band tendon, run you hand up and down the outside of your legand follow the pain, if you do have IT Band tendonitis as you move your hand down your leg towards your hip it will cause pain right where you are pushing down. IF you have that do not do anything to aggravate it. Mine never went away and turned into tendonosis. I was so glad when the surgeon fixed that during surgery.

17

Jodi-France,

No, the pain that I talk about that really bothers me is on the front of the thigh.

its a stifness/ pain. I do believe I also have a touch of IT Band tightness or tendinitis, but that is separate from what i am complaining about.

18

Your description of your problem sounds exactly like me.  You're right about the surgeon, they received their money and it's the end of it.

19

i re-read all ou comments again. First off I can tell you are not a cry baby. Second of all I think 9 months is long enough, if this was going to heal up on it's own you would be at least having some improvement by now, even if it was not completely healed up (no pain). Something is going on here that I do not remember reading on this forum in my 3+ years. Mid thigh pain is not a pain anyone I can remember ever posting, well at least 9 months after surgery, mid thigh pain. It's very unusual. I tend to believe it is nerve damage.

In France my surgeon required I meet with the anesthesiologist for a regular doctors appointment. The anestesiologist had a lot of questions for me which I answered and then he explained what he would be doing. He said the most important issue for him was to protect a very important nerve. He said he actually anesthetized that nerve during the surgery, I forget now exactly where that nerve was but it was on the front of my leg. If I remember right, and I think I do it was the femoral nerve.

Look up on Google- Femoral Nerve damage after total hip replacement. and also this article google this one,

"Delayed Femoral Nerve Palsy Associated with Iliopsoas Hematoma after Primary Total Hip Arthroplasty"

After 9 months you should not be in such rough shape. Of course for nerves you see a neurologist. Could be the leg lengthing also, but at least read up on femoral nerve damage after THR and see if your symptoms match.

20

Look for images of the femoral nerve, that goes right smack down the front of the leg.