Chronic pain after total hip replacement

I had total hip replacement last December. It had been a long and painful recovery. The surgery apparently is going well thru x rays, but I still have chronic pain in my butt causing a limp and still walking with a cane. I am almost as bad as before the surgery. The hip was bone on bone. I have done everything to try to alleviate the painful muscles, but nothing helps. I take 4 Advil every 8 hours for pain. Hoping someone can shed some light on what to do next. Thanks!

Hi, I empathize with you. Have you spoken to your PT ?    I had my THR almost 4 weeks ago, and have noticed a pain in my butt also....it feels like tightened muscles. I told my PT about it yesterday, and she said that it was one of many expected pains. She stressed that I  should do my stretching exercises and butt tightening exercises daily, and whenever I think of it. So, I will listen to the experts, and do what they say. Next week, when I visit my orthopedist surgeon, I will talk to him about it also. Are you doing your prescribed exercises regularly? Good luck!

What approach did you have Linda? Anterior or posterior? I bet it was anterior.

Posterior....I have been thru 2 months of PT. At home, I'm not that strict about it. Truthfully, I have been so depressed because I keep thinking that this is what my life will be like forever. The PT said that it is piriformis syndrome with sciatica. Very painful. I have tried every natural remedy known to man.....nothing really helps. Sorry .....going on and on. Sometimes it feels better to talk to friends in the forum rather than family.

Hi Linda.

I’ve had 5 THR all anterior I also had butt pain and still do at times.

Although I did also have muscle tears in the butt, which is also very common you should ask about that. Very uncomfortable 

Hope you get some answers.

Dear Linda

This is what I would do.  Make sure that you do all the exercises, use both crutches until you are walking strongly with a good gait and lastly see a good chiropractor.  

Good luck,, Richard

Dear Donni, I often wondered if I had a tear in the muscle. How did you find that out? I'm thinking of having a mri.....but would it show soft tissue? Thank you for getting back to me.

Hi, I had my second hip replaced this last January. I am still having pain in the front of my thigh muscle. I too take Advil everyday. The first hip replacement was a few years ago and I had pain in my thigh for 18 mos. I was hoping this time would be better but it’s not.  But it does seem to correct itself with stretching and time! 

Linda, I had butt pain and a severe limp - could not balance on my surgical leg for even a second after my THR, even 6 months later, and was still using walking aids. I had to go for a second opinion to a new orthopedic surgeon, who, from physical exam and MRI diagnosed torn gluteal tendons. They were torn badly enough that they could not heal on their own and I had surgery to repair them 15 months after the THR. Original surgeon had no clue what was wrong with me. He didn't have much knowledge about soft tissue injuries, apparently. My second surgeon is expert in that area and has pioneered new methods for gluteal tendon surgeries. 

I needed a MARS MRI, in which the images are taken and interpreted in a way that the distortions from the metal implants aren't as bad. MRI and musculoskeletal ultrasound are excellent for determining soft tissue damage.

Good luck in finding professional help that can truly pinpoint, diagnose and effectively treat your problem. My new hip joint was fine, but the gluteus medius and minimus tendons definitely were not, which caused all of my post-op difficulties.

Hi Linda 

My first tear was picked up by ultra sound and the second was found during one of my surgeries which was quite a good size so they stitched it back together.

Hi Annie! This so sounds like me! PT didn't really help with all the stretching so I do think it is something else like a tear. I didn't think an MRI would show soft tissue.....but thank you for this advice. Are you ok now? It has been life changing for me.....cant even play with my small grandchildren. They are so careful around me......be careful of grandma.....honestly; I have been put on antidepressants. Just not dealing with the pain with every step I take, limping and plain tired of it taking up so much of my thinking! All of you have been wonderful here. I feel not so alone in this battle. 💕

It is x-ray that does not show soft tissue in detail. I had had 21 physical therapy sessions, and still could not stand alone for a fraction of a second on the surgical leg. Original surgeon was still saying there was a "weakness", and I should do more PT and have some cortisone injections. Had to find a different surgeon who knew what he was talking about.

I posted in this forum when I was 5 months post THR and someone got on right away telling maybe this was my problem, and it WAS! I was so grateful, and started researching and got on my way to recovery. We have to help each other!

Post by AnnieK seems to be your symptoms.  How on earth does one get to tear a gluteal muscle😔 is that a surgical error I wonder. 

Let us know how you go and I hope you get it fixed. 

Surgeons & Physios always suggest stretching etc rather than really looking at what is going on. 

Hip replacements are supposed to fix things not make us worse.

All the very best to you. 

Hi, Annie, what a journey you have had. Any idea what caused the tears? Did you have them before the THR? Thanks, Mary

Mary, I did not! My second surgeon has a theory for why they tore, although we don't know for sure. Those muscles have to be teased apart lengthwise in order for the surgeon to gain access to the joint for the anterolateral approach I had for THR. Sometimes with older patients (I was 67) that type of tissue doesn't heal as well, or at all, as those of younger people after they are sutured up after the operation. So, it is possible that they didn't heal and then tore right down and into the tendons when my activity level went up. 

In the MARS MRI images you could see very clearly how those gluteal muscles had atrophied. They were filled with fatty inclusions and looked completely different from the other healthy muscles and those same muscles in my other hip looked.

It is 20 months since the gluteal repair surgery, and that leg will never be quite as strong as the other non-surgical one is. It is MUCH better, however, than not working at all and having that leg collapse when trying to stand on it alone, and having a severe limp as a consequence. I also have bad back problems, and I think most of my current struggles stem from that.

Gluteal tendons can tear from being injured, of course. I read the story of one woman who tore her gluteus medius getting out of the driver's seat of her car! My original surgeon insisted that it wasn't possible to tear gluteus muscles. He had no clue!

 

Hi inhal03672! My sentiments exactly! I had the surgery to make myself better and I am now worse than before! My hip was bone on bone so I had to have surgery. After surgery, the doc discovered that there was a fracture from pounding the socket in. Trying to heal that nonsurgically. Then, I do believe that there is something more going on than just stretching muscles. 6 months and still limping in pain and need a cane. But, the surgeon said the hip itself is fine!

Hi Linda, it is a slow process that takes a lot of patience and work. We're you assessed by a physiotherapist and it sounds like you have muscle pain and weakness and you must be shifting the weight or c ompensating with other muscles. I had to re learn how to walk since One of my leg s was shorter and the other was seized with arthritis so I would use every muscle but my glutes. I cannot stress physio enough. They suggested I video taped my walking on a regular basis and hot everyone at home on board to force me to be present and pay attention to how my pelvis and back were behaving. My limping has greatly improved. I don't use the cane anymore. I do my exercises every day in the pool or at the gym. Now the goal is strengthening the gltes and the hip abdominals. It is hard and I do get muscle pain but I push forward. Now if I do not exercises and stretch my body aches and I get that annoying and sharp pain in my butt. It is the psoas muscle and for being so tiny I cannot believe it can be so painful. If you can do squats or roll a tennis ball under your butt while sitting shifting the weight and moving your pelvis. If you have aqua fit or aqua movement enhancement classes, try them out. Hard ware is ok so the muscles, tendons, nerves and ligaments need to be tuned. Hope this helped.

Hi Claudia! This sure does sound like me! I must admit, I don't do the stretching as I should. I thought if I had a tear, that maybe, I shouldn't be doing them. It really does feel like sciatica from the piriformis muscle. The PT thinks this. Thank you for reminding how important it is to do excercises! People are so wonderful in this forum. Thank you.

Geeze, the things we can learn from other people! Thank you very much for the detailed information. I appreciate your answer, and, I hope that things improve for you in the future!  Sincerely, Mary

Hi linda

im hearing your feel the same way, its been a long road for me and finally at 6mths post op from my 7th surgery, i thought id be pain lighter BUT nope i still have so much pain yet my X-rays same everything looks good.

where to next.