Chronic pain following total hip replacement

Bones, joints and muscles
21

Hello sue. I have been researching this problem on behalf of my mum who is experiencing similar problems post THR. I am a health lecturer in imaging and can sometimes access research not always available to the public. One study shows that impingement on the Psoas muscle post op can be a cause of unexplained pain if all other tests are negative. Anyone can read this paper- just type the following into your browser:

 Pain related to the Psoas muscle after total hip replacement. V Jasani, P Richards, C Wynn-Jones

Journal of bone joint surgery 2002 

(Br) ; 84-B:991-3

I am not suggesting this is the cause of your pain but it is worth investigating if all other tests are negative. Good luck

22

Hi,  Thank you for the information I will definitely read up on this. 

23

cattwil,

I had tendonosis (tendonities that never goes away and becomes permenent) in both legs from my hip to my knee for 3 years. The right leg, the operated leg way way worse than the left leg. My tendonosis was debilitationg. A shopping trip to the grocery store had me heading home to lay down on the sofa, yeah bad pain. I could not carry anything over 2 or 3 pounds in my right hand because that would add weight onto that leg and the tendon would hurt.

Tendonitis pain does not radiate pain that I have found. My husband also has doctors confirmed tendonosis in his shoulder. There is a particular tendon involved, like the one I have on the outer right leg, it starts at the hip and stops at the knee, so you don't get spreading pain beyone or past the knee.

You can feel the tendon, I can feel my iliopsoas muscle, I know right where it is, confirmed by my physical therapist. This type of pain is not described as radiating and tingling or numbness, but just rather straight up pain, it hurts, it's sore. I rested it and I am much much improved now.

My French physical therapist ocmes 3 times a week and basically massages my leg with massage oil. Then he manipulats it, bending it at the knee and pushing the laeg up into my chest (well not all the way but you get the idea). He supports the leg and pulls it out sideways etc. I had been resting that Psoas muscle as I knew from my previous bouts with tendonitis you need to rest it and let it heal, pushing it by exerciing it just keeps tearing the tendon and leaves scar tissue on the tendon which I have on my tendon between my hip and my knee. I mean I can really feel the sar tissue on the tendon myself, I know right where it is.

So this time when I realized I was having tendon pain, I stopped evrything and simply rested and tried not to aggravate it. My therapist last week when doing his manipulation exercizes the one pushing the knee up into my chest, caused the tendons in ront of my hip to snap. I felt it, it was two different tendons and gave me a quite clear snap, like snapping into place. It dind't hurt really but it was an odd sensation. Kind of like they were in the wrong place and now were in the right place. 

What Sue describes is nothing like I have with my confirmed Psoas, iliopsoas. For Sue I go with what the others are saying as far as nerve damage. I have no issues with my back, thankfully. Typically the Psoas, iliopsoas tendonitis is desribed as groin pain. You might wnat to google iliopsoas tendonitis.

Here is a good article. obviously replace [dot]

www.ncbi.nlm.nih.gov/pmc/articles/PMC2642547/

24

cattwil,

I had tendonosis (tendonities that never goes away and becomes permenent) in both legs from my hip to my knee for 3 years. The right leg, the operated leg way way worse than the left leg. My tendonosis was debilitationg. A shopping trip to the grocery store had me heading home to lay down on the sofa, yeah bad pain. I could not carry anything over 2 or 3 pounds in my right hand because that would add weight onto that leg and the tendon would hurt.

Tendonitis pain does not radiate pain that I have found. My husband also has doctors confirmed tendonosis in his shoulder. There is a particular tendon involved, like the one I have on the outer right leg, it starts at the hip and stops at the knee, so you don't get spreading pain beyone or past the knee.

You can feel the tendon, I can feel my iliopsoas muscle, I know right where it is, confirmed by my physical therapist. This type of pain is not described as radiating and tingling or numbness, but just rather straight up pain, it hurts, it's sore. I rested it and I am much much improved now.

My French physical therapist ocmes 3 times a week and basically massages my leg with massage oil. Then he manipulats it, bending it at the knee and pushing the laeg up into my chest (well not all the way but you get the idea). He supports the leg and pulls it out sideways etc. I had been resting that Psoas muscle as I knew from my previous bouts with tendonitis you need to rest it and let it heal, pushing it by exerciing it just keeps tearing the tendon and leaves scar tissue on the tendon which I have on my tendon between my hip and my knee. I mean I can really feel the sar tissue on the tendon myself, I know right where it is.

So this time when I realized I was having tendon pain, I stopped evrything and simply rested and tried not to aggravate it. My therapist last week when doing his manipulation exercizes the one pushing the knee up into my chest, caused the tendons in ront of my hip to snap. I felt it, it was two different tendons and gave me a quite clear snap, like snapping into place. It dind't hurt really but it was an odd sensation. Kind of like they were in the wrong place and now were in the right place. 

What Sue describes is nothing like I have with my confirmed Psoas, iliopsoas. For Sue I go with what the others are saying as far as nerve damage. I have no issues with my back, thankfully. Typically the Psoas, iliopsoas tendonitis is desribed as groin pain. You might wnat to google iliopsoas tendonitis.

Try Googling for a detailed article

HSS J. Feb 2009; 5(1): 78–82.

PMCID: PMC2642547

 

25

Hi, Sue, 

I am keen to know how you are getting on and what your latest test results show.  

I am 38 years old and my history is age 11 unstable SCFE left hip and right stable.  Long story short I began to experience pain again aged 25 in the left side, and in my right side at about 31.  Eventually after a lot of insisting there was something wrong, I got to see a surgeon who diagnosed FAI in the left side (secondary to SCFE).  We knew the likelihood of it happening in right side was high as well.  Bottom line, I had left hip replacement aged 36 and right hip age 38. I haven't walked without crutches since age 36, apart from in a house from room to room.  My left hip continues to give me problems.  It's to early to say that my right hip isn't going to be okay.  At my last appointment (6 week post op check) my surgeon mentioned referring me to a rheumatologist for the first time ever, suggesting there might be something immuno deficient going on.  I don't know if this is true.  But all I know is that I used to be fine until I had the hip replacements.  And since then I have had nothing but pain in my buttock, thigh and groin.  I currently have groin pain only in my right hip.  I am convinced that there is something not right with the operation.  The left side was performed by another surgeon, so I don't even think it is that he wants to dismiss it because it was his work.  So far I have had only x-rays and an ultrasound guided injection to the iliopsoas tendon.  Even after the injection I still had the groin pain.  We haven't had any further tests on the left side as we were hoping that the right side coming good would improve the left.  It's not looking likely as I am now 10 weeks post surgery.  

I found an interesting article about cementless stems causing thigh and groin pain which I thought I would share here as there seem to be a lot of people with various complaints of pain.  

http://boneandjoint.org.uk/highwire/filestream/14830/field_highwire_article_pdf/0/507.full-text.pdf

I don't even know if I have cementless stems or not.  I only know that the cup component in my left side is screwed in with 3 screws (due to shallow socket) and my right side is cemented.  I would be interested to know if you have cemented/uncemented stem.  

Thank you,

Stacee

 

26

Hi Stacee,

You're so young to have been through everything you've dealt with already. I feel for you. 

I'm 45 and had FAI after a car accident almost 3 years ago. In May of 2013 I had a labral repair but it didn't repair enough damage so I had a thr in April of this year (8 weeks ago). I also have tendonitis in my iliopsoas and more recently in my tibial posterior tendon near my ankle on the opposite side. Although we assumed the ankle problem result from being on crutches for almost two years, my surgeon ordered some rheumatology tests. Much to our surprise, I tested positive for HLA-B27 and ANA. The results themselves don't confirm a disease but the are directly linked to rheumotological and auto-immune diseases like lupus, rheumatoid arthritis and other inflammatory diseases. Like you, I had none of these types of problems before my thr. I have no way of knowing if they are related at this point but I have to see a rheumatologist to find out what I can. It was my 6 week check up when my doctor mentioned it too. 

I also have "stem" pain. It's uncemented and apparently I'm one of the 30% of people who get mid thigh pain caused by the end of the stem settling into the bone. My doctor said it will likely last 6 months to a year but will eventually go away. I hope he's right. 

If you have tendonitis in your iliopsoas, the only thing that's really going to help is rest. I think it took about 3 weeks of not doing any exercises that irritated it and either lifting the leg with my arms to get in and out of the bed and the car or having my husband help me so I almost never used it before it got better. It flared up again a week later because I started doing too much too soon but I rested it again (it took less time the second time) and it's better now. It's pretty drastic not to use it but it really helps. 

I hope things improve for you very soon but, if nothing else, you know you're not alone. 😊 

27

Hi Stacee,

I have been to the Pain Clinic and the consultant thinks my pain is related to possible damage of the nerves (which is what I have been saying all along).  He has agreed to try medial branch blocks L3/4/5 for diagnosis of facetogenic lumbar back pain (these are injections done under x-ray).  He thinks my leg pain is referred pain from my back but I am not convinced due to all the sensitivity.  I am still waiting for this appointment to come through now, I was told there is a waiting list (surprise, surprise).  I will know immediately if the injections work.  If they do work I have been told they can then go in and permanently kill off the nerve root/nerves which should permanently solve my problems.  I am quite excited at this prospect and have something at least to aim for as I had nothing before, everyone else had basically dismissed me and said they could do no more.

As for the Rheumatology appointment that was a joke.  The consultant asked about my symptoms, read some notes then told me I had osteoarthritis and should not have been referred to him and that I do not have Lupus!  No tests were done.  I was basically dismissed like a naughty child.  If these injections do not work I really do not know what I will do!

Both my hips are cemented and according to the hip consultant they look good.  The second hip I had done (left) was pinned also - apparently to make it more stable.  Hips done by different surgeons, left is the one I have most pain in.  I do not have the groin pain I had before the hips were done.

Hopefully this is the year I get it all sorted out.  Will keep everyone posted as to the outcome and good luck with your pain.

 

28

Hi, Sue, 

What a waste of time going to rheumatologist to not even have any tests done to rule anything out.  

Interestingly my hip with the pins in it is the one that has been bad for almost 2 years.  It was replaced in July '12.  The pain I had prior to the replacement is gone, but replaced by a new and as bad pain.  Initially I couln't do a straight leg lift for about a year, this accompanied with groin pain.  However, not iliopsoas tendon.  But I wonder if it is something to do with the screws.  I am convinced it is something to do with the replacement joint that is causing my new pain.  I have had a full body bone scan and nothing else was picked up in my back or anything, it must be my joint replacement.  I've got my fingers xd for you.  Oh to have an answer that will take your pain away forever!  Keep in touch. 

29

Hi, Cindy, 

Thank you for your reply.  My surgeon has never mentioned stem pain.  I just have this feeling that something from the joint is causing my pain as I never had it before.  I definitely would agree that I did have tendonitis (or a strain) in the iliopsoas tendon at one time (however the ultrasound showed that it was not impinged which was what I was worried about initially as I couldn't do a straight leg lift).  My physio pushed me early on when I said I couldn't manage it, and I screamed in agony.  And I agree with you, the only thing that healed it was rest and time.  However, it was about 1 year before I could actually do it.  I still have some groin pain, but am able to do a straight leg lift now.  One thing I cannot do well is do the clamshell exercise.  It seems that something is not working properly for some reason.  I don't know if I have cemented stem or uncemented stem.  I wonder...I might be in that 30%.  Did you have your blood tests done by a rheumatologist or your GP then referral?  Please could you let me know how you get on with rheumatologist?  I look forward to hearing from you and HOPEFULLY improvement in your pain.  Take care, 

Stacee

30

Hi Stacee,

Its Feb & Sept 11 mine were replaced and I did not have this back pain after the February operation only after the second operation was done (like you the one that was pinned).  I like you had a full body bone scan and nothing else was picked up apart from degenerative wear and tear.  I know my second replacement is what is causing my pain, it was not there before.  I believe they have stretched my muscles/ligaments which in turn have damaged the nerves.  I am not blaming anyone I just want the problem resolved.

I will keep you posted, keep your fingers crossed these injections work!

31

Hi Stacee,

I had never heard of stem pain but it was in the fine print in the possible risks of surgery so it obviously happens.  I'm not sure if it only happens with uncemented stems or cemented too.  I've read that micro motions are the likely cause and since those only happen in uncemented stems, yours may be uncemented.  

The iliopsoas can make life miserable.  I still can't do straightleg lifts.  Clamshlls are INCREDIBLY difficlt too.

My blood tests were done by my hip surgeon because he became suspicious when I showed up at my 6 week check up with severe pain in my right foot (my new hip is on the left side).  Now he's referring me  a rheumatologist for additonal tests.  Apparently it takes several weeks to get an appointment so I will have to wait.  However, I'm seeing a foot surgeon next week for an MRI to see if the tibial tendon is ruptured.  At least I don't have to wait to deal with the foot pain.

Oh, also, don't ever let a therpist push you to the point of pain.  It's unethical for them to do that because it can cause severe damage that they may not be able to correct.  Not to mention the increased pain and slowed recovery for you.  You know your body and what it can handle and when it's too much.  No one else can or should make those decisions for you.

I will let you know when I know more about the rheumatologist.  I hope things improve soon for you too.

32

Thank you for your message Cindy.  I really hope you get some answers at your next appointments and ones that are able to be fixed!  You may have said in another thread, but when did you have your THR?  It took a year, maybe a bit more to be able to do the straight leg lift, though I still have some groin pain.  I must do more research on stem pain.  Please keep us posted on this thread about your results.  Fingers crossed for you!!  

33

Hi Stacee,

Thank you! I was 9 weeks post op on Thursday. My rheumatology appointment is on 7/14. Since I don't have any symptoms that I know of, they'll probably take a bunch of blood and test for lots of things. My therapist told me that she has patients who had tested positive for the HLA-B27 and ANA, like I did, but whose autoimmune diseases were dormant until triggered by trauma. I worry a little because a car accident started all of this for me. I certainly hope it hasn't awakened something else I don't want. 

Until I know more, I'm going to stay positive and focus on tiny improvements every day. I'll keep you updated. You do the same. 

34

Hi Sue & All

This thread was one of many hits I got when googling "Pain flare-up during THR recovery". Thought I'd post in case this strikes a chord with anyone and, if my problem recedes, then it may encourage others. Ok, long story as short as I can make it..:

I suffered back pain for years (low down, mostly right of spine). Docs attributed it to my age (40+ at onset) and my occupation (plastering). Pain was always worse after a hard day so their diagnosis made sense. It was nagging rather than debilitating so I lived with it,

Then out the blue I began to get the type of groin pain which I now know to be a classic symptom of osteoarthritis of the hip. Again, it wasn't agonising but I was assured that I would need a THR sooner or later so i decided to pre-empt any further deterioration and have it done then (last October) .

My recovery was slower than docs had expected but not worryingly so and the follow-up X-rays showed all was well so I resigned myself to just having to wait a bit longer than average for a full recovery.

After 6 months I was able to walk a couple of miles unaided and was cycling again. But the one thing I realized was that the back pain - in exactly the same place - was worse and constant rather than only after hard work. Also, I could now distinctly feel a phsical link from the back pain site to the residual post-op hip pain, and I now believe that my back issue was actually the first symptom of the hip osteoarthritis.

I had an MRI for the back and the neurology and rheumatology depts gave the all clear. Again I just hoped that all would be good in the end and carried on.

Further improvements were slow. I was able to get around with comparirively minor discomfort in back and hip; the degree of discomfort varied but it was never agonising and sometimes so slight that I hardly thought about it (the original symptomatic groin pain had gone). I usually had a slight limp but walked without a stick or crutch and was impatient to be 100% fit again rather than actually worried.

Then, about a fortnight ago, I suddenly got a bolt of pain down my thigh. It happened so suddenly and was so fierce that I actually cried out. I had  done absolutely nothing to bring it on, merely got up fro a park bench and then shifted my position slightly. For a full minute i was afraid to try to put any weight on it but it eased slightly and I was just able to limp home.

Since then it has eased a bit more (or maybe I've just got used to it) but it's still painful. The symptoms are different from before. The back pain remains the same but the new pain now seems to radiate all over, down through my thigh and all the way to my knee. As others have asaid, at rest or sitting it's not there, only when I try to put weight on it. Interestingly, walking DOWN stairs is almost painless, level ground is worse.

Also worth mentioning is the fact that (almost) every morning when I get out of bed the pain has disappeared overnight. I cross my fingers and try to walk as carefully and gently as possible but then always within an hour some slight movement will suddenly bring it back on again. Sometimes even after just sitting for a while I can get up (carefully) and walk several paces with almost no discomfort at all. Then I might bend slightly, or turn around, and it's back to painville.

I've seen the pain management team who want to give me injections into my back, and yet the osteopathy dept want to inject my hip! I have follow-ups with both departments but I'm not hopeful that they will communicate with each other and I don't know which, if either, injection site to choose. Is my hip/thigh/knee pain starting in my back, or is the back pain referred from my hip?

Sorry for the long first post, look forward to reading any follow-up comments from the rest of you, especially Sue87388. Sue, if you dip back into this thread, I - and no doubt others - would be grateful for an update. Hope you're improving.

Good luck everybody.

35

Hi Simon and all other followers,  Great timing Simon I have just received an appointment to have remedial nerve root injections into my lower back (done under x-ray).  My appointment is on 18 September so I will post on this site the outcome.  I have been told that the injection if successful should remove the pain I have and may last between 4-6 hours.  If this is successful they have said that they can permanently deaden the nerves affected and therefore remove any pain I am experiencing.  I am excited at receiving this appointment at last but also extremely nervous as this is my last hope.  I am praying this works as I am still a prisoner in my own home!

I hope your pain improves and you get back to having a good quality of ife.

36

Hi everyone,  I have just received a telephone call from the hospital cancelling my appointment for remedial nerve root injections this Thursday (18/9/14).  I am absolutely gutted! cry  I have been told another appointment will be posted out to me, they said hopefully end of October time.  I have waited five months for this appointment and feel totally let down.  I will of course post on this site and confirm when my next appointment will be and then the outcome (hopefully the next one will not be cancelled at the last minute).  I hope everyone is doing ok.

 

37

New appointment received today.  Remedia nerve root inejctions will now take place on 24 October 2014 (hopefully they will not cancel on me again!).  Everything crossed that it will work.

38

Hi Sue,

I am excited for you to have your hip injections and update all of us on your situation, only one more month to go! I joined this website/discussion because my mother (age 56) had a left hip replaced in Nov of 2013. Now I don't know all of her symptoms but I know for sure there is back pain, one Dr. said something about her sciatic nerve (not sure what came of that). Either way she is now in debilitating pain and has never been able to go completely free of a cane and is now using two! I am just a basket case now trying to help her figure out what is going on. She finally was scheduled for an MRI this coming Monday, but after reading through this dicussion I'm worried they won't be able to find anything. Anyways just wanted to drop a note and let you know that I will be following this in hopes of coming to a solution! Good luck!

39

Hi Cassandra,  I am so sorry to hear about your mother.  Try reading up on symptoms and diagnosis of facet joint problems and see if your mothers symptoms relate to this (I found this very useful for myself and it related to my symptoms more than any other site I have been on).  It actually states in the symptoms and diagnosis of facet joint problems that MRI's rarely find anything wrong and the same for X-rays.  Let me know how you get on and I wish you the best of luck.

40

So very sorry to hear of your distress.  The negative experience/symptoms you describe are virtually identical to those I have had after a disastrous resurfacing, then revision, on my right hip.  No one would concede that the excruciating nerve pain which began, suddenly, five days after my first operation, had any connection to the surgery.  All sorts of tests and interventions, not to mention medications, have been to no avail.  I have had to retire early from work and just have to live with the pain, stiffness (7 screws to secure the device) and immobility.  Latest development - I'm going in to have a THR on the other side, in 3 days.  Scary - or what?