Failed Hip Arthroscopy, PAIN, surgeons will not do hip replacement!

Bones, joints and muscles
1

Hello,

I wonder if any of you has a similar history as mine -

I had a failed hip scope March 2013.

First 3.5 months of recovery post-op were very good,

      then sudden Severe hip pain.

      For 6 months I was completely disabled.

2 sets of Xrays & MRI, multiple physical exams with multiple surgeons, have not revealed anything to explain the pain.

      Arthritis: only mild, very slow progression of joint space narrowing. 

       (Go figure! Everyone says it's amazing how good my joint space and remaining cartilage looks)

DO ANY OF YOU have (or used to have) a similar status - terrible disabling pain after failed hip scope, but no significant arthritis? 

    Question 1: Did you have a total hip replacement after failed hip scope despite "mild" arthritis?

    Question 2: Did you NOT have hip replacement surgery because surgeons don't recommend replacement because you don't have "enough arthritis to indicate replacement" ??

btw, I'm in Northern California, my health care is with Kaiser. If any of you want to recommend surgeons who have experience with BOTH hip scope patients AND hip replacement surgeons, I'd really appreciate it!!

For anyone who's interested in more details of my case:

Opinions from 2 hip replacement sugeons I was referred to who are very experienced and successful:

     1. Since I don't have moderate-severe arthritis, nothing else appears on Xray or MRI, and since 2 post-op steroid injections to hip joint did not relieve pain, they say hip replacement is not indicated.

      2. They only want to proceed with replacement if I develop moderate-severe arthritis.  (and that could be another 1-2 decades!)

Opinions from hip arthroscopy surgeons in the last 3 years:

      1. Since I'm older (now 58) and since no evidence of scar tissue, or cartilage/bone problems, they don't want to do another hip scope.

      2. They suggest pain management program (yes, I already did this program); stretching & conditioning for muscles & tendons (duh, I've been doing this all along).

      3. They emphasize that MRI often does not show "the whole picture"; there could be something hidden that is causing pain. I asked if impingement could return (in my case it was a CAM impingment), or if CAM or Pincer could develop in same or different location after the hip scope.  2 hip scope surgeons say "Yes". My specific surgeon said "No."

    

3 years of chronic severe pain, 2.5 years of some pain relief from low dose morphine tablets (15 mg) 1-2 times daily. 

Now Sept 2016, last 3 months pain has been increasing, and I had to increase morphine to 3 times daily.  In the last week 3 nights when I did not sleep for 1 minute. (Yes, even after 3 morphine doses, and ice packs numbing skin on my groin & hip)  Now I'm starting to freak out. I don't want to be completely disabled again, and I don't want to increase pain meds.

And if you're still reading   details from surgery notes

Surgeon found 1cm frayed cartilage (Grade 4), which was removed. Some arthritis in the joint was "cleaned up". FAI confirmed, CAM impingement (Level 2), bone shaved down and reshaped. In surgeon notes he wrote he was surprised to find way more extensive cartilage damage and bone spur than was revealed on MRI.

 

2

This must all have been so discouraging for you. I am so sorry. I wish I had relevant knowledge or advice but unfortunately all I can offer is sympathy and an ear.

I hope someone else can help.

Best wishes for resolution.

L

3

Wow that's a lot you are going through!! Unfortunately I have no advice or experience on this. Prayers that you find a solution and get better! I can't imagine being in that kind of pain and using that strong a pain killer! Hugs, 🤗🤗LD

4

I would seek out another othopedic surgeon. Failed hip injections should be an indicator that replacement is necessary, imo.

5

Hi glyn

i have no idea either except I had THR and developed crippling pain down to damaged nerve.  U extensively discuss orthopaedic opinions - have u also seen a neurologist to examine if pain is from a nerve?  Sorry if this has already been done but this is the only experience I can offer.

regards dot

6

Dot, sorry to learn about your nerve damage from surgery. I hope you will have some relief from it.

I will follow up with neurologist if I don't get any help from consult with 3rd hip surgeon, scheduled for September 19

7

Hi Trish, I just scheduled outside opinion today with a hip surgeon who does both hip arthroscopy AND hip replacement. Hopefully he has a wider perspective than only degree of arthritis shown on xray.

I am dismayed that 1cm of torn cartilage and moderate cam impingement ruined my life for 9 years... then I'm told hip replacement

8

Oops, didn't get to finish that sentence. Then told hip replacement won't help me.

If this is the reality, to be confirmed by outside hip surgeon, that we failed hip scopes with mild arthritis are "stuck" in limbo, indefinitely, until severe arthritis develops, then I will accept the reality.

I will post a report after my appointment with outside hip surgeon on September 19

9

So sorry to hear what you are going through. I don't have any experience of this but would look at getting another opinion if that is possible. Good luck and keep us posted.  

 

10

I am praying this physician will listen to you and give you a hip replacement. I am wondering how much of this is due to Obamacare? I found my recent replacement was more a matter of following a prescribed protocol than giving good patient care. I knew from symptoms in February that I needed a THR. But I had to start on NSAIDS first. No relief after several weeks enabled me to get injection. That lasted about 6 weeks. Second injection lasted less than 4. Surgeon was then able to justify my replacement. The joint space wasn't totally gone but both hip socket and ball were eaten away. This didn't show up on xray. Let us know the outcome of your consult!

11

Hi Trish, thanks for your feedback, very helpful to know your hip bones were eaten away - which wasn't visible on xray.

Ready prescribed protocol : I have asked if surgeon is telling me what is the organization's protocol vs. Industry protocol. He wrote back it was same protocol as he used at Harvard med school, and ucsf med school. And the process you went through matches what is documented in medical literature

Try all conservative measures first before surgery. (Though some surgeons have the experience and confidence to bypass that process with certain patients )

Did you have thr yet? If so, how are you doing?

12

I had my THR a week ago. Left-anterior approach. First one 5 years ago on right - posterior. This time is easier. Wish I had rehabbed before THR to strengthen thigh and gluteals. In hospital 3 days. Home now and going out to rehab 2x week. I pray you will find a Surgeon who will care for you appropriately! If you have a choice, ask for anterior procedure. Trish

13

Thanks for confirming anterior approach is better, that is what I would want too.

You know, when I do recommended exercises to strengthen thigh & glutes, some of them make my pain worse. Was that true for you before surgery?

Well, I'm eager to hear about your progress. Please keep me posted. 

The hip replacement surgeon I will see Sept 19 for outside opinion only does anterior approach. I talked to his nurse today to ask some questions - such as will this surgeon be discouraged from attempting THR in my case because the last 2 steroid injections to my hip joint did not help at all. 3 hip surgeons at my HMO tell me that's a deal-breaker in my case, considering that my joint space and cartilage look so good on MRI.  She answered that it makes my case more challenging, for sure, but acknowledged that something could be causing pain that just isn't visible on MRI.

Coincidentally, she told me that one of the hip replacement surgeons in her group was recently recruited by my HMO!  And is in my local area! She says he was mentored by the hip surgeon  I scheduled outside opinion with.  Both of these surgeons had extensive joint replacement fellowships, much specialized training, etc.  Both both train other surgeons on anterior approach.

I think between these 2 surgeons who have done THRs for many patients with failed hip scopes, I can at least learn some helpful info.  Best case scenario is that 1 or both of them will say (after thorough case review, and physical exam, of course) they have confidence THR will help me.

We'll see.

14

dear glynell, 

warm welcome to this wonderful hippies forum and thank you for sharing - 

wow ... I honestly don't know what to tell you - so many different protocols and rules and regulation, seems almost at random , where you live, the hospital, surgeon ...

I too had Kaiser Insurance when living in Los Angeles, and was told that "I was not a candidate for THR yet --- at time I was so happy ... 

things didn't get better and after 34 years in L.A.I moved back to Holland (long story, not hip related) - Here I saw GP who send me to xray, Ostheo surgeo who yelped what a perfect candidate I was for THR surgery ..... bone-on-bone ..yeah !!!this was 6 months after Kaiser Doc told me I wasn't ...

it is very well possiboe that cartilage went down from mild to severe -

i hope surgeons will come to an agreement for you and syrgery can be scheduled soon --

tough case , darling - where can you go from here ? second opinion outside network?

big warm hug

renee