Serious Pain 3 Months After Anterior THR

Bones, joints and muscles
1

I’m a 63 year old male with avascular necrosis bilaterally.  With left hip being the worst I had a total hip replacement done 12 weeks ago today.

My pain levels seemed normal until about 5 days ago when pain increased in intensity and appeared in several locations, worsening daily. Today pain is worst I’ve had at any time since the surgery.

I’m experiencing most severe pain in buttock to side of hip in the area of the hip socket.  There is occasional pain I’ve never felt before in my back and groin though not nearly as severe as around the hip socket area.

It’s a stinging and burning pain with qolts of sharp, brief stabbing pains as if poked with an ice pick or sharp needle. These cause me to jolt in pain but they go as quickly as they come but they come frequently.

There is constant burning pain at left side of hip from area of the hip socket down half way to my knee where I also feel a milder tingling, sticking pain.

Ive never experienced so many different kinds of pain at once.

A week ago i was doing well, off the cane and pain was mild to occasionally moderate and then only briefly.  Now it’s constant and in the range of 4 to 7 on the 10 scale with quick spikes to 8+ every few minutes, day and night.

Im taking ibuprofen 800 twice a day that helps slightly. I don’t like taking pain meds. They dont fix the cause, just prevent me from feeling it.  I’m hoping someone might have a clue as to what’s going on?  And I’m hoping this isn’t serious or prolonged, but it is a lot of pain I was not expecting.

I’ve done nothing to injure the hip, no falls, no running or jumping or anything other than walking around normally.

They’re getting me in to see the surgeon’s PA tomorrow, actually, in 12 hrs from now as I write this lying here In pain...looks like another sleepless night. Quality of life in this condition is poor.

Thanks for reading all the way through.

2

I also have AVN in both hips. I’ve had one replaced so far. I’m at a very similar stage as you in that I’m 11 weeks post op. At the moment I’m not experiencing any pain. I just wanted to reply so you know that you’re not alone. (Do you use Facebook at all? There’s a couple of really supportive groups on there for AVN.) I hope that your pain eases soon xx

3

Hi I'm 12 weeks posterior THR and I thought things would be better...I sometimes get a soreness under where the scar is like I've hit it...but I haven't....and both my thighs sort of burn and hurt....I was told to take paracetamol 500mg with the ibuprofen I take 500mg it helps the ibuprofen work...I've just started walking further the last few days at least a mile ....I thought this made it worse but I do think it helps...I do the excercies they gave me from the hospital and I find initially when I stand up a good stretch helps....I also have back pain but I do have degeneration in my spine...and both my feet used to get pins and needles at night but that's gone now...but I had a spinal block when I had the operation so I suppose it affects your nerves until it settles down...hope this helps think it's a long journey!!! We have to be patient .....

4

My first inclination would be to have it thoroughly checked to rule out infection or a loosening of the prosthesis or fracture- MRI if required.  When I am at that level of pain which I am on regular occasions, I don't fin over the counter NASAIDS to help.  The MD prescribed Tramadol 50 mg, 1-2 X 4-6 hours.  I find taking two in the morning, which takes effect in about 1/2 hour,manages my pain though the day, allows me to work in the shop without being crippled [ although still less efficient] and doesn't cloud my thinking.  Not everyone reacts well to the medication, but I have found it to be very effective.  If chronic pain is preventing you from walking, doing your PT exercises and ruining your quality of life, you might ask about it and see if it helps.  Best of luck.

Jim

5

Anyone else have trouble responding to folks at this site?

It took me 10 minutes if pecking on reply before if let me reply and thenonly to myself, I can’t reply to any of you.  I’m on an iphone 8.

Anyway, i saw the surgeon’s PA today and i guess the news is not good. Its bursitis in the hip i had replaced.  He couldn’t explain why it appeared 3 months post op thr.  

I had no idea bursitis could be so painful.

He prescribed a series of oral steroid meds then a followup visit in 6 weeks.

After that if its not improved he suggests physical theropy specific to hip bursitis.

He was not optmistic. He said it might improve or might not and could be a life long issue.

My other hip is in bad shape and I’d planned to replace it later this year but now there is no way im doing another thr.

I’m going to look into possibly trying stem cell implantation with the remaining hip. There are several places having remarkable success with stem cell vs. this violent thr approach. Surgeons wont talk about stem cells because eventually it will put most of them out of work.

I’m rambling, probably because I havent slept in days.

This prognosis really has me down.

6

Please be wary of taking steroids when you have AVN as it can cause progression in this disease. It’s one of the main causes of AVN. I’m not an expert at all and steroids didn’t cause my AVN but it’s risky when you already have it, I think. 

7

SBnKy-

I'd be very interested in learning which places are using stem cell implantation successfully.  Can you provide clinic information so I can research their studies.  I would appreciate it very much.  Hope your pain dissipates quickly.  Thanks.

Jim

8

I noticed issues a couple of times today, but just waited and later was ok. Sometimes it works better when I'm using the PC instead of the phone.

Hope you can find a solution to the pain that doesn't involve something that causes other issues.

9

Must be a cause to your bursitis. I myself had this and it turned out the acetabular cup was protruding & rubbing on my psoas which was giving me the bursitis.

The whole steroid route is a complete waste of time in my opinion. You may need a second opinion from another surgeon to look at your X-rays as I believe you have similar symptoms to me.

My outcome was a revision of my hip replacement with a smaller size cup ( not to be underestimated in how severe an option this is) a bone graft & screws & a full tendon release (again don’t underestimate how severe this is- it’s a total cut of your psoas to give it space from your cup, this takes a while to recover.)

I had my original (stuff up operation June 2016 & revision August 2017 with a new surgeon) I am nearly 6 months post revision surgery & recovering well. I would say I am at 75-80% recovered. My surgeon said by 12 months post op I will be fully recovered.

I have diligently worked at my rehab.

I can see light at the end of the tunnel. 

I completely empathise with you & strongly recommend you get a second opinion. 

There is a root cause to your bursitis and that’s what you need to get to the bottom of.

All the very best.

PS I’m in Australia 

10

Wow, what a horror story.

I agree that something unknown is causing my bursitis.  The PA I saw today said maybe i “over did it” in regard to activity.  All i do is lay in bed most of the time with pillows between my legs to ease pain a little. I walked about a block 4 days ago but if that caused it st 3 months post op something in there is really wrong.

I guess i should seek out another hip surgeon for a second opinion?

If something was not done correctly during my thr surgery the offending surgeon sure isnt going to admit to it.

Thank you all for responding.

11

Lord, I hadn’t thought of that but you are exactly right. My avn was caused by dislocation of hips during a high speed head on collision i was in years ago. The avn was disgnosed 5 year after the crash, because thats how long it takes for pain to surface after blood flow to the femural head is cut off during dislocation. 

I’m at a loss at what to do.

My lady friend brought  me natural curcumin to take in high dose, it acts as an anti inflammatory.

I think I’m basically screwed. 

12

I really advise joining the support groups on Facebook. There are people on there with loads of experience of this nasty disease. I’m sure they will have advice. If you’re in the US (I’m in the UK) someone may be able to suggest a doctor they recommend. 

13

No they never own up that’s for sure!  A second opinion is the way to go. No way known to man could you have ‘over done it!’ What a dumb thing to say. 

14

Sounds like you have infection I had same and thats what it was got pic line in and on antibiotics for 8 weeks that time

15

Hello SBnKY

Just wanted to share my experience mabe ties in with your specific diagnosis,bursitis. My revision 2017 was due to the primary prosthetic had irritated the area around the hip causing bursitis. The prosthetic had caused the tendons that attach to the muscles to the trochanter to become inflamed and irritated, the femoral component was slightly loose. It was very painful and the bursa was removed at the time of revision .

With such a complex surgery it's a miracle there are not more complications with THR. My surgeon was wonderful.

So sorry you have to endure another surgery. Keep in touch and I hope it's successful and your back on track soon!

Removing the bursa sac is like having an infected tooth removed so glad to have it out! 

Good luck.🤞

16

Be careful of natural curcumin.  It was on the DO NOT TAKE list of meds before my thr.  There must be a reason.  Ask your medical professional before taking anything for a medical condition (or to ward off one), prescription, otc, or natural.

17

Curcumin has natural blood thinning properties. It would interfere with the blood thinning meds given after surgery.

18

I’m now 15 weeks post-op for anterior thr and the pain has worsened after subsideng following 6 days of oral steroid treatment.

I was hoping the steroid treatment would end this pain in my hip but now it’s worse than ever.

Sharp stabbing pains so severe and sudden I can’t help but shout out in pain on occasion.

To compound things we’re in sw Florida and won’t return hone to Lexington Kentucky until 2nd week of March.

Even getting from the condo to the beach 100 feet away is a dreaded chore.

It’s not an infection—it’s not hot to the touch, no fever, no redness but there is a lump of swelling at the side of the hip.

My surgeon’s PA examined me and said it’s bursidis.  I think he’s correct, so what caused the bursitis specifically and what can be done specifically to remedy this?

Is the top of what’s left of my femur too sharp and cutting nto te bursa or iliopsoas muscle?

I think an mri might help answer that when I get home?

I wonder if I could get in to see an ortho doc here in Florida before we leave in 2 more werks?

Sorry for all the questions, this constant severe pain has ruined our month in Florida. I don’t want it ruining the rest of my life.

19

Sorry to hear of your debilitating pain.  I know exactly what is going on for you, mirrors exactly what happened for me & a growing Nos of people undergoing anterior hip replacement.

The bursitis is a direct cause of your surgery; the acetabular cup is rubbing on your bursa & causing the inflammation. From my experience & research the cup is protruding & it’s sharp edges are at the root cause. This is either too large a cup or the anterior approach just doesn’t allow the cup to be properly placed. 

I had to have revision surgery 12 months post anterior approach surgery.

Not to be taken lightly.

It’s a huge op

In my case bone graft, screws, cup replacement & cut of psoas to “lengthen the psoas” to prevent further irritation.

I’m 6 months post revision & just coming through this huge surgery. 

I would be asking if you could get just a psoas release. You will need a highly recommended surgeon.

Hip revision would be your last option as it’s such a huge & invasive surgery. 

But at the end of the day you will need a solution to this as it’s debilitating to continue. 

In my case I have reported the original surgeon to our Australian medical board as it’s clearly a case of incompetence.

I literally lost 18 months of my life to this.

Hope this helps.

I’m sure others on here will also be able to add to this.

Wishing you all the very best. 

20

Wow, your sxperience seems like a nightmare.

The hardest part is finding the right surgeon.  They do a good job of keeping their success/failure rates secret from potential patients.

I hope your pain has finally been resolved, in light of all you’ve been through.

Thank you for all the info.

My other hip is getting worse and worse and will need to be replaced as well in the next year because both my femural heads are dead from avascular necrosis bilaterally, and the thought of possibly having all this pain added to my right hip is depressing.

Thanks and best of luck!