Specific almost-six-month clunking question

[imgetinold]

I had a fairly normal amount of clunking, most of which has subsided.  I rarely clunk anymore.  I'm not even sure what I'm about to describe is clunking, but anyway.........

Here is what is happening when I'm in the shower, and washing my legs.

1.  Take small step forward with operated leg, knee slightly bent.
2.  Work my way down my leg to approx. the ankle, washing.

When I switch directions (move back towards an upright position), if feels like the "ball" re-seats into the cup.  No pain or anything, but if I bob up-and-down in that position, it definitely feels like something is shifting around.  It might just be a residual looseness of the hip capsule, but just wanting to see if anyone else has/had some sensation like this.

[John C]

Hi "imgetinold" (great handle by the way ;D)
I absolutely relate to the sensation you describe. There are certain yoga positions and movements in Tai Chi that are much like your shower movement. When doing them, I often feel what you are describing. Never any pain or problem associated with it, but it does seem to be one of those long term reminders that we have some new parts. It has certainly decreased with time, but that particular motion does seem to be the one that triggers it sometimes.
If I had to guess (guess being the operative word here), there have been some cadaver studies that have shown that this amount of flexion could cause some impingement (depending on the head/neck ration), and so a slight subluxation. So your feeling of the cup re-seating might be pretty accurate. If you were to stretch that far without the load angle of the weight bearing, we probably would not feel the re-seating.

[Baby Barista]

Here is my two cents... and it comes after lengthy conversations with my surgeon (Dr. Pritchett), another doctor with 35 years experience in PT, and research on my own.

I experience the same sensation from very similar movements. And yes, calling it "clunking" may be the most appropriate description. But I am certain that in my case, and likely a large number of others, it has nothing to do with the prosthetic itself.

Dr. Pritchett and the PT I spoke of, believe that sensation is often generated by the sacrotuberous ligaments, slipping and snapping over the ischial tuberosity. It might help to look at an anatomy chart after reading this. The torque and twisting on the leg during surgery applies a great amount of force to the sacrotuberous ligaments. That stretches them out. In a normal person, their tension keeps them pinned to one side of the ischial tuberosity. But in people who've undergone hip trauma (note I *didn't* say "surgery") many of them describe a snapping, clicking or popping sensation.

In fact, according to the PT, he has seen it in people who've suffered a rare hip dislocation *and* in woman who had difficult births. The common culprits he believes are loose sacrotuberous ligaments snapping over the ischial tuberosity.

This is not to say clunking of BHR components does not exist. But I'd bet what many people think is just that... isn't.

In my case I know it isn't. As a test, my PT performed a series of controlled movements of my leg (on my back, non weight bearing) to replicate positions that would move the sacrotuberous ligaments into a position likely to cause snapping movement over the ischial tuberosity. Guess what??? I snapped or "clunked" every time!

BUT.... when he used his fingers (in a very awkward manner I might add) to pin the sacrotuberous ligaments to their proper position.... NO CLUNKING!

My own theory connected to all this, has to do with the repositioning of the femur after BHR surgery. In my case, the prosthetic moved the plane of my femur to a slightly more proximal position. That in turn, puts the sacrotuberous ligaments in position more likely to transverse the ischial tuberosity.

According to Dr. Pritchett, this kind of movement by those ligaments is not problematic and unlikely to cause pain. It's weird yes. But I'm hoping in time as those ligaments continue to shrink to pre-op position... the "clunking" will shrink too.

[imgetinold]

Thank you both for the thoughtful responses.  Whatever it is.....if you (John) are still going strong after 4 years, then I'm not going to sweat it.

[OtterDriver]

Hello Everyone!

At eight+ months now...I've become quite accustomed to the sensation and usually don't give it a second thought!  Thanks to Baby Barista for the very thorough and reassuring discourse on the subject!

Any Hippies cruising to Alaska this summer?

Bruce

[morph]

Since my op I have experienced two different sensations. The first was about 3days post op, I was in bed and gently let my knee drop to the side. The sensation was for some reason what I describe as butterfly wings i.e a very subtle chinking sound which I am sure was the the two metal bits momentarily seperating. This has only happened once and when my muscles were at their weakest.

The second is what is described in this thread and occured during the first two weeks but has now more or less gone. I think Baby barista is correct and is a ligament/muscle issue. That is what I thought it felt like at the time. Although it is a bit disconcerting at the time but in no way painful.

[Jason0411]

I still clunk all the time but slowly get less. But then I did squish mine and make the joint looser.

Jas

[bilateralbliss]

Thanks for helpful explanations! Will definately be onto google medical terms  as suggested :) My right one clunks sometimes too, so its all about muscles and ligaments etc- expect will go in time anyway :)

[Jason0411]

As long as there is no pain who cares about the odd clunk??