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Author Topic: Still in pain one year post-op  (Read 5092 times)

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SpudAir

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Still in pain one year post-op
« on: March 08, 2010, 01:21:35 AM »
     Today I finally got back to Surface Hippy after having researched the whole resurfacing decision in December of 2008.  I've been unsure what to report on my situation, and just kept putting off getting on the forum here and asking questions, waiting for my situation to stabilize.  The following description of my problem got really lengthy to try and cover all the potential questions, so I jumped back up to this point to summarize: Is it typical to have significant pain and stiffness in the joint a year post-op?

     I had my right hip resurfaced in April of 2009.  I had played competitive basketball once or twice a week since I was about 15, and had just pretty much worn the hip out.  (The left is bad, too, but all the pain was coming from the right.) I'm tall and lean, pretty active (I teach elementary Phys Ed), and in pretty good physical condition, so was a good candidate for the surgery with a good prognosis for recovery.  I was 55 when I had the op done.  The doctor was very pleased with how the procedure went, although he said he was surprised by the size of my hip joint; it took the next to the largest size Stryker joint he had.  He gave a very positive prognosis for recovery.
    Therapy went well as far as mobility was concerned.  The joint still hurt almost all the time, kind of like a sprained ankle does the day after you do it, but it definitely helped to exercise it.  Three weeks post-op I had talked the doctor into letting me drive down to the YMCA and at least do an upper-body workout daily.  I'm sure I looked comical dragging my walker around from station to station in the weight area.  Six weeks later I had added really light squats and leg curls.  I went very cautiously, and never had any exercise-induced pain.  Daily workouts seemed to help.  Progress was generally positive, although I had good days and bad days.  Nonetheless, the pain was almost always there, except for sitting in a comfortable chair or a recliner.  If I'd get up from a chair or after driving more than a few minutes, the joint was really stiff and sore (like a sprained ankle) for about 30 seconds, but I could slowly get it to relax.  It was hard to find a comfortable position at night on either side, even with pillows between my knees, and finally ended up most nights on my back with pillows propping my leg up.
     Like I said, progress seemed to be marked by good days/bad days, but generally getting better over time.  That was until about six weeks ago.  I'm worried that I'm starting to go backward.  I've had one or two very bad days recently, when just standing for any length of time began to hurt a lot, the worst pain since the surgery.  It felt almost like the hip was out of joint.  It was better the next day, which was fortunate since I reffed kiddy basketball all morning.  But for the last couple of weeks it's definitely not as comfortable as it was six months ago.  It feels weaker and more painful on the stairs, with kind of a burning sensation at times.  Sleeping through the night has become a rarity.
     I really would like to get off any painkillers at all, and certainly thought I would be by now.  If I don't exercise almost daily the joint tightens up, so that it gets quite stiff and sore after sitting or driving for any time at all, and it hurts to stand up at first.  So I try to get a workout every day: weightlifting for about 40 minutes, then 20-25 minutes of mixed cardio on the recumbent bike, stairmaster, and a few walking/running laps around the track.  I take a couple of ibuprofen before working out every morning, and that helps with the inflammation and consequent pain, but lately the pain is often bad enough by early afternoon that I have to take more.  Most nights I can't sleep well unless I take aspirin or naproxen sulfate (Alleve) before going to bed.  At nights I often get referred pain down to my shin, which is what usually wakes me up.
     So the question: I'd like to know if it's typical to have significant pain in the joint a year post-op.  My doctor has assured me I'm better off than I would have been without the surgery, but the reality is that I'm having pretty much the same difficulties as what forced me to have the surgery in the first place.  I saw no poll about post-op pain this long after the surgery, which makes me wonder if I'm the Lone Ranger on this one.  The poll on "customer satisfaction" discouraged me, too, since I'm the only one in the crowd who rated my satisfaction at 50%.
     I went in to see my doctor on December 8th since I had seemed to plateau on progress with the pain and stiffness issue.  He gave me an injection at the surgery site at that time, and asked me to log the results over the next few days.  It was better for about a week, at least it wasn't so stiff, but it felt oddly "loose" and a little weaker, and kind of burned at times.  Those sensations went away, but I kept the log going.  Over the four months I've been logging things, I'd have to say I'm a little worse off now than I was then.
     Any ideas?  Recommendations?  Similar experiences?  This diatribe got way too long, but I kept imagining folks asking me questions, so I tried to answer those in advance.  Hope some of you can help.  I've decided if the pain is no better or worsens over the next two weeks that I'll go back in to the doc again.  I'm afraid he'll want to do something drastic, and I just don't want that again.

obxpelican

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Re: Still in pain one year post-op
« Reply #1 on: March 08, 2010, 02:50:06 AM »
If you're still having pain, IMHO, I would seek out an experienced surgeon to take a look at your most recent x-rays.  If you are having pain over 1 year post-op it's simply not the norm.

I would do it soon so that you can be on your way to a good recovery.


Chuck
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

NYRunning

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Re: Still in pain one year post-op
« Reply #2 on: March 08, 2010, 04:18:47 AM »
I am 14 months post BHR and after what seemed like good progress, have also begun to regress. Exercise is better than sitting, though soreness exists all of the time. Surgeon first said that it was a function of running too much, but after speaking with him the other day, he has suggested an ultrasound to see if I have any torn muscles in my buttocks. While an ultrasound is not definitive it may give some clues. If that is not diagnostically helpful, then the next step is an MRI conducted by radiologist Hollis Potter  at NY's Hospital for Special Surgery. My surgeon is in Tampa FL but he reports that Dr Potter uses an MRI protocol that produces a clear picture, something that he reports is not easily done with BHR patients using a traditional MRI protocol.  Good luck. I will keep you posted on what I learn.

Tommy

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Re: Still in pain one year post-op
« Reply #3 on: March 08, 2010, 01:07:46 PM »
NYRunning,
                 Do you mind me asking what  your weekly mileage and do you do any speed or tempo work?
 
                                                  Thanks Tommy
Dr Tupper  LBHR  6/02/09
Oklahoma

dw

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Re: Still in pain one year post-op
« Reply #4 on: March 08, 2010, 06:17:28 PM »
I'm a little over a year out - still sore from time to time, but not to the degree you're describing. I belive there's some scar tissue in there, which would be normal. I do not run, however. Lots of skiing, though, and elliptical training... plus a very active work around the house kind of lifestyle.

Out of curiousity, what kind of injection was it?

NYRunning

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Re: Still in pain one year post-op
« Reply #5 on: March 09, 2010, 02:32:03 PM »
Tommy,

Re mileage and tempo - nothing dramatic at all.  Run about 3-4 X per week of sessions that range from  3-5 eight minute miles to some repeat quarter miles @ a bit faster than 7 minute pace.  No marathon type mileage at all, much of it on treadmillls or in Central Park, which has some hilly sections.

Tommy

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Re: Still in pain one year post-op
« Reply #6 on: March 10, 2010, 12:41:43 AM »
Thanks, I don't think thats to much running at 14 months. The reason I ask is because when I increase the mileage or added tempo's to my training my BHR would get sore for a few days. Most of the soreness was in the butt.I back up a bit and it responds well.
                                           Tommy
Dr Tupper  LBHR  6/02/09
Oklahoma

Pat Walter

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Re: Still in pain one year post-op
« Reply #7 on: March 10, 2010, 01:34:20 AM »
Hi Spudair

Normally, people don't have any significant pain after one year.  If they had very bad problems pre surgery and used a crutch for months or years - it takes a very long time to try to get the mucles and bodies working normally.

Few people are taking pain meds that long. Few people are not sleeping at one year post op with such pain as you describe.  Something is not right.  Personally, I would question my surgeon why I was having such pain.  Have you had x-rays taken recently?  Is your acetabular cup properly placed at a good angle? Has it slipped?  Who was your doctor?  What hip device did you get? What surgical approach was used?  Certain approaches can cause more nerve damage than others giving refered pain. 

Certain hip devices have more acetabular cup probelms than others.  Less expeirnced surgeons have placed a lot of acetabular cups at the wrong angle with causes a lot of problems that usually lead to revisions. 

If you can add some more information, it would help.  It may be much more the doctor's placement of the device and/or hip device causing the problems that your body not healing properly.  That is the question you need to have answered.

I would most likely want a second and third opinon if I were your.  Get your recent x-rays and send an email and copy of them in a digital format to Dr. Gross of SC, Dr. De Smet of Belgium, Dr. Bose of India or Dr. Rogerson of WI.  Dr. Su of NY does a lot of revisions of other surgeons revisions.  You need to know what is going on and why.  If you surgeon is not one of the top in the US or overseas - you will most likely not get a good answer.  They may want to take a blood test to check your metal ions.  I would be concerned with still having pain at one year.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

SpudAir

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Re: Still in pain one year post-op
« Reply #8 on: March 13, 2010, 03:01:41 AM »
Pat:
     I have an appointment with my doctor next week, which is something of an achievement in itself.  As a teacher there aren't many minutes in the day when I can get away from class to see a doctor, so sometimes I have to schedule weeks out.  The doctor is Dr. John Q. Smith (no, I'm not making that up) in Caldwell, ID.  He's been great, but I realize he's not one of the top in the country.  I don't think that precludes his being able to perform admirably, however.  That said, I'm sure he'd also agree that the level of discomfort I'm having after this much time is not okay.  I don't like to be a whiner, and not having had several hip joints replaced gives me limited experience in the area of expected pain.  Probably I should have made more noise earlier.
    The joint was a Stryker joint, placed via anterior surgery.  The X-rays in December looked very good, with the acetabular cup appearing to be at the optimal angle.  Of course, that's to my untrained eye.  But it almost certainly hadn't slipped.  I'm somewhat concerned that the scar tissue is not only not healing, but is growing, creating pressure on the joint or something.  I've heard of similar situations--even my own wife had a problem with scar tissue hypertrophy after surgery for a dislocated shoulder and supraspinatus tendon tear.
    I'd be kind of surprised if surgeons of the caliber of Gross and DeSmet would be interested in troubleshooting a problem hip for someone who wasn't one of their patients.  But I'd be willing to send the info along to them if you thought they'd take a look.  I'm not sure how to get the X-ray in suitable digital form, however.  The last X-ray was a big film about 18x24 inches, too big to scan.  Is there an alternative way to get the picture?
    In any case, I sure appreciate your taking the time to make suggestions personally, Pat.  I'll get back to the forum here after my appointment Wednesday, hopefully with more and better news.  Thanks!

SpudAir

medgerton

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Re: Still in pain one year post-op
« Reply #9 on: March 13, 2010, 05:41:58 AM »
The place that took my X-Rays and MRI had the capability to put them on a CD for me. It was no big deal for them. I just had to ask for it.

SpudAir

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Re: Still in pain one year post-op
« Reply #10 on: April 01, 2010, 09:31:18 PM »
    Well, went in to see the doc again, two weeks ago now.  The X-rays look good, but there's no question that the pain level is not normal for a year post-op.  I did find out that the injection I had in December was cortisone, but it wasn't very effective.  This visit the doc prescribed feldene as a non-steroidal anti-inflammatory, but it was out of stock and the pharmacy was only able to fill the prescription just yesterday.  Hard to tell much after just one dose, but it seems to help, although I could put that down to a good workout today.  Over the weekend I took a trip by car, and at times the pain was very bad--had to stop and hobble around until it would loosen up.  Ironically, I get back to town here and go through a pretty decent workout, including squats, leg curls, stretches, recumbent bike, Stairmaster, and walking/running about 3/4 mile. During and after all that, some minor soreness, just enough to notice.  Something about my car seems to position the hip so that it really gets painful, but exercise doesn't seem to aggravate the soreness, in fact it seems helpful.
     The doc did say that it could be a problem with my back, and he would set up an MRI to check that out and probably a bone scan.  That was a couple of weeks ago, and wheels seem to turn slowly in that office, so I haven't heard when that procedure will happen.  If I haven't gotten some better news soon I'll likely come back and ask for some contact information from those of you who have had better success with your resurfacing procedures.

B.I.L.L.

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Re: Still in pain one year post-op
« Reply #11 on: April 12, 2010, 06:14:44 AM »
    Well, went in to see the doc again, two weeks ago now.  The X-rays look good, but there's no question that the pain level is not normal for a year post-op.  I did find out that the injection I had in December was cortisone, but it wasn't very effective.  This visit the doc prescribed feldene as a non-steroidal anti-inflammatory, but it was out of stock and the pharmacy was only able to fill the prescription just yesterday.  Hard to tell much after just one dose, but it seems to help, although I could put that down to a good workout today.  Over the weekend I took a trip by car, and at times the pain was very bad--had to stop and hobble around until it would loosen up.  Ironically, I get back to town here and go through a pretty decent workout, including squats, leg curls, stretches, recumbent bike, Stairmaster, and walking/running about 3/4 mile. During and after all that, some minor soreness, just enough to notice.  Something about my car seems to position the hip so that it really gets painful, but exercise doesn't seem to aggravate the soreness, in fact it seems helpful.
     The doc did say that it could be a problem with my back, and he would set up an MRI to check that out and probably a bone scan.  That was a couple of weeks ago, and wheels seem to turn slowly in that office, so I haven't heard when that procedure will happen.  If I haven't gotten some better news soon I'll likely come back and ask for some contact information from those of you who have had better success with your resurfacing procedures.










Hi there SpudAir, any new info ?  I'm having the same problem riding in a car and was curious if you heard anything new. Walking or biking is ok but car rides result in swelling, pain, and clunking.  Please keep us up to date with any new info, Thanks and good luck 8)   

John C

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Re: Still in pain one year post-op
« Reply #12 on: April 13, 2010, 04:02:13 AM »
Hi Spudair,
Just some thoughts from my experience. About 20 years ago, I was having severe pain in my right buttocks, which many people diagnosed as hip related. After almost a year, an MRI finally confirmed that it was definitely a ruptured disc in my back, which back surgery immediately cured. Riding in a car was definitely terrible before the surgery. Over the past 10+ years, I developed severe arthritis in my left hip, which I had resurfaced 2 years ago with good results. Right up until that surgery, I was not completely sure that my back was not involved again, but the resurfacing took care of it. The point of all this, is that it is not always easy to separate back and hip sources for pain in that area.
Hope things work out well.
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

NYRunning

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Re: Still in pain one year post-op
« Reply #13 on: April 21, 2010, 04:14:05 PM »
I have learned more about my situation which might be helpful.  The issue with MRI for MOM implants is that it is very hard to get a very good picture. The nation's reported leading expert is radiologist  Dr Hollis Potter at NYC's Hospital for Special Surgery.  Her report suggested that my pain was a combination of greater trochanteric bursitis, synovitis in the hip capsule, and some iliopsas strain.  What it also showed is that the implant has not moved nor is there any infection in the joint area. None of these diagnostic findings were known through either X rays nor an ultrasound.

Surgeon reported that I should try an ulstrasound guided cortisone injection to address the iliopsas area. I may do that but I am also investigating prolotherapy as an alternative treatment.

Will post when I know more.


B.I.L.L.

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Re: Still in pain one year post-op
« Reply #14 on: April 21, 2010, 04:28:55 PM »
Thanks for the update 8)

SpudAir

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Re: Still in pain one year post-op
« Reply #15 on: April 24, 2010, 06:04:54 PM »
   Well, I have a bit more information, but it's still inconclusive.  I'm a little irritated by how slowly the wheels turn at my doctor's office, which, from what I can tell, is due to office staff that don't feel very accountable for keeping things moving.  I had an MRI done a little over two weeks ago.  Doc wanted to see if there were any significant problems with my lower back that could cause nerve pinching and account for the hip pain.  Two weeks after the MRI I still hadn't heard anything from the Doc's office, so I dropped in on them and asked what was going on.  Don't know who dropped the ball, but they immediately got me into an exam room and the Doc came in shortly to talk.
   The MRI didn't show anything other than some slight central compression of a couple discs, which is pretty normal, and wasn't enough to cause any problems.  There is no nerve pinching apparent from the MRI.  The options for treatment are, at this point, not well-indicated.  Doc wants to try an epidural injection to eliminate neural problem from the lower back as the culprit.  Following that we'll try a bone scan to see if it reveals anything not showing on the X-ray.  I"m not optimistic that we'll find anything with either procedure.  I do think that after we try the epidural, which I'm fairly certain will be ineffective, I'll ask for copies of the X-rays and MRI and see if I can get them to one of the specialists Pat recommends.  I'd be surprised if they'd undertake on my behalf, however, not having been one of their patients originally.  In the meantime I sleep the best I can, and grit my teeth when I drive.  At least I can exercise with little or no difficulty, so I've got no excuse for not hitting the gym.  Mixed blessing that.

 

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