Iliopsoas release - any experience

[karen17]

I'm looking for any feedback with good or bad experience with iliopsoas release??

I had BHR on left side in June 08 at age 39. Around 5 months ago, start experience pain and aching. Went back to surgeon - had MRI, plain films, blood test etc. There appears to be no major damage or misalignment. My symptoms are typical of iliopsoas tendonitis, ie cant put socks on, cant cross legs, cant get in car etc without LOTS of pain. I also get aches and pains sitting for a long time and walking up hills or stairs, particularly at the back of the hip. I've had 4 steroid injections (two into joint, two into the tendon), all have made no improvement, and in fact, I think they have sped up the deterioration in movement. My surgeon is undecided if its metal allergy or illiopsoas. So rather than go in and remove the metal, he wants to try iliopsoas release.
Up until start of pain, I was fairly active - walking 4-5 times a week, cycling etc.

Has any had this?
If so, are you now back to normal activity - if not, what are the restrictions (my brain cant get round how your body operates 'normally' when something is removed??)
Also how long on crutches / off work etc.

thanks
Karen

[Jed]

Karen, I'm going through something similar at the moment. If it is tendonitis, it can be very stubborn, and not unusually efforts to address it, like passive stretching, can make it worse. Swimming certainly helps me - the kicking action of a gentle freestyle stroke will actively stretch those hip flexors in a non-provocative manner while the breast stroke's frog kick gives considerable mobilisation of the joint. Another thing you might consider is working the opposing muscles and tendons, particularly the butt muscles. Lifting the knee in cycling and walking up hills and stairs will directly stress the hip flexors and ilipsoas, so changing your activity for a few months (and it can take months) may help.
Good luck
John

[Pat Walter]

Hi Karen

Welcome to Hip Talk.

I have one suggestion after reading thousands of stories for over 5 years.  I would get a second and third opinion from several of the most expreinced hip resurfacing surgeons.  You did not mention who your surgeon was, how many resurfacing he/she has done and what device you have received.

The most common problems as you describe are most often from misplaced acetabular cups.  I am not saying yours  is not correct, but it is always best to have several of the top surgeons read your x-rays and get more input with you have diffiuclt post op problems.  There have been times when the surgeon did not read the x-rays in the same manner as doctors like Dr. De Smet of Belgium, Dr. Gross of SC, Dr. Su of NY, Dr. Bose of India and a few others.  You need more input before making decisions about what to do.

Just my suggestion since I have been involved with resurfacing for the last 5 years.  You can also get a blood test to find out what your metal ion levels are. That is one thing I think would be a good idea.  You did not say where you live either.

If you can add some more information, I can suggest who you can contact.  Any of the above doctors will give you a free consultation via email except for Dr. Su.  Don't use just one surgeon when you have on going post op problems.  There have been a handful of people now developing problems at 2 - 4 years post op with improperly placed acetabular cups. Their own surgeon usually was not able to determine that since they are not normally as expeirnced as the top surgeons.  Most had blood test to determine their metal ion levels and then went from there. 

Pat

[karen17]

Hi Pat,

Thanks for your advice. I live in Perth, Western Australia. My surgeon was Professor Bo Nivbrant, and he has done hundreds of resurfacing - he was the first in Perth to do them.

I had OA in my left hip from a sports injury about 20 years ago. I spent about 2 years trying to get help for the constant pain - the first couple of OS I saw told me to come back in 10 years. I wasn't happy as I could hardly walk, and not being able to play with my kids was not acceptable. By the time I was eventually referred to Prof Nivbrant, I was 39 and walking with a cane. He thought I was a good candidate  and did a Birmigham Hip Resurfacing. For the first 12 months its was brilliant. I was in no pain, walking, running, cycling, just being active. Prof Nivbrant took copies of my films for his research as he thought they were so good.

Then I started to find it was getting sore again, just getting dressed, putting on socks to start. Then getting in the car, then couldn't drive a manual car, now just pain all the time. I've tried complete rest, physio, and the steriod injections - all with no success. Its just getting worse each week...
There aren't that many surgeons doing resurfacings in Perth ( I think he said about half a dozen others?)- but he sent me for a second opinion to Daniel Fick. While I was at there, he had another colleague also review my films. None of them noted any issue with placement, or with bone structures.

I will ask if I can have the metal tests.  Also if you can recommended somewhere to send the films for another opinion, that would be great. My options in perth are limited!



thanks again.
Karen

[fedup]

There are a lot of scientific reports regarding iliopsoas tendonitis for hip arthroplasty (both THR and resurfacing). Having had this diagnosis, 3-4  tendon injections with corticosteroids, several MRI's, ultrasounds and an eventual iliopsoas tenotomy- I WOULD RECOMMEND THAT DO NOT GET THIS PROCEDURE- I am left with an unstable weak leg, despite increase size and strength of the other hip flexors, the leg will never be as strong as the other. Have you had your metal levels checked? If they are elevated, this is more evidence that the prosthesis needs to be revised. I saw 5 different surgeons, but no one would counteract the suggestion of my surgeon so I had no choice. My acetabular component was loose and afterwards the radiologist said it may have been diagnosed if I had been examined under fluoroscopy (xray) so that they might have seen the prosthesis move when the hip was in certain positions. Don't cut the tendon, find out what is irritating it: the acetabular rim, osteophytes on the femoral neck, scar tissue, a metal reaction with "pseudotumour or inflammatory mass" these are just some of the auses and they can't all be seen by MRI or ultrasound because of the scatter from the metal. I can provide you with journal references if you want, but surgeons don't publish poor outcomes, only good outcomes when it comes to case reports or case series. ps Did you have similar symptoms prior to surgey (femeroacetabular impingement, "snapping hips" with iliopsoas tendonitis can also occur in native joints usually with osteoarthritis.)

[Pat Walter]

Hi Karen

Both Dr. De Smet of Belgium and Dr. Bose of India will give you a free email consultation if you tell them your story about all your problems and attach a copy of your x-rays in a digital format as a .jpg  You can take a digital photo of your x-rays if they are not in digital format. Make them about 500 pixels wide or long.  The are both use to helping patients with a second opinon and are several of the most experinced surgeons in the world. Dr. De Smet has done over 3000 resurfacings.  I will post their information at the end of this note. 

Here is an article about how to convert digital x-rays   http://www.surfacehippy.info/xrayconversion.php

Pat

Dr. Koen De Smet
3200 Hip Resurfacings to date ***
ANCA Clinic
AMC-Gent
Krijgslaan 181
9000 Ghent
BELGIUM
Phone: +(1)32 9 2525903
Fax: +(1)32 9 2526457
+1 for USA & Canada:
E-mail: helpdesk@heup.be
ANCA Clinic Website


Dr. Vijay C. Bose
1400 Hip Resurfacings to date ***
BHR Regional centre - India
Apollo Speciality Hospital, 320, Mount Road, Chennai - 600035. INDIA
E-Mail: bose5vijay@hotmail.com
Telephone: 0091-44-(0) 98400 - 32251
Hip Resurfacing India Website

Info also available on this page  http://www.surfacehippy.info/listofdoctors.php

[Rolls]

Hi Karen,
How did you make out with this?  If you have ever read any of my posts, I seem to be suffering the same thing, with no relief yet.  I sent my xrays to DeSmet and Bose and got immediate and almost identical replies, while my Doctor has never mentioned any of them.  I regret not using a more experienced surgeon, but I didn't know about Surface Hippy at the time and I thought he was the most experienced in the area, Boston.  I am seeing another surgeon tomorrow in RI, so I am hoping for a new direction.  Keep us posted.

[karen17]

Hi Rolls,
I did end up getting the release - and I dont regret it. I had extremely painful grating pain every time i lifted my leg. 2y post op, and i had my walking stick out again, couldnt get in the car etc (not good at only 41!!!). This pain has completely gone.

However, 11 months on from the release and i still feel like my hip is not right. I still feel like i can feel the metal inside my hip. I had this with the grating as well, but its not as painful. Sometimes its more in my butt, sometimes its right in the front. Sometimes it feels like i just need to move a bit to get into a comfortable position (but no matter what i do, i can't get it comfortable). Its not really painful, just this discomfort.

I tried PT for about 4 months with no improvement, and sometimes making it worse. She tried everything she knew, and sort advice from her peers. She has recommended I go back to the surgeon, and has written to him for me - i just havent gone yet!

I think i am avoiding it as long as i can. I feel like its 'uncomfortable' and when it gets 'painful' i will go. I don't want more surgery, and I think that is what he will want to do.
Your post has inspired me to get my xrays digital and send to Dr Bose. the medicial community in Perth (Western Australi) is not large, so it cant hurt to go further  field!!
I'll let you knowhowI get on!!
Karen

[Rolls]

Hi Karen,
Glad to hear it was some relief.  But, it must suck not to get the total relief we are all looking for.  I saw my new doctor in RI, and the wife and I like him.  He did not have any answers for my RBHR though.  I had a CT scan, metal depressed, to see what is going on with the soft tissue.  I will get the results soon.  4 yrs post op and I have pain in my right knee and my left hip as well.  I was told about a book, "Pain Free" by Peter Egoscue.  I am working with that and it is helping some, but it is so hard to be a believer when the pain just won't go away.  But, I will keep trying for now.
Rolls

[Rolls]

Hi Karen,
It has been awhile.  Had my left hip done by Dr. Marchand in RI in October 2011.  It has been going much better than my right one ever did.  But, I still get the annoying pain from time to time in my upper thigh when I bring the leg up to 90 degrees in the front. I have tried lots of things, get some relief, it goes away, and then it comes back.  Is it just my age?  I don't know, just very uncomfortable, sounds very similar to your pain.  I keep trying different things and will keep you posted.
Any news from you?

[jgenese]

Karen, I had my left BHR done October 2010 by Dr. Marchand in RI. I also experienced the same pain. I had the Depomodrol/Marcaine injection into the bursa assisted by a CT Scan at South County Hospital in November 2011 which made a huge improvement but not totally gone. The reason is simple. The implants are too large and the psoas tendon rubs against it causing the discomfort. I started going to a massage therapist for myofascial release of the psoas tendon and it has made a huge improvement. I also hit the treadmill for thirty minutes each day after work. If you can find a therapist near you that has the proper training for this, I would highly recommend it.

[Rolls]

Thanks for that latest news.  Actually, I found some stretches on the Internet for Illio tendon release and it has, so far, given me some good relief as well.  Why does it take us so long to get relief, I surely don't know how the body works, but shouldn't the doctors and PTs?  Hopefully, we are on to something.

[hernanu]

I think some do, but they focus on the things they know.

The PTs I used were exceptional, but I still had to do some things for myself that helped a lot - like the roller and using a tennis ball on my iliopsoas.

The tennis ball was suggested by a personal trainer who I hired for a month after the PT was done, to help me put together an exercise regime that would include my PT exercises.
 

[Luanna]

Hern,
So, I'm sitting here with a tennis ball. What do I do with it? I've got the roller thing going now but haven't heard about the tennis ball.

Thanks.
Luanna

[hernanu]

There's two places you can do it to address the iliopsoas:

• On the inside of the upper thigh, next to the groin. There's a triangle there that is massaged by Chiropractors (I've read) to loosen the iliopsoas. Use the tennis ball there in a rolling motion.
• The muscle passes behind to the lower back. I took the tennis ball, leaned against it on a wall, then moved over my near central lower back.

I'm sure other folks may know more, those are the two I've done and have helped me.