11.5 months post-op sudden flare-up

[mountaingoat]

Hi everyone,
I'm a long-time reader and lately an infrequent poster mainly because, like so
many of us, I've been doing so well that I don't ever think about my hips except
when I go through the airport metal detector. My 1 year anniversary for
bilateral with Dr. Gross is coming up at the end of January and I'm back to
extensive hiking, cycling, some light trail jogging, telemark and xc skiing and
power yoga. I even hike multiple times per week with my 25-lb daughter on my
back in a pack :-)

I've really had no pain or issues at all in either hip since probably June of
last year other than just getting more strength and ROM back with each passing
month. I was actually surprised when I started to get back into jogging again
that I really had almost no pain afterwards. I started off very slowly with a
walk/run program at 9-months post op and am now up to running for about 45
minutes on trails 1 or 2 times per week. I've progressed a lot in yoga since last summer when I couldn't do any of the balancing poses and still lacked a lot of ROM but I've made a lot of improvements and am much stronger and more balanced at this point. 

In any case, the point of my post is that somehow in the last week I seem to
have really irritated the heck out of something in my left hip/groin from yoga? (that's when it seemed to start but I can't identify a specific thing I did and now its hurting from just any kind of workout). I wouldn't even be concerned enough to type up this email except that it is the
first time I've even needed to ice and take NSAIDs in more than 6 months and I
know I really tweaked something. It wasn't bothering me at all with skiing and
running last weekend and then I was in agony after a yoga class on Tuesday
night. It didn't hurt at all during the class - just for hours afterwards and was gone by
the next day. I didn't think much of it until I went back a few nights later and the pain came back and has persisted off and on throughout the last few days - its not terrible but its noticeable even with NSAIDs and iceand its bothering me at rest. I know that if it were something with the implant
than I would probably know immediately and would be in a lot more pain but I
just have that lurking fear that I somehow did something that will cause
long-term problems that come and go...which is exactly what I was hoping to
avoid with this surgery! My whole hip is really stiff and achey and I feel twinges in the groin and outer hip area. This hip is definitely the one that healed more slowly overall ~ it was the one which I fell on in the immediate post-op period (just back onto the toilet -nothing too serious) so I always have that in the back of my mind as 'what if the bone never grew into the cup'? Its just odd to me that I didn't have any significant problems earlier on as I was recovering and then this happened. I would think that if something was mal-positioned or didn't allow for correct ingrowth than it would have never really healed the way it did?

I've read through many posts about post-op problems but really this was out of the blue for me - I was doing perfectly without any pain for the last 6 months and this happened out of nowhere. I'm going back to see Dr. Gross next week for my 1 year check-up so of course I can talk to him then but I had hoped to have better news to share:-(  I'm going to take the rest of the week off of exercise and just see what happens but I'm definitely more nervous than I've been since the first few months after surgery.   

Any feedback would be greatly appreciated. Thanks!

Amy
Bilateral Biomet, Dr. Gross, 1/23/12 & 1/25/12

[hernanu]

Hi Amy, first off - the rest of your post was great, making good progress.

I had several setbacks like that, as I expanded my activity. I got one about three weeks ago, when I stepped up to a full hour of punching bag workouts. I was definitely sore and got slightly bummed out about it, but I remember in regular workouts long before I had OA, I would get tweaks and pulls periodically. I was indestructible, though so I didn't worry about it much.

Now, like you, I will have a thought that maybe the hip is involved, but it is most likely just muscular and stepping back a bit will sort it out. You're going to see Dr. Gross, so you'll get good feedback from him and probably realize it is just a muscular thing.

[mslendzion]

Mine still gets sore now and then. I shoveled snow a few weeks back and was in some real scary pain for a few days. I did nothing over the weekend and mine is somewhat sore today. I think we are just still healing a bit and am hoping you are just experiencing muscular pain. Wishing you the best.

[Dan L]

Great to hear you are doing so well overall despite the recent flare up, which I'm sure is trying.  if it persists probably worth a call to the surgeon's office to be safe.  I would guess as active as you are, it could be as minor as a muscle tear or pull in or near the surgical site.

I have not had any big ones for some time, thankfully.   A few isolated med/low flares with increased activity or dramatic weather changes is all I have experienced now at 15 months and 11 months, with 30 more days of some restrictions on impact activity on the one side, so I have not done most things that were prohibited.

Good luck and I hope this will pass as another blip in your recovery.

Dan

[phillwad]

Amy - you are right - chat with the Doc.  As we all get back to doing stuff we hear and feel all kinds of pains - sorry you have one.

This week I was rowing and kept geting this "bump" in one place in the stroke - working hard to foicus on keeping a good time/effort so rowed through - my mind was not being kind to me as I thought about my new hips.  My daughter comes - she is a real rower - and tells me I have something on the seat slide.  Wipes it off and my "bump" disappears - yes Dad felt stupid 

I hope yours clears up soon - Phill

[mountaingoat]

Thanks everyone. I am going to see Dr. Gross next week for my 1 year anniversary so I guess I will talk to him then. I am feeling a little better today but not where I want to be after a few days of rest. There seem to be so many nebulous little things that could be going on within our hips post-op and when you hear of people who are still having issues at 1-2 years out its a little scary. Obviously the vast majority of patients are fine but there are some who seem to have continued pain.

Just when I was getting to the point of feeling like I could relax a little and say out loud to others that my hips were doing great - well, then this happens. I always seem to eat my words in that regard. 

I'll keep you posted on what happens.
Thanks again everyone.

Amy

[mountaingoat]

So, I returned from my 1 year appointment with Dr. Gross yesterday with no better idea of what might be causing my sudden problems. He took a few more x-rays and said everything was completely benign and also did a physical exam and said no signs of psoas tendonitis or bursitis, which I basically knew. He could not offer me any explanation for why I went from near 100% two weeks ago to not being able to walk through the airport comfortably. It just doesn't make sense to me such that I feel like there has to be a logical explanation ~ if I had been having problems all along than it would be different but this came so out of now where that it doesn't give me a lot of faith that I'm not going to still be like this in 6 months. And then, of course, there is that whole fear of where do I go next?

I wasn't able to get a bone scan before I left due to scheduling constraints so despite Dr. Gross saying it would not provide me with any additional information, I am going to do so on Monday. I just want to feel like I at least tried to rule out a stress fracture or whatnot - even if it is not clear whether it is bone remodeling or a stress fracture.

Dr. Gross did offer me a metal ions test if I wanted one but said it was not likely to reveal anything at this stage. My understanding too is that generally any kind of metallosis or sensitivity would probably not start to be symptomatic at this stage and also that if I had a true metal allergy - which are exceedingly rare - I would have had more problems from the start.

So, I am stumped. I have a ski hut trip in 2 weeks which I had been looking forward to all winter and it doesn't look like I will do much skiing unfortunately. 

If anyone has any more ideas for anything I could try to get some diagnostic answers it would be greatly appreciated. I feel bad that I only recently came back to this site when I was having problems because you all were so great to me last winter when I was recovering, on crutches for 6 weeks and taking care of a 10-month old baby while my husband rafted the Grand Canyon.  I am endeavoring to be more present on this board for others as they go through their resurfacing journey.

Amy

[Dan L]

Mountaingoat;

By chance did your uptick in pain coincide with dropping tempuratures?  We have had really cold weather past week here in OH, and my pain has been at its worst since the actual surgeries.  I seem to get more pain as temps fall at/below high 30's and with temps in the single digits here recently, being outside in that seems to have been involved in my pain levels going up.

The cold induced pain over the weekend after a challenging hike (at 11+ months PO and with almost no restrictions on the last side so I challenged myself to climb some) was the kind I felt seemingly in the joint itself (or close to it in the soft tissues).  It hurt alot during and after the hike.

Today we are in the 40's and I'm back to virtually no pain.

Just wondering.  Maybe nothing.

Dan

[John C]

Hello Dan and Mountaingoat,
My 2 cents worth on the temperature issue. I teach on the ski mountain every day all winter, and temps can get pretty cold. Not uncommon for it to be around zero when I go up early each morning, and last week it was around 20 below for a few mornings in a row. I have to say that I have never felt any effect of temperature on my resurfaced hip, though I do dress pretty warmly. Just one person's experience with cold temps to add to the discussion.

[IslandCatt]

In any case, the point of my post is that somehow in the last week I seem to
have really irritated the heck out of something in my left hip/groin from yoga? (that's when it seemed to start but I can't identify a specific thing I did and now its hurting from just any kind of workout).

It wasn't bothering me at all with skiing and
running last weekend and then I was in agony after a yoga class on Tuesday
night. It didn't hurt at all during the class - just for hours afterwards and was gone by
the next day. I didn't think much of it until I went back a few nights later and the pain came back and has persisted off and on throughout the last few days - its not terrible but its noticeable even with NSAIDs and iceand its bothering me at rest.

It seems pretty obvious to me. Something you are doing in yoga injured the tissues in or around the hip joint. Each time you go back to yoga, you re-injure it more. I'm betting when you went back to yoga the second time, you didn't modify your session to make it both shorter and easier, which would explain why it hurt worse the next time.

You need to treat it like any exercise-induced injury. Stop doing any activity that causes pain and then gradually re-introduce your activities back into your routine. Since yoga seems to be the thing that caused this, yoga would be the thing you are going to need to be the most conservative about re-introducing back into your workouts both in terms of duration and intensity.

[John C]

Hi Mountaingoat,
I have two thoughts to add to the discussion about yoga possibly causing the problems.
In talking to Dr Gross, he theorized that pushing our hips beyond their "natural" range of motion may be the cause of many hip problems leading up to surgery. He particularly mentioned yoga and martial arts (being me) as possible activities that could cause this problem.
The second issue is that some studies with cadavers have shown that resurfacings can cause impingement if pushed through too great of a range of motion (many yoga asanas would easily fall into this category). If this happens, one of the side effects would be minor subluxation and associated looseness in the joint capsule, which could lead to clunking similar to what some people experience right after surgery.
If this were the case (all theoretical), a solution might be to avoid any major stretching and allow the joint capsule to tighten up again and stabilize the joint. Exercises that strengthen and tighten the joint would be good. 
All theoretical, but in reading the quote from your post about being in pain after yoga, it might be worth considering.

[hernanu]

Good post John, it makes sense.

[Dee Dee]

Hi Amy,
Just wondering if you were able to get some relief and/or answers.
Dee

[Roboclimber]

I am very interested in this topic because I have noticed the same issue with the stretching, and now that I am reading this I am really going to back off. It makes sense that these soft tissues are trying to heal, and whenever I work out of the range of motion, it hurts. I am bi-lateral BHR (at 15 mos post op R, 9 mos post-op L) with a fused lumbar spine, but I am a climber and runner....and just dying to get back to the sports I love, but I sense this is a more common issue than I thought. I just hope it goes away, as I used to be able to do the splits in a million ways.

[hernanu]

Hi Geoff, I am back to being fairly limber at 33 months (wow!?!? time flies) and 30 months left / right.

I started stretching (lightly) at about six months, then deeper stretches at about a year. Not as aggressive as the stretches I once did, but pretty deep at about 20 months.

Have now incorporated yoga into my workouts since about 24 months, and devised a strategy with my yoga instructor - I back off and do the less intense movement if and when any discomfort appears. I've only had to do this once or twice, the rest of the time the muscles and hip seem fine.

I think that yoga movement / positions, like with any other stretches need to be approached with respect. They are capable of stressing muscles that may not be ready for a particular movement, so like with people unused to that movement, need to be done gradually.

My instructor is careful and aware of my workout and talks to me some times about what issues I encounter; she is interested, since her husband had a THR and she wants to be knowledgeable about HRs.

I also don't take a full yoga class, limiting it to a half hour (which she offers every tuesday). I figure that's another way of easing into it.

The splits for me are either far away or just won't be in my future, but I am able to touch head to knee when standing, chest to thigh when sitting, etc. So I am more than limber enough to support martial arts kicks, which was my goal.

Just like with earlier recuperation, this does need patience. I didn't really feel completely strong and limber enough for my kind of workout until two years had gone by.

[Roboclimber]

Hi Hernanu,

This is great info - and thanks for this. Very much appreciated.

My ROM is so far from where I was 5 years ago...but many surgeries have passed since then (3 major). No one is trying to make false promises - just so you know. There's a lot going on...

That said, it is over a year on one hip, and coming up on a year on the other. I am just fishing around, but it appears the healing can be weird, and I may have been pushing this a bit - given my history. It is amazing what I can do (more than most), but odd at what I suffer (sitting....leg angles > 90  w load, knee and hip). I sometimes think this is just natural aging, but then I read posts and think - maybe not?.

Anyway, i have been absent - because i did not want to sound negative - but my previous spinal injury complicates things, and there is a lot going on.

Cheers...