Tenotomy of the iliopsoas ( tendon release )

You're before me then Tracy 😳. They have said it's looking like I will need this done but not until I'm much stronger. My tendon is completely stuck . There are 2 options available, either new socket smaller or reset ? Or cut the tendon. I was wondering what the recovery time is like really 😩😩

I am 7 months out of surgery and have had a terrible groin pain. Iliopsoas tendinitis. It has not gotton better with rest, nsaids, pt. My surgeon does alot of these. 15 minute procedure. Crutches for 5-7 days. Then only range of motion pt until 4-6 weeks. Gotta let tendon heal. Im just hoping it works to alleviate pain. He said back to work after 1 week. Im tsking a month as oi have a physically demanding job. I think i went back to work too soon after thr and that's what got this tendon so angry. When did u have thr sx?

Ohh wow I was so worried it would be a similar recovery time to THR . I'm 35 and 10 weeks post op , I have no external rotation at all , the tendon is totally stuck. It dose snap a bit if I'm walking and the pain is pretty constant 😟. They have tried stretch exercises but there's no movement at all .

No. Fairly easy. How long do u have to wait?

Mine is no stuck but vety painful groin and front of thigh. Even walking hurts. Ive been miserable..

They didn't give me an idea of when I can have it done , but just said I needed to be much stronger than I am now before they would do anything. Please let me know how you get on xxxxx

Where do u live. Your surgeon does this procedure? Hard to get that leg strong w an entrapped tendon.

Is it painful to walk? Did u have anterior or posterior approach w thr?

Yes my surgeon will do it , he's is very good and well known. I'm in the south east of Kent. I had a posterior approach , but I had a lot of muscle wastage due to being almost house bound for a year before surgery. This was his main concern when he saw me , saying one thing at a time .I'm getting stronger. It is painful to walk but my pain is at its worst if I'm in a sitting position and put my leg out straight and try to lift it up 😫😖. It's painful with many movements but that's the worst. X

Ill let iu know how my sx goes. I get date monday. They r tring to squeeze me in asap.

Was your hip replacement anterior or posterior? I am 5 1/2 months and still have groin pain when lifting leg and some now and then while walking. Was also told that it was psoas tendinitis and wait because it usually resolves itself. Have babied it, etc. but it has not stopped. Dr said he doesn't want to do a MRI until a year because it won't show anything very specific yet. He said if he does it now everything will still appear as a problem because it is still healing. How was yours specifically diagnosed? Thx for the info. Wlee

Hi wlee

Mine was anterior. I had mri at 5 months which showed nothing. After lidocaine in that muscle took away pain i had steroid shot which did nothing. Surgeon went in arthroscopically 3 days ago to release tendon and found 3 tears in my iliopsoas tendon. Explains my pain and why rest did not help. Back on crutches for a month ugh. Hope this helps it heal.

How much of the tendon is cut/released? I assume it's not the whole thing is it? Mine was anterior also. I live in Washington DC, where are you? How many months are you now, did you have general anathesia for the procedure and sorry for all the questions but I'm feeling nervous about all of this. (I wake up every day and keep hoping it's going to be my miracle day where the annoying gripping pain just stops.) I hope you start to feel better very soon and admire your moving ahead

Tendon not cut just released. No weakness after. Yes it was general anesthesia but a very quick procedure. 15 min. I am 7 months post op and live near boston.

I would really rest that tendon. See if it resolves without sx first. Mine didnt but gave it 3 months of rest before surgeon would do sx. At 3 days post op really really sore

Ouch just thinking about it. I do try to rest my leg (lift it getting in and out of car, etc.) but I work at a somewhat strenuous job as a High School ceramics and sculpture teacher....so always moving, turning and lifting. I am trying to be patient which is why I admire your move. We just started getting some heavy snowflakes a few minutes ago which is not average for DC in December. (It won't stick) Are you getting the nor'easter? Stay in touch and I hope you have an 'uneventful' recovery.

No snow. Cape cod. I also have physical job. Veterinarian. I think i overdid it at work. Be careful. I am off for a month now. Ur health is more important than work. Ofcourse i am nervous it won't work. Trying to stay positive but ive had a long road. First surgery was for labral tear which tanked. THR was 2nd. This is 3rd.

From everything I've read on line I think your surgery is the way to go. I'm sure having to go through the waiting and healing time again must be exhausting. Your profession and where you live is making me smile.... I always loved going to the Cape with my friends as a teen (grew up in NY) and worked for a vet in college and thought it was a brilliant and compassionate career.I'm sure I will do the same surgery myself if that's what it takes to get on with it all.

Just curious. Are you tall and thin with little body fat. Seems more common in them. I am.

Petite and thin......I don't think it's the length but maybe the amount of time and retraction on thin, semi-muscular body types.....not much body fat protection for the duration of a fairly violent surgery

Yup. No body fat to cushion those structures. Does it hurt to walk? I did.

Hurts more to walk steps but sometimes walking is bothersome. Seems to be getting less painful but way more frequent. Constant, in fact

Sure sounds like what i have.

Diagnose with lidocaine injection into iliopsoas tendon sheath under fluroscopy

if pain goes away then confirms that is source if pain. Often a steroid shot into tendon can help. Did not help me. That is why i had sx at 7 months post op. I was in terrible pain and back on cane. .mri showed nothing. Not all hip surgeons do arthroscopic procedures. That is what u would need. Id push for the diagnostic injection and mri. I would not wait a year.

Tracy...I hope you see this because I'm really in a quandry! I've had impingement pain in my right THR for 7(!) years! I had both my hips done 8 weeks apart and the left is as if nothing ever happened but the right (since the day I got home from the hospital) shows all the signs of classic impingement symptoms.  Went thru all the conservative treatments...PT for stretching...3 sessions of the giant needle into the tendon shaft so I decided to go for the surgical fix.  Now, here's the thing...its NOT a terrible pain...its a discomfort and only really hurts 5% of the time. Doesn't hurt walking or heavy gardening but I do pull my leg into the passenger side of the car and can't do any type of straight leg lift.  It used to "shift" on occassion while walking thru a supermarke which felt like a knife to the groin but that too seems to have ceased.  SO...after seeing my surgeon and getting a July 5th date for his OPEN surgery, I'm beginning to think maybe I shouldn;t do it.  It will be a complete cut of the tendon and I;m afraid of leg weakness, muscle atrophy and simply permanently modifying the natural structure of the body especially since it turns out its not a dibilitating condition.  I'm on the verge of cancelling the surgery then I'll lift my leg onto the ottoman and it hurts in the lift.  I wonder whether its worth the whole procedure for a discomfort. Love to know your outcome!! Thanks!

 

Hi Tracy

My symptoms sound similar. Im in San Diego, 5 weeks post anterior thr. Doing heel slides and standing leg raises causes horrible pain with a clicking in the joint area. . It only happens when I am actively try to lift. If someone lifts it for me, there is no pain. My pt wants me to keep up the exercises as long as there is no residual pain the next morning. I see the surgeon for a routine check next week.

Susan, I'm so sorry to hear 7 years! And so curious what you did. Did you cancel? Go through with it? I'm 5 years out from THR surgery. Today, saw a new doctor who is sending me for cortisone to see if it gives relief.. you know the drill, try to diagnose if psoas release is going to be a solution. But I got very freaked out when I learned today that the "side effect" is such dramatic leg weakness. The last surgeon I talked to about potential of this surgery didn't even mention that. I'm pretty much in pain most of the time, and walking is very limited. Still, seems like a bad bargain, to have to cut something so critical, and then the weak leg. I really wonder, I think that complete cut means the leg weakness would never resolve.  What did you end up doing?

Tracy, how has psoas release surgery turned out for you? Very curious and hoping you are well.

Hi I am very much in the same boat, it's been one year now after THA I'm only 44 and have had persistent pain in groin since, tried injections multiple pain relief two days if that. Terrible pain with any hip flexion activity.. i.e. Putting on pants etc or just lying down flat to sleep. I had same situation as you.. labrum tear... then THA... and still no relief!!!  Wondering how this turned out for you... I can't afford another 6-8 weeks off my life but can't continue the daily pain and no physical activities in life. I have very physical job as well as a chiropractor and want to be pain free especially after having a total  hip ... you would think I'd be better so disheartening ... who was your tendon release surgeon?? Want to find someone who does and sees a lot of these if I'm going to undergo Another surgery!

patricia - you're saying you went from a labrum tear to a THR also?  What is happening here, no one should take this path, not you, not me, but what kind of doctors let it go this way. There is labrum tear surgery and has been for years. Why wouldn't anyone try that first?  So,, here's where I am at with this:  Last month I saw the new potential surgeon, a guy in Farmington CT. He's from mayo clinic originally. He said he'd do the diagnostic that other surgeons have told me about too, which is to do cortisone and see if it helps relieve the groin pain. Then, pending that's the response I have, that would be how he'd know if psoas release was the right surgery to do. So, i was schedled to get that injection tomorrow. But I was thinking about something he'd said 'up to 40% loss of strength' and I hadn't focused on it in our initial appointment because I thought he meant I'd have to work hard in PT to get the strength back. He certainly didn't say "this is a very unfavorable last resort kind of surgery" -- but the thought was kicking around my head as I got closer to injection day. I called his office back, his really nice scheduler/assistant gal, and asked her if she could find out if he meant that I could ultimately get back to full strength. A week later she called me back, this last Thursday morning, and said: "No, it's a certainty that you'd lose that much strength permanently, and that's the trade off for being out of pain".   It stopped me cold, and I thought, who in the hell would do that?  I've said goodbye to that surgeon, and it's back to hunting for any other doctor with experience,  I literally think at this point that we need to be an uproar. The more hip replacements that are performed each year, the more of us in this damn spot there will be. We need to be damn near activists at this point. I'm sorry you are in that spot. too.

Do you know if what you had was a 'fractional' release or full release?  Fractional is multiple small cuts, enough that psoas can heal, but "release" means cut the tendon fully. If your surgery went well with good results, would you mind sharing the surgeon's name please? 

Maysie. Boy do i agree with you. I've had 3 cortisone injections, one in the bursa and i believe it proves nothing...the tendon is so long. I would love to know what doctor does a fractional release. So far i have been to 3 different orthos, only one knows the release but he wont do it because of deficits it causes..

Does a 40% loss of strength mean you cant do stairs, or ????

Any ideas on how to be activist?How to get the word out and make docs more accountable for negligence? I don't know where to begin

Hi Marcy, I wish I knew. We should all put our heads together. I am left with what I think is a lifetime disability and it's impossible to sue a doctor because he doesn't care enough to be more careful. I'm thinking about starting a blog. What do you think? I also called one of the writers of the local paper and see if they would consider doing an article on the fact that so many of these doctors are taking payola from Stryker and i gave him the CMS website where you can check. But he didnt seem enthused just said he realized so many patients arent being treated in their best interest and that everyone should know of the site. Still he has to talk to editor.

I am open to any idea. Im investigating to see if i really needed hip replacement to begin with.

Ideas, anyone?

Hi Tracy

I know you wrote this awhile ago, but wondered what your "release" really was? A tenotomy of illiopsoas?

Release is medical-ese for "cuts"

I'm wondering just how it all went for you

Can you tell me what you have heard are the side effects. Of course my doctor is telling me I most likely will have a full recovery which I know is BS. I have had 5 THR and 2 TKR and I am 42 years old. This is the first time this has every happened and I feel it was the doctors fault as he failed to get the X-Rays from the previous hip replacement and they called me the Friday before surgery asking if I had signed a release which I had two months prior. I feel they put two big of a ball in my hip but I cannot prove it and like I have read, how can you really sue. I am a physically active young 42 year old and don't want to be limited more than I already am. So my question is what are the physical limitations after a release?

How did it go for you???? What has been your physical limitations/side effects???? I have had 5 THR and 2 TKR and I am 42 years old and this is the first time this (Iliopsoas tendinitis) has every happened and I feel it was the doctors fault as he failed to get the X-Rays from the previous hip replacement and they called me the Friday before surgery asking if I had signed a release which I had two months prior. I feel they put two big of a ball in my hip but I cannot prove it and like I have read, how can you really sue. They say the only thing is to release the tendon as the cup is perfect and I have tried all the alternative options. I am a physically active young 42 year old and don't want to be limited more than I already am. So my question is what are the physical limitations after a release?

Wow, keldog, I'm so sorry to hear that's what you've been through. I can't imagine why a 42 year old woman has had five total hip replacement surgeries. That aside, though I am interested, the thing about traditional psoas release surgery is that you can't ever fully recover from it. The "trade off" is that it gets you out of pain (provided they diagnosed the problem correctly) but you have permanent significant loss of strength in that leg. The newer surgery called fractional iliopsoas lengthening, is different in that they never sever the tendon from the bone. Instead, they make multiple small cuts to the tendon to release some of the tension and it's able to heal lengthening the tendon overall, so that in theory, the tight tendon isn't getting aggravated rubbing over the acetabular. Once you fully sever the tendon, there's no going back. I'm signing up for fractional iliopsoas lengthening, but not the full release. And I'm making damn sure my paperwork says so.

Hi I've had THR 2011, 2013,2015 with tendon releases in 2012,2015 2017 and still have pain at times last tendon release right side thigh still numb from cutting nerve. I had a nasty infection when they did they hip in 2015 the infection was between the cup and pelvic bone didn't show on x-rays just the pain was getting worse was on heavy antibiotics for two yrs

Tracy, how are you doing now?  looks like you are maybe a year out from iliopsoas release. 

Hi Keldog

Wow i too have had 5 THR and 2 Tendon releases ,im 56yrs.

i am 4 mths post op from my last THR and in so much pain still in my groin its crazy.

my first was in 2015.i had a fall after my 3rd THR in a shop there was water on the floor, the fall totally wrecked my tendon.

i haven't driven now for 3 yrs my confidence is shattered and i don't have the strength in my leg to lift form a sitting position or from laying.

so driving scare me.

my pain is 24/7 walking to far hurts actually everything thing hurts its taken away quality in my life and has limited me so much.

whats next for me ( nothing they say you gotta learn to live with it.

i live in Australia (Sydney ).

so i guess this happens everywhere.

I cancelled because first I read all about the mechanics of the psoas tendon and how it connects the torso to the lower body and second, my Dr was going to do open surgery as opposed to arthro and cut it completely. Since I wasn't debilitated I opted out

Hi,  You mention the CMS website. I have just been there but when registering am told to choose an 'Application'. Having looked at the applications I am nonetheless wiser. Which one would you suggest that I choose? I would love to thoroughly check out my surgeon before he starts hacking at my illiopsoas. Also would be interested to see if he was taking payola from Striker when I had my failed THR.

Many thanks,

Penelope.

tracy,

who was your doc and where? did your OS talk about any risk of dislocation after psoas release? did you have central compartment release or by the lesser trocanter?

14 months post thr having groin pain and limp, miserable...ty jeffrey

Tracy ,I am 13 months post THR and have terrible groin pain...they believe its Psoas and are recommending a "Psoas Release"...could you please tell me who your doc was?and where hes located. Need someone who does this type of surgery ? Congrats on your surgery...hope you are doing fine!!!

Was the surgery easy?

Thank you , really appreciate the help...Jeffrey

tracy,

who is your surgeon and where is he located?

Hi Tracy, many of us on this board hoping you did well and can name your surgeon. Many of us are desperate at this point having been in pain and handicapped for years. please respond if you get this.

I did not have the surgery. Opted to try and wait it out. As of now -- 12 months out from injury -- I can walk with minimal assistance. It gets annoying but still am doing much better than originally. Am not hearing anything good regarding the surgery. One doctor mentioned stem cell injections but they are vey expensive - $7,000. per injection which insurance does not cover. Another doctor suggested sugar injections at $500. per injection. Think I made the right decision to just give it time. You have to do what you feel is right for you!! Good luck!!

I have intermittent groin pain and I'm 8.5 months out. It's not terrible most of the time, more annoying than anything. It does hurt bad for a couple of hours 1 or 2 times a week. Had an injection into the greater trochanter bursa and that helped a bit. Not sure what's next. Maybe I'll have to live with it? I see the Dr again in 4 days.

i am scheduled for the tendon release surgery, a year out from THR very nervous about it but want to get back to every day exercise. I am not that debilitated either. was wondering if you ever got better without the surgery?