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Facing surgery to repair gluteus minimus tear & possible revision

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AnnieK
AnnieK

I had a THR in July 2015, and have never yet been able to walk without a limp/pain. I had no limp pre-surgery. My previous thread was titled "22 weeks post-op, still can't walk unaided...". 

My orthopedic surgeon has been unable or unwilling to figure out what is wrong, or to even admit that there is a serious problem. He sent me to a physiatrist who ordered a lumbar MRI (no problem found) and did a sacroiliac joint steroid injection (no improvement). Went back to orthopedist and he ordered an MRI, which I had to push him to do, and the radiologist's report said there was a mild strain in the gluteus medius. I told the ortho that I thought I had an actual tear in my gluteus medius or gluteus minimus, and asked about surgery. He says surgery is never done for that. He said to take prednisone and go back to PT to strengthen the weakness in my hip/thigh.

I was unhappy with this, as I know that there is something wrong. More exercise only makes it worse. If it were a mild problem, it would have corrected itself by now. I do walk a fair amount, considering that I use a crutch or walker, and my healthy leg muscles are in good shape. I did a lot of online research about what my problem could be and to find a new doctor.

I saw a new orthopedist yesterday, one who has pioneered methods of gluteal tendon surgical repair. He ordered a bone scan, to rule out prosthesis loosening and infection, and another, better MRI. Again, the radiologist who read the MRI didn't see much, but the orthopedist looked at the scans and DID see evidence of a tear in the gluteus minimus. He says a "tear" is the same thing as "non-healing". The gluteus minimus and medius have to be separated during surgery in order to do the anteriolateral approach that was used on me.

The new doc says that my tear won't get better on its own. It requires surgical repair. He is also wondering if the positioning of my prosthesis might have prevented the healing of the muscle/tendon. So he is sending me to a revision specialist for a consult to see whether he thinks a revision is necessary to reposition things. I see him on Tuesday.

Steeling myself for further surgery. I am tired of being debilitated for 7 months now. Plus I have had a rotten head cold/sinusitis for the past 3½ weeks that has me really down. I had two orthopedist appointments on my birthday, while really sick with this cold, hardly able to speak. I hope I won't need a revision in addition to the tendon repair. Will know soon. Sigh.

Main takeaway: keep pushing for answers if something is wrong.

13 likes, 168 replies

168 Replies

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  • lynne88756
    lynne88756 AnnieK

    Posted

    HI Annie i can really understand where you are coming from think we have spoken  before .  I am 2 years post op and in chronic pain and sick of being palmed off . I know there is something wrong and seeing a new consultant next month. I had a biopsy taken in april findings were not much a a little metallous which he said this would not be the cause of pain. Yep been sent to  psychiatrist too and put on a drug called duloxetine for nerve pain but also can treat depression he said well thats a bonus lynne ........Yes i am tried and the painis debilitating too this was ment to be a life changing op which  has left me disabled . I have a tear but he is not willing too operate as he says i am worst every time they do it.  I think my cap is to big and rubbing against something....keep me updated Annie oh can i ask you where you are ??  my hip joint is american system . ..titanium with plastic and cover is cluster titanium i think . i am going to the board where you can request what you have . you take care Annie x
    • AnnieK
      AnnieK lynne88756

      Posted

      Hi, Lynne! Terrific that you are seeing a new consultant soon, as maybe he can help figure out how to help you. Having a tear is painful, as having a cap that is too big and rubbing...ouch!

      I am near Chicago, Illinois in the US. My hip is a ceramic head and plastic cup. I am not 100% yet (it will be 2 years since the THR in one month), but I am finally working on doing stairs alternately, like normal, but still have pain and some weakness. I can't really walk normally yet, either, as I still have pain and stiffness, but mainly in my back. I can't really blame the THR or tendon repair surgery anymore for that. 

      I keep on hoping the best for you, Lynne! Keep me posted about what's going on with you.

    • lynne88756
      lynne88756 AnnieK

      Posted

      Hi Annie hope you are recovering a little more since we spoke . I am some good news my new consultant is going to do revision seeing i am in chronic pain . Alll my scans are showing nothing but he said not all things show . He said the tear is not due to my pain . So after 2 yrs of pain and crying they are going to do something they should of done a long time ago.

      ​I am loosing my job this month due to the op where i have worked for 23 yrs within the NHS where i had the surgery done . Oh well being pain free or a little better is my main reason to get better. Keep me updated how you are getting on . No date for operation yet. x 

    • AnnieK
      AnnieK lynne88756

      Posted

      That's terrific news, Lynne, that you are getting your revision! Let us know when you do get a date.

      But that's awful about losing your job, through no fault of your own, and where you worked faithfully for so many years! I hope that when you finally recover well after the revision that you will be able to get another job, so that you can have needed finances for living.

      I'm doing ok, and like you, I just wanted to be better, and I am. I had MRIs of my lumbar and thoracic spine last week, and results show no new bone breaks, so that's good. Today I got fitted for a thoracolumbar corset brace, and it holds me up over the shoulders and allows me to walk more supported and comfortably, with less pain and less need for walking aids. So I think my hip/leg is in fair shape, and most of my walking problems come from issues with my spine. The brace is quite large, front and back, and I wear it over my clothes, and it comes up so high that it can interfere with my neck. I don't wear it all the time, but when I do when I am walking, it helps a lot!

  • jerrine
    jerrine AnnieK

    Posted

    I am seeing my surgeon for similar reasons tomorrow. I had a pin and screws put in to repair an intertrochanteric fracture (a really messy one) in early March 2015, My recovery was very slow and soon after I graduated to a cane, leaning heavily on it, my car was hit by a truck, reaking my pelvis, ankle and shoulder. (This was early July, 2016.) In spite of my pelvis and ankle healing well I still can't fully weight bear and I have all the symptoms of a gluteus medius tear. Also, I now have bone on bone arthritis in both hips. I have been told I definitely need a hip replacement with the hardware from my break taken out at the same time. I also likely need a repair to the glut med. Anyone on this thread have experience with this scenario?

    • AnnieK
      AnnieK jerrine

      Posted

      Yikes, Jerrine, that's a lot of bad luck you've had! I can't even imagine what it must have be like to have had all of those breaks, the tear, and followed by severe OA in both hips.

      I had a THR and then a gluteus medius repair 15 months later. My glute med ripped very soon after my THR, or perhaps never healed after the tendon was dissected during my antero-lateral THR. I have heard of people having both of these procedures done during the same surgery. In fact, during my tendon repair, another surgeon was attending who dislocated my THR implants and checked things out to make sure that the implants were in solidly with no loosening, and that it didn't look like there was any infection.

      I can believe that you are having lots of pain and can't fully weight-bear with double hip bone-on-bone and a gluteus tear. I hope you can get it done fairly soon. The key will be to find a surgeon who is experienced with both procedures. 

    • jerrine
      jerrine AnnieK

      Posted

      I've been bounced through a couple of surgeons who didn't feel they were the best to tackle it, but this one is a specialost in orthopaedic trauma surgery and the surgery will be done at a trauma centre, so I think I have the right doctor. The question is how long I will have to wait. Thanks for the sympathy!

  • carol3114
    carol3114 AnnieK

    Posted

    I'm going on 2 years with pain in my hip and on the opposite side along the butt crease. I had urinary tract surgery for Transitional Cell Carcinoma in 2015. Since then I've had a second surgery and all scans are currently clear. When I awoke from the first surgery I was unable to walk because of extreme pain in what I think is the glute medius. Also, I have what feels like a torn tendon or muscle on the sacrum side. I have had many doctor visits, PT, Pelvic Therapy and injections. The SI and hip injections only helped for a very short time and didn't help the sacrum pain at all. Can any of you help me determine a Dr. to see. The Boulder/Denver, Colorado area would be best, however I would be willing to travel if someone can help me with the problem. Most drs have said I need to take pain medicatioin and learn to live with it. This isn't acceptable to me. Please tell me the type of Dr. I should be seeking.

    Thanks,

    Carol

    • AnnieK
      AnnieK carol3114

      Posted

      Hello, Carol, so sorry to hear about your difficulties. It sounds like you have covered many bases trying to find out the source of your hip and butt pains. What kinds of doctors have you already seen?

      If I were you, I would find an excellent orthopedic practice, with physicians who have a variety of specialties, especially including the hip and the spine. For example, the practice that I found AFTER I had my THR with the complication of a gluteus medius tendon tear, has a number of various kinds of orthopedists, including the surgeon who eventually did surgery to repair that tendon tear. I will private message you the link to that practice, which may give you an idea of what to look for. I'll send the link to the page which mentions all of the specialties, and then there are links to each of them describing the types of conditions and the physicians there who treat them. This practice has a number of physicians who are rated as top physicians in the Chicago area, including the surgeon who repaired the tear and my spine/back doctor.

      Wishing you success in finding someone who can help you!

    • carol3114
      carol3114 AnnieK

      Posted

      Thanks Annie. I will keep searching for an answer. I did see a hip specialist who said my MRI doesn't look too bad. I don't see how it's possible I can only walk 1/2 block before my glute and leg are so painful I have to stop and I have this burning pain on the sacrum/tailbone side. I'm just not sure if I should see a neuro surgeon or another orthopedist. I sent (another) message to my urologic oncology surgeon asking for a referral to a sacral tendon specialist and to a pain management specialist. Thanks for the links, Carol

    • AnnieK
      AnnieK carol3114

      Posted

      You are welcome, Carol!

      Since you are having a lot of sacral/tailbone pain, the sacral tendon specialist sounds good. You are thinking about seeing a neurologist, perhaps, because it might be nerve pain?

      It sounds like you are quite debilitated from whatever is wrong. If any of the doctors couldn't walk 1/2 block without intense pain, they'd be screaming for answers, I'm sure! Keep pushing for answers and seeing other doctors until you get one. There is a very delicate balance going on inside of our bodies, and when one thing goes out of whack, others usually follow, too. I used a walker inside and a crutch or two outside for the entire time between my THR and glute repair (that was 15 months), and then for another 6 months post glute surgery. I'm still only about 75% back to normal, and it might be back/spine problems that are plaguing me now. 

    • carol3114
      carol3114 AnnieK

      Posted

      I do suspect a nerve injury but it hasn't been confirmed. At slightly less than one year post surgery my cancer spread and I had to have another big abdominal surgery. My hip/leg pain has been there all along but the focus was then on surgery and chemo. Now that I've completed it I would really like to get back to being able walk without pain. It's been a long process. Thanks, Carol

    • AnnieK
      AnnieK carol3114

      Posted

      Having cancer, and recurring cancer, and all of this hip/leg stuff - what a horrible ordeal you have been going through! May you reach your goal of walking without pain, Carol. You certainly deserve that! 
  • gingery56
    gingery56 AnnieK

    Posted

    I just found this post and wondered what the outcome was?  Did you have surgery to repair the tear in the gluteal medius? If so, how did you do? Are you pain free now?
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