Facing surgery to repair gluteus minimus tear & possible revision
Posted , 40 users are following.
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
lois99104 AnnieK
Posted
Jusy recently received MRI results showing gluteus minimus tear. Now I'm looking for an orthopedic doctor in the southern VT NH area. Any one have suggestions? From reading posts to this forum it sounds like the surgery has a long recovery period. This is all new to me and seems very frightening. My first pain was also about 10 yrs ago and misdiagnosed as bursitis. A corisone injection was given with tempoary results. Over the past 4-5 years things have gotten progressively worse, asumming it was arthritis in lower spine. My leg(s) have become very weak. Sitting at a computer for work became a problem so I had to retire early. Sleeping is constantly interrupted by pain. Siatic nerve like pain has been excruciating and the right side of my right leg and foot are numb. The diagnosis explains a lot but now I'm not sure where to go from here.
AnnieK lois99104
Posted
Lois, that's a great first step, that your gluteus minimus tear was seen on MRI scan! Often, unless it is a specialist in gluteal tears, they don't even see the tears. I had an orthopedic surgeon and 2 radiologists miss my tears on the scans. So now you are on a search for a surgeon. I found my surgeon by googling, believe it or not!
I had surgery to repair my gluteus medius and gluteus minimus tendons 13 weeks ago. A few other things were done, too, including a bursectomy and smoothing out the greater trochanter so that nothing would catch on it. I was 6 weeks with only 20 pound weight bearing on the surgical leg, and I started physical therapy 3 weeks ago. So far, so good. My gluteal pain is gone and my limp is much better. After 1 1/2 years of not using those two glutes, they are quite weak and are taking some time to strengthen, but I do see positive progress every week. I am hopeful, though, that I will be able to walk totally pain-free and limp-free. The surgeon said that it takes 6 months for full recovery, and can take even longer, depending on how weak your unused muscles were to begin with.
As to how I found my new surgeons, I googled gluteus medius repair surgery and one of the links that popped up was who ended up being my surgeon. He is in a practice that is a few minutes drive from my house (in a suburb of Chicago), and he is a pioneer in minimally invasive approaches to this surgery. I had open surgery, though, since they also wanted to check out my hip prostheses, to make sure they were ok. I have a name of another surgeon in Milwaukee. Keep looking and asking for referrals from other physicians.
Wishing you all the best in your search, Lois!
jacqueline45239 AnnieK
Posted
very interesting story and your problems. I am going through very similar thing. Been diagnose with trochanteric bursitis and injected onboth sides with steroids, No camera and after MRI scan proven that I have bilateral gluteus medius tendinopathy and a tear rather than busitis. Like yourself had physio and told nothing else can be done. Trying to cope with the pain, the swelling and cannot
find a consultant to hep me. I have noticed you find a pioneer consultant for your problem, can you give me any advice ? I would appreciate it.
Jackie
AnnieK jacqueline45239
Posted
Here is a link to my most recent thread about the tendon repair surgery. I updated it today.
https://patient.info/forums/discuss/having-gluteus-medius-repair-surgery-possible-hip-revision-tomorrow--543982
I can message you the information about my surgeon (Chicago suburb) and another one in the Milwaukee area, if that would be helpful to you!
deborah_03126 AnnieK
Posted
Hi Annie, how are you now 1 year on from this post? I'm nearly 6 months post op and still not walking properly. Ultra sound showed blood around the muscle which consultant thought could be the cause of the muscle having not healed. Have been told to rest and restrict weight bearing, but 2 weeks on there is no improvement. Concerned after reading your post it's maybe a tear...will keep pushing for answers
AnnieK deborah_03126
Posted
I'm doing pretty well, Deborah! Had the surgery 16 weeks ago. I updated my thread about it today - here's the link to the thread:
https://patient.info/forums/discuss/having-gluteus-medius-repair-surgery-possible-hip-revision-tomorrow--543982?
I'm running out the door now, to go to physical therapy!
Kerry-NY AnnieK
Posted
Hi Annie--
I found your post after doing some searching about the sever pain I've had in my butt. I was first misdiagnosed with a hip problem and had a THR over 3 years ago, which did not address the problem. I was then told I had piriformis syndrome, but multiple injections didn't help at all. I was then told the problem was coming from my back and I had spinal fusion surgery at L5-S1 3 months ago. I cried for weeks prior to that surgery because I was so worried about having another surgery that didn't help. Well, here I am, feeling that same pain in my butt with every step I take. I'm wondering if you had the surgery for the gluteal tear and whether or not it has helped you. I'm just desparate for relief! Thanks for any info.
AnnieK Kerry-NY
Posted
Kerry, yes, I did have gluteal tendon repair surgery 16 weeks ago. My butt pain is gone, and I am on the way to walking unaided.
For details about the surgery and recovery, you can check out my last couple of posts on my thread about the surgery and post-op, which I have linked here:
https://patient.info/forums/discuss/having-gluteus-medius-repair-surgery-possible-hip-revision-tomorrow--543982
After my THR, when I couldn't balance on my surgical leg at all, even 4 months post-op, and I had pain in my butt, my surgeon's first thought was that it was related to my back. They did an x-ray and MRI, and found nothing wrong.
They even did a sacroiliac injection, which did not help the limp or pain at all. After getting a tip from a poster here on Patient, I did research to see which muscles work to hold the hip steady when only on one leg and suspected a problem with my gluteus medius and/or minimus. My original surgeon did not believe that those muscles or their tendons could be torn. So I had to seek out a different surgeon, one for whom this kind of surgery is a specialty. Fortunately, his office is only a couple of miles from my home!
ShelleyS1102 AnnieK
Posted
Hi Annie, How are you feeling? I hope each day brings you more and more comfort. After your gluteal tear surgery, are you now able to walk unaided? Has the limp abated? I have had hip surgery twice and my glutes were cut both times. The last surgery was 3 months ago, and I am left with a limp. I still do my elliptical mchine for 20 minutes daily. Went to PT and didn't get the proper exercises. Now I have a print out of how to help a pelvic tilt and I am about to try them. . My doc says that because I am able to balance on the operated leg (with healthy leg help way off the floor or even moving front to back) that my glutes are pretty strong and that after my THR (anterior-no muscle cutting) he THINKS my llimp will be gone. Do you have any thoughts on this? Thanks.
AnnieK ShelleyS1102
Posted
Shelley, I had the surgery on Oct 27, 2016. Here is my thread about it:
https://patient.info/forums/discuss/having-gluteus-medius-repair-surgery-possible-hip-revision-tomorrow--543982
It's been 18 weeks now, and I am doing well. I walk mostly without aids in the house, unless I am carrying something heavy-ish. Outside I use a cane, because of the longer distances and uneven ground. I don't have the gluteal pain anymore, and I can finally balance on the surgical leg alone. That means my walking is much better. There is still some weakness in that leg, but it is getting stronger every day, as I move around more and do appropriate exercises.
I also have problems with my back. I had a compression fracture in a vertebra last summer and it was so painful and difficult to recover from that it is still affecting me. I've been doing mild physical therapy for 7 weeks now, and it is helping with both leg and back. I am focusing on exercises to strengthen my glutes, and keep my hips steady while walking.
I think that the fact that you can balance on your operative leg is a good sign. I think it is probable that you can continue to strengthen to the point where you won't have a limp, but there are many different possible reasons for a limp, so it is not a sure thing. So you are going to have an anterior THR soon? I can't understand why having a THR would make a limp that is caused by torn glutes go away. Would they check the glutes and repair any partial tears while they are in there? Then that statement would make sense.
Wishing you the best as you have yet another hip surgery and try to deal with your limp!
ShelleyS1102 AnnieK
Posted
Annie, I can't believe that a surgeon told you that glutes, etc. can't be torn. I imagine your surgery proved him wrong (and thank goodness you did your own research and found him to be quite mistaken!) 18 weeks out and you are doing great! It must be wonderful not ot have that pain anymore and to be able to get about without a cane...most of the time. Eventually, it should get to "all of the time".
I happen to agree with you about my THR which is in April. Don't see how this can help wtih torn glutes, either, but I think my surgeon (in whom I do have trust) thinks all of my muscles are inflamed or torn because the first 2 hip surgeries I had involved (femur rod insertion and removal) cutting the glutes and the ITB down the outside of the thigh, with the 2nd surgeery being recent). Also, after my first surgery (putting in the rod) I was 100% fine and still running 2 miles daily. No limp. My limp occurrred with the rod removal. And the strangest part of this entire fiasco is that my pain travels from the groin, to the side of the thigh and top of the knee, down to on top of the anke and the foot AND the pain level and location changes almost by the minute. Not quite sure wha that is about. But if this doesn't go away shortly after surgery, I will have a glute MRI and then travel to NYC to HSS where they have a agit clinic and I can get a proper evall.
Continue feeling great and have a nice weekend sans cane!!!
AnnieK ShelleyS1102
Posted
Will do, Shelley! I am still shocked by my former surgeon's insistence that gluteus tears cannot happen. That's partly why he isn't my surgeon anymore. I haven't gone back and told him anything about my repair surgery. Waiting until I am 100% recovered.
Sounds like you have all kinds of angry soft-tissue problems going on. There is lots of pushing and pulling and stress on soft tissue during hip surgeries, and you have had two, with another one to come. I had two surgeons in on my second surgery. One checked over my hip prostheses to make sure everything was in there tight and correctly, and also did a bursectomy and smoothed the trochanter because I had some illiopsoas catching going on. The other did the tendon repairs.
It would be ideal if they could check your gluteal tendons when they are in there for the THR, possibly preventing having to do surgery on your hip a fourth time.
ShelleyS1102 AnnieK
Posted
Boy, you really know your stuff, Annie! Are you in the medical field or just knowledgeable??? I will be having THR using the anerior approch and my doc told me he isn't going anywhere near what was cut before, and he feels we should leave everything alone and that my limp will disappear. I don't. But we shall see. Will keep you informed, as I'd like you keep me!! It's so nice to have someone to talk to who understands....But I do hope that your total recovery is in the near future. Mine to follow...Take care.
AnnieK ShelleyS1102
Posted
Nope, not in the medical field! But I do like to be as informed as possible about medical conditions that affect me and my loved-ones, so I really delve deep. I even taught myself to read the MRI images of my hip by comparing mine to normal ones that I found on the internet!
Since your surgeon is doing anterior, I understand why he can't open you up on your side for exploratory, too. My new surgeons only do anterior and posterior approaches for THR. Wish I had gone to them for my THR, as the dissection of my gluteus medius during the lateral approach likely didn't heal correctly and then tore. Don't know for sure, but it's possible.
I hope you can get all of your hip problems take care of soon. Do let us stay in touch and keep me posted about what is going on with you! I will keep making updates in my third thread about my recovery, as I keep getting closer to 100%! It was in this forum that I got my first tip that I might have a torn glute or two. This place is invaluable for getting people with similar problems together.
ShelleyS1102 AnnieK
Posted
It sounds as though your glutes are mending nicely and now, instead of a Grade 3, which you had prior to surgery, you probably now have a Stage 2, leaning towards Stage 1 which means you will no longer be listing to one side. Bye bye limp. Do let me know!!
Also, can you drop me a note, when you have chance, of your fav glute strengthening exercises. I have gathered some from the internet, but would like to compare what I have found to what truly works for someone whom I really trust--YOU!
Be well. And work it, girl! Sounds like 100% is right around the corner!!!! See ya, Trendelenburg! Smiles.