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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

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  • Shay3r
    Shay3r AnnieK

    Posted

    HI Annie,

    I just found this forum. I am glad you are getting better. I have been suffering from outter thigh and hip pain for nearly 3 years now. Before that. I had pain in my right si joint. I received a cortisone shot for that and it went away. That is about the time I began to notice the hip pain. I went to my Dr office and was sent to physical therapy. That did nothing. I then thought it might be a vein causing the pain as it was right on a vein. Was referred to a vascular specialist. Had to wait many monthso to get see one. Another few months to get tests. All normal. One day I was stretching and got horrible pain all up and down that thigh. Went to my local express care and Dr said I needed an mri. Went to my local dr office and got orders for the mri. I had the mri on October 4, 2016. Mri shows a labral tear and a gluteus minimus partial tear. Was referred to orthopedic surgeon. He recommended a cortisone injection into my hip joint. After the injection, the side pain was still there. He injected a non guided shot into the side of my hip and sent me to physical therapy. So far the PT doesn't work. It just hurts more. I just got a call the other day and may now get the arthroscopy. I wish your surgeon traveled. I am near Springfield. I am worried about recovery. I get a few weeks vacation. My job requires me to stand. I am occasionally able to sit though.

    Thanks

    • AnnieK
      AnnieK Shay3r

      Posted

      Shay, so sorry you have been suffering! It's good that you got the diagnoses in October 2016 of the partial glute min tear and the labral tear. Those are two very different issues. What is the prognosis for the labral tear? Might it heal by itself, and has it been checked to see if it has healed? Or does it require surgery?

      Gluteal tendon tears that are mild enough may heal on their own, given enough time and rest for the muscle. Do they know the extent of the tear, and whether it has done any healing? My gluteal tears happened very soon after my THR in July, 2015, and had not healed at all by the time I had the repair surgery in October, 2016. 

      If you do need surgical repair, then you need a surgeon who really knows what he is doing. Might a labral repair be done at the same time? I get your concern about recovery. I am almost 70, and it has not been easy for me, with the 6 weeks of 20 pound weight bearing, and taking almost 6 months for me to be able to walk around pretty well. I don't have to return to work or do any demanding physical activities.

      Hope you can find some good treatment options in your area!

    • Shay3r
      Shay3r AnnieK

      Posted

      So far all they have done is give me a cortisone injection under ultrasound for the labral tear and an injection without guidance into my greater trochanter and ordered PT. PT isn't working so I go to talk to my surgeon on the 19th to see about arthroscopy. I don't really know the extent of the tears. I know the labral one is pretty big after reading my mri results. I don't think that one is actually bothering me though. I have heard you get groin pain for that one and all my pain is on the outside of my thigh and down my butt region. I am about 3 to 4 hours away from Chicago. My surgeon said he can do it, but I guess I had better make sure.

      Thanks

    • AnnieK
      AnnieK Shay3r

      Posted

      Shay, I am pretty sure that you are having pain from the torn hip labrum. Even though pain is most often in the groin, you can definitely feel it elsewhere. See this quote (I'm not putting in the link, so that my reply won't be blocked): "Pain in the front of the hip (most often in the groin area) accompanied by clicking, locking, or catching of the hip are the main symptoms reported with hip acetabular labral tears. Joint stiffness and a feeling of instability where the hip and leg seem to give away are also common. The pain may radiate (travel) to the buttocks, along the side of the hip, or even down to the knee."

      A large labral tear is a significant injury, and it is causing you pain and disability, and needs to be treated. I am not at all surprised that PT isn't helping, how could it? Can PT heal a soft tissue tear? I think not.

    • Shay3r
      Shay3r AnnieK

      Posted

      Thanks.

      I hope you continue to improve. 1.8 miles is good smile

    • teresafahey
      teresafahey Shay3r

      Posted

      Hi Shay. I agree with Annie that it could well be a torn labrum. Mine presented as pain through the groin as well as lateral hip and buttock pain. But I had no clicking feeling or noise that they talk about. With me, the buttock pain was probably the torn gluteus medius tendon, and I also had some other issues that were previously unseen/unknown. I think every single experience is different, and the hip has so many parts that can have issues that it's really hard to know until the surgeon goes in arthroscopically and actually looks at the joint. Ha...I'm an old retired operating room nurse; if there's one thing I learned during all those years it's that every person experiences symptoms differently. Just please please please make sure that you have an experienced surgeon who specializes only in hips. It will be worth every penney and every bit of travel if you have to go to the big city to find one. You only have one body, and handing it over to someone with less experience can affect you for the rest of your life. 

      Please let us know what they find during your surgery. We're rooting for you.

    • Shay3r
      Shay3r

      Posted

      I saw my surgeon on Friday. We plan on doing arthroscopy to repair the labrum and hopefully the minimus. He says it depends on what it looks like when he goes in. My MRI shows a partial tear and I had the MRI without contrast, so I'm pretty sure it's definitely torn. I am wondering if it could be worse than what they saw on the MRI since it was done without contrast. I am currently waiting for preauth from my insurance. If they approve then it will probably be in late June. I will also have to wear a brace postop.

    • Shay3r
      Shay3r teresafahey

      Posted

      Thanks. I am in central IL. The surgeon I am going with is just outside the Springfield area. He specializes in hips. Waiting on preauth from my insurance and hope to have surgery toward the end of June.

      How are you doing with your hip now?

    • AnnieK
      AnnieK Shay3r

      Posted

      Good news on the future labral repair surgery, Shay! I do hope that he will repair any tearing he sees in the gluteus minimus. Why wouldn't he? No point in letting it sit there torn when he is going to be looking at it anyway.  The brace is such a good idea to keep us from overdoing things and disturbing the healing of these tissues. Keep us posted. You could even start your own thread about it, and maybe get some support from other Patient members who aren't seeing your posts here.

    • teresafahey
      teresafahey Shay3r

      Posted

      Keeping my fingers crossed for you, Shay! 

      The hip that was scoped and repaired on May 19th is improving. I do still have some pain, but I think that's normal at this stage. I had numbness from the hip to the knee after both repairs, for several weeks postop. The innervation is coming back now on the left, and with it comes some hypersensitivity, which the surgeon's PA told me would happen. Occasionally, it can be pretty bad, but it's getting much better every day, and the numbness has really improved. I'm looking at 10 more days in the wheelchair/crutches (yahoo!!!) and then 2 weeks of crutches/cane, when I can do 50% weight bearing. I'm laughingly uncoordinated on crutches, hence the wheelchair.lol

      Looking forward to hearing how this goes for you. It's a slow process, but it is so worth it in the end. 

    • AnnieK
      AnnieK teresafahey

      Posted

      I'm with you, Teresa, on feeling unstable on crutches. They scare me to death, unless I'm able to fully weight-bear. Glad you are feeling better, and sorry for those difficult days. It IS slow, but you'll get there!

    • Shay3r
      Shay3r teresafahey

      Posted

      I'm glad your numbness is going away. I sometimes get that in my foot on the bad hip side. My doc office called yesterday and said my surgery was approved. It is scheduled for June 22. I have to return to work after 2 weeks, so I hope it goes well and I show good improvement.

      I'm glad you will be able to put some weight on it some soon. Keep improving smile.

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