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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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  • Bkoz73750
    Bkoz73750 AnnieK

    Posted

    Thank you for sharing your story.  1.5 years post thr and have pain daily with just simple walking, along with every other activity.  During the course of trying to find the source, I have been told there are tears in muscles/tendons but since it's note a full tear, surgery is not warranted.  Other possible problem is iliopsoas impingement.  I'm consulting with surgeon #5 to try to figure out what is going on.  Sucks!

    • gingery56
      gingery56 Bkoz73750

      Posted

      I've been dealing with this back/hip pain for 4 years now and the last year has been tough.  I finally said, "Uncle" and told my PT after 8 months of 3x a week therapy that I'm ready to get an MRI (again) and see what's going on.  I had it yesterday and will be seeing a neurosurgeon soon.  I also plan to go to Southwestern Med. School spine clinic in Dallas for another opinion.  I hope you find out what you can do for relief.  The therapy I believe finally after months really helped my hips, but now the L5 & sacrum are giving me fits. 

       

    • AnnieK
      AnnieK Bkoz73750

      Posted

      You are welcome, Bkoz! Neither of my tendon tears were complete, but I had surgery. Without it, I would still be in lots of pain, and have a terrible limp, and not be able to walk without aids. Glad you are getting different opinions. I had that impingement as well, and it was taken care of during my tendon repair operation. Are you able to balance on your surgical leg alone? I was not. When I tried, my leg would collapse immediately. And it didn't get any better in the 15 months after my THR. Since the tendon repair, I can balance on that leg just fine.

      In case you are interested, here is my thread about the recovery from that operation. https://patient.info/forums/discuss/having-gluteus-medius-repair-surgery-possible-hip-revision-tomorrow--543982

    • AnnieK
      AnnieK gingery56

      Posted

      Good for you, Gingery, for continuing to push to find the source of your problems! Beware that your MRI may be interpreted incorrectly. In my case, two radiologists and one orthopedic surgeon didn't catch my torn gluteal tendons. A diagnostic musculoskeletal ultrasound could also be done.  We all deserve to get correct diagnoses and treatment for what ails us, and anatomy and physiology of our tendons, muscles, bones and connective tissue has been known for a long time and is not rocket science!

      So sorry about your spine problems. Mine are awful, too, with crumbling vertebrae. That makes it all so much harder and is my main issue these days. I am taking a heavy-duty medication for osteoporosis to get my bones stronger, so maybe I won't have any more compression fractures.

  • marilyn_6
    marilyn_6 AnnieK

    Posted

    I have a labral tear and gluteus minimus tear in the left hip and it has taken months to find a Orthopedic surgeon who can repair both tears by doing a scope. Once he talked to my orthopedic surgeon who at first said I need a THR now they agree I need both and will do both surgeries at the same time. Because I never had hip pain until I tore the gluteus minimus doing yoga I’m not convinced I need the THR. My MRI shows there is no cartilage on the back half of the hip joint with  the labral tear in the front half that dies have cartilage in the joint. 

    In addition neither will answer how I can rehab at all with one saying no weight bearing on gluteus minimus for 6-8 weeks and the THR putting weight on it the day of surgery and walking within 2-3 days on a walker. 

    How will either heal correctly? 

    Any advise?? 

    • AnnieK
      AnnieK marilyn_6

      Posted

      Marilyn, my sympathies to you with your difficulties and multiple conditions. This is a great question to pose to whoever is going to be doing the THR part of your surgery. 

      Would you have one or both surgeons working on you in the same operation? If there are multiple conditions addressed in a single surgery, the most conservative protocol for recovery is probably what will be recommended.

      I had two surgeons for my second hip surgery. First surgery was THR with my original surgeon, then I damaged my gluteus medius and minimus tendons, somehow, or they tore after those muscles were teased apart during my anterolateral approach for my THR.

      So I had a second surgery during which a new surgeon did exploratory, dislocating my hip prostheses and checking for problems. Also my greater trochanter was smoothed and a bursectomy done. The second new surgeon repaired both tendons. Since the protocol for recovery after the tendon repairs was 20 pound flat-foot weight bearing for 6 - 8 weeks, to give the tendons time to heal properly, that was what I did. He also had me wear a brace to help me to keep to the rule of no bending past 90 degrees. If I had only had the exploratory and other work done, and not the tendon repairs, I would have been able to fully weight bear from very early on, like with my THR.

      Waiting to fully weight bear should not hinder your recovery from THR. So much goes on for a THR that is pretty brutal, and the stretched and stitched soft tissues and cut bones requires quite awhile to heal, and the prostheses (if uncemented) require time to have bone grow into them. 

      I'm not sure how NO weight bearing would figure into this. As I said, my surgeon recommends 20 flat foot weight bearing, and I had two gluteal tendons repaired, and they both healed fine. No weight bearing would have been very difficult to manage.

  • marilyn_6
    marilyn_6 AnnieK

    Posted

    That’s a lot of different issues to have surgery for too! Thank you for your feedback. I was told today they would not scope the hip but make additional incisions to avoid possible infection of the THR. I’ve decided to do just the scope and repair the tears now. Hopefully it will eliminate my pain since I did not have any hip pain before injuring my hip. I also feel like I will heal better like you said the 20 lbs limited weight bearing on that hip for rehabilitation period. 

    I’m glad I found this sight, it’s been helpful to read about other experiences and think through the surgeries. I wish we had more surgeons locally that perform scopes of the hip but I’ve had nothing but excellent recommendations for the surgeon who will do the hip scope. 

    • AnnieK
      AnnieK marilyn_6

      Posted

      Best of luck with the surgery! Take it very easy afterwards and allow the repaired tissues to heal before challenging them too much. It is easy to tear them again when they have just been stitched.
  • brittylee7
    brittylee7 AnnieK

    Posted

    Hello,

    I just wanted to reply on this thread to let you know that I have sent you a message. I hope that you will get it and be able to reply! Thank you!

    • AnnieK
      AnnieK brittylee7

      Posted

      I did get it, and I replied to you with the information about my surgeon and how to contact him! Best of luck to you, brittylee7!

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