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Psoas Impingement after THR -research

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carolyn63196
carolyn63196

Hi there folks

I’m trying to gather some information regarding psoas impingement after hip replacements. I would be very grateful if anyone has suffered this problem could post their story. Could they tell me when the symptoms started and how long did it take to diagnose. Also how was it fixed and did it sort the issue. It would be most helpful if you could inform me of what geographical area you are.

Kindest regards

Carolyn

3 likes, 62 replies

62 Replies

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  • loribikes
    loribikes carolyn63196

    Posted

    I had severe pain following my hip replacement in December 2015. I had cycled and hiked a lot right up to the surgery so was in fairly decent shape. After I could barely walk and had a significant limp. Got a steroid shot in my psoas bursa and the pain went away, then I had hip arthoscopic surgery and they found a 10mm bone fragment. Still recovering.
    • carolyn63196
      carolyn63196 loribikes

      Posted

      Gosh what a nightmare for you. Did you have a CT scan first or did they decide to go straight in?

      Cheers

      Carolyn

  • Dsilk05
    Dsilk05 carolyn63196

    Posted

    Hi Carolyn, 

    I was just going to search psoas when I saw your post. 

    I’ve been dealing with startup pain since my first THR in Nov 2016. I just had my other hip done Nov 2017. 

    I was at physical therapy yesterday for pinched nerve from lower back and a different therapist attended me this time. He noticed how tight my upper thighs were. So he looked for psoas muscle in my groin, something I found out later. He massaged it for several minutes. I have to say that did wonders because this morning I got out of bed without startup pain. I’ve mentioned the pain to 2 different surgeons but they said it happens and to walk walk walk. 

     Not sure if I had an impingement but I was feeling a pulling or catching feeling in the same area and that is gone also. 

    Hope it’s completely gone. Just need to know how to keep that muscle from tightening again which of course has caused me lower back pain. I’ve had a pelvic tilt for years. I’ve wondered if it was due to this muscle. Plus with the hip pain prior to surgeries causes anyone to walk differently which in turn affects other areas of the body. 

    • carolyn63196
      carolyn63196 Dsilk05

      Posted

      Hi there, I’m sorry to hear of your difficulties. I think if you are given the appropriate stretches early on ( if they think psoas) then this can reduce the risk of impingement. I find the stretches help for a few hours especially the lower back pain but it all comes back as soon as I sit down. 

      Cheers

      Carolyn

  • maree32074
    maree32074 carolyn63196

    Posted

    Hello Carolyn

    I can relate to your problem and it is so painful. After my second THR my psoas tendon was twisted and my specialist recommended hydrotherapy which I did for 12 sessions and with an excellent physiotherapist in the pool it did the job.  I continue to do exercises myself in the local heated pool.  I have since had a revisit of this hip and once again the psoas tendon is an issue and this time day surgery has been recommended to "nick" the tendon in two places. I have until November to decide if I want to do this or just put up with the pain.

    All the best

    • carolyn63196
      carolyn63196 maree32074

      Posted

      Thank you for your reply. Can I ask if you had a ct scan before they offered the release? I’ve had two ultra sound scan which show impingement but the ct scan showed nothing. My consultant is now referring me to another consultant to review all my scans. It’s been a nightmare :-(

      Cheers

      Carolyn

    • maree32074
      maree32074 carolyn63196

      Posted

      I had an ultra sound which picked up swelling/inflammation.  My specialist knew straight away that it was the psoas issue. 

      The first problem with the psoas was after my 2nd THR on my right hip.  I have since had a revision of this right hip (due to metal corrosion from a faulty hip replacement) and the psoas is once again a problem but nothing like the pain from the first time which makes me hesitant to have corrective surgery.  The first time I could hardly walk without excruciating pain but after the revision it is only a problem getting in and out of the car, in and out of bed etc as I need to swing both my legs across.

      Hope this helps.

    • carolyn63196
      carolyn63196 maree32074

      Posted

      Thank you for letting me know. I’ve had two ultra sound scans which shows up psoas scarring and lesions. He then sent me for a ct scan of which I had the results yesterday. He claims the cup is not over hanging but didn’t mention the psoas. I know have to see another consultant ( probably because I complained it’s taken nearly three years to get a diagnosis )

      Carolyn 

    • Patientzero007
      Patientzero007 carolyn63196

      Posted

      Carolyn. Im in the U.S. but from my experience over here the psoas tightening wont show up on anything. Dr diagnosed it by flouroscopic cortisone shot to see if that brought even small relief. Ultrasound cortisone shot was not proven effective since they were not able to go deep enough to inject cortsone as they were with dye under florouscopy...i had 3 useless cortisone shots done incorrectly until i met dr who said if it was not done a certain way it would help not be effective...i just had psoas release surgery 14 days ago and its been rough for me..hope this has helped.
    • carolyn63196
      carolyn63196 Patientzero007

      Posted

      I’m so sorry it’s been a rough journey for you :-( I had two cortisone injections whilst having the ultra sound scans. Neither were affective and I didn’t have them done until two years after my symptoms started. 
    • Patientzero007
      Patientzero007 carolyn63196

      Posted

      Hi Carolyn i was told by dr who specializes in psoas release that he rarely sees a cortisone injection done with ultrasound effective to diagnose...as was my experience. He sent me to hospital to have it done with dye under flouroscopy to reach all the way deep to trocanter...sure enough that time within 3 days i had 40% relief then went up to 80% in 2 weeks...pain relief only lasted 2 weeks but it was done for diagnostic..

      Also last night i was doing research on my meds to see why i was healing slower after psoas release, which is no walk in the park and i came across alot of info on hip pain caused by Crestor. I was taking crestor, a statin and believe it was adding to pain...please do research in any meds you may be taking for side effects...

      I have learned to get over this you have to be your own detective..take care!

  • Bkoz73750
    Bkoz73750 carolyn63196

    Posted

    I just happened upon this forum.  It's incredible to know that I'm not the only person experiencing side effects from THR.  It's almost comforting to know I'm not alone (though I don't wish this on anyone!!). I'm in Wisconsin, but from the threads I'm reading, maybe I need to move to Florida to have surgery [smile]

    1.5 years our from THR. Initial recovery in first 3 months was amazingly well, then all hell broke out.  My original surgeon "released" me from care and told me activities as tolerated. That was a mistake on his part. No restrictions?  Nope!. Well, I love boot camp style workouts, so I returned to working out.  Initially it was ok but then there were less and less activities I could do, and now I can't do anything with the hips/legs. Original surgeon could not wait to wash his hands of me, sent me to pain management. All PM wanted to do was give injections, which were not helpful. Sought out another surgeon who specializes in THR, and he took an x-ray Dec 2017; radiologist says it normal.  Tests for infection, allergic reaction all normal.  ANOTHER round of PT.  I've had so much PT in the last year!! That surgeon told me he does not do scopes and I need to find someone who will do a iliopsoas release. I found another doctor, his first question to me was if anyone told me that the x-ray from the last surgeon I saw was not normal.  WHAT?? I looked at the x-ray with this new doc and on one of the x-ray views, the femur stem is in a flexed position however this new doc doesn't think that's the problem if it is not loose. Now I had a nuclear bone scan and there is increased uptake at the ball/socket but not around the stem. He offered another steroid injection and/or iliopsoas release surgery. I am just so confused and leary about all of these doctors. Why are none of them confident about what the problem is. I have anterior hip and groin pain - constantly.  Literally cannot bend normal, have to stick my leg out to the side, and then coming back up is so much pain, cannot squat, cannot walk up steps normal, walking in general over 1.5 mph causes pain. I never used to say "can't" and the only time I would stop doing physical activity is out of pure exhaustion, but now all I'm saying is I can't do this or can't do that. (Sorry this is taking longer than I thought it would but I guess I really needed to vent). EVERY doctor told me to work on strengthening glute muscles and core. I really want to knock them up side the head. My glutes are not weak, and I have a fairly strong core, considering the exercises I'm able to do without pain

    • carolyn63196
      carolyn63196 Bkoz73750

      Posted

      Hi Bkoz73750

      Thank you for posting and I’m so sorry to hear about your journey. I totally sympathise with you and the frustration from being active to disabled. I saw another consultant yesterday who went through all my scans. For the first time it was admitted that my problematic hip is in a different position to my other replacement. It will be three years in June since I had the hip put in and it’s never felt right. The groin and snapping pain as affected my life so much and I’ve been pushed from pillar to post. The plan now is to sort the psoas after I’ve had another ultrasound scan. This time I won’t be having a steroid injection ( weren’t affective). I have faith in my new consultant and I’m beginning to see some light at the end of the tunnel. I’m so saddened that when patients have a gut feeling there is something wrong we are either ignored or told “It will settle down”. Psoas impingement is easy to diagnose so god knows why my previous consultant took nearly three years.

      Cheers

      Carolyn

    • inhal03672
      inhal03672 carolyn63196

      Posted

      Wishing you all the best. I completely relate to your journey and it frustrates me no end that crappy orthos are out there inflicting this on us. 

      Kindest regards

      Inhal 

    • inhal03672
      inhal03672 Bkoz73750

      Posted

      Oh your story is so like mine it’s terrifying.  

      I too have had my life on standstill and am still recovering from psoas release to fix up the debilitating pain & inability to walk, move let alone exercise. I’ve tried to push through & maintain an active life for the past 3 years but it is draining.

      What I don’t understand is why an orthopaedic surgeon is not aware that hip surgery is dependent on keeping the psoas free from impingement. I mean that is basic anatomy surely. A car mechanic knows that placement of parts impacts on other connecting parts! Jeez psoas is a significant player in hip replacement. How about understanding that before barrelling into the largest bone in the human body through the smallest of incisions (to make it less invasive!!) the psoas must be preserved and it’s function guarded otherwise people will become disabled and they may as well put up with s****y hip pain rather than be promised hip surgery to fix that pain to only be a worse situation at the end of it.

      Makes me so mad.

      You’re not alone. I hope your issues are resolved & that your original surgeon gets put on some register that alerts other prospective patients that they are at risk should they allow that surgeon to operate on them. 

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