Tenotomy of the iliopsoas ( tendon release )

I'm glad you canceled your surgery too, sounds like you had pretty good function nonetheless. I wish I could walk even a mile. I walked around a furniture store, something too big that I usually wouldn't dare take on, I won't even go to stop in shop, it's too big to walk that much. The day I walked around the furniture stores (2), I was so lopsided, that I threw my back into incredible spasms that would not stop, and ended up in an ambulance, hospital overnight in screaming pain. They tried valium and other things to get it to stop spasming. I hate drugs, but ultimately it took morphine. So, I can't even walk around two furniture stores. I sure won't do the complete psoas cut, but I can't go on this way. I think about ending it all sometimes when the chronic pain goes on too long. I mean, I can't do anything much but work at my office job, watch my house start to look like a hoarder owns it because I can't pick up after myself. It's been 5 years of trying to stay positive, find other things in life that bring me joy, but I so miss being able to leave my home for more than a couple of hours. I need a solution, and I think maybe there isn't one. 😦

Hi Maysie,

I really relate to your story and hope that you have found ways to have new joy in your days. I also am severely limited between the psoas pain that has gone down my leg and up my back when I walk. It has gotten to the point that I am getting willing to try the full cut of the tendon if I can't find a better solution first. I know it is a risk. If I find a solution I will come back here and report it. It may be considered"rare" that we have this result from THR but our lives are important too. Your life is important and I hope good things/people bless you.

Faith

hi Jeffrey,

I'm in a similar situation except instead of 13 months I'm almost 6 years since my surgery. I'm in the NYC area. This weekend sometime, when I'm not responding on my small phone screen, I'll give you the rundown of Drs, types of psoas release surgeries, and diagnostics I've encountered. maybe sharing information will help.

I had an arthroscopic release done in NOV. 2017 after a year and a half of severe pain. I've been pain free since then. DR. Farshad Adib from Univ. of MD in Baltimore. HIGHLY RECOMMEND!

Hi Maysie8717

Would love to know about different types of psoas release. Had my THR in November of 2017 and have been in pain pretty much ever since. I came to this and other sites and self diagnosed an impingement last June. My surgeon (obviously) didn't listen. Had X rays, a bone scan, more PT, and a steroid injection. Finally got a second opinion. The result, psoas bursitus caused by impingement. Again my surgeon refused to accept this. Finally had a MARS MRI, which showed psoas bursitis caused by impingement! Not pleased. My surgeon says all he can do is a total surgery to cut my psoas. I do not think that I want this done. Maybe a younger more up to date surgeon would help. I live in the Jacksonville, Brunswick, Savanna area.

Please can you offer some advice?

Thank you.

Hey Remo, so nice to read something positive!! And, a doctor's name too. Can you please tell us if you had the fractional psoas release, or a full release? The full cut sounds like it's generally a disaster in the long run. The fractional lengthening is what I'm wondering if I should try.

Hi Penelope,

Yeah, surgeon not listening... I totally get that, same thing here, for years even though other surgeons were clearly seeing there was a problem. I wonder what an MAR MRI is. I have been told repeatedly that an MRI wouldn't really show anything useful, although, after all these years, I feel like I maybe had one early on. I've had all kinds of tests. The thing I have learned that REALLY seems important, is this: there are different kinds of psoas surgeries. The "full cut" or psoas release, is the one where, if you read some of these threads, you'll see people end up with their backs cockeyed ever after, and new problems with strength. I almost did it, and it is crazy what happened. I had talked to the surgeon (one of many I've seen) and he said, well, yes, he thought psoas release would do the trick. But, he mentioned something about 40 percent loss of strength. I had assumed he meant in the aftermath of recovery, that it would start off that bad, but get better. Then I started to think maybe he meant it was a 40 percent chance of some loss of strength. The more I thought about it, the more I realized I needed to ask him to clarify. When I called, the assistant got back to me and said, oh it's a definite 40 percent loss of strength, permanently. Definitely. I said "cancel the surgery, I'm not going to take a bad situation and make it permanent". They said, well, it will get you out of pain. I thought, also not moving gets me out of pain, and while that's not a great solution, it is at least leaving me with hope.

Continued my search, I found out about "fractional psoas (iliopsoas) lengthening". Unlike a traditional psoas release, where they cut the psoas entirely, which is why you end up with permanent loss of strength, the fractional approach is small cuts, which allows the tendon to stretch out. It was explained to me as if you took a piece of slightly stretchy fabric, made little cuts in it, and then tried to stretch it, it would stretch further. and then, while stretched, if doing PT, could heal lengthened.

Sounds good but... the doctor I talked to, at Hospital for Special Surgery in NYC, is buddies with the HSS surgeon who did my hip replacement and who denies all of the facts, despite my having been to top notch PT specialists, and highly respected second opinion surgeons. I was ready to do it anyway, I was desperate. So December 2017, I was signed up to do the fractional release surgery with this surgeon at HSS. I was going to have to pay for it myself, because even though I have good insurance, the only insurance he takes is Blue Cross Blue Shield. They told me it would cost 9K, but they wouldn't put it in writing.

HSS touts their amazing reputation, but it all felt shady. Being desperate (original surgery was 2012), I thought I have to do something. A little wary thought, I realized as I was gearing up to do the surgery, that I'd been signing waivers and such, but no one had given me paperwork saying the diagnosis, or the surgery they intended to do. So, knowing HSS was playing fast and lose on my first surgery, and the records, I asked this doctor's office or written diagnosis and what the surgery they recommended was called. They emailed me something saying "orthroscopic surgery" (which is like saying they're going to open a door using small key, but nothing about what they'd be doing once inside). They didn't say fractional illiopsoas lengthening, though that's what we discussed. They also didn't give any diagnosis, just stated "hip and groin pain". It was so shady. Worse than that, I'd literally asked the surgeon in my appointment with him, if he needed to do a diagnostic such as a cortisone injection/floroscopy. He said nope, no need. The papers he sent to me actually said he'd done that diagnostic, and dated it for the day I'd just had an office visit. I figure if they're that shady about their paperwork, I'm not going under the knife with the people at that hospital ever again. They spend way more on advertising than they actually care about people.

But, I suspect the surgery "fractional lengthening" is the only way to approach surgery. A full cut is a dead end, no way back, and has a lot of bad side effects like screwing up your back and permanent loss of strength.

Now I'm looking for any information about a surgeon who may have done fractional lengthening for one of the posting patients here who had success and would recommend their surgeon. Or hell, any other non-full-cut successful surgery option.

That's the full story, too much, but hell, it's not like I can go for a walk, so typing a lengthy post, may as well.

OH NO, THERES NO EDIT BUTTON! So sorry, thought I'd be able to go back and edit that down.

that's so great to hear remo! was it partial release (fractional lengthening) or full release? do you have full strength and functioning back?

Hi Maysie,

Thanks so much for taking the trouble to send such a detailed reply. No edit button needed!

You have been through a lot. Glad that you didn't go for the full cut. Having searched this topic it sounds like a really bad idea. My surgeon admitted that it would impede my activities a bit, ie. taking a step up, lifting my foot over the curb, into the car or over the cat. Now you tell me about back issues.

I also suspect that my surgeons great reluctance in admitting my psoas problem, was not unconnected with his desire to be blameless, possibly fearing a lawsuit. Though doubtless I merrily signed away all rights before having the surgery.

I'm not sure who or what HSS is but it sounds very 'iffy'. You are wise to run a mile.

I also need to find someone who will do the fractional lengthening. The problem, which we all have no doubt, is finding a surgeon within less than a 100 or so miles from home. All the follow up visits etc. have to be a reasonable distance away.

I have one more question for anyone reading this. My other hip is now on the fritz and I have to decide which type of surgery to have. I have heard that accessing the hip from the front is the best option but is also more difficult and requires a surgeon well practiced in doing this. Any advice would be welcome.

Btw. a MARS MRI (think there are other names for this machine) is apparently different from a regular MRI, in that the signals don't bounce of the metal giving a fractured image. This obviously is pretty crucial to the reading of something involving tiny measurements. I had to travel to Florida to get mine.

I do wish you the best of luck with your search. I hope that you can find a great and trustworthy surgeon to help you.

Hi Jeffrey,ag

I'm in Lancaster PA so Baltimore is only an hour south. Did your Doctor do that "step cut" to lengthen and not cut all the way thru or did he do the full cut and disengage the tendon completely? I don't have SEVERE pain, but I have enough 90% of the time where it impacts certain activities. I finally got back to an aerobics class last week and was able to do the class but I haven't been back because it fired up the right groin with a continual deep ache.

He did not cut all of the way through. Mine was more complex than he expected, though. I had ALOT of scar tissue to work through. He tried for an hour to get it into position to lengthen. Finally, he was able to do it. Prior to the arthroscopic release, my pain was SEVERE when I sat in a chair and lifted my leg with feet flat on the floor. Today, no pain.

Remo, I'm so happy for you. one of the first true success stories I've seen here. I've lost the thread a bit... who was your surgeon?

(i suspect I've got a lot of scar tissue at this point too. been 5 years since hip replacement)

Dr. Farshad Adib at the Univ. Of MD Orthopaedics in Baltimre, MD. He is awesome!

How long a recovery, may I ask??

I think part of my problem is scar tissue because the labrum was torn before I had the THR back,in 09 and every time I'd bend over, the right groin would go into spasm, like a little engine humming away deep in tbe top of my leg. Then when I woke from surgery, the whole area we in spasm, WOW DID THAT HURT! And I had to demand a hot pack to relax the muscle. my left was done 10 weeks later and I swear it's like a natural healthy hip, like nothing happened. Sure wish the right came out like that!

I think my recovery was longer because there was so much scar tissue to deal with. They gave me extra nerve block, so I was completely off it for two days at home (came home the same day) until the numbness wore off. I was using a cane just for stability for a couple of weeks. Did therapy 2 times a week for around a month.

My groin felt like someone was stabbing me with a knife every time I lifted my leg. No longer. Pain is gone. The leg still is not as strong as my other one, though.

Thanks so much Remo. 😃

Hey Remo - I have another question, since it sounds like you, like me, had the issue happen AFTER your THR. What did the surgeon who did your THR say? Did he say you needed this kind of surgery, and he (or she) just doesn't do it? Really curious, my surgeon who did my THR (who is at HSS in NYC) was no help, didn't want to admit there was an issue for a few years, then said "well, this happens sometimes, my colleague does the lengthening surgery, go see him". I went to him, but that guy sent me paperwork with lies, literally claiming I had diagnostics that I didn't have, dates and everything, which I guess he figured might help with insurance, but when I asked if it was a mistake, repeatedly, no one from his office would reply -- so, not going under the knife with someone shady. But I'm really curious if your original surgeon knew this is what you needed, took any responsibility, or perhaps is in same hospital as DR. Farshad Adib ?

Hi Jeffrey, I was very interested to see that you searched for help in LA area as I am originally from there and was wondering if I should go back to look there!

• I consulted with Dr James Ross in Deerfield Beach FL after reading here that one of his patients had great success with his psoas release. I liked him and still am considering getting the arthroscopic cuts and scar tissue work he suggested but I asked him about fractional release and he replied that he had never heard of it. I am concerned about that because I would like my surgeon to be as well informed about all the possible and more conservative procedures. Still making my mind up about how to proceed and will try to get more opinions from surgeons. I have the problem of being in an rural area now and having to travel far and wide for help. For Dr Ross I took a 2 day trip. If you know you want the full cut of the tendon he would be a possible candidate for you. Deerfield Beach was, by the way, a very nice place to visit! Pretty aqua sea and white beach. Here's hope for your recovery.
• Faith

Hi Penelope, I also had a surgeon who would not listen and just kept referring to "perfect xrays" that showed two hip replacements in place every time I went back with the same complaint. This was in Honolulu.

I live in the same area as you and have not found a doctor who can be helpful with the post hip replacement psoas impingement. Can you give me suggestions with at least who not to waste time getting an appointment with? I would really appreciate it. I had bilateral hip replacements done in 2014 in Honolulu and have never been able to get out of pain with the left one. I had the diagnosis of psoas impingement done Duke Raleigh but then had to get surgery for my lung cancer there before I could do anything for non life or death psoas pain. The cancer is gone from that lung but they created a new problem during the surgery so I don't want to go back to that hospital for another surgery.

You may have read about arthroscopic surgery vs open surgery and Dr James Ross in Deerfield Beach FL does that, but he doesn't do fractional if that makes a difference. I want an opinion with a surgeon who knows arthroscopic fractional as well. Dr Ross is pretty young so I thought he might fit your request but he says he never heard of fractional release.

Faith

Faith, that's so interesting what you learned about Dr Ross. thx for sharing it here. i was thinking of reaching out to him to learn more about his work, you saved me and probably others here, some time!

Remo, i had an email correspondence with Dr Adib. He's in Maryland and I'm in Connecticut. close enough! I've met with my local ortho last week and asked if he could be sort of correspondence partner as I get further into this. I'm guessing it would be best to try to do recovery at home and have a Dr here who has a working relationship with dr. Adib. What was your recovery like? how long, first week what's it like?

appreciate any details you can share.

Hi Faith, I am sorry not to have replied sooner, I see that you posted two months ago, right about the time I was having my second hip surgery, somehow your message got lost in the shuffle.

I found a new young surgeon for my second hip, I really like him. Dr. Sedory works for Optim out of Savanna Ga. but has various offices throughout this area which he visits. He did my surgery with the anterior approach, which I highly recommend. Within four days I was walking around the house unaided without a cane, after ten I could negotiate the supermarket and now at two months I am pretty much back to normal.

Sorry, I got off track! I still have pain and difficulty with my left impinged hip and cannot give you an answer to your question about arthroscopic fractional release, however I will be going for my second (and last) check up with Dr. Sedory in two days. I will ask him about this and let you know should I discover anything.

I do have a question for the community re. the Girdlestone Procedure but it is a pretty long paragraph so will post it separately.

I hope that by now you may have found someone, though imagine that you would have posted if this were the case.

Maysie,

I got an answer from Dr Ross where he says he does know about fractional release but it doesn't always relieve pain and is an open surgery instead of the less risky arthroscopic one. So I want to amend what I wrote about his answer. I would like to go with arthroscopic myself, although it is hard to psych myself into another surgery!

Hi Faith,

I'm interested in why Dr Ross said the fractional release is an open surgery. i understand it to be arthroscopic. But maybe that's not always how they do it. I sure will check! It's true that it might not work, but if it does, it leaves the patient with a shot at a full recovery. if it doesn't, then the likely next effort is revision surgery... which I'm sure all of us want to avoid if possible. Sounds like the only thing worse than revision surgery is the surgery we all just read about called Girdle stone.

Hi Penelope,

It is wonderful to hear that you have a great outcome from your hip surgery and are happy with Dr. Sedory. He sounds like a real find. I did ask Dr. Ross/Deerfield Beach FL about fractional and he thinks it is done with open surgery which is more full of risks and that it works less often for the patient to get out of pain. I am thinking I will go with the arthroscopic and hope for the best. No outcome is guaranteed and I read some research reports that claim that if the iliopsoas is cut it will grow back. That idea will keep me from sitting for long times in case it might grow back short and be a pain problem again. These last words are just my thoughts and not backed up in research of course.

May we all on this site be in no pain in the days to come no matter what!

Maysie, Dr Ross said that at the level of the hip replacement the tendon may not be fully visualized (for fractional release) . I am assuming this is why it would more often be done in an open procedure - for the visualization. I watched a tenotomy surgery on utube and can understand from that about the visualization problem! Good luck with your research and your choices.

Hi Faith,

Good luck with your arthroscopic release. Presume your surgeon checked for a psoas bursitis? Much of my pain has been attributed to this, I have pretty large collection of fluid in this area caused by the impingement. My new surgeon is taking another MARS MRI to see if this has grown bigger since the last radiology report, if so he suggest draining it before trying surgery. Another huge needle experience Yippee!

...and yes, "May we all on this site be in no pain in the days to come no matter what!"

im not sure if this helps but im scheduled to have a arthroscopic psoas release surgery with a dr in Panorama city , his name is dr shore but hes with Kaiser . still not sure if I will follow through with the procedure after reading all the messages here . ive been in severe pain since my thr and was hoping this was the answer .

Hi Juanita, just make sure to find out if it is a full psoas release (cut through) or if it is a fractional lengthening release. Also, as I've found doctors who say one thing, mean another, tell him you need the diagnosis and name of surgery he's doing in writing, because you have learned from others that it's best to keep your own documentation records in advance of surgeries. Just tell him your friend who is a nurse says the proper way to do things is to have your documentation records in advance of surgeries. Don't let them tell you it's all in your file, don't worry, or that they'll send it to insurance, ask them to email you a copy too - and just pretend you understand that to be standard practice. Good luck, God bless, and hope you find the right solution!

@faith22640 Thank you Faith, i went to see Dr. Fabid in Maryland on Oct 2nd, thinking I had the right solution, to do this surgery, but he said that this surgery is not what will solve my issue. No idea what will, but says this is not it. Which was heartbreaking. I'm at a loss now for any kind of proposed solution. I appreciate you telling me about the open procedure being for visualization probably, that makes sense.

I had the partial release two years ago. Dr. Adib did it in Maryland. Feel great! No more pain. Just need to make sure you strengthen the muscles afterwards

I so wanted to do it with him (I spelled his name wrong above), I even asked him if it would be 'worth a try' because I have no options. Sadly he said it's not the right surgery for me in his opinion.

good luck

Thank you Remo. i really do appreciate that you tried to help me, told me about him, and told me about your experience.

Hey Remo, it's been a while, and I have a question. When you had your surgery done, what did they say was your diagnosis? Any details might help me better understand. I feel like over all the years this keeps going, it morphs a bit. And no one ever gave me a concrete diagnosis. Any thoughts would be appreciated. Thank you. Maysie (Sarah)

Hi Juanita, how did your surgery go with Dr. Shore? Are you doing better I hope?

The pain was caused by wrong angle of the acetabulum along with the tightness of my psoas tendon. both of these caused the tendon to rub up against the cup. Causing inflammation. My doctor said although the angle was not wrong, but If he would’ve done my replacement, he would have placed the cup at a different angle. Hope this helps.