Tenotomy of the iliopsoas ( tendon release )

So glad to hear! This is what I feel I need to help with constant pain over year past THR that never gave me relief. Did you have the fractional release done? If not where did they cut or release from? Who was your second opinion doc?  Can you perform hip flexion ok and without pain now?

Hi Patricia,

I can perform hip flexion without pain. It's weaker, but getting stronger. They said it may take 6 months. 

I had a psoas tendon release. They CUT it. They gave me the photos, so I can defiantly say IT WAS cut. They cut it at the lesser trochanter, which I think yields the most relief if I remember correctly.

I confirmed this with my doctor pre-surgery because I wanted to know exactly what was involved. He said the psoas tendon is encased in the psoas complex ( group of muscles and this tendon).  He said that often they refer to the release/cut  as a "lengthening", because by cutting the tendon, you are in essence lengthening the psoas muscle complex. All 3 orthopedic surgeons told me that the tendon does not really do that much. All the muscles will stay intact, so joint stability will not be compromised. 

In my case, I believe this tendon was actually getting caught  during several movements as I had pain with more than one movement. The most excruciating was then I flexed my hip up, knee bent, then straightened my leg and lowered. This would hurt whether I was standing or laying down. I felt as if something was getting pinched when I did that. I also had pain posteriorly and deep when I would adjust my position when seated...such as on an airplane to get more comfortable or riding in a car. The more activity I tried, the worse it got. I felt like it was constantly inflamed. I'm an extremely flexible person, so all the stretching in the world did not seem to help this. Often I felt like it was a very tight guitar string being plucked. There was also a deep thud when rotating my hip out. This hurt. 

To diagnose, here's what had to happen. My original surgeon made all the recommendations and was the primary point person for guiding what to do next. I'm in south Florida, so I'm not sure if the names will help, but here goes in order. 

1. MRI with artifact removed---just showed fluid and a slight possible impingement in one area.  I was told to remember that the MRI is performed while you are in one position. It does not show what happens during flexion, rotation ect...

2. Lab work to rule out infection and second opinion with revision surgeon who looked at MRI and listened to my symptom history and strongly suspected impingement.  He advised the psoas injection to diagnose. (Dr Vince Burke, Fort Lauderdale, FL)

3. A dye guided psoas injection (at hospital) to see if symptoms were relieved---had to keep a journal for two weeks. 80-90 percent of all the symptoms were relieved for about a week. All symptoms returned by week 2. 

4. Back to original surgeon to report my symptom relief and reoccurrence. (Dr Steven Naide, Pompano Beach, FL) 

5. Referral to orthroscopic surgeon for release. (Dr James Ross, Boca Raton, FL)

6. A little bit of physical therapy and back to my THR surgeon for follow up.

7. So happy I did it!!!  Finally pain free 13 months post THR.

Good luck with whatever you do. Pain following THR is not a usual occurrence. It can be frustrating and lonely. Hang in there. I hope you get some answers and relief soon. 

))))

Hi Hippy Chick. I went out of network to Dr. Ross we are in the process of trying to get authorization right now for the surgery...Boca Regional is not a network hospital so that's the sticking point...I did tell him that patients were bragging about him online...

How many times per week did you have to go to physicial therapy after tendon release by Dr. Ross? and was your tendon release at Boca Regional HOspital?

PM me if you want...we should really exhange numbers!!...lol

Chrissy

You are so great, thank you so much for taking the time to spell this out. My situation sounds very much the same, I'm a year and a half out of THR with no relief and what I feel is more pain.  I'm so sick of living this way and really can't afford to take anymore time off of my business for another surgery so I'm really hoping to find the solution and get it done so I can have some kind of life. Unfortunately the surgeon I went to is zero help and doesn't seem to care that I'm in constant pain still or figure out why. Been to a few others, and done the pain injections with some relief but then pain returns. I don't think the release surgery is a common one done by orthos and I really want to find one that has performed these post THR

So thank you for the info and so glad to hear you've gotten relief, I'm in this state of depression that like you say no one understands.... because everyone else has had wonderful hip replacement experience and never felt better ... wish that was me.

Hi Patricia, KSHippychick did a great job in her reply> Don't feel alone please...I am right there with you...I had an anterior total hip replacement in Feb 2017 and about 3 to 4 weeks later this horrible deep groin pain started...So far with the time previous to surgery up till now I have been unable to work which is about 18  months..Somedays i can barely make it from bedroom to the kitchen...I am single and very down about this whole thing...I have been to see about 6 orthos and they didn't know sh...t....

Listen to KShippychick...unfortunately the tendon release is about the only way to go...my insurance didn't even have an in-network ortho who knew how to do this release!!...I went to see Dr. Ross out of network and am waiting on authorization for surgery from insurance company.

I feel like you do that life is passing me by... If you are in South Florida I would recommend Dr. Ross or google the procedure and see what comes up in your area. Problem is all the orthos want to do this anterior hip replacement cuz its easy, fast recovery and big $$$  but they don't know or care to fix the problems it brings...

Do whatever you have to do to get control of your life again, just don't expect it overnight...Wish i could offer more :-(

Chrissy

What a clear & concise post! Thank you so very much for your post. Been a massive learning curve for me. 

Hi Chrissy

Great post. Here’s to a good outcome for you. Such a harrowing journey. 

In your opinion is it the anterior approach that is the problem? If so why do think this is so.

I had my right hip done posterior approach nearly 7 years ago; 10 weeks post op I was 100% 

18 months ago left hip went & I got sucked in by the “it’s less invasive, quicker recovery” hype & saw another surgeon as my previous surgeon won’t do anterior approach. This is where my nightmare began!!! 

Would love to hear your thoughts on why anterior approach has greater risks.

Wishing you all the very best.

Thank you but I believe kshippie chick wrote one of the best post detailing what a journey this is. I think the anterior approach is a problem and results in more tendonitis than the posterior approach based on all the responses I'm seeing. and the real problem lies in that very few orthos know how to fix this problem yet it seems that all of them have learned how to do the quick anterior hip replacement which is referred to as a superpath hip replacement in Europe. it is a journey and at 63 years old it has taken a huge chunk of my life out so I honestly can't recommend the anterior hip replacement because it's a coin toss whether it comes out great or you end up with these problems. They say that it's only 5% of the people that have these tendonitis problems but I think that it's really much higher. Hope this helps in some way as the others have helped me

Hi Chrissy, like you I have had no pain relief for year and a half and had pain for over year previous to THR, I was once extremely active in sports, hiking you name it I did it, I now don't even recognize myself and feel crippled at 45 years of age. I too am single and support myself and a business as a Chiropractor, I help everyone else while I'm in severe pain and try not to show it. Just putting pants On and off is an ordeal , let alone walking or lying down . All that time, money and hope to get my life back with a THR, I'm worse it's so depressing. My THR doctor is an a**hole and basically could care less and has nothing to offer as to why.  I've researched things to death and like you said unfortunately most docs don't ever perform the psoas relief and if so have hardly ever done it , which is not comforting. I'm willing to travel out of state to find someone who has done quite a few of these and knows what they are doing, but I can't afford weeks away from my practice again to recover. 

Trust me we totally get what you are going through...I didn't even see my ortho after hip replacement only his PA...its money making at its best....How close are you to Florida?  unfortunately there is no easy answer...I went to see soo many orthos who didn't have a clue or they knew what it was just couldn't do anything about it...I am waiting to get insurance authorization because i had to go out of network to get the doctor who can fix this...so if that doesn't go through, i am pretty much screwed. But i feel that it will..

I don't know how you are even able to work? some days its too painful to walk around the house, I lay around all day....I don't want to take pain pills but there are days I have to just to go to grocery store.

The recuperation on the surgery is minimum a couple of weeks, full rehab within 6 months...but I have NOT had it yet, so that is not first hand experience, just info from my dr...He specializes in this, if  you were close enough it would be worth the trip..His name is Dr. James Ross in deerfield beach, Florida...He has done several other people on these boards.

Hi Patricia. I'm 50 so I totally understand. If you do go forward with the psoas release, the recovery is not bad at all. You'll be released with a hip brace (yuck!) that you are to wear for 2 weeks to protect yourself from over extending your hip. Ten days out I cooked Thanksgiving dinner (with brace). There was not much pain at all. You will have weakness during the first week or two. I did not need anything stronger than Aleve after day 1. You probably could return to work, light duty, after one week. The physical therapy was very straightforward and I only went 3-4 times. The assignments were all doable at home. I had hip arthroscopy at 45 for a labral tear and FAI impingement, hip replacement at 49, and recently the psoas release. The release was a piece of cake, comparatively. I truly hope you find some answers. I had more than one emotional episodes over this! It is so frustrating!!! Hang in there and don't give up! 

Hi this is Chrissy, Did Dr. Ross put you in a back brace?? he did not mention that to me??

I got my Surgical date of Feb 21, so I will let you know how it goes. Thankfully KSHippyChick had it already and provided ton of info...

Getting major cold feet...I just hope it stops inside thigh/groin pain!! its been in hurting for such a long time...almost feels like bone!

Dr. had me go for flouroscopic cortisone injection but i only got about 40% relief, that was 2.5 weeks ago and that horrible horrible pain is coming back.

So stay tuned and I will update forum

Chrissy

That's great! I really do hope you get complete relief from surgery, the groin pain is awful !!!!! It's a chore just putting on and taking off clothes as well as getting in a car for me.  Anxious to know how you do . I too only had about 40 percent relief with the hip injections but I have to say just having some short lived pain relief was soooo nice, let's hope this will take care of it for you. Sending you healing thoughts!!! 💕

After reading all the post and everyone is giving great details, I feel not so alone.  At 18 I tore my labrum, and had my first scope, and then followed with two more over a period of of 9 years. 3 years ago I had THR  (anterior approach)o n the right side, and have been in pain ever since. I knew something was wrong about a month out, sharp pains in the groin and also lower back (which has been maintained with sacrum injections). Issues with stairs, general walking, lifting, pretty much day to day life, on top I am a new mother. Been in physical therapy for 3 years on and off, have tried injections in the Iliopsoas approx 4 in 3 years (none gave any pain relief),endless PT, X-rays, MRI's, bone scans and doctors. Finally now I am going for the tendon release at the end of the month. Just want to know how may people have had great results with this surgery? This is my last option. Other than this my doctor is at stand still, with no other option than this to hopefully relieve pain.

Any stories with for anyone who has had similar issues, and successful surgeries?

Thanks!

Hi Stephanie. I am in fact, going into hospital tomorrow early am for tenotomy release. So I will keep everyone posted...Chrissy

By the way it is extremely common for patients to experience psoas problems after THR if they had a failed labral tear surgery and then got a THR. That is exactly what happened to me labral tear surgery by Dr Phillipon in Vail in 2013, THR in Vegas by Dr Swanson who then retired to sell weed in Vegas (true story) now going for Psoas release in March by Dr Ross. It is so frustrating especially after seeing many friends that had THR and have no pain and live very active lifestyles!

UPDATE: Had my post op appt with Dr. Ross...my healing is slower than I wanted but i am 63 years old and was in constant pain before surgery. I have alot of swelling still so walking is slow...The hospital physicial therapist started me on some pt exercises to do at home and im afraid it was too soon. So Dr. Ross does not want me to start physicial therapy until  i see him in 1 month. I still have buttock/thigh pain which I had prior to surgery but he said that improvements are seen within 6 weeks! so I will take any improvement. I was in a tremendous amount of pain before...I really wish I did not have the anterior hip replacement but hip preservation instead.

I did ask Dr. Ross if this could happen to me again and he did say as long as surgery was performed correctly that it should not happen again....at least he had not seen in.

I hope this helps...I believe you are scheduled for surgery with Dr. Ross soon...He is the only dr I have found that can actually do this surgery and has been successful.

Just take it easy and look to strengthen your butt muscles. Having my surgery in 16 days with Dr Ross. Im hopeful!

I hope everything goes well. I'm very happy I did it!

Hi Randi..im feeling little better each day...i just had alot of swelling.everyone heals at different rate....but i cant wait until end result and im back to normal life!!

Please tell Dr Ross we all communicate on the forum and he's the hero! Keep us posted!

I am going to my post op tomorrow, with Dr. Tabaddor out of University Orthopedics in RI, scheduled for surgery 3/23/18. I am very nervous cause I am only out of work for a a total of 4 days following the procedure. I am at a desk all day, doing the say thing I probably would be doing at home. Reading everyone's stories give me great hope, maybe this is my final answer! Been a long road, and not looking to be 100% pain free just 50% pain free from my pain today.

I inadvertently just replied to your message to me 8 days ago, somehow missing your update to Randy. I'm crossing my fingers  you feel better swiftly.

Hi.  Thank you for such a wonderful detailed post.  It sounds like you had an easy recovery that was completely successful.  Is that still true today (April 9). I have been following patientzero007 and I think someone else who had some  version of a tendon release by Dr. Ross who seem to be having a lot of ups and downs and aren’t doing so well.  I’m almost 5 months out - the pain (upper thigh, inner thigh, butt around groin and groin pain and sometimes referred throbbing of knee and occasionally of shin) began about 2 months post op.  What I notice now is less pain when resting but very stiff and if I accidently turn my leg wrong or put on socks or tie shoe laces, severe pain.

My question is do you know if Dr. Rossi does different versions of the release and did you have the same version as patientzero007.  The thought of more surgery is terrifying.  I’m 68 and have always been a very active walker and hiker.  I can’t walk at all now without paying a heavy price.  I don’t quite understand how the muscles can be unaffected if the tendon that attaches the muscles to the bone has been cut.  I wish I understood this better.  Thank you.  susan

Patricia, how are you doing now? I am 2 months out and it is a rollercoaster ride!! which dr said was normal...major problems getting dressed and in and out of car...i recently pushed it AGAIn, so another week off as swelling makes it difficult to do anything. Don't know if i will get full function back...Also along with psoas came ichial tuberosity where you sit bone gets inflamed and is very painful..

Please let us know how you are doing...Thank  you...Chrissy

did they cut the whole tendon off the lesser trocanter? and was it all arthroscopic not"open"? how is the weakness in your leg?