THR 6 months apart. Chronic pain 1 year after last hip

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I had total hip replacement done in June of 2016 for the first hip (right leg), and again in Dec of 2016 for the second (left leg). I should also note that at the time I had osteoporosis related to a hormone deficiency, which has resolved somewhat through replacement therapy. I still have osteopenia. I'm a 50 year old male who was very active at the gym (5 days a week for 2+ hours each visit for weightlifting).

The first hip (right leg) went without issue, and within 6 weeks I was up and around and back at the gym. Mobility was still somewhat limited due to the remaining hip but I was in a good place.

The second hip (left leg) was a different story. The surgeon indicated that the plate initially sunk into the pelvis like it was made of warm ice cream. They had to do some last minute adjustments to place a larger plate and joint (successfully). This required some adjustments to the height of the implant but they were able to get the lengths to match even though the implant heights were slightly different. They also had an extremely difficult time getting the hip out of the socket during the replacement. The muscle had become so short and tight there was a lot of damage done to them during the process. Recovery was very slow. Over the next 6 months I would have 6 courses of PT, with most in-home but some out of the home as well. The home ones went fine, but the ones where I went to a facility did not. I have severe rib pain, which has gotten worse since the surgery. It makes laying on my sides or back excruciating. I've suffered from stress fractures to the spine, pelvis, tibias, femurs, and ankles. The therapists didn't seem to know how to deal with someone in my situation so I was forced to drag myself around on the table for various stretches and exercises. I looked like a fish trying to walk. All while in horrible pain. In the home I could at least use a bed for the PT and it was a bit easier on my ribs.

I finally asked for another in home PT session a few months ago (it's been a year since my last hip replacement on the left), and that one went very well. I regained all of my flexibility and range of motion (my replacements are ceramic with very big joints allowing me a wide range of motion). Unfortunately on the very last visit I seemed to pull a muscle in my right thigh and my PT sessions ended ended on the assumption it was temporary and it would heal. During all of this, I was experiencing severe pain in my knees (directly below the kneecap), in my arches of my feet, and in the quadriceps). Walking more than half a block or so would cause very sharp, extreme pain to my knees. If I continued walking beyond that, it would also start sending spikes of pain into the arches of my feet.

The knee and arch pain affects both legs. The quadricep pain affects only my right leg (the first hip replacement). My left hip replacement is largely without issue.

The surgeon has been telling me for a year that I must continue to stretch and the pain will resolve. All of the imaging shows perfect implants with no issues spotted with the hardware. I just had an hour+ MRI with contrast, and the only item of note was a new stress fracture above my right knee, approximately 2 inches above the kneecap. The same leg that hurts, but in the wrong location for the pain.

The problem I have now, is that when I do exercise, I get a 'tearing' sensation in my right qaud, and then my leg wants to buckle as if the muscle has been cut. Initially this pain started as a 'popping' when I was laying on my my back and I moved my leg left and right with the knee bent. It would pop in my hip, with my legs about 3-4 inches apart at the knees. After about 5 pops, a deep ache would start. This popping only happened with my knee bent at a specific angle. This popping later turned into this tearing sensation which I have today. This tearing pain has been ongoing now for about 4 months. This pain also prevents the leg from bearing weight once it happens. It resolves after 2-4 days.

I've started back to the gym doing very low weights and high reps. I am able to finish my workout this way, but I am typically unable to walk for 2-3 days after a workout session. When I can start walking again though, my motion is less painful and I have more strength.

At this point, outside of the fracture, which is painful but less so than the quad pain, my only options seems to be to take a lot of opioids and muscle relaxers, and just work through the pain. I take tramadol for pain, methocarbamol for a muscle relaxer, gabapentin for nerve pain, and a single Tylenol just to help as well. Without these I can't function much at all. I'm often forced to resort back to my walker around the house.

I don't know if I'm looking for general suggestions, or just venting. I've been through so much physically I don't know how much more I can tolerate. I've managed through a stroke, all of the fractures, a year in ankle braces, the THR, and now 2 years of using a walker and a cane and largely unable to walk any distance. It seems like I can walk a bit further, but doing so will usually put me on my back for the next 2 days recovering. I see people posting about gardening, or mowing lawns. None of these are possible for me at the moment. Its extremely frustrating not being able to DO things. Just going to the gym is a big help, and either the trip itself is having a positive effect, or the strength exercise is helping somewhat.

It's difficult for me to even bend over let alone get on my knees. Any stretching sets off the same pain. Working out seems to allow me to avoid it if I'm careful but I often still end up unable to walk due to pain. I'm only doing 5 different exercises or so on the legs (leg press, calf extension, lower back extension, hip abduction, and leg extension. Each of these has very low weights (ranging in the 10-30 pound range). I'm not overly concerned about the rip pain, the knee pain, or the arch pain. Those didn't exist before the surgery and I'm hoping they are due to inactivity and having to learn to walk again with my weight in a slightly different place on my pelvis.

The thigh pain though is bad. It prevents me from working or even walking much for days at a time. The MRI was clean though. The doc still insists it's just tight muscles. It feels like it's ripped open to me. 

1 like, 7 replies

7 Replies

  • Posted

    Wow. Have you sought any 2nd opinions??

    I’m 47 had anterior THR 7/2017 and have have ongoing pain. My thigh and groin pain has been persistent especially transitioning to walk from sitting, lifting my foot off the ground more than 8” or so & I’m unable to do much against gravity, such as lifting a “clam” motion. 

    Anyway sadly, both 2nd opinions think I need it redone. Likely a muscle impingement that won’t resolve on its own. My pain with all these motions has not improved at all. Such a bummer. My original surgeon also said (with 3 post op X-rays) “all looks good with the implant...”

    • Posted

      I've had multiple imaging done by 3rd parties. Each imaging lab also indicated the same thing about the hardware, saying the implants look good and the surrounding structures are unremarkable.

  • Posted

    Dear Ron

    Goodness I'm sorry to hear af what you are having to deal with. Having read all that you have written this would be my approach.

    I would get myself two arm crutches rather than sticks or canes and concentrate my efforts on walking really well with a good posture and a good gait. I would ditch the gym and just try to do the normal hip recovery exercises.

    Good luck, Richard

    • Posted

      I hadn't considered that at all. Have others used crutches to good effect? The cane does cause me a bit of pain and a very awkward gate. They sell the down at my local pharmacy. It also seems like this might open up a longer range of walking for me.

    • Posted

      Dear Ron

      The reason for using two arm crutches is very simple and basic....just like using both legs<G>   It is to provide proper and balanced support whilst your muscles are recovering the strength to the point that you are walking strongly with a good gait and to train your body to walk correctly.  If you do this automatically when you no longer need them your body will tell you because you will be able to walk normally!

      Some physios seem to be set on getting people to use just one when they are not waling correctly.   If you need one then you really need two!

      Cheers. Richard

       

  • Posted

    Lifting any weights was the one restriction l had after the 6 week ck up. Bikes and other body strengthening exercises and Swimming were good and most exercises were printed out by PT to follow daily at home to increase stability and strength. 

    After 7-9 months later I could lift some small weights and build strength and conditioning. My PT specifically warned me against lifting any weight heavier than 15 # .

    6 months later I was riding horses slowly to build confidence and strength and doing well with both hips replaced . Eventually about a year later had strong leg muscles to control the horses and not put the implants at risk. I also had to change the way I rode to accommodate and care for long term hip components. 

    I beleive its all a individual decision and what make life better after THR is a very individual decision. Of course a supportive surgeon who is honest with what can be accomplished in each patients circumstance after THR.

    • Posted

      Thanks Hope4Cure. I've been very actively engage with my surgeon on this. He only recently released me to go back to the gym with the restriction on weights, which I adhere to religiously. In addition to the THR, I also have some risk associated with osteoporosis so fractures are always a concern (apparently I ended up with a fracture anyway which I'll have to deal with).

      I did noticed tonight that when I had a bout fo that sharp tearing pain, It actually DOES start at the base of my tibia and spike upwards. I normally immediately take all the weight off the leg as soon as the pain hits but tonight I was in a position to slowly go through the motion without risking falling. I think this fracture may indeed be part of the cause of my newest pain. Unfortunately there is no easy fix for this, other than just waiting for it to heal.

      I just saw him a few days ago and he seemed ok with me continuing to go to the gym. I did see some pretty remarkable improvements in 'standing' strength. I've had a particular issue with gaining strength going from a sitting to a standing position.

      I can't thank all of you enough for the suggestions in here. I'm going to look at getting some crutches to try that. It helps even just talking to others who are going through or who have gone through this.

      General question to you others recovering; Did any of you notice the general pains after THR tend to migrate from the hips, down into the quads and groin, then to the knees, and then to the calves and arches, or was this just me?

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