Conflicting Recommendations - Hip Replacement

Posted by jennsb @jennsb, Apr 10, 2023

I am 56 years old with chronic hip pain in both hips. MRI shows an impingement in my left hip and labral tears in both hips and moderate osteoarthritis. I also have bursitis. My pain is on the outside of my hips. Joint replacement doc said that if the arthritis is causing the pain, I would have pain in interior/groin area which is why he thinks most of my pain must be coming from my bursitis. I've been through PT 3 times, steroid hip injections, injections in bursa, trigger point injections and nothing has helped. My doctor finally recommended hip replacement surgery but he is retiring, so he referred me to another doctor who said he would not recommend hip replacement but did not give me any other alternative recommendations because I've already tried everything. Should I now get a third opinion?

Interested in more discussions like this? Go to the Joint Replacements Support Group.

@jennsb I would probably get a third opinion at this point, but first I would search for the best possible orthopedic surgeon I could find. How? First, ask the PT whose patients have the best results. Then start asking friends, family, coworkers, anyone at the gym or golf course...what you will find is that pretty soon the same name crops up twice, three times...
Then it is time for a third opinion - with that doctor.
That is how I found a new ortho when I needed to change 12 years ago - and I still see him today!
Sue

REPLY

I agree. I asked my friends about a doctor and all agreed on the one I used. I had lots of arthritis in my hip which was causing pain down my thigh so I opted for a hip replacement
10 weeks out.

REPLY
@becky060599

I agree. I asked my friends about a doctor and all agreed on the one I used. I had lots of arthritis in my hip which was causing pain down my thigh so I opted for a hip replacement
10 weeks out.

Jump to this post

Hi Becky - Is your pain on the outside of your hip or inside/groin area?

REPLY

Down the outside of my thigh and sometimes about 6 inches above my knee

REPLY

I too am 56 and have had both hips replaced. Definitely if it was from inside joint you'd have some groin pain. I'm puzzled why you don't with a labral tear.
But please research trochanteric pain syndrome often misdiagnosed as bursitis which is why none of those things helped you. Find the best possible Ortho who can do the best possible MRI that exists(there are different types) so you can rule out a torn or chronic degeneration of abductor muscles. These are the two smallest butt muscles on outside of hip. I have this condition and in Jan had a TENEX procedure which fixed my torn gluteus minimus tendon and removed scar tissue from both those muscle tendons. I'd recommend that procedure first if not having groin pain. Sounds like, unfortunately, in future you will have to have hip replacement but put it off as long as can. Find the best physical therapist also. They must be able to do stretching for you and fascia release. Not just make you do exercises. The piriformis muscle in butt and the major butt muscle, plus the Iliopsoas muscle are getting stressed with a torn labrum. These muscles must get individual attention diligently and get stronger before a hip replacement or you will be in worse shape! I know from experience!! I had arthroscopic labral repair before hip replacement. Maybe if get outside muscles better, you can have arthroscopic repair of labrum and put off hip replacement even longer. The key is to unlock all the compensating muscles! It's extremely hard to find the therapist who knows how or cares to take time to. You must research all this and learn as much as possible because surgery can make you worse if not ready!!
Best wishes..God Bless you!

REPLY
@gilyha

I too am 56 and have had both hips replaced. Definitely if it was from inside joint you'd have some groin pain. I'm puzzled why you don't with a labral tear.
But please research trochanteric pain syndrome often misdiagnosed as bursitis which is why none of those things helped you. Find the best possible Ortho who can do the best possible MRI that exists(there are different types) so you can rule out a torn or chronic degeneration of abductor muscles. These are the two smallest butt muscles on outside of hip. I have this condition and in Jan had a TENEX procedure which fixed my torn gluteus minimus tendon and removed scar tissue from both those muscle tendons. I'd recommend that procedure first if not having groin pain. Sounds like, unfortunately, in future you will have to have hip replacement but put it off as long as can. Find the best physical therapist also. They must be able to do stretching for you and fascia release. Not just make you do exercises. The piriformis muscle in butt and the major butt muscle, plus the Iliopsoas muscle are getting stressed with a torn labrum. These muscles must get individual attention diligently and get stronger before a hip replacement or you will be in worse shape! I know from experience!! I had arthroscopic labral repair before hip replacement. Maybe if get outside muscles better, you can have arthroscopic repair of labrum and put off hip replacement even longer. The key is to unlock all the compensating muscles! It's extremely hard to find the therapist who knows how or cares to take time to. You must research all this and learn as much as possible because surgery can make you worse if not ready!!
Best wishes..God Bless you!

Jump to this post

Also, the thigh pain above your knee means the rectus femoris muscle is overworked and sounds like your tensor fascia lata on outside thigh is tightening up. These are also compensation type muscle pains that must be worked on.

REPLY

Yes.....get a referral to a doc with a lot of experience. This is hard enough to trust just anyone! God bless.❤

REPLY
@becky060599

I agree. I asked my friends about a doctor and all agreed on the one I used. I had lots of arthritis in my hip which was causing pain down my thigh so I opted for a hip replacement
10 weeks out.

Jump to this post

....And how are you now? How was the whole experience, and was it what you expected?

REPLY

@jennsb I am facing the same issue as you are. I'm sneaking up on 52, have confirmed labral tears in both hips with cam impingements, mild dysplasia and signs of arthritis in both hips. I occasionally get pain in the groin, but mostly experience the classic "C" sign of pain over the top of the hip as well as discomfort in the quads and chronically tight lower back muscles which can lead to occasional spasm.

I met with a hip preservation specialist who evaluated me and said that while I was still a candidate for labrum repair, I fell into a gray area given my age, slight dysplasia, the length of time I had been dealing with the issue and signs of arthritis already present. These factors combine to reduce the chance of successful outcome from 90%+ to something more like 80% and the surgery would not do anything to help with the arthritis pain which would likely continue to progress.

I am very likely to pursue bilateral hip replacement vs. going forward with the repair. My understanding is that the recovery from repair is no picnic and can take up to a year to feel normal again. I don't want to go through with that only to have a short time before total hip replacement is back in the conversation. It is a big decision and one that requires careful thought.

My advice is to seek that second opinion, but to also do the following:
1. Go to bonesmart.com and read through the forums on hip replacement pre-surgery and post-op stories so you know what you could be in for.

2. look up the paper "Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty" from the Journal of Hip Preservation Surgery. The paper is unlocked and easily accessible. It discusses what the complicating factors are for successful outcomes from repair. It helped me to set my own course to deal with the issue and it may help bring some clarity to your own situation and direction.

Best of luck to you on your journey.

REPLY

So met with the doctor again and he thinks it is bursitis
Having blood tested to rule out infection. He talked about a cortisone shot or maybe get an MRI. He says based on the X-rays the surgery was a success so he doesn’t think it is in the bone.

REPLY
Please sign in or register to post a reply.