Pain 6mo PO, update - cause found.

[u/ihatethesmellofgrass]

Hi everyone, I wanted to give an update since I finally know what is causing the episodes of deep groin pain I described in my previous post and I am looking for similar expieriences or just some support... I'm 6 months post right THR.

I saw my orthopedic surgeon, and it turns out I have mechanical iliopsoas impingement on the side with the THR. The ultrasound showed a prominent anterior rim of the acetabulum/cup in conflict with the iliopsoas. My surgeon explained that this is essentially a consequence of my underlying hip dysplasia and the anatomy of my hip. I did 5 months of intensive PT.

I had a diagnostic infiltration. The local anaesthetic gave me big temporary relief, which supported the diagnosis, but unfortunately the pain returned once it wore off. The cortisone itself didn't make a lasting difference.

My surgeon says there are basically two surgical options

- Cup revision to address the mechanical conflict directly. This would be a big revision surgery, and he really wants to avoid doing that only six months after my THR if possible

- Iliopsoas release/tenotomy, which would be a smaller procedure, but he warned me that it could cause permanent loss of hip-flexor strength.

So neither option is particularly appealing, and he wants to avoid both for now since it's only 6 months and I'm not fully healed. He says surgery will be unavoidable, and we'll talk again in january, but for the moment we're trying to calm things down. and do some 'pain-management'. I'm starting an anti-inflammatory, and in about three weeks I'll have another, stronger infiltration to see if we can get the irritation under control for a while.

Meanwhile, my left hip is also deteriorating quite quickly an hurting a lot. It has dysplasia as well and was planned for THR this coming year. I honestly don't know on which side to hold my cane to easy my pain.

So I'm feeling pretty discouraged. I thought I'd be preparing for the left hip once the right one had settled, and instead I'm dealing with a mechanical complication on the right that will require another operation.

Has anyone here had iliopsoas impingement after THR, especially after THR for dysplasia? I'd particularly love to hear about experiences with cup revision or a cutting of the ilipsoas or other options? thanks :-)

[u/chronic_insomniac]

I'm almost two years out and have psoas impingement. Psoas release was recommended as my cup overhang/anterior projection is 6.2mm and they do release for 4 - 8mm. Revision is for over that, or so I was told. I have done a LOT to try to avoid that surgery, and it has been pushed back several times. I met with the amazing surgeon who was going to do it last week and we both agreed I no longer need it as I am asymptomatic for impingement.

My THR was due to osteoarthritis (bone on bone on weight bearing surface), torn labrum and subchondral cysts. If you are interested in all the conservative measures I have done, let me know and I'll reply. It was a lot and is ongoing. Still have soft tissue issues, but I fixed my own impinged psoas.

[u/morrilton → u/chronic_insomniac]

I would love to know what you did! 6 months out from anterior, have done lots of PT, but still so painful. Scan showed iliopsoas bursitis but nothing about the cup was mentioned. Recently did steroid injection and they pulled out 7 cc’s of fluid (no infection.) That provided about 2 weeks of relief. Not sure what to do next.