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Started By
Message
Need orthopedic 2nd opinion
Posted on 6/6/21 at 9:35 am
Posted on 6/6/21 at 9:35 am
I’d just like to get a message board second opinion on this for shits n giggles:
I’m 52 and have been having horrible hip pain. Pain is in the side of my hip and hurts after I’ve been sitting, walking up stairs, sleeping on that side, etc. I’ve tried Diclofenac, Celebrex, and Mobic with no improvement. My GP gave me a steroid shot in the bursa and no improvement (I don’t have confidence that the GP actually hit the bursa). I saw an orthopedic and he shot xrays and did a preliminary evaluation. I told him I was born with a dislocated hip and spent my first 18 months of life in a brace. He said my hip socket is very shallow and that was probably why it was dislocated. He diagnosed bursitis and tendonitis aggravated by the hip structure and my age. He sent me for 6 weeks of PT and then I will go back to him.
I’m 4 weeks into PT (3 times a week as prescribed) and have not seen any improvement. I do the home exercises and fully participate in each therapy session (I’m not half -assing it). In addition to the exercises and stretches, the therapist has done ultrasounds and 2 sessions of dry needling with more to come next week. Still no improvement.
Has anyone had this issue or seen this issue in patients? Can anyone offer advice? I’m getting very discouraged at this point. The ortho said he was fairly certain I would NOT need a hip replacement, which relieved me. But what other options or treatments are out there?
Thanks!
I’m 52 and have been having horrible hip pain. Pain is in the side of my hip and hurts after I’ve been sitting, walking up stairs, sleeping on that side, etc. I’ve tried Diclofenac, Celebrex, and Mobic with no improvement. My GP gave me a steroid shot in the bursa and no improvement (I don’t have confidence that the GP actually hit the bursa). I saw an orthopedic and he shot xrays and did a preliminary evaluation. I told him I was born with a dislocated hip and spent my first 18 months of life in a brace. He said my hip socket is very shallow and that was probably why it was dislocated. He diagnosed bursitis and tendonitis aggravated by the hip structure and my age. He sent me for 6 weeks of PT and then I will go back to him.
I’m 4 weeks into PT (3 times a week as prescribed) and have not seen any improvement. I do the home exercises and fully participate in each therapy session (I’m not half -assing it). In addition to the exercises and stretches, the therapist has done ultrasounds and 2 sessions of dry needling with more to come next week. Still no improvement.
Has anyone had this issue or seen this issue in patients? Can anyone offer advice? I’m getting very discouraged at this point. The ortho said he was fairly certain I would NOT need a hip replacement, which relieved me. But what other options or treatments are out there?
Thanks!
8
Posted on 6/6/21 at 9:39 am to MissTiger91
Sounds like you need a hip replacement. Are you looking for recommendations for an orthopedist for a second opinion? If so, where are you located and who are you seeing currently?
Posted on 6/6/21 at 9:57 am to jfw3535
No I’m not to that point yet. I just wanted a second opinion/input from y’all on the board. Also to find out if anyone has gone through this and can offer insight.
Posted on 6/6/21 at 10:05 am to MissTiger91
I'm your age and had a total hip replacement a couple years ago for a totally different reason. I'm no medical professional, but it sounds like arthritis or some degenerative condition, and given the lack of responsiveness to treatment so far, that's why I said a hip replacement might be in order.
Posted on 6/6/21 at 10:12 am to jfw3535
quote:
'm your age and had a total hip replacement a couple years
How was it? Was there a lot of down time or a fairly quick recovery?
Posted on 6/6/21 at 10:13 am to jfw3535
I’m an NP and worked in surgery for 15 years. I agree with jfw. If you’re wanting to be pain free and have better mobility, a total hip may be the best option. Anterior approach technique and you’ll be walking the same day and go home that afternoon.
Posted on 6/6/21 at 10:49 am to tke_swamprat
you'll be walking the same day regardless of approach may just have some precautions.
that being said unless you are obese and your gut will overlap the incision risking moisture and bacteria getting funky in your fold, the anterior approach is my preffered method (not a surgeon, a pt)
i prefer joint replacements as last resort as they do have a life to them and ruining the homeostasis of a joint and joint capsule should be considered.
that being said, typical route for most orthos is injections/pt and if that fails then surgery is discussed. due to your shallow acetabulum, you are at increased risk of needing a replacement due to the inherent relative instability of your hip and development of OA.
did the surgeon mention any degenerative changes?
that being said unless you are obese and your gut will overlap the incision risking moisture and bacteria getting funky in your fold, the anterior approach is my preffered method (not a surgeon, a pt)
i prefer joint replacements as last resort as they do have a life to them and ruining the homeostasis of a joint and joint capsule should be considered.
that being said, typical route for most orthos is injections/pt and if that fails then surgery is discussed. due to your shallow acetabulum, you are at increased risk of needing a replacement due to the inherent relative instability of your hip and development of OA.
did the surgeon mention any degenerative changes?
This post was edited on 6/6/21 at 10:50 am
Posted on 6/6/21 at 10:56 am to PTBob
quote:
did the surgeon mention any degenerative changes?
No he didn’t see any degenerative changes. And he also ruled out arthritis.
After 4 weeks of PT shouldn’t I have seen some improvement?
Posted on 6/6/21 at 11:06 am to MissTiger91
i would've expected at least some minor changes. although sometimes these things take extended time. your hip didn't get in that condition overnight and can sometimes take some time.
do you have a follow up with ortho scheduled? would recommend continuing PT and then following up with ortho after you finish for him to take a 2nd look. hip replacements typically aren't done without degenerative changes unless you have a hip fracture where a replacement would provide better outcomes than just an IM nail.
do you have a follow up with ortho scheduled? would recommend continuing PT and then following up with ortho after you finish for him to take a 2nd look. hip replacements typically aren't done without degenerative changes unless you have a hip fracture where a replacement would provide better outcomes than just an IM nail.
Posted on 6/6/21 at 11:10 am to MissTiger91
I’m not an expert, but if your ortho doesn’t think you need a replacement, you really may not. Surgeons like to be a little quick to declare surgery is necessary sometimes. So, if he says you don’t need it, give your PT some more time before jumping into surgery.
Posted on 6/6/21 at 11:18 am to PTBob
quote:
do you have a follow up with ortho scheduled?
Yes, I have a follow up appointment with him on 6/23 and I have 8 or 9 more therapy sessions to get through between now and then.
Posted on 6/6/21 at 1:31 pm to MissTiger91
Pain to the lateral aspect of the hip usually is more extra-articular vs intra-articular. In other words, not coming from the joint so I wouldn’t be quick to jump to a replacement.
There was a study done on trochanteric bursitis and more times than not, it’s actually some kind of gluteal tendinopathy so that’s probably why the injection didn’t work.
Assuming it is a tendinopathy, it needs a lot more than 4 weeks to get better. And I hate calling out other PT’s, but ultrasound isn’t doing shite
There was a study done on trochanteric bursitis and more times than not, it’s actually some kind of gluteal tendinopathy so that’s probably why the injection didn’t work.
Assuming it is a tendinopathy, it needs a lot more than 4 weeks to get better. And I hate calling out other PT’s, but ultrasound isn’t doing shite
This post was edited on 6/6/21 at 1:32 pm
Posted on 6/6/21 at 2:10 pm to MissTiger91
Hip impingement?
Posted on 6/6/21 at 8:10 pm to MissTiger91
Sometimes just getting more muscle around a joint helps it a ton. Core, glute, and leg workouts may just be what's needed. As other people have mentioned recently on this board, knees over toes youtube is pretty helpful.
Posted on 6/7/21 at 11:35 am to MissTiger91
As the other posters have mentioned, you may be a candidate for replacement and it very well may help you.
But, if you really want to fix this without, you need to treat it like a job.
What % of your time are you in PT or doing other support work? What are you doing the rest of the time? Sitting? Not to be a dick, but to actually create change in tissues, you need time to make it "stick."
I'd recommend a 3 phase plan:
1.) Serious SMR work, take a look at old mobility WOD videos from Kelly Starrett, get into that hip capsule for at least 30min a day, you can do it while watching TV
2.) Strength work. I'm not suggesting you train aggressively, but anything to strengthen your glutes and hamstrings will help.
3.) Deep Flexibility work - Something like ROMWOD, even a few key poses done every day for 30min.
With this, I'd STILL expect 4wks to meaningful change.
But, if you really want to fix this without, you need to treat it like a job.
What % of your time are you in PT or doing other support work? What are you doing the rest of the time? Sitting? Not to be a dick, but to actually create change in tissues, you need time to make it "stick."
I'd recommend a 3 phase plan:
1.) Serious SMR work, take a look at old mobility WOD videos from Kelly Starrett, get into that hip capsule for at least 30min a day, you can do it while watching TV
2.) Strength work. I'm not suggesting you train aggressively, but anything to strengthen your glutes and hamstrings will help.
3.) Deep Flexibility work - Something like ROMWOD, even a few key poses done every day for 30min.
With this, I'd STILL expect 4wks to meaningful change.
Posted on 6/7/21 at 7:54 pm to MissTiger91
I had a similar issue, turned out pelvis was out of alignment. 4 weeks of PT and a shite ton core work has improved it significantly.
Posted on 6/8/21 at 8:35 pm to TheZaba
quote:
Pain to the lateral aspect of the hip usually is more extra-articular vs intra-articular. In other words, not coming from the joint so I wouldn’t be quick to jump to a replacement.
^^This^^
Posted on 6/12/21 at 9:35 am to MissTiger91
I am 61 and had osteoarthritis in my right hip. I did the physical therapy thing at the recommendation of my orthopedic Dr. The last place I went for PT, after a few sessions, the Physical Therapist recommended I go back to the Doc as it wasn’t helping at all. After doing two steroid shots with no relief, I opted for hip replacement surgery. So far, it’s the best decision I have made. He told me after surgery that my hip was in bad shape.
When I first went to the Orthopedic Doc, he told me that even though he would recommend exploring all other avenues besides surgery, it was ultimately my decision.
When I first went to the Orthopedic Doc, he told me that even though he would recommend exploring all other avenues besides surgery, it was ultimately my decision.
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