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Groin pain after hip replacement

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I had a right hip replacement in Jan. 1010. For two years I was doing great, no pain and was able to resume my active lifestyle. During the past year, I have had pain in my groin with active flexion and external rotation. MRI and bone scan were unremarkable as was blood work to r/o infection. I had a hip arthroscopy in Sept. 2012. Some scar tissue was removed. This was thought to be the cause of my pain. I am now 3 mos. postop with no relief of pain. Had cortisone injection but no relief. My OS is recommending a revision. I have concerns because i'M relatively young (57). My dr says it isn't my psoas tendon. Im getting frustrated and going to obtain another opinion. I can't go to the OS that did the original surgery due to health insurance network.
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replied January 4th, 2013
Especially eHealthy

Sorry you are having problems.

To have a full revision of the total hip would be a very big procedure, especially since the etiology of the pain is not known.

If there was evidence of loosening of the prosthetic components, then revision is about the only thing that can be done.

You are wise to get a second opinion. To just completely take out well fixed components, in an attepted to "see if things get better", is not really sound medical judgement.

It may be that you do come to some further surgery, but there should be a solid indication for the surgery, in order to place a patient under the risks of an operative procedure.

Unfortunately, it sounds like you have had the "million dollar" workup. You have had the MRI and bone scan, plus the blood testing, and the hip arthroscopy, so just about all of the significant problems have been ruled out (infection, loosening, scar tissue impingement). You do not say where the cortisone injection was given (in the joint or in the iliopsoas bursa). Did the physician rule out the psoas tendonitis/bursitis by examination? If so, then you probably do not have it. But, if it is just after looking at the MRI or other study, then you may still actually have the disorder. With iliopsoas tendonitis, there will be increased tenderness with certain movements, such as hip flexion. Since you state that you have tendnerness with hip flexion and external rotation (if the pain in directly over the true hip joint anteriorly), it could be psoas tendonitis or bursitis. If there has not been an injection directly into the tendon sheath or bursa, you might give that a try.

Good luck. Hope that you find out what is causing the discomfort.
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