Medical Questions > Conditions and Diseases > Orthopedics Forum

Help in Reading Post Surgery MRI for Severe Thigh Pain After THR

User Profile
Hello,

I am a 58 y/o male experiencing severe thigh and hip pain following a cementless right THR on 6-14-11. The thigh pain originally felt like a quad pull. Now it feels like a deep bone bruise. The hip pain starts near the surgical incision and radiates to my glutes. My doctor sent me for an MRI on 8-25. Could someone please help me understand the MRI report below? Thanks in advance for any help on this.

RESULT:
Interval placement of right hip arthropiasty. The tip of the femoral component is directed posteriorly within the proximal femoral shaft abutting the posterior cortex.
There is some marrow edema at and inferior to the tip of the femoral component extending for approximately 11 cm. Mild edema within the rectus femoris at the level of the mid thigh.
Small of fluid/edema lateral to the hip postsurgical changes.
There is a sizeable amount of fluid at the posterior aspect of the hip measuring approximately 5 cm x 2 cm in axial dimension by 8 cm in craniocauaal dimension.
Gluteus insertions on the greater trochanter are intact.
Very mild edema in the adductor musculature.
There is a small amount of fluid/edema within the posterior aspect of the vastus lateralis which may reflect small tear.
Thigh musculature is otherwise intact.
Incompletely visualized small Baker's cyst.
Did you find this post helpful?
First Helper User Profile Gaelic
|

User Profile
replied August 29th, 2011
Especially eHealthy
Tallguy1953,

I will be happy to go over the MRI for you.

But, first, let me note, that it is very common for patients with cementless THR to have mid thigh pain after surgery. It is due to micromotion of the femoral stem within the femoral canal.

The patient often complains of anterior mid-thigh pain. The pain usually subsides with time, most resolving within six months of surgery. But, in a few rare cases, it can last quite a while, and in some, forever. In those that the pain does not resolve, many have to undergo revision of the femoral stem.

As to the pain around the surgical incision, you are barely two months out from your surgery. In routine cases, it takes 6 to 8 weeks for the soft tissues to heal completely. The healing is with scar tissue. After the tissues have healed, the scar tissue must then mature and soften, and for the muscles to back into condition. So, again, it can take several months to get over these major surgeries, to where you feel like you are close to being back in shape.


As to the MRI:

"Interval placement of right hip arthropiasty. The tip of the femoral component is directed posteriorly within the proximal femoral shaft abutting the posterior cortex." >>> There has been a THR done. The femoral component has been placed into the femoral canal in a position, where the tip in touching the posterior cortex (hard outer bone), or the back side of the canal. This is okay.

"There is some marrow edema at and inferior to the tip of the femoral component extending for approximately 11 cm. Mild edema within the rectus femoris at the level of the mid thigh." >>> Edema within a bone can be from many things, but in the case of it being post-op THR, it is usually due to the stress applied to the bone during placement of the prosthesis. The canal is reamed to take out the bone marrow and cancellous bone (spongy bone), then the prosthesis is hammered down the canal to seat it. This puts hoop stress on the cortical bone and compresses the cancellous bone further down the canal.
Thus the marrow edema is indicative of some trauma, sort of like a bone bruise, to the bone.
The rectus femoris muscle is the top most quad muscle. These is some edema, or swelling, within the midsubstance of the muscle. This could be coming from the bone bruise effects. It is also possible that it has caused during the positioning in surgery and during the actual surgical procedure, as the leg was moved around. it is essentially a contusion (bruise) in the muscle.

"Small of fluid/edema lateral to the hip postsurgical changes. There is a sizeable amount of fluid at the posterior aspect of the hip measuring approximately 5 cm x 2 cm in axial dimension by 8 cm in craniocauaal dimension." >>> Around the surgical incision, there is still some swelling, with one area of fairly good size. This most likely represents a post-op seroma (collection of serum from the blood), which the body has not resorbed completely yet. This far out from surgery, it is not likely to be an acute bleed.
This could also account for your continued hip pain around the incisional area.

"Gluteus insertions on the greater trochanter are intact." >>> Some of the attachments of the gluteal muscles have to be taken down during surgery. These are reattached during the closing of the wound. These attachments are okay.

"Very mild edema in the adductor musculature." >>> The adductor muscles are in the groin, along the inner thigh. Again, there is just a little swelling in them, which is probably resolving from the surgical trauma. The leg is moved around quite a bit during these surgeries.

"There is a small amount of fluid/edema within the posterior aspect of the vastus lateralis which may reflect small tear. Thigh musculature is otherwise intact." >>> The vastus lateralis in the outer most quad muscle. There is a small fluid collection, that the radiologist states may be a strain within the muscle fibers. It is hard to say what they mean by this without looking at the films. Because if it is the same as the other fluid collections, it is most likely the same as them, post-operative changes.
Unless you have sustained a quad strain in the last few weeks. So, the orthopedic surgeon will have to look at the films, to see what the radiologist is speaking of here.
The rest of the muscles in the thigh are okay.

"Incompletely visualized small Baker's cyst." >>> Posterior to the knee joint, there can exist an enlarged bursal sac, next to one of the heads of the gastroc muscle insertions. This bursa actually connects to the knee joint. It can fill up with joint fluid. When it is large enough to be felt or seen on MRI, it is called a Baker's Cyst. They are usually left alone.



You need to go over the study with your surgeon. The results of any study have to be correlated with the patient's history and symptoms. The results should never to interpreted in isolation.


Hope your thigh pain resolves, along with the discomfort in your hip, and you get back to normal activities very soon. Good luck.
|
Did you find this post helpful?

User Profile
replied August 30th, 2011
Gaelic,

Thank you for your informative and most helpful reply! I was starting to go a little nuts wondering if there was something really wrong. Mostly because I forgot to mention that this THR was on the heels of a lumbar decompression on 4-9-11. I have been down since the middle of Feb.

I have already made an appointment with my orthopedic doc on 9-1-11. I'll post the results of that visit here so others having the same problems might get some insight.

As for the quad situation, my doc released me after 8 weeks and said I could resume activity with-in reason. Unfortunately, idiot that I am, I obviously didn't understand what "with-in reason" meant Rolling Eyes. I think I may have done too much and pulled my quad a little. Maybe it was due to being sedentary for so many months and the muscles being weak. I am back on crutches and that seems to be helping as it takes the weight off my hip and leg.

My real problem now is that I started out patient therapy and had to stop due to the severe pain I am experiencing. I know you're not my doc, but any thoughts on when I could/should continue therapy again? I don't want to wait too long as I don't want the muscles to atrophy. P.s. My doc is not a real fan of therapy. He always tells me that he feels most therapists do more harm than good.

Thanks again for your reply.
|
Did you find this post helpful?

User Profile
replied August 31st, 2011
Especially eHealthy
TallGuy1953,

The best way to go at therapy is to let pain be your guide. Workout type pain, you know the type I'm speaking of, is okay. It is the sharp, intense, sudden pain that you want to avoid.

If the workout pain is still there the next day, and is uncomfortable, you may have done a little too much the day before, and you may need to back off a little.

Having been out of action for a while, your muscles are going to be weak, and you will have to get them back into shape. And, it takes a lot longer to get back into shape, than it does to decondition, to get out of shape. We used to tell the athletes that it took two days to get back, for every one they were out of practice. That's just a ball park estimate.

Of course, it doesn't help that you have the complication of the back surgery. But, the findings on the MRI, are coming from you THR surgery. After the decompression, hopefully your leg pain (if you had it) went away. But, it does not help that you are rehabilitating from the back surgery, then wham, you have to work on the hip.

A therapy that has been found to work very well with both hip and back patients, is pool therapy. The warmth of the water limbers up the muscles, making them more pliable. The buoyancy of the water, takes the weight off the lower extremities. And the water provides resistance for strength training. You can walk in the water, getting the gait training back and you don't have to worry about crutches or falling down.

Otherwise, walking is great for strength and cardiovascular fitness. Throw in some light weight training and easy stretching (within the limits of motion for the new hip, of course) and it will take you a long way to getting back.


Hope everything goes well with your appointment. You might ask your surgeon for specific exercises he recommends that you do, since he does not seem to think PT is a good idea. Good luck.
|
Did you find this post helpful?

User Profile
replied August 31st, 2011
Gaelic,

Thanks again for the info, it is very much appreciated! Your suggestions on therapy seem spot on. I think many people (me included) think that they have to let the therapist control the intensity of a recovery workout, when it's the patients body that should be the determining factor.
|
Did you find this post helpful?
Must Read
Think you might be experiencing bone loss? Check out this Intro to Osteoporosis and evaluate your risk for developing bone weakness. ...
Although bone mass loss is normal as we age, some people are more at risk of developing osteoporosis than others. Are you at risk? More here....
Do you have severe back pain? Do your bones break frequently or with little pressure? You might be experiencing osteoporosis. Found out more here....