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Possible Psoas impingement post anterior total hip replacement?
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doublehippy posted:
I had my second hip replaced 6 years ago with the direct anterior approach. Approximately 2 years post-op, I started experiencing pain in the groin and thigh....so much so, that I ended up having an aspiration and bone scan to rule out infection or loosening. My surgeon suggested it "could" be a muscle and wrote me a script for PT. That was 2 years ago and I still have the pain. It doesn't hurt to bear weight, climb steps, get up from a sitting position. However, the pain will wake me in the middle of the night when I try to extend my leg from a bent position....just like it did prior to the replacement. Certain flexion hurts...especially flexing the hip/leg back...not forward. It's also been suggested that the pain could be referred from my back (stenosis, DDD), but I've always felt that something was being "pinched" in there. It most definately feels like a muscle/ligament/tendon pain. What sort of diagnostic test would show an impingement? I understand that an x-ray guided injection into the psoas could provide relief.....but, obviously, need to have a diagnosis first. My OS assures me that my x-rays look fine and, as mentioned, we've ruled out loosening and infection. Should he be the one I see re: checking the psoas? if not, what sort of specialist? Thanks so much for any input!
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KevinHilton responded:
In some cases an Ultrasound or CT scan can be done to provide greater evidence of this problem, however in many cases the diagnosis is confirmed after a trial injection of the psoas tendon sheath using flouroscopy or ultrasound as you have alluded to. Usually an orthopaedic surgeon is responsible for the evaluation of this disorder, however he/she may have a radiologist do the actual injection if it is done under flouroscopy depending on hospital policy.


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