Question
Dear Sharon,

I had a total hip replacement a year and a half ago.  Initially I was doing quite
well into my recovery.  Hoping to get back to an active lifestyle.  About
3 months into my recovery something horrible happened and I have been
quite disabled and in pain ever since.

I am 44 years old and had hip displasia as an infant. The left hip did not form
correctly and as a result I my left leg was 3/4 inch shorter and I had very
limited external hip rotation.

My surgeon lengthened my leg, so that now my legs are the same length.

I was beginning to train quite heavily 3 months into my recovery, hoping to
get back to some competitive cycling.  During this time i noticed some pain in
the area of my ischial tuberosity as well as some numbness in my heal
and outer toes.

I went back to teaching full time at the 3 month mark and began to
experience increasingly sever pain mostly in the left buttock.  A burning,
numbing, aching pain. It only became worse the longer I worked.

Since then, I have only been able to work part time, and sometimes the pain
gets so severe I have to take time off.

The doctors here are stumped.  X-rays are text book perfect.   I have had
nerve conduction studies, tried active release therapy, acupuncture,
Lyrica medication, physiotherapy,  a Botox injection into the piriformis
muscle,
and a cortisone injection into the ischial tuberosity area where the pain seems
to radiate from, MRI and ultra sound imaging show no notable abnormalities.

The pain seems to radiate from the area of the ischial tuberosity.  There is
actually a palpable mobile mass in the area.  When I sit on a hard surface it
moves and is quite uncomfortable.   The pain can radiate there and move to
other areas around my left buttock and to the outside of my leg where the
incision is.

The chronic pain is driving me crazy.  At the moment, I have had another flair
up.  It is painful to stand, walk and sit.  Any physical
activity seems to worsen the symptoms.  Heat and rest are the only treatment
options that seem to give me some relief, and healing.  However it takes so
very long.

If you have any insight, please let me know.  I am at the end of my rope.

Thanks so much,
Tanya  

Answer
Dear Tanya

The ischial tuberous area that you are talking about is very open to bursitis.  Is it possible that you may have  bursitis?

If not, and you don't have bursitis, I would look for a second opinion.  My first reaction was that you may have nerve damage but if you are telling me that nerve damage has been investigated and not found, it must be something else.

You might also want to look into chiropractic work, especially trigger point massage.  Trigger point, when done correctly can be beneficial in alleviating pain.  Just be sure that your chiropractor is aware of your prosthesis and stays within the limits of your range of motion.  

You should check out any additional work you have done with your surgeon though to ensure that you are not going to exacerbate any existing problems you have now.

Another thing you might want to look into is sacroliliac involvement.  That can be a radiating pain and cause havoc with your system

If all else fails, find a teaching hospital in your area and go for a second opinion.  Teaching hospitals have cutting edge technology and may find something your surgeon has missed.

Best of luck to you

Sharon Davis