Oh goodness. My left hip has been really painful in the past two weeks. Just... weird. Tingley- almost like a foot about to fall asleep. Then the pain started. It's pretty bad with walking (and I am a 3+ times a week hiker/mtn climber and trail runner- I *must* walk!!). My PsA has been managed well with Mtx, pred, and Stelera, and aside frome the regular achies and spine pain, I have been doing better in the past year than I have in the past 7 years. Now this. So, I got shot up with cortisone, hoping and hoping that it is some type of bursitis. That was this morning. It has been getting worse all afternoon. My doctor said that if this doesn't work, the concern is avascular necrosis of the hip. What??? Dang it. That does not sound nice at all. Apparently, long term prednisone can cause the blood supply to your hip to be greatly reduced and your hip can just... die. Gah. I am 37, and an athlete. It is what keeps me sane. I need 2 working (and alive) hips for that! And other things! Dang it again.
Has anyone had this happen? Did you need a hip replacement? Other surgery? Do you think I should panic a lot or just a little, at this point?
Whoa there, Kyra! I know how you feel: my hip started giving me more grief last month, and I asked the doc to x-ray it. Sure enough, it is now “severe” arthritis. But the worse news was, they thought I had AVN. I panicked, of course.
In my panic, though, I figured this much out: if it’s AVN, your hip usually goes downhill fairly quickly. It can be anything from months to years. They can do various surgical procedures to try to correct/stimulate the blood flow, and they would usually do that in a younger person. If that fails, a hip replacement is needed and that solves the problem. At my age (60) they would probably do a THR fairly soon.
They will probably do a nuclear bone scan on you. That has to be the easiest medical test ever, although it is time consuming because they inject you with isotope and then you have to wait 3 hours. Then all you have to do is lie there for about 45 minutes while they scan. I fell asleep.
And the result? Not AVN, just (!) severe arthritis.
AVN is serious, no doubt about it, but it is not a medical emergency. Get tested, keep calm and carry on.
All of what Seenie said but, just though I'd mention there is more "art" than "science" in getting shot up. Sometimes they miss. Other times they do the wrong spot because its refered pain etc etc. As often as not it get s better for no reason....
Thanks guys! I am not really one to panic much, but this thing has me a bit nervous! Still, I will Keep Calm and Carry On (I needed that one Seenie!) and wait for the diagnostics to be done next week before I do too much damage to my psyche. I appreciate the support and the advice
Lamb, what shot are you referring to? The isotope goes into the same vein that they use to draw blood, inner arm. No art, no brainer
And AVN rarely resolves itself spontaneously, as i understand it.
Not the isotope seenie. Doing the cortisone shoot up. ( It could be strictly the entheses that are inflamed - common in PsA doesn't always show in studies (infact rarley does) and usually NOT helped by cortisone but hurts Like the dickens. Its goes away as easily as it comes and does infact cause damage.) AVN does not as you say resolves itself. I'm sorry I was not more clear. Just because the the shoot up didn't work isn't time to panic. sometimes we hear only the WORST scenario - and why wouldn't we? our luck hasn't been too goo to this point eh?
I guess I really DO need to take some time off, I really am not being very effective at communicating.
Aww, Lamb, no worries. I figured that you were taking about cortisone when you said "shoot up"- that sounds like a more hit or miss job than injecting with some sort of isotope, which sounds like precision would be, umm, required. Thanks for the clarification though!
Sorry, Lamb, I misunderstood. You’re right, though, about the cortisone’s being a bit hit-and-miss. In my pre-TKR days I had a several shots to the knee. I was lucky have good luck with them. I especially liked the way the cortisone was mixed with an anaesthetic. Sigh – immediate relief! I suspect that cortisone to the hip is more complicated than to the knee. I’ll be asking about that when I next see my doc.
Kyra, I’m in England at the moment, and the “Stay Calm …” meme is everywhere, on decorator cushions, mugs, t-shirts and such. “Stay Calm and Eat Cupcakes”, “Stay calm and Drink Wine”, etc. LOL! My favourite is still Stay Calm and Carry On. Who would have guessed that 70 years after its creation, that slogan would still be around, and still reminding us to buck up?
Lamb you’re so right about the shots being painful when entheses is the pain source…the shot in its self didn’t hurt me, but for a month after the pain in my shoulder was really bad, when I was offered another in the other shoulder I refused point blank!
My rheumatologist has always advised against steroid meds in general and has said to try and cope without because of complications that can be associated with them. I’ve been close quite a few times but thankfully have managed without.
Hold in there kyra, ill keep my fingers crossed for you
X
My husband has been having this problem for a few months now. I talked him into going to the dr and having X-rays. The dr told him it looks like bone on bone and is pinching a nerve but offered no treatment options. I know this does not help but its depressing for him because it is obviously painful. I didn’t know the prednisone could do that but I will ask the dr at the next appointment if this could be the cause. He says his pain is worse when he sits… He it currently using this big expensive device called a suna dome and hoping it helps…
Kyra, I have a metal A frame round my hip bone basically holding it together due to degeneration. I am a little restricted as I am told not to run or jump, but I still horse ride for enjoyment and swim to keep fit (not that I like it) so please don't panic as life won't stop, although it may have to adjust somewhat. I am a tad mindful of cortisone injections as I feel they mask pain and in my case I overdo it every time I have them, I never learn.
What I will say is that how you treat this news is up to you but I will bet that you can get a lot of support on here. My fingers are crossed that the doctor has erred on the side of caution with you.....and in the mean time I wish you good health
Seenie- I love that motto. My grandmother, one of the most amazing and interesting people that I have ever met, lives in Bath now, but she went through the war in Bristol, which was heavily bombed. She just epitomises that saying. Don't know how they did it with such grace and practicality. Something to strive for...
Juniper- Another rider!! Riding is a *huge* concern to me as well. I have a swedish warmblood mare who is just one of the best things in my world. I am So worried that I will have to put riding/training on hold! I am sure that she will survive with a vacation (lol), but the thought of halting progress in our (dressage) training stinks. Still, if I can at least go and sit on her bareback while she eats grass in the sun, life will be very good. Amazing how much therapy horses (and pets) provide. Just being with them brings down the blood pressure.
It has been a bad Saturday. The pain is just getting worse. Even laying down it is bad, and tramadol isn't touching it :(. Ahh well, gives me an excuse to watch Antiques Roadshow and read my French Revolution novel (Madam Tussade was a real person! Who knew?). Nothing I can do 'till Monday but Keep Calm and... you know ;P
Kyra...I certainly do not ride like I used to ...but to keep the hope alive in you, I have had this bone malfunction (as I like to call it) since I was a teenager and I am 46 now and I still ride (yeehaa) your mare sounds a beauty and I am sure you will be back in the saddle at some point, and good luck with the dressage (I am tipping my hat to you), I am riding a cob type (she only has one eye, due to a tumour) but I only ride for fun now ....I broke a welsh pony to pull a cart as I thought I would not be back in the saddle but here I am, so don't give up and give give horsey a hug from me as I know she will be your therapy at times and enjoy a spot of bare back, well why not.....hope you are feeling a bit better today, as you put a big smile on my face telling me about your horse, so that's a good deed you have done lol ...take care Kyra
I have had the same thing which was put down to bursitis. I also had a cortisone injection that took several days to calm down. I actually find it is worse for a while after then settles down. It was crippling pain. But try and be patient for a few days and rest as much as you can. It might pay to get an ultrasound on your help to make sure it is only bursitis and there is no joint damage. They can assume it is but sometimes they are wrong. Don’t panic yet, give the cortisone time to work. Mine is still working a but but starting to wear off. I am going to get an ultrasound when I get the next injection to make sure nothing else is going on.
Sorry to hear you are having trouble with your hip. Like you, I would be nervous thinking about AVN. I've been experiencing new problems with my hip, and I can appreciate how scary it can be!
Coincidentally, my personal physician currently is dealing with AVN, and has been for about a year now. He told me that in a small number of cases, depending on the size of the involved area, AVN can spontaneously resolve on its own. Since consulting with an orthopedic surgeon at Johns Hopkins, my doc has been using crutches and "resting" his hip. At some point, he said, there are other treatments that can be done to try to encourage reestablishment of blood flow to the necrotic head of the femur.
You may be interested in this abstract of research completed by the NIH. The sample size is small, but they are willing to say that results showed that in some cases, AVN can resolve. Still, even though the sample size is small, I suppose if you can prove that with appropriate care, AVN resolved in one case, then you've proved it is possible. It's good news for those of worrying about AVN!
