Causative or natural Arthritis?

[Pro]

Hi Guys,
I'm just after some advice regarding leg/hip pain. I know this will be a bit long winded but it's just to include as much detail as possible.
I am 34 and I took a nasty impact right at the top of my left thigh a couple of years ago.
When the injury happened my left leg was in a forward position and my right leg was back as i was in a pulling something heavy motion. I was hit on the top of my left thigh, pretty much central, almost where the crease is if you raise your leg and again just above my left knee. The item that hit me was quite heavy and came from above in a downwards motion at a considerable force.
The pain was massive, almost like a huge electric shock when i took the impact but when i got over it i could walk.
Pain was there for sometime and the area was heavily bruised but strangely i also had bruising / tenderness on my backside/ left buttock.
After a month or two things seem to settle down although there was always a niggling feeling that was not there before.
My job changed a few month after the accident and it involved a lot of walking and pulling heavy containers around.
The niggling feeling began to get worse up to a point it would keep me awake at night and i couldn't get settled any more. About a year later i decided to visit a physio as it was becoming unbearable. They said it could possibly be muscle damage but he would like me to go and get an xray on my hip.
I went and got an xray and it came back as having possible avascular necrosis and the physio said he couldn't do anything else at present until the condition gets confirmed.
I then went onto get a MRI scan and was saw by an orthopedic surgeon who said i had early degenerative changes in my left hip and there was no sign of avascular necrosis on the MRI scan. He also said that he didn't think the accident was the cause of the pain.
I attended more Physio which didn't do much good.
I then went on to get an anesthetic/steroid injection in my left hip. Immediately after this it felt great, like i had a new leg. The next day i was back to square 1 with the pain.
I am attending a different Physios now bearing in mind it has been just over 2 years from the date of the accident.
I cant walk very far, I'm always in pain and my range of movement is decreased in my left leg.
I know that my Hip is in need of a replacement but the orthopedic consultant said he wouldn't do it because of my age.
My current Physio says that my condition could well be the result of the impact. I think she mentioned that if the muscles were damaged all the weight would be put on the hip joint which could cause wearing as the muscles are supporting the joint properly. Does that make sense?
It does to me as when my job changed my hip was getting pounded every other day with walking and pulling, twisting etc..
What are your thoughts about it; is the orthopedic consultant right, it had nothing to do with the impact? Or is the Physio right?
I do believe the orthopedic consultant was very tunnel visioned and as when i was asking things he was dismissing everything. He looked at the MRI scan, saw the arthritis but never gave me an explanation why i have it except "it just happens".
If any more info is needed i'll give any details you require
Please help.
Thanks,
Pro

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[jennifer]

Helo Pro,

I guess both the surgeon and physio are right. Because of your age and nature of work so the surgeon decide not to replace ur hip coz there will be many contraindication with the new hip later on and this might cause a failure to the surgery.

In my opininion, if the pain is bareble, that means it doesnt affect your sleep or causing you to take pain killer daily, prohibiting you from going to work...i guess you should continue physio. They will have pain relief tx and exercise that keep your muscles strong and able to hold on to the joint.You should decide with conservative tx like maybe hydrocollator pack...that you can use at work or during sleep..at least to keep you painfree during daily activity.
Modify your work routine...like give it a break for 5-10 min after half hour work or something.

As you get older...IF (not asking for it) pain is untolerable, i guess Hip replacement can be done.

Thank you...

Jennifer

[Pro]

Hi Jennifer,

Thanks for the reply
I am no longer doing that job anymore as the pain became unbearable.
Do you think my condition is result of the impact my thigh took? Is it correct that if the muscles were damaged then a year of pounding on the joint every other day would result in arthritis due to lack of support from the muscles? I had one day heavy work and one day rest. This was for just under 1 year.
Thanks

[Pro]

Something else to add, If i lie flat on my front and raise my left leg it hurts and feels shakey. Like as if my leg is real heavy. If i tense my leg/buttock muscles and do it the pain is hardly there.
When walking and this is really hard for me to describe being non technical termed so apologies in advance. At the top of each thigh, if you prod about with your thumb and i mean right at the top where your leg bends there is something like a thin tendon / muscle (feels approx 1/2 - 1 cm width, seems to stop at the boney hip bit that sticks out and seems to travel vertically down my thigh). When relaxed, on my injured side that whatever it is feels much harder than the good side. If i put some pressure right on it when i walk it takes a lot of the pain away.

[alophysio]

Hi Pro,

That last post has contained the most useful information you have written.

1. From what you describe, you hve a muscel imbalance in the hip. Most likey this is the posterior hip muscles casuing anterior translation into the from of your acetabulum - in other words, the muscles at the back are pushing your thigh bone forward into the hip cup and so you are getting arthritis type symptoms from the grinding.

2. Because your body doesn't like dislocating it's joints, the muscle at the front your describe sounds like rectus femoris. This will be working hard to stop your thigh bone from dislocating.

3. When you tense your butt muscles with your leg muscles, you might be restoring the balance in the hip and activating your deep core muscles in some wierd way enough that you can lift your leg painlessly and without so much effort. This actually indicates that your problem is not "weakness" per se because you can't build that much strength so quickly (in seconds). Therefore it sounds like a coordination problem (motor control)

4. Pressure on rectus femoris relieves your pain because you are kind of giving it a rest (trigger point therapy).

When you walk, try thinking of "sinking" your thigh bone towards the back of your hip joint. See if that changes anything...