Dr. Joel Scott Tupper, MD

Dr. Tupper is very experienced with shoulder replacements and would be happy to consult with you. Please contact our office at 405-962-8123 to request an appointment. Thank you, Dianne

The unanswered question here is, What do you mean by "hip pain". In my practice, the hip is referred to by pain in the groin or inguinal pain, pain over the lateral aspect of the hip and pain in the buttock. Inguinal pain is true hip pain, the hip joint is located anterior and pain from the joint is typically in the groin. Lateral hip pain, pain over the greater trochanter, the bony knot you feel on the lateral aspect of the hip is most often related to bursitis and can be diagnosed and treated with a local anesthetic/steroid injection. Buttock pain can be related to SI joint inflammation or if your lumbar issues are at L1-L2 or L2-L3 levels, nerve root irritation at those levels can cause pain to radiate around the hip. In answer to your question a single AP hip x-ray can demonstrate whether significant arthritis is present in the hip joint.

Burning pain over the anterior thigh bilaterally is likely related to your back issues and due to irritation of the L2-L3 nerve root. To confirm this an MRI, EMG and physical exam would be necessary.

You don't give a lot of detail, but with hypothyroidism, it is likely the pain is secondary to swelling and edema, particularly if you have issues with your weight. It is unlikely that either of the two medications you mention are causing the swelling or pain. If you press on your shin for a few seconds and it leaves a dimple after the pressure is released, that is called pitting edema. It can cause the pain you're describing. It can be treated with compression hose, fluid restrictions and other medications called diuretics or water pills. If this is the cause you would best be served with a visit to your PCP. Joel Tupper, MD

It is certainly possible to have persistent soft tissue pain after a significant crush injury. The ligaments, tendons, muscle and other supporting structures of the foot can be injured in a crush injury, like you describe, and may not be demonstrated on plain x-rays. It may take several months to fully heal and the symptoms resolve.

Severe joint pain with sarcoidosis is relatively rare. Arthroplasty is used to treat degenerative joint disease from sarcoidosis. Sarcoidosis or chronic granulomatous disease has been noted to be a rare side effect of arthroplasty as well, particularly with metal on metal implants or catastrophic failure of implants. This is similar to the issues with leaking silicone breast implants. Sarcoidosis as a comorbidity while having a revision TSA is uncommon and no specific study addresses any known complications. It may affect how well you tolerate anesthesia more so than healing the surgery, if you have granulomatous formation in the lungs. It will likely affect your immune response to the surgical insult, but your infection risk is not likely to be greatly affected due to the fact that you would still develop an appropriate white blood cell response to any bacterial challenge. Depending upon how the TSA has failed, I am not sure you would have much of an option besides revision arthroplasty and would have to accept the surgical risk.