I am looking at needing a Psoas Tenotomy on my left side after my hip replacement. Anyone have experience with this? I am super concerned the impact to my riding.
So for anyone looking at hip replacement and worried about this, I will say the psoas pain is so much less than hip pain. I am definitely glad I had the replacement.
Well, shit. I’m sorry this is where you wound up with this 
I had a psoas release as part of my periacetabular osteotomy (not in the plan, but it was badly damaged/scarred) and I still have pretty considerable dysfunction and weakness. I work around it, and it’s not…terribly…burdensome, but there are things I absolutely cannot do. Like mount from the ground, because I don’t have the function to get my foot up there.
I also have to be really careful with how I use or attempt to strengthen the flexor, because it’s just dead easy to piss it off and make it cranky.
From what I understand (and I could be wrong, I dunno) a tenotomy is more serious than a release. Based purely on my own experience with losing flexor function, I’d be very hesitant in your shoes.
I’m really sorry to not have a more positive outcome to report, and also that this is an issue at all for you.
Well shit is right! I am worried as the psoas is there for a reason and as a dressage rider, my seat as a whole is pretty important and I am worried about losing mobility/control of the left side. My hop flexor have made it through surgery with a minimum of issues…probably due to the psoas impingement.
Fwiw I don’t find i have issues once I’m actually IN the saddle. Getting there is harder than it used to be because anything that involves lifting the foot is hard.
But yeah, the psoas is absolutely there for a reason. Where I notice it most is trying to engage it with a closed hip angle. So, putting on pants. Getting into the car. Trying to step forward while picking out feet.
Standing straight up, I can get my foot maybe 12" off the ground. If that hip angle is closed–like trying to put on pants standing up–it’s really significantly less.
So I mount with a block. I should really mount from the off side. But even with a block, I usually need to use my hand on my knee to help get my foot high enough to hit the stirrup. My horses aren’t crazy tall, like 16.1 ish?
If your psoas is pissed, really pissed, maybe this trade off is worth it. I don’t know. But I’d get a few opinions, because I don’t think this can be reversed?
that is my concern - once its gone there is no going back. I have been doing some research and want to see if I can get an injection for the time being.
Right now I am mounting by just swinging my right leg over from a very high surface. I cant put my left foot in the stirrup as the angle of mounting is not tolerable. 2 mounting blocks stacked (eek!) work well.
I don’t remember - are you in one of the THR groups on FB? There’s one for riders, one for active people. I’m sure there are a lot of experiences with what you’re going through, and maybe some alternatives to consider before surgery, in addition to a possible injection.
I am in a Riders THR group on FB.
Eeek. Man, that’s extreme. I’m really sorry. 
I totally agree an injection is worth a try, and find it kind of surprising that wasn’t offered before surgery.
And while it would sure suck a lot to go through all this again, I’d really talk to a few other surgeons on if revising is worth considering. I know your guy says no, but…does anyone else have a more positive view? In your shoes, I’d really want some additional input on that.
Fingers crossed that an injection helps a lot though!
Might it be worth a consult with a PT who specializes in post op hips. Do they have a feel for short and long term patients who opt in or out of the tenotomy / release? Do you have a PT now?
I was released by the pt I worked with after surgery. A pt could definitely help me strengthen and manage the pain.
that is great that you have a good relationship. Forgive me for being a second opinion type person, has anyone suggested consulting a Urogynocologist. Their specialize in pain and management of the pelvic floor and rehab from same. I had never heard of the specialty until I had excruciating pain ( doubled over, couldnt walk at times) in the lower right quadrant and hip. The diagnosis is intimate as were my therapy sessions ( I had no issues with this) . Floor exercises at home after then. Absolutely pleased with results.
I like to think cutting is a last resort
I just found a great PT that specializes in myofascial work. I had my hip replaced in January of this year. That was heaven on earth for the arthritis in the joint but has done nothing to stabilize or decrease the pain of my longstanding gluteal tendinopathy in the same hip.
For the first time in over 3 years I am optimistic on at least greatly lessening the pain. No lie…it hurts but in just 2 sessions, both pain and function have improved. Those tendons have already had PRP, a tenotomy and shockwave. I have not found one ortho in Boise that will even deal with the tendon issue. I get the “at your age” crap. The tenotomy on these tendons was minimally invasive. It is called Tenex. Done in the physiatrist’s office with sedation. That helped a lot and I waited 3 months before the total hip but have an idea I should have waited 3 months longer? The doctor that did the tenotomy said 3 months was fine but they stretch, hammer and manipulate a lot of tissue to get the hip in (anterior approach). Too late now anyway.
Anyway, this specific type of PT seems to be helping a lot. I am only able to get in with him 1x a week so progress may be slow but I will take any progress I can get.
I do have some psoas tendinopathy in the right hip that was replaced in 2014. I believe that really originated from a bad PT experience before the hip was replaced. It has not bothered me as much lately. I just kept stretching and icing if I needed too. I mostly ignored it and the pain at least has gone away. The right leg has been my anchor/strength leg for 3 years now because of the issues in the other hip and the psoas issue has given me very little problem.
I am hoping you can find relief. You might see if anyone offers Tenex in your area if you decide a tenotomy is necessary. It is truly minimally invasive. I was prescribed PT afterwards but I was happy with the outcome…up to the time of the THR.
https://tenexhealth.com/
Jingles you can find relief. Tendons are such a pain in the ass (or wherever). I have multiples seem to be particularly wimpy 
.
Did the tenotomy cause you any destabilization in your hip?
And, thx for all of the info!
No…none at all. I just had a little stab wound that wasn’t even stitched. And it was much less painful than the PRP. Now the Tenex is very minimal compared to regular surgery.
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