Bilateral THR Anterior 6 days out - advice on lower leg pain!<

[cookster65]

Hi from Michigan,

I had been meaning to post in the pre-op area before my surgery but there was so much to do beforehand that I never found the time! But reading about some others' experience with bilateral THR surgery on this forum was SO helpful - I was having a hard time getting info about what to expect when having both hips done at once. I am so very appreciative of all those before me who've shared their experiences. I admittedly haven't read through all the bilateral postings, so hope I'm not asking something really obvious. I tried using "search" and "lower leg pain" but didn't find anything specific. So will post about my experience now and maybe someone out there can give me some advice

I had my surgery on the morning of Friday June 17th, and all went well. I had an epidural for pain initially which was great. I did notice when I first woke up after surgery that my lower legs really hurt a lot (plus I was FREEZING!), and I was pretty miserable and someone finally came and they did something that helped. I rested for a while, then I was able to stand up and walk a few steps back and forth, and sideways, later that day. The next day, I was able to walk around the floor and did the 4 steps up and down that they had in the PT area.

On Sunday, they took out the epidural in the AM and then I switched over to pills (oxycodone, every 3 hours). It was mostly ok, but Monday morning my right leg from the knee down started to really hurt badly after PT. They suggested I double up on the dosage of the oxycodone going forward, but I noticed it made me a little woozy, so was hesitant. It felt better once I took same dose and it kicked in. Someone later figured out that I had been taking every 3 hours but the new nurse that came on missed the time somehow and didn't give it to me for 5 hours, so maybe the delay was the issue. So I've stuck to every 3 hours and the originally prescribed dosage since then, even though I've had bouts of intense pain in the lower legs.

On Sunday the PT person also had me go in stairwell and practice going up and down 17 steps, in preparation for going to the place where I am staying. They wanted to send me home on Monday, but we had some logistical issues getting the house set up where I will be staying, so it took an extra day in the hospital and came "home" on Tuesday, which was probably a good thing. But all in all everyone seemed really impressed at how I was doing.

Since going off the epidural I noticed the expected extreme stiffness in my upper legs and hips, especially when getting up from bed or if I sit in one place for too long (ie more than 45 minutes or so!). My right leg was more problematic and weaker prior to surgery, and I'm told the surgeon had to put two screws in on that side, but the other side he did not. Since surgery the right leg has generally been more swollen, especially my ankle, and that leg sometimes cramps up when walking or standing, while the other is much easier. I do have 15 steps to get up to the second floor at place I am staying, but I just do them once in the morning and once to get back up at night so far. Stairs were not much of an issue for me prior to surgery, I have 54 from walking into my building to get to my apartment door - so I am very used to steps!

Yesterday was my first full day at "home", and I tried to walk around and stand with full weight on my legs to do stuff when I could, but I was in a lot of pain by end of day. I wore my fitbit and can see I did total of 791 steps. But all day, I was having a hard time getting comfortable anywhere in a resting position - in bed, sitting up in my armchair, sitting in straight back chair with arms, in bed/laying down. Getting in and out of bed is the worst as I'm sure has been said, and really struggling to find the right sleeping position so I can keep my toes pointing up, not cross my legs, etc. - I can only lay flat on my back, which is not so comfortable. My heel is very sore on left foot, so last night we tried putting a soft pillow under my feet to elevate just a bit and another cushion under my knees for support there, and that felt better, but I still notice I wake up in the middle of the night and my lower legs start to almost seize up. It doesn't always last at the super high pain level, it comes and goes but it is very painful when it happens. I have been really regimented setting alarms to take my oxycodone, and try to remember to do ankle pumps even in bed, so not sure what else I should be doing. More walking, or getting up in the night to move around?

I just laid down for a nap on the hospital bed that we rented to have downstairs. At first I didn't elevate my legs - just laid on my back with ice packs on the side of my hips, but after 15 or 20 minutes I noticed my heel hurting, so we put a pillow put under lower legs. I slept soundly for an hour, but when I woke up I immediately got hit with that wall of pain in my knees/lower legs. My mom came to help me out of bed, and I walked around a bit and then sat down in my armchair. Felt better for a bit but I can not relax. As I type this I'm super tense in my shoulders etc., so probably using computer is not the best thing (don't have a laptop tray as someone advised- so have it on a pillow on my lap). I have been sitting now for an hour, so got up and walked around for a few minutes, then sat down again. My husband asks what should we do - more ice? elevate? use the cold compressor machine? Nothing sounds appealing. This site says rest, ice, elevate, so trying to do that as much as possible, but can't figure out how to feel comfortable. It's almost like restless leg syndrome on steroids!

Is this just par for the course at 6 days out after bilateral THR? If anyone has advice/ideas I would be very grateful.

Thanks!

 

[Krista]

Oh my gosh, Cookster, you are doing really well for 6 days out with bilateral! The forum advisers will be around soon with lots of links and information about post-surgery for you to read. In the meantime, here is the Library Index for you to look up what is concerning you the most. The first couple of weeks are the worst, and it is key to be correctly medicated so that you can stay ahead of the pain. Also key are, as you noted from this site, rest, icing and elevation. Your 791 steps seems like a lot to me. Can you rest more? And that's a lot of stairs for bilateral, I couldn't have done it, and was glad I was all on one floor. Here they recommend as much icing as you can do, you can't overdo it, and plenty of time in elevation.

It was weeks before I was ever comfortable in any position for more than a few minutes, although having enough pain medication helps with this enormously. I hope one of the Forum Advisers can help determine if you are getting enough, as it sounds like you are having lots of pain. A wall of pain is not good. Hang in there until more help comes!

 

[Josephine]

You must expect everything to be really sensitive and easy to make painful for the first couple of weeks. This is, after all, very major surgery and you've had TWO of them to boot! I think much of your problem is that you've been doing a bit too much and probably aren't taking enough pain meds.

So ... in order to get a good handle on things, I'd like to ask you some questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine)
Do remember to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how often and for how long are you icing your hips?

4. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

5. what kind of PT exercises and exercises at home are you doing? How much and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

6. What is your exercise routine?
Exercises done at home: (enter number) of sessions each day
enter exercise + enter number of reps and sets etc., etc.

 

[Josephine]

oops! nearly forgot these!

Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Activity progression for THRs
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

 

[Hip Hip Hooray!]

Hi @cookster65, Congratulations on your bilateral surgery. I had both of my hips done at the same time, too. It noticed a shift after the first two weeks. Those stairs sound like way too much to me. I didn't do any stairs. (I'm fortunate that I live in a flat cottage.)

The Percoset really helped me with pain. I know some people don't respond well to it, but for me, it was like a miracle drug. I also took Tramadol, (which I didn't notice having an effect, but I still took it.)

My knee and ankle were sore after this surgery. I had injured both of them as a young dancer. I iced them as well. I think this surgery can wake up cellular memories in old injuries. It's a traumatic experience, so the body is sensitive. Many people on this forum have knee pain after this surgery.

I did the basic PT exercises, but I reduced the number. I'm the type that would do way too much, so I just did ten reps, then 15. I worked up to 30, (total, per day,) and didn't increase it. The walker really helped me, as did laying on the couch, icing, and resting.

This recovery takes a lot of time and patience. I would make sure you are getting effective pain medication. I missed one dose of Percoset in the beginning, and boy did I regret it! Staying ahead of the pain worked for me.

I think you will continue to get better. Sleeping will become easier in time. Most of us had trouble sleeping after this surgery. It's a long journey, but worth it. Please take it easy, and take care of yourself.

 

[Cynthia777]

Thought I'd throw my two cents in....My surgeon who studied under Dr. Matta (one of the top US surgeons) did not recommend PT for me (he even owns a PT facility). I asked him if I needed PT and he said I didn't because I was doing so well, so I should just walk. Here is an article (2015 study) that more or less supports what @Josephine said....

http://www.aahks.org/aahks-news/wel.../aahks-2015-hip-surgery-and-physical-therapy/

 

[cookster65]

Oh just checked back - wow - thanks @Krista, @Mikessp, and @Hip Hip Hooray! This is all helpful. Maybe I should try icing my lower legs - although I have to say my ankles are less swollen today! I have had issues with my knees before but not from injury - they have been better lately and was told to get hips taken care of as that would likely clear up the knee problems.

Before I answer you @Josephine, here is more context on where I'm at today:

The visiting nurse who came this morning said that because my life before surgery was pretty active, I am probably not moving around enough, as the house I am in is old and I can't get up any speed, where at the hospital I was able to do some turns around the hall and loosen up a bit. So I went to the hospital this afternoon, where I could find long stretches of carpeted hallways and I walked with my walker - total distance .5 mile - sitting down a few times in between to rest. It felt great - my knees hurt a bit but not terrible - like a 3/4. They just feel like they are being pulled at - I think because my upper legs are so tight.

So with that in mind - here are my responses to your questions @Josephine:
1. I've been laying in the hospital bed propped up with ice since I got home. Overall at this very moment I'd say only a 2ish pain level - but I'm totally stationary. I did get up for a minute a while back to get something, and notice when I first get vertical after laying here, an intense pain seems to wash down my knees and lower legs - like a level 7/8, but then I walk around and it subsides and gets to maybe a 4/5. Otherwise, it's generally an achy/throbby pain in my lower legs, stiff and occasionally sharp in my knees, and soreness/stiffness in my upper legs. FWIS I do have to say this is the best I've felt laying down (and awake) in a while.

2. 5 mg oxycodone every 3 hours
1000 mg tylenol every 6 hours
also celebrex - 2X per day

3. I ice probably 4-5 times per day for maybe an hour at a time, maybe longer, and I "sleep" with ice bags at night. I also have this machine that does compression with cold water, but it is cumbersome to get it all set up and strapped on, and I can only do one leg at a time, and I have to sit or lie to do it, so when I get up I am all stiff. So I did 30 minutes on each leg yesterday, twice. Today - I wasn't too excited to do it again, and no one has been around lately to move it and get it set up and strapped on me etc. Maybe will try again later.

4. I am lucky that I am staying with family who are amazing, so have people around doing all my cooking cleaning etc. - so I have none of that to worry about. My husband is staying here with me for a couple more weeks, and my mom comes over too, so I am very spoiled in not having to worry about any of that!

As for activity, I was only mostly sitting and then walking around this house the two days (before today). My dr said wait a few days after going home to go outside. The house I am staying in is older with lots of small rooms and different floors in each, so I just do a couple/few times around as it is kind of jolty with the walker - tried/trying to do this once an hour, except when napping etc. I'm only a little active in the morning upstairs - gathering stuff to take downstairs for the day, organizing, washing face, teeth etc. It's mostly a lot of turning (trying not to twist, crossing legs etc!) and moving back and forth and trying to maneuver around with the walker. and all the stuff all over. I have also been trying to follow advice to rest, but as I said, it seems whenever I sit (or lay down) for too long I get super stiff. It feels better if I don't let myself stay in one place/position for too long (ie 30-45 minutes).

5. My Dr told me only do 4 PT exercises, and then just walk. I have post-op appointment on July 6th, Dr said after that if all is well, I will start going to outpatient PT, 2-3X per week.

PT exercises - they suggested 2-3 sets per day:
1. Bend knee up down/sliding foot back and forth on plastic bag 10-15 X
2. Push back of knee down into bed and hold 5 seconds.
3. Glute squeezes - hold 5 seconds - 10-15 X
Also:
4. Ankle pumps - 10-15 times - as much as possible

I have found that the first two exercises hurt my knees a lot, so I will just do the glute squeezes and ankle pumps going forward. And now I am going to plan to have someone take me to the hospital (it's really close by), or to an outdoor track (with smooth surface), so I can walk more over the coming days.

Haven't had much routine so far! The last 2 days I did all 4 exercises 2 times per day and walked the circle around the house from one room to next, maybe 12-15 times?? I know I did close to 800 steps but never went outside. Today I just did 15 glute squeezes - 2sets so far, 15 ankle pumps - probably at least 10 sets so far, maybe more. I walked around the circle in the house maybe 6-8 times, also back and forth in the small space I have upstairs. I had .4 miles on my fitbit when I went for my walk, then did another .5 mile walk at hospital.

Thanks again - sorry such long answers ! Hopefully you will have some thoughts!

 

[cookster65]

Oops - "FWIS" - was supposed to be FWIW = "For what it's worth"

 

[Cynthia777]

Oops, sorry @cookster65, I didn't mean to hijack your thread (I'm getting old)! How fortunate that you have great support at home!

 

[Josephine]

when I woke up I immediately got hit with that wall of pain in my knees/lower legs. My mom came to help me out of bed, and I walked around a bit and then sat down in my armchair. Felt better for a bit but I can not relax. My husband asks what should we do - more ice? elevate? use the cold compressor machine? Nothing sounds appealing.

I've just posted this here as an aide memoir about your problem!

The visiting nurse who came this morning said that because my life before surgery was pretty active, I am probably not moving around enough, as the house I am in is old and I can't get up any speed, where at the hospital I was able to do some turns around the hall and loosen up a bit. So I went to the hospital this afternoon, where I could find long stretches of carpeted hallways and I walked with my walker - total distance .5 mile - sitting down a few times in between to rest. It felt great - my knees hurt a bit but not terrible - like a 3/4. They just feel like they are being pulled at - I think because my upper legs are so tight.

I actually don't agree with that nurse.You are only one week out and shouldn't be doing half that much activity.

only a 2ish pain level. Overall at this very moment I'd say only a 2ish pain level - but I'm totally stationary. I did get up for a minute a while back to get something, and notice when I first get vertical after laying here, an intense pain seems to wash down my knees and lower legs - like a level 7/8, but then I walk around and it subsides and gets to maybe a 4/5.

That 'wash' of pain is due doing too much walking!

2. 5 mg oxycodone every 3 hours
1000 mg tylenol every 6 hours
also celebrex - 2X per day

Good, okay

3. I ice probably 4-5 times per day for maybe an hour at a time, maybe longer

4. I am lucky that I am staying with family who are amazing, so have people around doing all my cooking cleaning etc. - so I have none of that to worry about.

Jolly good!

5. My Dr told me only do 4 PT exercises, and then just walk. I have post-op appointment on July 6th, Dr said after that if all is well, I will start going to outpatient PT, 2-3X per week.

By 'just walk' he didn't mean going on a hike as you have been doing! You should read this Activity progression for THRs

My comments in bold
PT exercises - they suggested 2-3 sets per day - I suggest once - read this Evidence shows that less really is more when it comes to exercising!.
1. Bend knee up down/sliding foot back and forth on plastic bag 10-15 X - that's heel slides which are totally inappropriate and unnecessary for a hip -better for knees!
2. Push back of knee down into bed and hold 5 seconds - these are also are a knee exercise
3. Glute squeezes - hold 5 seconds - 10-15 X -and yet another exercise that is unnecessary
4. Ankle pumps - 10-15 times - as much as possible - this one is just an anti-clot exercises and since you are already quite active, you can stop doing them!

I have found that the first two exercises hurt my knees a lot

I have no doubt they do but they aren't appropriate for hips so just don't do them!

And now I am going to plan to have someone take me to the hospital (it's really close by), or to an outdoor track (with smooth surface), so I can walk more over the coming days.

I strongly recommend you don't do that. It's what is responsible for your 'wash' of pain!

Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots as you have done. All they need is the best therapy which is walking and even then not to excess.

 

[Hip Hip Hooray!]

Oh my God @cookster65, no wonder you are hurting. I can't believe you are doing all that exercise, plus the stairs. Yikes. Especially after bilateral surgery. Most people here do much better if they back off of the PT or excessive exercise. There's plenty of time. I am still shocked at what you wrote.

p.s. Why are you doing ten sets, when they said to do two to three sets? I did the low amount of the basic exercises. For me that was 30 reps maximum, and I worked up to it very gradually. Please be careful. Your body has just been through a major trauma.

 

[cookster65]

Hi all - thanks for this advice! @Cynthia777 - no worries! All info is helpful!

@JosephineA - thanks so much for the info about the PT exercises. Very happy to stop all that stuff.

@hip hip hooray - they told me to do ankle pumps as often as I can as much as I can when I'm sitting, so I am just automatically doing sets of those whenever I think of it.

I feel confused because everyone tells me to walk right now. For the first two days I only walked around this tiny house - which is like doing an obstacle course - so now that I feel ok to go in the car I feel like I can just go walk around the hospital. The ½ mile didn't bother me and I slept better last night, so we will go over there again this afternoon. I can actually walk and not be craning my neck to watch the floor over there, and take normal strides, so it feels really good.

I'll just listen to my body and sit down when I need to. As for steps, I use handrail and cane and just go slow, it isn't bad and I don't really get tired from it - but keep in mind I live up 54 steps in real life, so I was doing that at least twice a day if not more before surgery with no problem. I will still only go up and down once a day for now though.

Thanks again everyone for all this advice. I really really appreciate it! Will try to take more time next week to participate in this forum now and hopefully can give back to others as you guys have for me!

 

[Cynthia777]

That's the way to do it (let your body tell you how much)! I've followed that mantra and it has worked out so well with both of my THR's.

 

[Josephine]

@JosephineA

LOL my name is not JosephineA! The A is my badge of office, so to speak, as I am an Admin! If you take note, you will see people like skigirl or Jaycey have an M for moderator and Celle and Pumpkln have an FA for forum advisor!

they told me to do ankle pumps as often as I can

Yes, you do need to do that for the first few days but you are a week out now and active so it's no longer necessary.

I feel confused because everyone tells me to walk right now. I feel like I can just go walk around the hospital. The ½ mile didn't bother me and I slept better last night, so we will go over there again this afternoon.

Then I suggest you walk no more than 20 minutes tops. Remember I said that this was why you were getting those 'washes' of pain. That's pretty typical of overworked muscles so soon after major surgery.

 

[cookster65]

Ha oh sorry Josephine (not JosephineA!) Now I get it ! That makes sense what you are saying about limiting to 20 minutes I will try that as a guideline, and stop the obsessive ankle pumping!! Thanks again!


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[Josephine]

Jolly good!

 

[Hip Hip Hooray!]

I misread what you wrote. I thought you were doing 10 sets of all the exercises...that's why I was so shocked. My mistake; I'm sorry.