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Long Term Restrictions and Limitations

Discussion in 'Hip Replacement Recovery Area' started by YoungM, Jan 12, 2009.

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  1. YoungM

    YoungM Graduate

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    Hi,

    Can you clarify the long term restrictions and limitations?

    With THR, is there a 90 degree restriction for the rest of your life?

    This is a silly question, but are you able to wear high heels eventually? I currently wear flats all the time and would love to where heels again.

    ~M
  2. mvo

    mvo Member

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    Hi there,

    I have seen a couple of web sites where that 90 degree restriction is recommended for life, but I think that is very conservative – most have that restriction for just 6 weeks, some say 3 months.

    High heels are on the “after 3 months list” on the documentation I had. I only have high heels on one pair of winter boots and as it is summer here I haven’t tried them out! I am quite tall anyway and a bit of a klutz so usually stick to flats.

    If in doubt, ask your surgeon. My surgeon’s only lifetime restriction was “no running.” My sister’s surgeon had no running, no yoga and no trampolineing (spelling?) on his lifetime restriction list.

    Hope that helps,
    Monica
  3. Annette

    Annette Member

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    I was also wondering about wearing high heels again.
    I see my OS on January 27. I had a RTHR 3/26/07 and a LTHR on 1/28/08.
    I plan to ask him about lifetime restrictions and would be interested in what other members have been told by their physicians or PT's.

    Annette
  4. PRGal

    PRGal Graduate

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    My OS blessed anything & everything at my 5 week post visit, including heels and any exercise I wanted. However, I had a direct anterior THR so I had no restrictions at all anyway.

    Wearing high heels is really more about balance (and grace :) than dislocation danger. If you were comfortable wearing them before, you probably will be again. I'd still probably stay away from tottering around in 4-inch Manolo Blahniks though! (I'm 11 weeks post-op and have worn 2-in heels for the last month, with 3-inch on occasion.)

    "Lifetime" restrictions seem to be as varied as the individual surgeons (as in the above yoga restriction versus horseback riding that a few other posters on this forum plan to return to--I mean gee, what a spread!) Most seem to encourage staying away from pounding, high-impact activities (like running). I'm sure Jo will provide the expert opinion, but I think that's more about potentially reducing the wear & tear on the prosthesis rather than dislocation risk. Personally, I'm fine with giving up marathons, etc., since I never did 'em anyway--but if I were young, active & really passionate about something, I'd just do what I loved. After all, as so many here say--this surgery gives you your life back, so might as well live it!
  5. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    The objective of any kind of joint replacement is to restore the patient to a full and active life . Of course, common sense would tell you to restrain yourself from extreme sports and if you were an adrenaline junky, tough on you!

    But the common or garden, ordinary things of life you really should be able to do. Most surgeons who apply restrictions like no high heels and such have probably had a patient (or two) who came to grief that way but come on! Everyone has the potential for accidents, joint replacements or not!

    The common sense things I would advise against are things like jumping down the last 3-4 stairs in a fit of joi de vivé and jogging and/or marathon running!

    However (she slips on her anecdotal hat!) McKee had a patient who loved to jump down the last few steps at home, just to show off to visitors and friends! Never knew what the long term results of that was but McKee used to go pale every time the subject was brought up! And another patient who was an artisan roofer and one of his contracts was to look after the tiling on the Norwich Cathedral spire which is 315ft high! He returned to work after having his hip done (1965) and continued to work until his retirement some 10 years later.

    So I'd say wear high heels by all means but not the 6" ones (with or without platforms)!
    Moderation in all things.

    [​IMG]
  6. YoungM

    YoungM Graduate

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    Thanks all! I'm not sure how I will feel about heels at all -I wear them so infrequently now (being that my limp is apparent even in flats). I will be sure not to a small heel if and when I can. Nice picture, Josephine!
  7. pampalm

    pampalm New Member

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    I've been wondering about lifetime restrictions myself.

    I'm currently 10weeks Post - Op (anterior THR on Right side). I was given the 90-deg bend restriction, no crossing the legs at the knee, though the ankle was acceptable, no pigeon toes - no running, no trampoline etc.

    QUESTION: I have a rebounder (mini-tramp) that I had been using for exercise before, my surgeon is not familiar with it so he automatically said 'no'....however, from what I'm reading....a mini-tramp isn't gymnastics either - it is low-impact etc. is this okay after 3 months?

    QUESTION: I was told NOT to bend over and touch the floor (tie shoes, pick things up etc) but to use the 'golfers bend' - I have found myself bending straight down all the time. I told my doctor and he told me not to do that but it is so unconsciously done....how dangerous is that?

    QUESTION: Had my right hip done - When getting into bed, I notice that I bend my knees and then lean my weight onto my right hip, like I'm going to lay onto my side. Sometimes I feel movement in my hip -- is there a different way I should do this? Is this bad?

    QUESTION: (similar to above question) - When kneeling on the floor, I notice I lean into my right hip to go all the way to the floor -- is this bad? (I would have a tendancy to do this movement when gardening, cleaning etc).


    QUESTION: When laying on my back, to help stretch my back, I might bend my knees, keeping my feet flat on the floor and then spread my legs at the knees, allowing my knees to try to touch the floor (or bed). (I don't make it that far because I don't want to strain my hip) Is this not a good movement either?

    I can't tell you how many times I've dreamt that my "hip popped out" of place and I'll wake up in fear and feel myself all over.

    Since my surgery, I've been almost afraid to do anything for fear that "it will pop out" and I'll fall to the ground. :)

    Like y'all have said, the purpose of a hip replacement is to give you your life back.....

    Thanks for any responses...
  8. Mudpro

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    Hip restrictions are in large part predicated on what type of hip you have. Ones with a small ball and a teflon like lined cup may move more easily than some others, but they seem to be more prone to dislocation than say the large ball metal on metal types.

    I've got a Birmingham hip resurfacing device and all restrictions were lifted at 6 weeks. Even then, my physical therapist is going slowly with "midline" type of movements. At week 7 my knee is well past 90 degrees and I am only an inch or so away from being able to put on my sock without the contraption given to me at the hospital.
  9. Laurie

    Laurie Senior

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    Hi, I agree with mudpro, my hip is metal on metal with large ball and was told there is not much chance of dislocation. However, I had restrictions but they were basically lifted at one month. I was still careful until I naturally felt ready to undertake all activities.

    At 5 months, can't believe how easy walking briskly, even over bumps, curbs, etc is. I am still not as limber as I would like on the right side. Am going to ask the Dr about this at my 6 month check.

    I totally understand your fear of popping something. I felt the same way in the first few months--not on my mind much now.

    Laurie
  10. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    First of all, Pam, dislocation is a risk not an inevitablity. Secondly, it's more down to the healing, strength and security of the muscles around your hip joint rather than the type of prosthesis (although if either of the prostheses are poorly placed, this could cause a dislocation but in which case it would be more likely to show up in the early weeks after surgery than this late stage.)

    Let me explain

    The first layer of stability is the capsule and the smaller ligaments as shown here. These have to be cut in the front -
    just a 'T' shaped cut, nothing too dramatic! - to get into the joint and do the business!

    [​IMG]


    Then there are the principle muscles that keep the femoral head located in the acetabulum (socket) as these ones. These suffer the most during the operation as, in the anterior approach, as they are not only cut but stretched as the hip is dislocated and they are retracted (pulled aside) to allow the surgeon access.


    [​IMG]


    But these are, of course, firmly sutured back in place at the end in 'layers' which is to say first the capsule, then the ilieo-femoral ligaments, then the bigger muscles, then the fibrous sheet over the big muscles called the tensor fascia lata, the fat and finally the skin! Very secure!

    The anaesthetic will also play a part as it causes all the muscles in your body to lose tone and tenstion. It's partly the drugs, partly the long period of immobility on the table and partly the trauma of the surgery that causes this. Not to mention the loss of tone and strength that occurred over the months or years of the increasing debility and any deformity that might have developed.

    Now, it takes all the layers a while, not only to repair and heal, but to recover tone, bulk and strength but eventually
    it will. PT plays a big factorf in this though mostly it's down to time, a good diet, rest and decent pain management.

    There are stages in the healing; first intention healing where the tissues beging to stick together, the beginnings of the second stage where tissues begin to grow across the incision and become more stable (much like those ants holding leaves together!)

    [​IMG]

    then the final stage when the new tissues begin to mature and strengthen. After this all the tissues start to regain their strength and tone and do what they were intended to do which is hold the hip joint together and stable.

    Now at 10 weeks, I would suggest that you are pretty much entering that last stage and, with some care and consideration for the nect couple of months, you could carry on doing what comes naturally. Even the most conservative surgeons lift their "no flexing beyond 90 degrees" restrictions at the 6 week mark.

    Hope this all helps!
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  11. UTdave

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    PamPalm,

    Your surgeon sounds very conservative. As Jo said above most of these restrictions are lifted at 6 wks and with anterior approach most of our local surgeons are not even going with the 90 degree limits. I was very careful - even now at 15 wks. When my surgeon told me to 'have at it' at 2 months I thought he was joking and tried, again, to clarify what I do for recreation (Downhill skiing, downhill mountain biking, rock climbing). He didn't blink and said go for it. Needless to say, I am still scared and only after 3 months passed did I hit the climbing gym (indoors = controlled), did my first wheelie on my bike last week and planned on my first off-road mountain bike ride this next week.

    Remember how the surgeon told you to call him when you were ready for surgery? I asked, of course, 'how will I know when I'm ready?' to which he said 'you'll know when the time is right'. Damn if he wasn't right. I suspect that principle is at play even now.

    The moral - look at the guidelines your surgeon gave, but listen to your body just as much.
  12. Jamie

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    Wonderful advice UT.....
  13. YoungM

    YoungM Graduate

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    Great post, Josephine. Thanks for that too.
  14. pampalm

    pampalm New Member

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    Josephine and all -

    Wonderful and much appreciated advice! (I was out of internet range for a bit so didn't get to revisit this until today).

    Thank you all so much - I have noticed (just like UTDave said), that by listening to my body, unconsciously I might add, I've already started doing things I thought I couldn't do!

    I am still careful but excited about all this - It's like a 'wow' moment! I've been working out with a personal trainer for the last 3 weeks as I've got goals to lose a lot of weight this year to 'lighten the load' on my hip and she had been wanting me to do certain stretches and such and I was so scared I told her no, but noticed in the last few days, that it's starting to gradually happen.

    Listening to your body (and surgeon) are good things.

    Thanks all.

    pam
  15. JudyS

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    I must add my 2 cents worth now that I am back with the living. My surgeon did have me on full restrictions for 3 months. I had the traditional posterior although my incision is only about 5 inches.
    My only llifetime restricition is no running. After my back heals if my back surgeon says it is ok to run a little, I may negotiate with my hiip surgeon for a few up hill mountaln slow miles per week.
    Now I know I am feeling better!!!

    Judy
  16. petey

    petey New Member

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    Hello. I am new to the forum and this looked like a good place to join in. I had a THR just over a year ago. The only problem I had was kicking myself for waiting so long to have it done. I recovered rapidly and with no major complications. At the one year visit with the surgeon I only had two questions. They were about dislocation and wear on the joint. His response was that no matter what I did I probably would not dislocate and I shouldn't have to start to worry about wear for about 20 years.

    Since then I have been doing almost anything I please. However, I have not been able to talk myself into complete disregard for the original restrictions. I try not to break multiples of the restrictions at any one time, but this is in most cases a good idea even if you don't have a new hip.

    The one thing I did after the THR was to lose about 50 pounds of weight. I was very heavy and the surgeon said the weight loss made a great deal of difference in his lifting of the restrictions.

    Petey
  17. JudyS

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    Welcome Petey

    Glad your replacement is doing so well. I love mine which I got on June 6th. I recently had back surgery and a new onset of seizures while in the hospital. I had the grand mal type and woke up pretty contorted. I was sitting in the lounge chair, the nurse had to help and get me out of it as my legs were a mess. But, even with that no dislocation!!!

    Welcome again
    Judy
  18. Jamie

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    Welcome to the forum, Petey! Congratulations on your weight loss!!! It sounds like you are doing well following surgery. You should continue to gain more confidence in your hip as time goes by. One day you'll just find yourself doing things and you won't even think about the hip at all!
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