THR Shibbard’s recovery thread

[shibbard]

RTHR (anterior) on Tuesday 4/23, surgeon said it went “perfectly”. A little excitement in recovery as I suffered an extreme drop in BP, it took about 4 hours there and a trip to ICU to get it stabilized. My poor husband was in the surgical waiting room for 6 hours with not much info, thanks to propofol I guess I don’t remember much of it. Anyway, i got stable and transferred to the regular Ortho floor by 8 pm, even got out of bed and did first PT that evening. MorePT and OT yesterday morning, discharged by 10 am and home by noon. Kind of a whirlwind adventure!

I’m on a walker for 2 weeks per doctors orders. My hip feels perfect, some bruised feeling in quadriceps, and a distinct sharp burning pain about 1” lateral and parallel to my incision when I walk or completely straighten that hip joint, or doing my butt-clench exercises. The dressing over the incision and visible skin looks fine. Internal stitches pulling? I slept great last night at home in my own bed, napping a lot today. Icing and exercising between naps.

 

[Layla]

Wow, that was an interesting start! A trip to the ICU! Thankfully things turned around and you were out of bed moving within hours. It's wonderful you slept well in your own bed your first night home.

I will leave our Recovery Guidelines with best wishes as you begin healing. Stop back often and share updates so we're able to follow your progress.

HIP RECOVERY GUIDELINES
As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for THRs
The recovery articles
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
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?

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

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.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[myglasshalffull]

Congrats, just take it easy first couple weeks, don't overdo. My prescription (I'm not a doctor), is rest, ice, elevate. Get up & take a spin around the house, maybe fix a coffee or a snack, sit & chill then back to bed & nap.
I was able to cook at home after first week. However I needed a lot of sleep so I slept when I could & ice was my very best friend.
Best wishes.

 

[benne68]

Welcome to the Recovery side, @shibbard.

Sounds like you had quite a journey to get here. So please take things S L O W L Y! Give your body the chance to recover from the trauma of surgery (and your ER visit!).

We are here to help.

 

[Freyagirl]

a distinct sharp burning pain about 1” lateral and parallel to my incision when I walk or completely straighten that hip joint, or doing my butt-clench exercises. The dressing over the incision and visible skin looks fine. Internal stitches pulling?

Probably swelling that is pressing on incision and making the skin tight and sore. I found it lasts for a week or so and gets better with lots of icing and elevation.

 

[shibbard]

**Update**

Day 10, this is just about the first day I’ve felt like I may actually return to normal!

I had almost no swelling at all, nor really even that much pain. But I was so very tired for the first 7-8 days. I would get up around 6 am (normally rise at 5), take my meds, do exercises laying on the couch, walk one circuit around the house then take a morning nap. Get up, not hungry for lunch, take meds, exercise, walk once around house, take afternoon nap. Get up, make myself eat a bit of supper, watch some Jeopardy, exercises, walk, go upstairs to bed by 7 pm almost shaking with fatigue. I was also icing in this schedule as much as possible.

Yesterday I skipped the morning nap, but was still very tired in the afternoon and evening. Today I left the house for the first time, DH took me to see my horse and visit a bit with barn friends this morning. I walked on my own! I’ve been using the walker a lot around the house just due to fatigue but today I felt very stable without it! Took just a short nap this afternoon even after my big adventure.

My primary pain has been a burning, pulling sensation parallel to and lateral to my (anterior) incision. Really quite painful when my leg was straightened when walking, (or during butt clenching exercises) but nowhere near the joint or even the incision. Also burning tenderness to touch along the outside of my thigh. I messaged the surgeons office about it and was told “Normal, should resolve eventually but can’t say how quickly… don’t do the butt-clenching exercises” isn’t that the punch line to a joke? “Doc, it hurts when I do this?” Doc - “So don’t do this.” This continues and I can’t really say if it’s getting better or if I’m just getting acclimated to it.

Otherwise some random various come-and-go aches around the joint like tendons and ligaments complaining. Usually later in the day after my pathetic attempts at activity. A couple of instances of knee and outer calf pain but nothing really bad and so far always gone by the next morning. Occasionally I’ve felt just a little instability in the joint itself but today it feels really strong and tight. Yay!

I used tramadol evening and morning for about 4 days. I think some of my fatigue could have been caused or Exacerbated by that. Came off for a few days and had a few nights of bad sleep so went back on evening only for one day. Last two days acetaminophen only, no tramadol. Dr. prescribed OxyContin if needed after Tramadol but I never used it. Some mild stomach upset from all the meds, plus constipation on and off but that’s gradually resolving.

Waterproof dressing comes off on Monday. I have some tenderness over the incision area but what I can see looks good. I’m ready to get it off.

I think I see a light at the end of this tunnel. Hopefully this will help reassure others going through some of the same symptoms. It gets better! And, of course, I have no hip pain! With all the recovery stuff it’s easy to forget that part!!

My return visit isn’t until May 24, 4 weeks po. Unless I have concerns prior.

 

[Freyagirl]

Sounds very similar to my recovery. I think actually all the tiredness and napping ensured rest and recovery. I found that there was a vast improvement at the two week mark with both hips as swelling went down and energy increased. Hope it continues to improve for you.

 

[djklaugh]

@shibbard It sounds to me like you are doing quite well over all! The fatigue is normal - it takes a lot of energy to heal from this surgery (from any surgery actually). I remember having "nap attacks" for months after my hip replacements.

The odd twinges and strange sensations are also normal. Consider how long it took for your hip to get so bad it needed to be replaced. During that time all your muscles and tendons in that leg .... AND in the other leg, your back, and possibly other areas of your body .... were getting out of shape and not functioning as they should. So now every thing needs to be retrained and reconditioned. Even the odd numb sensations are normal and usually are temporary.

Brava to you and may your healing progress steadily

 

[shibbard]

**Update**

Day 22, so about 3 weeks in...

Between day 10 and today I've had some ups and downs. Fatigue has come and gone, there have been a couple of days when I didn't need a nap but not many. When I don't get one I'm bone tired by bedtime.

About a week ago, everything felt great and I started walking more. Not a lot because of the fatigue factor. But in spite of the fatigue I've been feeling stir-crazy and have felt that some of the lethargy is due to lack of activity. So for a few days I was doing about 3000 steps a day, that's not much, but much more than I had been doing. Last Sunday, I came in from my walk with some soreness in the area of the joint, as well as down my quadriceps and around my knee. I iced and elevated, but it seems like I've regressed because since then I've never since been at the same level of no-pain that I was last week. I am walking with a limp from the pain (mostly right around the joint) during the weight-bearing phase of my stride. Not using any aids but I'm considering a cane if I can lay my hands on one. Just thinking it might help me move more but irritate my hip less. I did notice some slight swelling just lateral to the incision ( I had almost zero post-surgery swelling). I think I have been guilty of icing less than I should have when things started going so well. Increased icing has reduced that swelling.

I contacted my surgeon's office Monday and after a bit of question and answer I was assured that this was normal pain, but to back off of activity for a few days to try to dial down the pain level as well as increase icing. I'm better today, after basically doing nothing Monday and yesterday and icing more diligently. I'm just disappointed because this just hanging around the house doing nothing is not for me. I know we all heal at our own pace but I still held out hope that I would be one of the outliers that came back to normal function in no time! Oh well. I'm getting better just not as quickly as I had hoped.

The dressing has been off for a week and the incision looks good. It was glued except there's a two sutures, one at the top and one at the bottom. Kinda itchy but I guess I'll leave them in until my recheck a week from this Friday.

Nerve damage - The burning/pulling pain in my thigh, meralgia paresthetica, has been resolving gradually. I still have burning along the outside of my upper thigh, but only when touched. Fortunately clothing doesn't really irritate it, and it doesn't bother me sleeping. The internal pulling/burning is getting better daily. It was terribly painful and bothersome when walking for the first 2 weeks or more. Every step was near-agony. Now I feel it on first couple of steps after sitting but it resolves with activity and is overall less and less. So if you're reading this later and suffering from this, it has gotten better for me and I believe it will continue to do so. There's hope.

I'm doing my PT exercises diligently too. I've added a couple that I gleaned carefully from the internet. Supine, straight-leg leg lift - almost impossible to raise my leg more than 5-6 inches! I do like 3 reps of that one. Standing abductions (to go with the supine I was prescribed), and what I call 'chair-squats', basically sitting down and raising myself from a sturdy chair, without resting on the seat unless I need to. So sad that this is my level of ability! Other than the leg lifts my ROM is good and strength is gradually returning. I'm being careful of rotating outward because my surgeon cautioned me I'm at higher risk for dislocation than normal based on my physiology. I wish I knew more I could do, and will be asking my OS when I see him next Thursday. I may even ask if I can get a PT prescription. I want to get back to riding and competing my horse as soon as possible and this inactivity is killing my fitness. At my age (66) rebuilding that is no small task.

I will continue to report in, because reading back through old posts has given me a lot of information about various recovery situations many members have gone through and I've been able to apply that to my own situation.

 

[benne68]

I'm sorry you landed on the ODIC (overdid it club) bench, @shibbard. But that's your body reminding you that you are still very early days in this year long recovery.

At 3 weeks post-op your hip still has not healed from the trauma of surgery and overdoing it is only going to slow your progress.

You might find this chart helpful in understanding why you need to give your body more time to heal:

 

[shibbard]

I understand that I must have overdone it. However I believe I was already following the weekly guidelines for postop activity at 2-3 weeks published here (walking <10 minutes) so it isn’t surprising that I’m a littler disappointed to be in more pain now. It’s not like I went out and ran a mile or something. I read a lot of responses here from people at week three that are pain-free so I admit I’m not happy that I really can’t say that.
I get that I just need to back off activities for a while and I’m doing so. I’d already made that change before posting so no need to chastise me! It is just disheartening to regress.
I have made progress in some regards (nerve damage healing) and I included that as encouragement to other members feeling the same issue.
I posted so that a) new people coming here (like I started a few weeks ago) could read an account of how things are going for me to help them understand what their experience might be like and b) I guess maybe hoping someone would chime in saying they had a similar experience and it all turned out OK.
I see my dr a week from tomorrow and hopefully I’m either better by then or he’ll have some advice of what to do differently. Right now I’m just sitting on my butt. Icing and elevating.

 

[myglasshalffull]

I don't think you were being "chastised." And if you are reading our experiences you will see many of us were where you are right now. And those charts are just examples of where you should be, not written in stone.
First of all if you are limping you need an assistive device, a cane, a walker, crutches. It's better to use device than limp.
I was on a walker for way longer than I wanted to be but at my first post op appt I still had a fracture revealed by the X-Rays & told 4 weeks of light weight bearing or more surgery. So you know I barely moved!
Try to relax, trust me, I didn't want to believe how long it was going to take me to feel better. But I finally had to resolve to be patient. I'm a go-go kind of person but unfortunately hip fracture made me slow down.
You will recover, don't worry about that, might take a little longer than you hoped for.

 

[luvcats]

I'm sorry you had such a set back. It's soooo frustrating. Our brains like progress to be linear, and it refuses to conform! I think sometimes those charts and guidelines make things worse, because there really isn't a 'normal'.

I wonder if the PT you've been doing might not be more of an issue for you than the walking? My surgeon tells me that often they don't even prescribe PT for hips, walking, chairs, cars, all that is PT enough for a while.

I hear you about just sitting around. I've been disabled by the hip for a while, and my knees several years before that, but even then I have hobbies and sedentary creative projects stacked high that I'd like to be working on, but my brain just isn't ready. I wish I was a TV watcher...

 

[benne68]

It is just disheartening to regress.

You didn't really regress. This is a roller-coaster recovery with a lot of ups and downs -- especially during the first few months.

I'm sorry if you felt my post was intended to chastise you -- it was not. I've been through what you are experiencing now and just wanted to share some of what I learned here.

Anyone who claims to be "pain free" at less than a month post-op is probably not being honest. Perhaps they have some pain-free moments, but the truth is that we all struggled with this two steps-forward-one step-backward dance in recovery.

 

[Eman85]

Yes, I did that and I not only did it once but over and over with my first THR. In the end it all turned out OK but every time I had a setback it just restarted the recovery clock or turned it backwards quite a way. I'd also say that in the end the hip I babied turned out to be a better recovery experience. When I got to my second hip I wasn't looking for new and exciting exercises or any fast track. I learned from my first and I took it real easy and just walked. I learned not to walk for distance or speed, never counted steps or measured distance. I walked slowly with purpose.
Just to really put a damper on things, 3 weeks is early in, I had my biggest set back with my first at 3 mos.

 

[Layla]

Aww, I am sorry you took benne's post as chastisement. Knowing her as a colleague, that certainly was not her intention. I believe she was only watching out for you. It is very easy to overdo it early on and while I also followed the Activity Progression for THR, it is only a rough gauge. Some excel and some lag behind, both are okay. Try not to compare your recovery to that of other's. Difficult I understand, we all seem to do it.

You are so early into the healing process in the entire s scheme of things. Twenty-three days in is nothing when you consider having the implant in place for life. There will be ups and downs, but you will get there. I hope you're encouraged by your visit with the OS next week. We appreciate you sharing your journey here and wish you only the best!
Have a nice weekend, shibbard!
@shibbard

 

[Valentine]

@shibbard - it is so very frustrating to have to be still for so long. I had some of the same feelings you describe- wondering if part of the problem was that I was taking it tooo easy. It’s a puzzle trying to figure it out each day. When I had discomfort, I started reminding myself that it was healing that I was feeling take place (and sometimes I rolled my eyes when I said it haha).

I have a question- you said your dr told you that you are at a greater risk for dislocation due to your physiology. May I ask more specifically that physiology is?

I actually had a dislocation (I am about 12 weeks post op and 6 weeks post dislocation)… and I did turn my foot outward slightly while lifting my lower leg (laying on couch) when it happened. Everything is textbook in the imaging, so I am a bit worried it could be something with the way my body moves- or it could be a fluke and I need more time for the hip capsule to heal and harden. My dr said he could take me to the OR and move me through range of motion (controlled) under xray to see if there is anything that didn’t show in still imaging. I am still deciding if I want to do that. I see him next week and have more questions for him about it.

I am feeling a lot better though and what I noticed happen in my recovery was what felt like a long time down, then some random improvements and small setbacks- then huge strides out of nowhere. Recovery should definitely be more linear!!

 

[shibbard]

I'm sorry if you felt my post was intended to chastise you -- it was not. I've been through what you are experiencing now and just wanted to share some of what I learned here.

Fair enough, I guess I was being too sensitive about it. I'm definitely cutting back on activity as directed by my dr's office and recommended by all here. Sorry!

I wonder if the PT you've been doing might not be more of an issue for you than the walking? My surgeon tells me that often they don't even prescribe PT for hips, walking, chairs, cars, all that is PT enough for a while.

Maybe so! I skipped it yesterday and will do again today. Still having some hip pain in the weight-bearing phase of my stride. New cane should show up from Amazon so at least I can get around the house as needed.

When I got to my second hip I wasn't looking for new and exciting exercises or any fast track. I learned from my first and I took it real easy and just walked. I learned not to walk for distance or speed, never counted steps or measured distance. I walked slowly with purpose.

OK yes, that's what I am trying to do - but I'm back to where I feel like I can only walk around the house as needed. I just feeling so limited to not be able to go out to the barn and visit horses, walk around even the yard in the beautiful spring weather. Can't a gal feel a little sorry for herself? Apparently I am just not a very patient patient. I do appreciate your sharing your experience and will try to revise my inner dialogue to accept things as they are.

I have a question- you said your dr told you that you are at a greater risk for dislocation due to your physiology. May I ask more specifically that physiology is?

@Valentine , sure, no problem. I have levoscoliosus, which is curvature to the left of the lower part of my spine. Dr. says this makes my lumbar and sacroiliac areas much stiffer than normal, so my pelvis doesn't tilt as freely as it should. Therefore when the hip is flexed, it's more likely to pop out than a normal person. To be honest I never really noticed this about myself, I've always been pretty flexible - but he showed me in an xray they took before surgery specifically because they knew about the scoliosis. He seemed more concerned about it before surgery than after, and it was a primary reason he went for an anterior approach rather than posterior (he does both.) His plan before surgery was to implant the largest cup and ball possible, and if that didn't work out as planned he had a dual-motion implant available, but Plan A worked out so he was very pleased with that afterwards. I asked him 'how much more likely, like 10% more likely, 10 times more likely, 100 times more likely?' knowing there wasn't a precise answer but wanting some idea, he chose the 10x more likely option.

I ride and compete horses and Dr. wants me to wait 5 months before even getting back on, in order to allow all the ligaments, tendons and the joint capsule to heal up and really tighten around the joint. It was the combination of my back issues and my commitment to an active sport that worried him, but he's committed to bringing patients back to their prior level of activity as much as possible. At my age the clock is ticking on this sport anyway, hence my impatience.

Early days after surgery it all felt really loose and wobbly but lately that feeling has dissipated; things feel very tight and secure around the joint. so that's very positive. I have a lot to be positive about and thanks all for reminding me of that.

 

[Valentine]

Thank you very much for sharing that. My daughter rides and competes (or did before work had her move across the country) so I know that has to be hard for you to be patient. Your horse is beautiful! That takes some leg strength to do!

My husband is familiar with all things ortho and he wanted me to have a large ball/cup also and was pleased with what my surgeon chose and what my anatomy would accommodate.

Hope today is one of the days you get a big dose of improvement!