THR Should I be Concerned

[rkoldschool@com]

Hello all my name is Rob. I'm 48yo Male. I'm 3 weeks post Total Hip Replacement (Anterior) on my right hip.

Phenomenal surgeon and experience. Left hospital following day on cane which I was able to drop after week 1. I still keep it around and/or take it with me for safety or after I've been sitting for a while just to warm up. I've also been icing non-stop.

Here's the crux of the issue, originally when walking my stride was extremely limited because I had a very sharp (felt like muscle tearing) or (someone stabbing me with a knife) in the center of my quad about 3-4 inches below my incision. As the days went on, that went away or loosened up and I only ever really felt it if I really opened up my stride or the same pain was activated during PT.

Last Wednesday my PT, as they always do, massaged my glute and quad area, primarily where the acute swelling still exists. That night I felt more of that pain that I hadn't felt since leaving the hospital.

At the following session last Friday I told my therapist about the increase in pain I'd experienced which she attributed to general healing, trauma from surgery, i.e. soft tissue agitation that the surgeon told me about as a result of surgery, using muscles correctly that I haven't been using correctly for a long time and general muscle soreness that comes along with PT.

Sounded perfectly reasonable to me. Continuing on with my session my PT did the same thing, i.e. worked me out, added a couple of minor flexion exercises btw like walking over cones frontwards and sideways, but also hopped on the bed and actively stretched my leg backward toward the rear increasing my range of mobility.

It hurt, and I did experience that same sharp pain I'm not going to lie but I was ok to walk out with my cane. Later Friday evening I could barely walk, meaning I could not stride leaving my right leg in the rear position, I had to walk surgery leg forward then bring good leg up to meet it due to the pain I experienced when stretching or striding.

I unfortunately had to resort to my pain medication since I hadn't taken since week one. Thankfully rest, ice and the meds helped significantly but I'm not quite sure I'm ready for my session tomorrow.

Here is my question. Is this normal, do I have anything to worry about? Could I or the PT possibly be doing damage and if so, what course of action should I take?

BTW, my surgeon's office is closed over the weekend which is why I'm posting here. Thank you so much for your time and help.

Rob

 

[TomT]

Im on my third week of recovery and am also experiencing success followed by set back so I'd say that what you're feeling is normal.

 

[Jaycey]

Welcome to BoneSmart!

also hopped on the bed and actively stretched my leg backward toward the rear increasing my range of mobility.

Please do not let PT do this! You say you had anterior approach. This stretch is very risky just out of surgery.

Does your surgeon approve of all this PT? It sound overly excessive and you are hurting due to it. It it were me I would stop all this and let your hip settle. Then just walk - that's all a new hip needs.

Here are your recovery guidelines:
Hip Recovery: The Guidelines
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
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 this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

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?

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.

 

[Pink Peony]

Hi Rob - welcome to the forum. I also had the anterior approach, and am just about at 6 weeks post-op.

I must say, during PT, they never "actively stretched my leg backward". In fact, the risk of dislocation for anterior is when you extend to far to the rear, and with a foot turn-out. If you can't reach your doctor's office, I personally would cancel your PT appointment, until you confirm with your doctor about this particular movement. Especially, since you experienced pain.

At three weeks, I believe I still occasionally was taking Tylenol, and if you are still experiencing pain, it may help. I balanced getting off of pain meds (especially oxy) as quickly as possible, with not getting behind the pain.

One take-away from this forum that I have learned is trying to let our bodies heal, as well as being our own advocates.

 

[Michael1000]

Good Morning...... This is all new to me also so I am not quite certain what to expect but I will add this: I did a lot of research and waited quite a while before I moved forward. I have learned that even in the past couple of years, the medical worlds understanding of the healing process has changed some. There are more and more Doctors (including my own) who do not recommend PT immediately following surgery and some who never recommend it. My understanding is that that is because there were too many incidences where the Therapist was pushing the patient too much and it was not effective. I am not sure if this answers your question at all. Just curious if the PT that you are using is someone that your Doctor recommended?

 

[Pink Peony]

Just curious if the PT that you are using is someone that your Doctor recommended?

Michael - I just had a "prescription" (?) for six weeks of PT from my Doctor, not a specific "person". His practice does have a PT practice, but I ended up choosing a practice associated with a local hospital (which is actually one that my doctor operates out of). I have been very happy with my PT person, in terms of progression of our sessions, recommendations on exercises, and my favorite part, when she massages the area of swelling. Living in a metro area, there are many PT choices, and I think I also read a few reviews on the PT practice that I chose.

 

[rkoldschool@com]

I am not sure if this answers your question at all. Just curious if the PT that you are using is someone that your Doctor recommended?

Hi Michael. Tks for your input. My Surgeon believes in an aggressive PT regimen and did recommend my PT practice. I am however pretty positive that there is no communication between PT and my Surgeon and the PT's follow their own courses of action. I'll have to be a better advocate for myself next time.

 

[rkoldschool@com]

Tks Tom, Much appreciated

 

[rkoldschool@com]

Welcome to BoneSmart!

also hopped on the bed and actively stretched my leg backward toward the rear increasing my range of mobility.

Please do not let PT do this! You say you had anterior approach. This stretch is very risky just out of surgery.

Thank you Jaycey. I think I was just going along with the, they must know best approach. I'll do what I am comfortable with and nothing more. Thanks again

Rob

 

[Eman85]

Every OS seems to have a different approach to PT and it seems there is little communication between the OS and the PT. My OS recommended I do all of my own PT at home from a handout sheet given at the pre-op hip class. My OS warned me if I did decide to go to outside PT they most likely would hurt me and he didn't recommend it. So far I've had 2 THR's and no PT and it seems to have worked out OK for me.

 

[rkoldschool@com]

Hi Rob - welcome to the forum. I also had the anterior approach, and am just about at 6 weeks post-op.

I must say, during PT, they never "actively stretched my leg backward". In fact, the risk of dislocation for anterior is when you extend to far to the rear, and with a foot turn-out. If you can't reach your doctor's office, I personally would cancel your PT appointment, until you confirm with your doctor about this particular movement. Especially, since you experienced pain.

At three weeks, I believe I still occasionally was taking Tylenol, and if you are still experiencing pain, it may help. I balanced getting off of pain meds (especially oxy) as quickly as possible, with not getting behind the pain.

One take-away from this forum that I have learned is trying to let our bodies heal, as well as being our own advocates.

Thank you so much I appreciate it. I am allergic to many of the pain meds and thankfully don't have an addictive train. I stopped taking the meds except 1 or 2 at night to help me sleep. My biggest concern honestly was, what was the pain I was feeling. Was it just what the PT said or was I actually ripping or really stressing something. The Doc did say he had to really stretch my tendon and Rectus Femoris so is it me stressing those as they try to heal. Who knows but hopefully I can get ahold of my Doc early tomorrow.

 

[rkoldschool@com]

Every OS seems to have a different approach to PT and it seems there is little communication between the OS and the PT. My OS recommended I do all of my own PT at home from a handout sheet given at the pre-op hip class. My OS warned me if I did decide to go to outside PT they most likely would hurt me and he didn't recommend it. So far I've had 2 THR's and no PT and it seems to have worked out OK for me.

Tks so much I appreciate the insight! Glad to hear everything is working out for you!

 

[Jaycey]

I must say I a very surprised any PT would do this stretch to someone just out of anterior. It is the one restriction they usually impose just post op. That kind of stretch is how they dislocate your hip joint during the procedure.

Never be afraid to question and stop PT. They are often on automatic pilot trying to do the same thing to every patient that walks in the door. In any case it's far too early to tell you that you need to increase ROM.

 

[rkoldschool@com]

I must say I a very surprised any PT would do this stretch to someone just out of anterior. It is the one restriction they usually impose just post op. That kind of stretch is how they dislocate your hip joint during the procedure.

Never be afraid to question and stop PT. They are often on automatic pilot trying to do the same thing to every patient that walks in the door. In any case it's far too early to tell you that you need to increase ROM.

Tks Jaycey. I feel like they saw how great I was doing and thus felt like they could in-turn do whatever they wanted to advance my therapy. I will however make sure I tell them what I am comfortable and not comfortable with. Do you by chance know what that pain I was feeling is? My brother who was a massage therapist for years who also had a THR (posterior) said it could definitely be me reaggravating surgical trauma including nerve damage. Tks

 

[Pumpkin]

Sounds like you PT is too aggressive with the massage to your thigh, and irritating the soft tissues.
The stretching to the rear is a red flag that your PT is out of date. While rare, the position for dislocation for an anterior THR is the position your PT is stretching your leg.

Should you decide to continue PT, ask for some one else, or go to another clinic with up to date PT's.

IMO, you should cancel your PT and let your hip and leg recover from the trauma.

Should you decide to see a PT after letting your hip heal, they can help you with balance, gait, and pacing yourself so you do not cause additional irritation to your hip,
Who ever you decide to see, it would be best if they are gentle to avoid further irritation and pain.

 

[Hipster-2]

3 weeks is pretty early, so if it was me I would pause the PT until this pain resolves. Medicate and walk shorter distances, with as short a stride as needed to avoid further aggravation, until everything cools off.

I doubt that you have done any major damage. I had a lot of soft tissue complications after right THR that began with a large seroma, then progressed to serial formation/rupture and development of painful scar tissue and unrelenting suicide pain. For this left hip (now 6.5 weeks post-op) I have been doing frequent ultrasound exams of the surgical site and thigh just because I can (I am a veteterinarian), and because I was terribly anxious about further seroma formation. One of the interesting things I found was that although I did not have any visible seroma externally (pretty much zero visible swelling from about 7 days post-op) there were certainly various pockets of fluid within my leg at different levels all the way down to the bone and implant - and most of the areas that became painful/tender as I started to get more active corresponded to those areas of fluid accumulation. These were NOT pathological fluid pockets in any way, just what you would expect following major invasive surgery of this nature. While some of these fluid pockets absorbed spontaneously in the first week or two, others persisted for weeks and would sometimes hurt as I started to walk more, incorporate a longer stride, and do some light extensor stretches. The soft tissues in that location would hurt more same-day and for a couple-few days afterward, and when I scanned with the ultrasound the fluid pocket that had been in the area was suddenly half the size or gone. So I think the pain I experienced was related to movement of tissue planes, disruption of some of the muscle/fascia/fibrin walls that enclosed these temporary fluid pockets, and then diffusion and reabsorption of this fluid. In other words, a natural consequence of the healing process in conjunction with an increase in physical activity and range of movement.

However, I must emphasize that the pain I experienced from this was NOT excruciating, and was NOT associated with any change in my ability to weight-bear, etc. It was just a back-step in comfort compared to what had gone before, and it resolved with a few days of TLC, ice, and a more modest walking schedule while things settled down. Once this pattern repeated itself several times I stopped bothering to ultrasound my leg and just carried on. I did NOT try to push through it, and had it happened in PT I would have paused that until I was back to baseline.

 

[Jaycey]

Do you by chance know what that pain I was feeling is?

At only 3 weeks out it is definitely post op trauma. You don't need a training program - you need to heal. Take a break and get this pain and swelling under control. If you feel you need PT later, go for it. For now be kind to that new hip.

 

[rkoldschool@com]

Do you by chance know what that pain I was feeling is?

At only 3 weeks out it is definitely post op trauma. You don't need a training program - you need to heal. Take a break and get this pain and swelling under control. If you feel you need PT later, go for it. For now be kind to that new hip.

I definitely will. I'm taking my time I promise. My surgeon wants 3x per week. I'm gonna have to slow it down. Thank you so much Jaycey

 

[rkoldschool@com]

Thank you for the input Pumpkin. I appreciate it. I'm going to call my surgeon tomorrow morning and talk to my therapist tomorrow afternoon.

 

[rkoldschool@com]

3 weeks is pretty early, so if it was me I would pause the PT until this pain resolves. Medicate and walk shorter distances, with as short a stride as needed to avoid further aggravation, until everything cools off.

I doubt that you have done any damage, per se. I had a lot of soft tissue complications after right THR that began with a large seroma that progressed to serial formation/rupture and development of painful scar tissue formation causing unrelenting suicide pain. For this left hip (now 6.5 weeks post-op) I have been doing frequent ultrasound exams of the surgical site and thigh just because I can (I am a veteterinarian), and because I was terribly anxious about further seroma formation. One of the interesting things I found was that although I did not have any visible seroma externally (pretty much zero visible swelling from about 7 days post-op) there were certainly various pockets of fluid within my leg at various levels all the way down to the bone and implant - and most of the areas that became painful/tender as I started to get more active corresponded to those areas of fluid accumulation. These were NOT pathological fluid pockets in any way, just what you would expect following major invasive surgery of this nature. While some of these fluid pockets absorbed spontaneously in the first week or two, others persisted for weeks and would sometimes hurt as I started to walk more, incorporate a longer stride, and do some light extensor stretches. The soft tissues in that location would hurt more same-day and for a couple-few days afterward, and when I scanned with the ultrasound the fluid pocket that had been in the area was suddenly half the size or gone. So I think the pain I experienced was related to movement of tissue planes, disruption of some of the muscle/fascia/fibrin walls that enclosed these temporary fluid pockets, and then diffusion and reabsorption of this fluid. In other words, a natural consequence of the healing process in conjunction with an increase in physical activity and range of movement.

However, I must emphasize that the pain I experienced from this was NOT excruciating, and was NOT associated with any change in my ability to weight-bear, etc. It was just a back-step in comfort compared to what had gone before, and it resolved with a few days of TLC, ice, and a more modest walking schedule while things settled down. Once this pattern repeated itself several times I stopped bothering to ultrasound my leg and just carried on. I did NOT try to push through it, and had it happened in PT I would have paused that until I was back to baseline.

Thank you Hipster-2. I appreciate you sharing. I will ensure everyone from surgeon to PT knows what my plan is moving forward. Last thing i want is to do any unnecessary damage. Thankfully each day it gets getter and better.