Revision THR In the waiting<

Break2

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Hello everyone,

I’ve been reading posts on this forum and decided to join in the hope that shared experience will help me learn to manage my pain. I first broke my hip in an accident in Mexico in 2004. After 2 unsuccessful surgeries in 2004 and 2005, I underwent total hip replacement in 2006 and felt miraculously healed the moment I woke up in recovery. For 12 years I was able to live a full pain free life with the ability to do everything I wanted to do physically, except running and jumping, which I have no desire to do anyway.

On January 9, 2018, I slipped on black ice and fell directly on my left hip prosthesis, causing the shaft to move and suffered 4 fractures in my left femur and hip. I spent 2 days in the local hospital and was moved to Baltimore, Maryland for surgery on January 11, 2018. I received a new ceramic head ball, a new stem, a nice claw plate on the trochanter fractures, and 9 cables to hold it all in place to promote healing.

Since I’ve had experience with hip surgeries, I felt prepared for recovery this time. Doctor said it will be a lot of pain and that I can have the claw plate and cables removed at 8 to 12 months postop. There is evidence of healing on follow up X-rays, so I just have to be patient and take care of myself. It was feeling better every day, then plateaued around 8 weeks, then got progressively worse as I became more active and bursitis and tendinitis kicked in as a result of the claw plate and cables. I’ve had 2 steroid injections in the hip and thigh, which were helpful, but I still have what feels like sciatic pain with swelling. I have a short leg and need a heel lift to improve my gait. Doc says these hips of ours are adjustable and he will correct leg length issues when he does the hardware removal.

I do my own PT and still use ice daily. I’ve been taking oxycodone and Tylenol for pain relief. I am unable to work regularly and it is hurting my business (which I am the owner). Now, due to the supposed “opioid epidemic” in the USA, I am on my last prescription for oxycodone and have to find a new way to manage my pain until September when the source of my pain will be removed. How am I supposed to handle the pain without meds when I am only able to take care of my basic daily needs with meds? I am being referred to “pain management” by my surgeon and do not know what to expect.

In addition to my home therapy, I get a full body massage once a week and my yoga instructor is teaching me a home restorative program.

Does anyone know how many steroid injections it is safe to receive? I think if I could get one in my sciatic area I could manage the pain without narcotic pain meds. I don’t know how people manage chronic pain. This has been enlightening for me. It’s frustrating and depressing.

Good news is doc says I have good bones and this was just a horrible injury. I will never laugh at ice fall videos again. It is not funny.

Sorry for the long introduction. I’ve been holding everything in for a long time. Feels good to get it out, even if you all think I am crazy. Thank you for listening. I’ve added a pic of my new hip for reference.

break.jpeg
 
@Break2,
Welcome to BoneSmart, glad you joined us.
I added your surgery/injury dates to your signature, let us know if anything needs correction.
Please let is know if it is your right/left hip, thanks!

You have been through a lot, recently a big surgery on your hip, healing can take awhile.
As for steroid injections your OS should be tracking all injections and keeping you within acceptable limits.
@Josephine our forum Director/ and Orthopedic Nurse may be able to better advise.

Here are the recovery guidelines, the articles are short and will not take long to read.

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 these
5. At week 4 and after you should follow this

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.
 
Hi @Break2 Welcome to BoneSmart!
What a bumpy ride. My heart goes out to you. I'm sure from the accident in 2004 until the THR in 2006 must have been a difficult time. Followed by 12 yrs of normalcy. Then the fall. I'm so sorry you're struggling and suffering pain with the bursitis and tendinitis due to plate and cables. Hopefully Josephine will be able to answer your medical questions and offer some structured advice.

I agree, falls aren't funny. I think we'll all view falls differently after THR.

There is no need to apologize for a lengthy explanation. Your situation is extensive with a lot of detail.
We're here to support and encourage in any way we can, so stop back often, we're always here.
Best wishes for a peaceful, relaxing weekend!
 
Thank you, Pumpkin! I tried to edit the signature, but received a message that I am not authorized to save the changes. Here is what I tried to save:

Revision THR and ORIF, left hip and femur 1/11/18
Periprosthetic fracture of the left femur and hip 1/9/18
Left THR May 2006
Free Vascularized Fibular Graft, left hip September 2005 failed repair
ORIF left hip November 2004 nonunion
Left hip fracture November 2004

Thank you for the articles also. Definitely helpful!
 
@Break2 Wow that's impressive hardware you have. Bet you will be glad to get rid! Josephine will need to advise on the injections and may give you input on your x-ray. I do know that you need to wait for a period of time between having an injection and surgery.

Have you thought about stopping all that PT? Hips don't really need it and the activity may be aggravating the situation.
 
Layla thank you for the support. Jaycey I feel like I'm part robot now! I've not had any formal pt and what I do at home is minimal. sometimes I think I should be doing more, even just daily activities, but it hurts every day. Sometimes the pain is intense, but most of the time it is just there, nagging me whether I am moving or sitting still. That's what is so exhausting and depressing for me.
 
@Break2 You poor soul what a journey, every bit of you must hurt and ache with all that metal. Have you thought about the pool, I feel being in the water is so helpful it seems to ease everything, walking in it just eases bodily and mental pain, however much I have not felt like going, it has always made me feel better. I shall be watching how you go, take great care. Can you get tramadol in the states I have a few combinations that help. Paracetamol and codeine or tramadol and co-dydramol. Hugsxxx
 
:welome: and WOW-SA!!!!!!!!!
That is some kind of picture...I freak myself out with my prosthetic xrays but you've got me beat.
Think you should definitely take the pic with you TO the pain management clinic.
I also transitioned to a tramadol/extra strength tylenol regimen...and thankfully my OS, although having to redo my prescription 7 days at a time, was able to do so for many months.
Certainly hate that you had that happen to your new hip....I agree with you and Layla, NOT FUNNY.
Hope you get some help with meds and dont forget the "many times forgotten" painkiller, ICE:ice:
 
Clodaghcov I am joining the local indoor pool next week. I remember how good it felt in the pool after my past surgeries. The one place where just walking felt normal and without pain.

Mojo333 I have taken Tramadol in the past, but it seems mild for this pain level. Still better than plain Tylenol though. Ice is my new best friend. I don’t leave home without my ice pack.

Though it is sad to see so many people who have gone through the revision experience, it is encouraging to receive such wonderful support and to be graciously welcomed among you. I am very grateful for each of you. Thank you for your kindness!
 
Switched from Tylenol to Advil today and my pain level went way down. Such a relief! I can only do this a couple of days at a time as some argue that NSAIDs prolong fracture healing. Anyone else heard of this? Also, lots of ice and rest today, although I had to turn down a shopping trip with my sister for it.

I hate missing out on so much life. I feel like I’m losing a whole year of my life because of one little slip on the ice in January. I can’t have my next surgery before September and then I have another recovery. I have to spend the summer in flat shoes that support a heel lift. No sandals or flip flops this year. I want to visit my grandchildren, but the thought of a 5 hour drive one way makes me reluctant to go. She lives in the mountains and I am used to flat lands where I live. Plus her house has 3 sets of stairs from being a split level. I have issues with balance on flat surfaces and all stairs. In addition, my fear of falling or being in an accident has grown exponentially since my last fall. It’s sad when my first thought about going for a visit is how will I keep my ice handy the whole time!

I want to be positive and look at all of the good, but it is a relief to be able to unload some of my frustration with people who understand. Am I just being a whiny baby?
 
Hi @Break2
No, you are not being a whiny baby. You've been through a lot. You are missing out on life due to an accident. You didn't fall on purpose but you're sadly suffering the consequences of that accident. My heart goes out to you. Having another surgery on the horizon, but still 4 months away, and anticipating another recovery, must feel overwhelming. Like....when's it going to end?!! I know I'd feel as though my life was on hold. Just try to hold onto how good you'll probably be feeling by Christmas. I know it's a long time off but you'll be feeling well enough to ring out the old and Welcome the new. Good riddance 2018!

That's a lot of sitting in the car to go visit your daughter. You'd have to break up that drive with frequent stops to stretch and walk. It also sounds like a lot of navigating stairs while there. Do you feel prepared for that? A couple things to consider - Whether your daughter can visit you instead, or you postpone the visit until your comfortable with stairs and not needing to worry about ice packs.

This is the place to vent because we understand. You'll find encouragement and support here which I've noticed you've freely given to others. Thank you for all the kind words of comfort and consolation you've provided.

I hope today is good and the week to come peaceful!
 
Whining is definitely allowed..and who wouldn't in your situation?
I know I have some close calls that could have had catastrophic results, so I too am very over cautious about situations where I think I can fall.
We have members on here that have been told they cannot have surgery due to other issues, (Gidget) ones that have come from being bedridden for up to a year and wheelchair bound (MobiM) and who all still struggle. Zinnia and many others come to mind.

That is certainly not to say you don't have the right to bemoan your situation...but sometimes it does help to see that as bad as things are..there are others that struggle too.
There are very inspirational stories here, and yours will be certainly one of them.
Keep the faith, venting and even tears can be very therapeutic..
Hope you have a peaceful Sunday.:flwrysmile: we are rooting for you !
 
Does anyone know how many steroid injections it is safe to receive?
It's generally accepted that a person can have injections once every 3 months. I've been having them in my shoulders at that rate for nigh on 14 years! Cortisone shots: are they safe and is there a limit to how many?
Switched from Tylenol to Advil today and my pain level went way down. Such a relief! I can only do this a couple of days at a time as some argue that NSAIDs prolong fracture healing. Anyone else heard of this?
They do indeed! However, there is a much more serious issue with NSAIDs which is this Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

@Josephine yes, please! I feel like my doctor says something a little different every time I see him. I get more consistent answers from the physicians assistants here in the US.
 
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@Layla thank you for your support. I know it would be difficult and painful to visit my daughter right now, but I miss them so much. They won’t be able to visit me until late July. They have 6 children, so when they visit it can be overwhelming for us, even without broken bones. But it is lovely chaos nonetheless! The newest was born last August and I have not seen him since Christmas. Maybe I can get to a better place once I see the pain management doctor. I’m setting the appointment up today when their office opens.

@Mojo333 I remember being wheelchair bound and quite immobile 12 years ago. I went 18 months through 3 surgeries up and down the east coast looking for solutions and relief. My bone graft turned necrotic by the time I had my first THR in 2006. I recall being so desperate for healing and felt very fortunate and blessed when I found my surgeon at Johns Hopkins. As bad as it was then, I feel fairly confident that I can do this again. Most of the time, that is. I am human and I have my moments, like Saturday night when I could not get to sleep before 5:00 am Sunday morning. It took me all night to shut my mind off from all my worries about myself and my family.

I am grateful for this forum and all of the wonderful, intelligent, supportive conquerors I am blessed to be surrounded by. I feel my time spent here is well spent, considering how much idle time I have these days. Once I figure out all the ins and outs of working this forum I will be better at using it. I’ve tried the apps, but they don’t work very well on my droid and iPad yet. The app just shuts down and kicks me off and doesn’t seem to have all the features that the browser version has.

Hopeful that everyone has a peaceful, healthy week ahead!
 
Here y'go then!

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 approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

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

7. are you doing any exercises at home? If so what 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!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
In answer to your questions:

1. Lateral

2. pain levels: 3 regular pain level, 6-7 breakthrough pain level

3. medications: Oxycodone, 5mg, 1 tablet every 4 to 6 hours
Tylenol 500 mg, 2 every 6 hours OR Advil, 200 mg, 2 every 4 to 6 hours.

4. icing: Ice various areas, 30-40 minutes 4 times a day and at night.

5. elevating: Yes, most of the day every day

6. activity level:
20 minutes of activity that involves standing or walking or driving
Light housework - laundry, dishes, bed making
Online shopping
Paid house cleaner
Meal kit delivery service

7. Exercises done at home
2 times per day, kneading massage from upper hip to knee
2 times per day, Foam roller for IT band tendinitis, about 5 minutes. This hurts a lot.
Therapy pedals 5 minutes 1 time per week. (I think this one irritates my IT band)

No PT

I also have a private yoga session Tuesday which I think will be very helpful. My instructor is well versed in anatomy and I trust her immensely to provide helpful tips on core strengthening and stretching. I respect my limitations and a good yoga practice will not cause pain.

I’ve noticed that increased standing activity causes increased pain. The leg length inequality is wreaking havoc on my low back and sciatic areas. Even with heel lifts, I have developed an awkward limp that I believe is related to the claw plate. It looks like Trendelenburg limp to me.

I feel quite useless most of the time. I went back to work for 5 hours one day and the next day I was not able to stand or sit without pain. I was not comfortable at work and the pain really interfered with my ability to concentrate.
 
I certainly can't imagine the amount of time..and Experience...you've had with recovery and being restricted.
Glad you are here as your spirit shines through as positive and hopeful.
6 Grandchildren! How wonderful and wild...sometimes we do just make a way don't we?
Please know we are rooting for you all the way.
Keep the faith!:friends:

I use the browser on my smarter than me phone also...
App doesn't do well for me either:sorry:
 
2. pain levels: 3 regular pain level, 6-7 breakthrough pain level
I don't believe in 'breakthrough pain'. It just tells me that the patient's pain isn't properly managed.
3. medications: Oxycodone, 5mg, 1 tablet every 4 to 6 hours
Tylenol 500 mg, 2 every 6 hours OR Advil, 200 mg, 2 every 4 to 6 hours.
I'd avoid Advil (ibuprofen) if I were you. It has dangers Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers. I think you need to take 2 oxycodone once or twice a day.
4. icing: Ice various areas, 30-40 minutes 4 times a day and at night.
You accomplish little or nothing in 30 minutes. Ice for at least 40-60mins and more than 4 times a day.
5. elevating: Yes, most of the day every day
Jolly good!
6. activity level:
20 minutes of activity that involves standing or walking or driving
Light housework - laundry, dishes, bed making
Normally I'd expect you to be doing more but given your pain levels, I'd say no to that.
7. Exercises done at home
2 times per day, kneading massage from upper hip to knee
2 times per day, Foam roller for IT band tendinitis, about 5 minutes. This hurts a lot.
Therapy pedals 5 minutes 1 time per week. (I think this one irritates my IT band)

No PT
You say "no PT" then you list a number of exercises!! The massage is okay provided it's light and the foam roller the same. Have you seen these articles? ITB (ilio-tibial band) issues and treatments.
I also have a private yoga session Tuesday which I think will be very helpful. My instructor is well versed in anatomy and I trust her immensely to provide helpful tips on core strengthening and stretching. I respect my limitations and a good yoga practice will not cause pain.
Yoga's okay provided it is VERY gentle. Very VERY gentle!
I’ve noticed that increased standing activity causes increased pain. The leg length inequality is wreaking havoc on my low back and sciatic areas. Even with heel lifts, I have developed an awkward limp that I believe is related to the claw plate. It looks like Trendelenburg limp to me.
I don't recommend using shoe lifts for LLD. It really doesn't help in the long run. You need gait training more than Yoga!
I feel quite useless most of the time. I went back to work for 5 hours one day and the next day I was not able to stand or sit without pain. I was not comfortable at work and the pain really interfered with my ability to concentrate.
Well you're 17 weeks out which, while it might seem on the money for a routine hip replacement, is about par for a revision after the history you have. You really have got to listen to your body/hip and be guided by what you experience in terms of pain. There is no way round this. You cannot hurry it, improve it or make it better. You just have to 'go with the flow' until things settle down and improve.
 
Pain management appt scheduled for Monday, May 14. Saw my primary care doctor yesterday to get enough pain meds to carry me to my May 14 appointment. Had to have a consult with the doctors office and initial and sign a 2 page contract for controlled substance prescriptions. Was informed it is now standard practice, even for a one time prescription for 7 days of pills. US doctors are really reluctant to prescribe pain meds with the current media frenzy about opioid addiction.

@Josephine , I was prescribed 10 mg every 4 to 6 hours earlier in my recovery, but they changed it to 5 mg every 4 to 6 hours, limiting me to 6, 5 mg pills per day. I do find that taking 2 instead of 1, along with 1000 mg Tylenol can alleviate my pain for 5 to 7 hours, whereas taking only 1 pill just reduces my pain. I have been taking 2 some times, especially in the morning, but keeping my total consumption at 6 or less pills per day so I don’t use more than the prescribed amount. I think I’d get most relief with 2 oxy every 6 hours, but will have to get my prescription changed in order to do that.

Is the goal of pain management to eliminate pain or just make it more tolerable? I don’t understand why they lowered my prescription when I was still having significant pain. I will discuss this with pain management next week.

I have 8 ice packs and use 2 at a time. I switch them out about 4 times per day. It feels like they are losing their ability to stay really cold. Maybe I need to buy new ones or just switch them out more often.

I am interested in gait training. Can I teach myself or should I ask for PT prescription? I don’t feel the heel lifts really make any difference.

I’ve been told I have adult ADD and I’m normally very active and fidgety. I don’t feel like I am overdoing it, but perhaps I am. It’s been 4 months since my surgery which seems like forever to someone who can normally work 50 to 60 hours a week. I’m usually “spring loaded” when I have to sit for any reason. This is a total lifestyle change for me. Hard to wrap my head around it. I might just print copies of my X-ray and post them around my house and in my car as visual reminders that I have major limitations temporarily and I need to stop pushing myself and just let it heal.

Thank you for input. I greatly appreciate the support from you and others here on the forum. My family is supportive, but they really don’t understand the long term effects or how to support me right now. I look fine from the outside, except when I walk. They don’t see the pain. Hubby says he’s jealous and wishes he could be home and not have the alarm clock every morning. I’d rather have the alarm clock than the pain clock that wakes me up!

Today I get to see the oral surgeon and have a tooth extracted. My 30 year old crown came off when I was eating milk duds last week. Can’t be fixed so it has to come out. Happy, Happy, joy, joy! The fun never seems to end.
 

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