THR Post Op -Limp

[Abs850]

Evening all,
Someone sign posted me here and I’m very grateful for any advice - I am 33 and 4 weeks post THR (lateral) and my limp awful. I have googled the life out of it and stumbled upon a name given to this type of limp after surgery like this. My torso leads over the effected side and I’m limping like hell which is getting my down. My job is a physical trainer so am someone who is active ALL the time and I’m struggling mentally! I’ve managed to get onto an assault bike with no pain and a ski erg utilising arms only but you can’t get very far with that technique. My question is will it ever disappear? I am undergoing intense physio…everyday I am stretching and conducting strengthening exercises, I’ve even managed to do some exercises in the pool. Maybe people are walking fine after 4 weeks and I don’t feel like I am progressing also my lower back pain is off the chart…like 8 out of 10 on a pain scale.

Any advice would be greatly appreciate

 

[Layla]

Hello and Welcome to BoneSmart! Thanks for joining us. Please share the exact date of your surgery and which hip and we’ll create a signature for you.

Limping at only four weeks post op is not uncommon. You mentioned googling your limp, but didn’t name what you believe it is. Please share your thoughts, maybe we can better advise then. Hopefully you’re still using an assistive device as we recommend doing until you’re no longer limping.
Here’s a tip - Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.
You can also check out the One Step Program - see link at top of page where it says “Proper Gait Is Everything”.

I‘m sorry, I am not familiar with an assault bike, but it sounds aggressive, lol.
I also am not sure what a ski erg is. The activity you’re engaging in sounds pretty ambitious for only one month post op. You may want to reconsider engaging in as intense physio and stretching and strengthening exercises just yet. This could be hindering the recovery process from the “controlled trauma” of THR that your body is healing from and not ready to take on a training type workout yet.

Its also easy to overdo it in the water and not notice it until later. I will leave our Recovery Guidelines. Check them out when you have time and let is know if you have questions. I hope you find relief soon. Stay in touch!

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.

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

BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide

Activity progression for THRs​

6. Access to 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 the at each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Eman85]

I think someone sent you this way because of the opposite thinking of intense physio here. I'd say 3&4&5 might be an interesting read.

 

[Boofit]

My torso leads over the effected side and I’m limping like hell

What you are describing sounds like you are walking with a Trendelenberg gait. It sounds like you had the lateral approach for your THR like I did.


You are only at the 4 week post-op stage!! I had my THR 5 weeks ago and what you say here causes me some concern:

I am undergoing intense physio

I hope you realise that cut muscles and bones take much longer than 4 weeks to heal, and during the THR surgery you went through a month ago:

• your hip was cut open,
• your muscles cut to access the joint,
• the femur pulled out,
• the head of femur sawed (yes, using an electrical surgical saw) off of it,
• the marrow from the stem of femur was scooped out to make room to pound the stem of the metal prosthesis in,
• the acetabulum was reamed and the socket prosthesis placed in and maybe screws added to fix it in place,
• then everything had to be tidied up, the new metal prosthesis popped into place, the muscles sewn up, and finally the skin stitched, stapled or glued.

It was a traumatic surgery your body endured.
Now is NOT the time to be doing "intense physio" in my humble opinion.

The ski-erg may offer a low impact full body work-out, but with pain in your lower back at level 8 - Even without a THR, is it wise to do this?

Maybe people are walking fine after 4 weeks

Do not compare your recovery to any other recovery. Every THR recovery is unique.

Less is More. I understand you would be most keen to get into shape so that you look credible to your clients, but please do not delay your recovery by trying to attempt too much too soon. Seems like you are back at work. If I were you I would explain to my clients the type of surgery I went through and explain to them that your recovery will take time, that you can still help them to reach their goals by demonstrating upper limb and maybe even trunk exercises, but only giving them detailed explanation of lower limb training procedures (use diagrams and photos if necessary).

Wishing you a good recovery. Slow and Steady wins the race.....

 

[Abs850]

My surgery date was 14 Jun and it is on the left side.

Trendelenburg gait is what I was referring too…it is killing me, my posture feels so bad and it’s effecting my mood. Will I ever be able to walk correctly again?

Wow seeing what happened to me during surgery written down is eye watering…in fact it’s made me think about what the hell am doing and should I slow down…am guessing I should.

I am conducting my rehab exercises everyday trying to build up glute/adductor strength. My hip flexor feels so tight…I cannot raise my leg if it’s straight from the lying position not even a little bit unless my leg is bent.

Thank you for the advice…I guess I thought I’d be walking without aids by now :( but I don’t know why I had that thought.

 

[Layla]

Trendelenburg Gait is what initially came to mind when reading your post, but took care not to concern you needlessly if this wasn‘t what you diagnosed yourself with.

I definitely recommend you slow down. You are healing from “controlled trauma” you really need to heal first and slowly move back toward sensible workouts once your leg has healed. This recovery can take a full year and even longer for some.

You need a recommendation for a reputable PT to work with who can formally identify your gait issue, rather than depending upon your self, or a diagnosis read here. Look to your PT to recommend what you should be doing for therapy and to monitor your progress. You need to go slow and easy and not do anything that causes pain. Your body is trying to heal and it is healing, but you need to help it along with an abundance of TLC, not work against it as you have been and quite aggressively it seems. Assault Bikes and SkiErgs can come later.

Please read through the Recovery Guidelines and let us know if you have questions. BoneSmart staff is ready and willing to advise when needed. I suggest you pick the cane back up if you stopped using it until you are no longer limping or dealing with gait issues. Rest and ice any / all areas of discomfort according to the instructions under the article ICE in the Recovery Guidelines. Take a look at the Activity Progression for THR to see what type of activity is safe at this point. You will be surprised. Again, I highly recommend you look into the One Step program designed to deal with proper gait. Link at top of page with pic of lady in aqua dress and the phrase “proper gait is everything”.
Take good care and know that we’re here for you if you need us.
@Abs850

 

[Doglover7]

I cannot raise my leg if it’s straight from the lying position not

Not sure if this is a straight leg raise but I know that was one of three things I was told to specifically not do. Not sure if its the same. Also got conflicting messages from the hospital PT versus home PT ...took my leg at the hospital and moved it to the side ..home PT said that was one of the things I absolutely shouldn't be doing? Honestly I am just walking and taking it easy, 3 weeks today finally took short few feet unaided, limping still but not like before.

 

[Going4fun]

You're only a month out. Most patients aren't walking without aid by then. I didn't walk without a cane til week 8/9. And my hip feels fantastic now.

Be careful of doing those rehab exercises. You really can set back your recovery. How about just getting out and walking with a cane? Walking with a cane DOES strengthen your muscles and it prevents you from overdoing it. I used to get great walks in with the cane.

I don't think surgeons would diagnose "Trendelenburg Gait" so early. They would say you're recovering. It's sorta like judging the surgery based on being sore at this point. Most surgeons would say it's totally natural to have gait problems at this point.

You are not helping yourself by ditching the cane. You will naturally ditch the cane without thinking when your body is ready. I'm so sorry you got the impression you should be walking fine by now. You just had major surgery. Major. It's highly organized and fast--and that might give you the impression this was just a bruise but no, it was major surgery. And you're only one month out. People can have casts on for longer than a month.

 

[JohnWilky]

Blimey Abs you’re only 4 weeks in and lucky the you have any gait , never mind trelendenburg , you’re only 34 and must have been fitter pre op than most , especially me ! Take it very easy as advised , I though I was ‘ten men ‘ and pushed it too easy , too early and not surprisingly had a few set backs , hey you’re younger than most on here but you more than realise how long it’s going to take for the soft tissue and muscle to repair.
Take things gradually and you will be back to near normal soon.
All the very best of luck.

 

[Abs850]

I really appreciate peoples advice and guidance….I guess I’ve been really naive and thought I’d be walking completely fine by now as ive read some people stories and kind of expected to be the same. I calmed down my activity and rehab exercises today after last nights chat and decided to stop trying to rush everything. I’m so worried the gait will stick and the more I read the more horrified I get…I’ve been using my crutches all throughout. My PT told me to stick to 2 crutches at all times to help rectify the gait issues. I suppose when training is your life and career it all gets depressing when someone takes that away from you…angry that I needed this type of surgery this early in my life.

This site has been immensely useful to me so thanks @JohnWilky for the signpost!

 

[Abs850]

I cannot raise my leg if it’s straight from the lying position not

Not sure if this is a straight leg raise but I know that was one of three things I was told to specifically not do. Not sure if its the same. Also got conflicting messages from the hospital PT versus home PT ...took my leg at the hospital and moved it to the side ..home PT said that was one of the things I absolutely shouldn't be doing? Honestly I am just walking and taking it easy, 3 weeks today finally took short few feet unaided, limping still but not like before.

Straight leg raise…feels like my hip flexor is going to rip off. Nothing fires and I just can’t do it ‍

 

[Eman85]

It's not the same for any 2 hips, my left I could raise and hold my leg up. My right I couldn't will it to move at all for quite a while. No exercise or forcing, it just came back on it's own with time.

 

[djklaugh]

@Abs850 One thing that I have not seen others mention - and if you've already done this you can ignore my post - are you wearing shoes that you wore a lot before your hip replacement? If yes then get new shoes! Old worn down soles and heels on shoes can keep you walking in the old limping pattern!

 

[Hip4life]

Surprised by how your hip is calling the shots in your recovery? You're in good company here. That was my biggest revelation and tip from this forum. For whatever reason, I initially came away from my surgeon's office with the impression in 6 weeks life would be back to normal. I was missing a lot of important details. My hip told me I wasn't ready for real life until week 14. Even then, you will continue to heal for up to a year or more. Not that you won't be doing almost everything before then but you will notice little things that keep improving. Your age and physical fitness is obviously in your favor. The limp will improve as the healing occurs and strength returns. It can't be rushed. Your assistive device is a tool just like any other. Just be patient with yourself and give yourself the time to heal properly. In the scope of things, this is a very small window of time that will hold you back but it is well worth it for the long term.

 

[Layla]

How are you doing since we last heard from you? Any improvement? I hope so, even if it’s only slight. This recovery biz takes time as I’m sure you’ve realized.
I hope you have a nice Sunday and a good week!
@Abs850

 

[Abs850]

Hey there…still struggling here, am checking out everyone else’s stories to find some comfort in know am not alone. Back pain is still and issue…when I look in the mirror my torso looks curved which is a worry but something I will ask my surgeon about when I next visit him. I’m still using 2 crutches to ensure am walking correctly, hip pain is minimal now but back pain is still aggravating me whilst sleeping & walking. You know when you wonder what life was like without all this.

 

[benne68]

hip pain is minimal now but back pain is still aggravating me

Back pain is a problem for many of us after both THRs and TKRs.

My surgeon explained that it happened because I'd been favoring the bad hip for so long that my back was completely out of alignment. The pain was the result of the body trying to adjust to my new posture.

I found that heat and massage helped me get through the worst of it and it eventually resolved.

 

[Layla]

Happy Three Month Anniversary!
How are you doing? Please leave an update as time allows. We'd love to read an update on your progress.
I hope you have a lovely Autumn!
@Abs850

 

[Abs850]

Hey all,

I have finally reached 3 months. Wow I never thought I’d get here! Hip is getting stronger everyday and I’m walking unaided all the time which is fabulous…I still can’t go far (no more than 10,000 steps) until my back starts hurting.

Limp is much better but not 100% as I am still hinching my hip due to my glutes on the effected side just not firing - my butt is literally dead!

My physio still cannot get to the bottom of the back pain - I am back on pain meds so that am not tense and can try regain some free movement. More investigation will take place in November to give it more time to settle…hopefully it will.

Hip flexors are still super tight but am working on that daily. All in all beginning to feel more positive.

 

[Hip4life]

Just throwing out an idea: has your PT tried manually pressure releasing your hip flexors? I had this done, at least on my left, and it felt so much better, my back felt better and I was able to stand taller. It would certainly be worth a try.