THR 10spro's Recovery Thread

[10spro]

Started this thread a couple days ago but the drugs kept me pretty sleepy. Had left hip replacement on 6/2/23 and finally writing this on Day 3. It's been an interesting road so far. I'm on the ERAS (Enhanced Recovery After Surgery) fast track plan. Daily schedule is walk for 5 minutes, ice for 20 minutes, rest for 40 minutes, then do it all over again, all day, plus fit in some basic stretching exercises too. I barely have time to sleep. My day of surgery was really quick. I arrived to the hospital at 5am and was home by 1pm same day. In recovery, he asked if I could wiggle my toes, I said not yet, and he said let's get up and walk, I said I don't think so, and sure enough, still numb. I felt like I was taking longer than they wanted to allow for this fast track schedule. Now that I've been through it, I do feel like total of 10 hours for this type of procedure is really too soon to go home. Nobody ever said it would be partial weight bearing, and that I would struggle just to get into bed. All the education and handouts they give you ahead of time never mentions that. The few people I spoke to said they never needed a walker and had no pain. That is not my experience. So I am managing, struggling, but getting by. Making sure I eat healthy, though not much of an appetite. Home health nurse is coming tomorrow and I almost feel like telling her no because I'm just barely getting around with the walker at maybe 65% weight bearing. I'm not sure what exercise she's going to want to give me. I'm all about challenging my body, but I also think it's important to listen to your body. Will update again in a couple days.

 

[diane71]

Wow - that's such a fast process. I'm in Scotland and here they get you up on the day after surgery if possible, but you don't leave hospital until late day 3 or 4. Listen to your body now and don't do anything that isn't comfortable! As has been said here many times, hips heal pretty well themselves and once you're able, walking is the best recovery exercise. I'm not sure about those people who never needed a walker and had no pain?! That sounds pretty strange to me. Every body is different, of course, but if you take your time all will get slowly better. Patience is important (says the most IMpatient person on earth!) Good luck in recovery and keep us updated!

 

[CricketHip]

Hi @10spro and congratulations on your new hip! You are indeed on a fast track. How are you feeling about this now that the pan has been put into action?
I am guessing that you agreed to this due to either your love of sports, or work environment? Or is this a surgeon's plan.
I think you are already wondering "what the heck?" So I will leave you our Hip recovery guidelines and you can peruse through them at your leisure but please make sure to read the BIG TIP at the bottom of the articles.
HIP RECOVERY 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.

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?

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.

 

[Layla]

Hello and Welcome to BoneSmart and recovery. Congrats on your new hip!
My dear new BoneSmart buddy, please know that recovery doesn't have to be this aggressive and you will still have the same result. You will hear this from many here that have recovered from THR before you.

You are recovering from the controlled trauma of a major surgery. Your leg needs time to heal and you need to rest. I will share what we recommend at this point and that is icing for as long as you want and for as often as you like to, while elevating, always taking care to place fabric between your skin and the ice source.

Following surgery ice is frequently used as a means to minimize pain and swelling resulting from the surgical trauma. Following injury, patients are commonly advised to ice no longer than 20-25 minutes several times a day. But with a surgical incision, it is perfectly fine to ice your wound as often as is comfortable for you, providing you place fabric between your bare skin and the ice source. A small towel is ideal for added protection. This is why the ice machines have pads that don't get quite as cold as an actual ice pack. Icing is an excellent means to control pain following surgery and each individual needs to find out what schedule works best for them.

As far as exercise goes, the handful they send you home with are fine as long as they're not causing you any pain.
It is not necessary to exercise your injured hip to promote healing. The trauma sustained through THR will heal on its own. Often though, we're impatient and want to move the process along. In doing so we run the risk of struggling with pain and setbacks stalling the healing process. The best therapy for recovery is walking, but not to excess. Start slowly increasing time and distance incrementally in an effort not to overdo it.

You mentioned you barely have time to sleep. Sleep is important now and making your best effort to get adequate sleep and rest is beneficial. Our body does it's best healing while we're sleeping. so...if you're tired, please take the time to sleep.

The majority of members start out with a walker. Most use a walker for a minimum of two weeks and many for much longer, then normally transition to crutches or a cane. So there is no shame in using a walker.

Don't hesitate to back off the nurse for a couple days if you're tired. Also, you don't have to do anything that hurts with PT, if it hurts, STOP and tell them you're not comfortable with that particular movement.

At this point, only three days post op, a five minute break to walk, go to the bathroom, or to the kitchen for a drink or snack is about all the activity you need once every hour or two.

Best wishes and lots of comfort to you as you begin the journey.
Stop back often, we'd love to follow your progress!

 

[CricketHip]

Okay. So. Please read through the articles and you will see that an easier pace can be had and it also will be much more pleasant for you.
It's difficult for me to imagine that the excess activity and stretches that early on will speed up the healing process.

I took my time with both of my THR's and was back to work part time, at 8 weeks, which is about 4 weeks ahead of schedule. I don't recommend rushing that either but I felt good enough and was self employed with a list of needy people wanting on my schedule.. so it helped me mentally to start in at 8 weeks. The purpose of this story is that I recuperated slowly, only did exercises that didn't hurt me. Iced almost continuously and was to get up hourly and walk a few steps which usually involved a bathroom break- doing it this way, the BoneSmart way had me in great shape soon enough.
So if you don't want that person coming into your home, cancel them. I doubt the Home Health nurse is going to make you do much, maybe just check your vitals and incision?

 

[Eman85]

Fast track? Get off at the next stop! They did get me up walking post-op but they waited a while until I felt like I wanted to. I couldn't imagine not being able to wiggle my toes and being up walking.
You sound like your in a normal recovery.

 

[Layla]

Fast track? Get off at the next stop!

Gotta love this guy, Eman, he tells it like it is.
Men don't tip toe around like us women.

 

[Caison113]

ERAS seems like a bit of BS to me, but what do I know having had two hip replacements? I pushed pretty hard and was back in the gym less than a month out from surgery, but I gave myself a solid week of rest/ice before I worried about next (literal) steps. I can't imagine anyone not needing some walking assist and not having pain. That is totally delusional.

It will be interesting to hear from you about your progress and whether this approach really moves the needle. I will end by saying to listen to your body and allow yourself some rest in the early days. There's no medal for finishing "first" but there are penalties to going too hard and suffering a set-back. Good luck!

 

[LeftKath]

No walker and no pain! Ha!
My two Anterior THR weren't given a nifty acronym but they were done out-patient arrive at 6am, home that afternoon. I am 11 days post surgery and weaned myself off of the walker gradually. Even though I can now walk a bit around the house without crutches, I still use a walker in the middle of the night and for getting in and out of shower.
It gets better but it just doesn't follow a schedule.
Take Care!

 

[tanvat]

10spro,

I had a left THR on April 13 and a right THR on June 1 at age 49. I went into a surgery with a good fitness level and an active background. My first recovery exceeded my expectations, and I hope my second will too.

But, as I’m sure you are well aware, to replace your hip the surgeon cut off the tool of your femur, used a corkscrew to dislocate your sawed off femoral head, reamed out your hip socket - ie ground lit down to good bone, and then literally hammered a metal spike into your hollowed out femur, hammered in a metal hip socket, and rotated - ie twisted - your leg 90 degrees to test stability, all the while stretching muscles and tendons to such a degree that it causes a serious grade 2 muscle strain in multiple major and minor muscles, and the reducing the hip - ie pressing the components together and stretching the already damaged soft tissue tight to hold the ball into the socket - then multiple layers of sutures.

Given this reality, an “enhanced” recovery can only mean, AT BEST, maybe you are walking better than you would have been at say week 8 or beyond with a real possibility of setting yourself back by. It letting the traumatized soft tissues heal.

And the overlooked elephant in the room in my opinion is doing too muscular too soon so as to increase the risk you interrupt the all-important bone ingrowth that starts in earnest in the first several weeks.

You implant is likely press fit, meaning it’s just nailed into the hollow part of your femur and held there by friction. Repeated, excessive forces - that is, anything much more than easy walking - in early weeks may impede secure bone ingrowth and harm long-term stability in the femoral stem, thus increasing revision risk down the line.
No matter how miraculous modern hip implant materials are, long-term success requires solid bone ingrowth. I am not a doctor, but given the risk reward trade offs, it seem imprudent for a doctor, therapist or anyone else to counsel and push patients into aggressive rehab routines with hopes of may knee walking around better a couple weeks earlier - it seems prudence dictates taking the slightly longer road that gets to the same place and may well keep you there longer.

Eg - I found PT useful at first but bowed out after being repeatedly encouraged less than 3 weeks out to do full weight-bearing exercises solely on the operative leg - why?? I could have done it, but what would I gain? Nothing, really except incurring totally unnecessary risk of impeding the bone ingrowth that was literally just beginning.

Rehab is not a race, it’s a process with a lot of delayed gratification aimed at a lifetime of results. Next week and. Ext month matter only insofar as that is the timeframe for small steps that add up over time - next month is not the goal, it’s next hear, the next decade, etc.GivenYouNoNo

I know this is a bit of a preachy rant, but I feel strongly that patients should not be pushed into unrealistic short-term timelines even if a doctor is the source of that advice.

 

[myglasshalffull]

Fast track, some with no walker? What universe is this???
You have already received some great advice, listen to your body and don't do anything that feels uncomfortable and hurts.
Welcome and keep reading here, we all have had this surgery.

 

[10spro]

DAY 5 UPDATE: I'm so glad I found this online community. You guys really get it. I feel like I've been fed so much generic information up to now, but it didn't match the reality that I've been going through. Thanks to all of you who have shared that it's ok to recover on my schedule, not some random fast track thing, which I never asked for, and was never informed of. So Day 5, every day is a little better, still using the walker, still sitting on ice, still doing 5 minute laps walking around the house, but not every hour on the hour. The home health nurse came, and she was actually much more aware of our reality than I was expecting, probably because she visits the actual patients and see the struggles. I am honestly a bit relieved to have this healthier mindset going into the long haul recovery. I can't thank you guys enough for sharing your experiences. On to the next milestone: surgical dressing is removed on Friday. I hope that is as uneventful as it sounds.

 

[Mojo333]

Yes, likely uneventful.
Healing has to happen before rehab.
You have nothing to lose on the easy does it track, and a much harder road pushing things too early.

Relax and heal.

 

[Eman85]

Take some time and read some of our recovery threads. We have all had at least one THR so we all speak from experience. Draw your own conclusions from what you read and our advice as no two hips are the same. just keep in mind that it's your hip and your recovery from an elective surgery that you chose to have. Understand what exactly was done to your body to perform this procedure, you'll be amazed that we can even stand let alone walk! It is amazing and a new lease on life but the recovery takes time and a lot of healing. It's become such a common procedure that the true severity seems to get lost in the hype about it.

 

[Sockeyewillie]

Tan at said “ Repeated, excessive forces - that is, anything much more than easy walking - in early weeks may impede secure bone ingrowth and harm long-term stability in the femoral stem, thus increasing revision risk down the line.”

I wondered about this statement. With my initial THR I was not wise to Bonesmart. I only discovered it after things were not going well with my long term recovery. While my OS says PT likely had nothing to do with my need for revision, he also instructed me to stop PT after several weeks of visits.
I certainly have approached this recovery different. This is week three and the only weight bearing exercises I have done have been balance and walking. And I’m even a bit cautious about the balancing exercise. Everything else has been done while lying down other than some IT stretches.
My question remains, Can the ingrowth of bone to the femoral post be debilitated by weight bearing exercises?
Thanks

 

[tanvat]

10pro,

To be clear I’m not a doctor. What I was referring to is potential risk from excessive weight bearing exercises early in the recovery process. What is “excessive” and “early.” I don’t know. Some
If that depends on one’s reference point. I plan to get back to week-long wilderness hiking trips next summer. That is a year-long goal, not a 3 month goal. And even then, I will modify my trips and scale back former ambitions to preserve my two new hips - and even then, may have to scale back even more or they don’t cooperate. But if the goal is to get back to comfortably strolling the neighborhood, then 3 months may well be reasonable. But in the first several weeks any lower body exercise more strenuous than a short walk just seems like too much - why place additional stress on the implant until the bone has a chance to start ingrowth? Just walking places full weight on the hip, and even that is magnified by the impact of the step. That is what hips are, both our originals and the prosthetic implant. Some bearing exercise is important because it stimulates and maintains bone growth, just like muscle. But it seems prudent to ease back into full activity over the course of several months, not several weeks. Some things, like healing from major surgery, just can’t be accelerated that much.

 

[10spro]

DAY 10 UPDATE: You guys can appreciate this so much more than my friends or family. I was standing next to my walker, got distracted with the phone, finished the call and then turned to go into the other room. I got about 8 steps when I realized I did not bring the walker. It took me a minute until I said "what am I doing" and came back to get the walker. My husband and I had a good laugh. Recovery is such a slow process, but little wins like this, getting just that little bit stronger, closer to not needing the walker, that helps get through the day. My little 5 minute laps walking around the house with my walker are getting easier, and some the little ROM exercises are not as hard as they initially were.

I do have a question for the group about your incision...and yes I know everybody is different. It was supposed to be mini-posterior but I see now it's a dang long incision...probably my higher BMI at work. Anyway, my incision continues to drain, not a huge amount, and mostly clear, but enough to keep the side of my pants wet now that the dressing has been removed. I asked the doctor about removing the surgical dressing on Day 7, and he referred me to the home health worker, who suggested we remove it. I now understand the home health workers they're sending are not nurses, they are physical therapists, and really have no clue. I'm sorting through all that, but at the same time wanted to ask this super group of experienced hippy's about your experience. Is this drainage normal on Day 10? Does anyone have recommendations for getting the incision to close and keeping it clean and dry while it's still draining?

 

[tanvat]

Re the walking - that’s great! I can relate - you’ll just do something you couldn’t do before and it’s great.

Re incision - don’t know.

 

[Layla]

Hi, It sounds like you're doing pretty well.
As far as the drainage goes, it may be okay as long as it's clear.
I am not understanding why your surgeon would allow a PT to be in charge of inspecting your wound and making the call on whether to remove the bandage. As long as the wound is open, there is a risk of infection. Consider calling the surgeon's office tomorrow to let them know the incision is still draining and ask what they suggest. Cover it? Don't cover it? Keep it dry? etc.

Just an FYI
Some common signs of infection are:
Fever
Unusual or increasing pain
The incision is hot to the touch
A change in the size of the incision
A change in the odor of the discharge
A yellow or green discharge that is increasing
Redness or hardening of the surrounding area
Excessive bleeding that has soaked through the incision
@10spro

 

[10spro]

As far as the drainage goes, it may be okay as long as it's clear.
I am not understanding why your surgeon would allow a PT to be in charge of inspecting your wound and making the call on whether to remove the bandage.

Very frustrated with the level of care. The surgeon prescribes home health care, which is great, but it's that agency who decides the actual person that comes. Every one of my questions so far that I directed to the surgeon is redirected to home health care. I will take it up with the agency tomorrow and insist they send a nurse next time given this issue. I did finally get a response from the surgeon office, it's more of the generic "drainage is normal after surgery". I swear it's like everything else, you have to be your own advocate.