THR Pain in hip after nine years.

[Josephine]

The new pain is in the area of L1b-d and L1b-e, almost on the line between d and e. It is where the joint moves as you swing your leg backwards and forwards, if that makes sense. I feel it when I put weight on my hip, but not when I am at rest.

Like this?

This is the spot of the trochanteric bursa and your pain is very typical of Trochanteric bursitis in every detail!

My pain level was about a 1-2 most of the time until yesterday, but this new one is more like a 4.

Sounds about right for TB.

I am taking percocet 5/325. One pill every 4-5 hours, except at bedtime, when I take 2. I have also been prescribed norco 10/325, but it was not handling my pain, so I am only taking the percocet.

One every 4-5 hours? Is that all you are prescribed? Surely it says 1-2 every 4-6 hours doesn't it? You need to take two at least once more during the day.

Also try taking regular Tylenol (325mg) when you take the one percocet. You'll find it makes a LOT of difference. You just need to add up all the acetaminophen and make sure you don't exceed the safe daily level of 4,000mg.

I ice my hip for about 45 minutes very hour.

Ice it more! Like 2-3 hours at a time. And put the ice pack on that painful spot.

I haven't really been elevating my leg. I recline on my couch with my legs straight out in front of me.

That's fine. No need to do 'toes above nose' for this!

Activity level-
- make my coffee, breakfast and lunch,
- wash my dishes,
- make my bed,
- shower,
- personal hygiene.
- did a load of wash yesterday
- straightened my bathroom.
- take a nap every afternoon
- get up and walk a little every hour.

That's an awful lot for 2 weeks out! Did you not read your recovery articles? Especially this one Activity progression for THRs.

PT
- ankle pumps x10 - these are okay, just anti-clot exercises and you can do these as much as you like

twice a daily: once a day is plenty
- thigh squeeze x10 - ok
- buttocks clenching x10 - ok
- heel slides x10 - you don't need to do these for hips
- lying kick, pillow under knee x10 - 'kick'? A gentle lift is all you need for this but 5 a day are plenty. In fact, stop them for for the next couple of weeks to let the TB settle down

- leg slides (abduction,adduc) x10 - much too early to do these and quite possibly the reason you have TB
- (for IT band) sit on chair, foot flat on floor, slide backwards, hold, then return to start x10 - this is not an IT exercise and will most likely actually worsen the IT tendinitis.

Short summary - you're only two weeks out. First two weeks should be dedicated to nothing but rest and pain management in the form of pills and ice. Doing too much almost always results in tendinitis in one form or another, TB being the most common. If you ignore this and carry on doing all you have been doing, you risk turning this acute inflammation in to a chronic condition and trust me, you do NOT want to go down that route.
Pain - acute and chronic issues

 

[Dmcfad2]

@Josephine You are such a dear! I feel like I have my own personal nurse. I am going to do everything you say!
The spot on the diagram is correct. I read the article and it sounds like what I am experiencing. I certainly don't want to make it worse!
On the percocet, I was prescribed 1-2 every 4 hours. I will do what you said and add Tylenol to my dose and add a second pill another time during the day. Probably my late morning dose.
And I will ice more!
I will curtail some of my activity, too and my exercises, as you suggested.
Do you think my tight quad/IT band will loosen up by itself as time goes by? I am still a little swollen and perhaps this is part of the issue?
Thank you so much for your advice. I really appreciate it a lot.

 

[Dmcfad2]

@Josephine One more question. I was supposed to start straight leg raises this week. Should I do those yet? And when would it be okay to start heel slides again? Those actually made my quad feel a nice gentle stretch and It seemed like it was making my leg stronger. Thank you.

 

[Josephine]

SLRs are what cause ITB problems so I would leave them for a week or two and then just start with a very few, say 3 or 4 and slowly build up. Like I said, hips really don't need much PT. I know a number of hip surgeons who order no PT for their patients at all. They just tell them to 'be normal'! Unlike knees, there's not much can go wrong with hips!

Heel slides aren't necessary for hips either. I have no idea why they were included.

With rest, pain meds and icing, your ITB should settle down. I can't faithfully promise is definitely will, only time will tell. But I can faithfully promise that it will get worse with exercising!

Oh yes - and try this Acupressure massage.

 

[Dmcfad2]

@Josephine Thank you so much.

 

[Dmcfad2]

Post op day 16 I feel I am making small improvements. My pain seems to be lessening. My quad is still so tight. I can't bend my knee back more than 102°. My other knee bends to 133°. I am hoping this will resolve in time. I am still swollen and that may have something to do with it. But, right now it is disturbing to me in that I have less range of motion there than I did before surgery. The back of my thigh and knee are also tender to the touch. I am walking with a cane in the house, concentrating on standing up straight and not limping.
When I got my staples out yesterday, the nurse said my incision looks great. She put steri strips over it and said they will fall off by themselves. I can now get it wet. She also told me something that shocked me. She said that I would have the hip restrictions for the rest of my life.....no bending past 90°, no turning my toe inward and no crossing the midline of by body. Really....FOR LIFE??? I am bummed about that one. Has anyone else been told that?

 

[birdlady]

Yes, my OS said the same thing. I can't believe that's really necessary, but I'll be interested in seeing how many others are getting the same advice. How can you put on your socks or tie your shoes without bending more than 90°?

 

[VF]

Best post op ice? Ice pack home made it something fancy? 10 days to surgery!


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[mystikfairy61]

@Dmcfad2 My OS told me I don't have any restrictions, although I am following the not doing the inward twist and bending past 90 degrees at the same time just for peace of mind.

@VF I found some gel reusable ice packs at Walmart for $3 and they work really good but the hospital ended up giving me a really nice 2 sided ice pack that has freezable gel packs, they gave me 4 of them so I always had a set ready. Also the alcohol and ice mixture as well as frozen peas make great ice packs. Hoping the next 10 days pass quickly.

 

[chaseyboy]

@Dmcfad2...as far as restrictions.....did you have the posterior or anterior approach? ...I had the anterior. ...with no restrictions. ..I do know only working for orthopaedic doctors that the posterior....side of the hip incision does have lifelong restrictions. ...my way the anterior....I am never supposed to kick my leg backwards.....lol....that's what I was told....

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[younghippie]

I am having posterior and was told by my surgeon that I will have no restrictions.

 

[Dmcfad2]

I had posterolateral.

 

[Briggieride]

I have been reading up on this and am learning that a lot has to do with the ball size of the artificial joint. But not only that, although that one is a biggie, it's the approach too. I was told 120 degrees life time restriction because I have a smaller implant, but was not told what size femoral head. With 90 degrees you should not have any problems reaching your toes as when you bend over you also bend your back and tilt your pelvis. The problem is when you don't bend your back or tilt your pelvis, because past the 90 degrees the stem of your implant will touch the cup. I'll attach something interesting which will illustrate the issue.
The illustrations make it clear what happens with a small femoral head versus a large femoral head.
broken link removed: https://www.ganapathihipkneesurgeon.com/does%20size%20of%20the%20ball%20matter%20in%20hip%20replacement.html

 

[Briggieride]

@Josephine . Indeed, there is nothing simple about any of this. It's interesting though how many different thoughts on the subject are out there and because of that I find it important to educate myself a bit and read up on what I have questions about. Then I try to make an informed decision on what to do and not do, all the while listening to what my body tells me.
I had read about 'the healing ridge' of incisions and that one needs to do nothing, because, like you wrote, the body is perfectly capable to heal itself. My PT told me that I could make my scar nicer and the lumpiness go away and she sounded very convincing. Still, I am skeptical [a trait inherited from my father who always said: trust, but verify], but I decided that it would do no harm. And the cocoa butter is cheap and smells nice. Instead of eating chocolate I rub it on my hip [the cocoa butter] and it does not make me fat like putting chocolate in my mouth might.
I am almost 9 weeks post-op and I am almost deliriously happy that I am able to do what I call 'marathon gardening sessions' again. Today I transplanted, finally, my Cardiocrinum cathayanum to multiple different locations. It's a tad late as it already has leaved out a bit, but today being rainy I hope it will survive. That's just one thing I did in the garden. Yippee, I love the smell of turned over soil.

 

[mystikfairy61]

@Briggieride You are making me want to plant a garden now!! After our wonderful ice storm we had at the end of January we are still cleaning up the mess that it left in its wake. So I have been outside but it has been raking etc. But still being outdoors and having the energy to do it and no pain, its FABULOUS!!!

 

[Josephine]

I can't bend my knee back more than 102°. I am still swollen and that may have something to do with it. But, right now it is disturbing to me in that I have less range of motion there than I did before surgery.

Don't worry about it. You are only 2½ weeks out yet and the body is still reacting to the trauma of the surgery. Forget about your knee. At around 3 months it will be back to normal, probably sooner.

She said that I would have the hip restrictions for the rest of my life.....no bending past 90°, no turning my toe inward and no crossing the midline of by body. Really....FOR LIFE???

Certainly not! That's a myth like so many others! The opinions on this vary so much it's enough to make your head spin! But the most prominent opinion by far is NO restrictions about anything at all! Just get back to normal life. Most surgeons' hopes are that THRs eventually become a 'forgotten hip', so how can you do that if you're forever double thinking about every little thing you do? It's impossible. So I suggest you just nod and smile sweetly when anyone says such things and go your own merry way regardless!

I have been reading up on this and am learning that a lot has to do with the ball size of the artificial joint. But not only that, although that one is a biggie, it's the approach too.

No it doesn't. It has nothing to do with anything like that, only surgeon's opinions. Besides which, no surgeon can dictate much less control what his patients do for the rest of their lives! It's simply a CYA stance (work out the acronym for yourselves!) so should anything happen like a dislocation, he can stand off and say "but I told you not to do that"! If you want further proof, read in here Stories of amazing hip recoveries.

 

[psychteach]

I can not wait to get out and play in the soil... So excited to get back to that .Just different varieties in our south Florida climate... !!!!!


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[Dmcfad2]

@Josephine There you go again, making me feel so much better! Thanks. I think I love you!

 

[Hoppy Nanny]

@Dmcfad2..... Restrictions for life..wow...that's a long time..LOL...thought 12 weeks was enough. Well, I am doing everything with my new hip...bending, twisting, crossing midline....and it's great!!!! Think Josephine is tight ..it's CYA time! Xxxxx


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[Josephine]

Josephine is tight

I'm tight? No way, I am very generous!