THR 18 Months Post Hip Replacement Question

[Poppet]

Welcome @TJCal - I am 2.7 years post and I have found as I increase my level of activity I experience a niggle here and a niggle there - I am a Natural Medicine Practitioner and understand the healing timeframes very well and have found that I suffer from soft tissue aches.. It is different for everyone.. You might find these articles interesting

The following is a link to an article which provides the current science regarding the healing beneath and around the implant and approximate timeframes for the healing phases and processes and the relevant nutritional information for each phase.

Healing Phases & Nutrition

This second link is to other nutritional articles which you may find interesting, including one relating to bone health.

Nutritional advice for pre op and recovery

 

[Josephine]

@TJCal I'm so sorry not to have stopped in here before but I've been a little under the weather!

is a 38mm CoCr ball on a titanium stem. This seems to be a time tested combination. What is the risk that this could be a problem? Should people with this type of implant get checked regularly for metal ions in the blood? Is it correct to assume that all metal implants have some corrosion when placed in the body?

Well I can understand your worries but I don't think you have any real cause for concern as the principle reason for problems is hips that have a metal head and a metal socket - what we call metal on metal or MoM. Since you don't have this, I really wouldn't worry.

However, if you do wish to inform yourself about this issue you should read these articles
Metal-on-Metal Hip Implants: FDA Safety Communication
Metal-on-Metal Hip Replacements: Solving The Uncertainties Dec 2011
Metal on Metal ion levels: safe upper limits for MoM hip resurfacings set by scientists
Metal-on-Metal issues and DePuy recall: regulation of joint prostheses in Australia
Metal on Metal warning (old but ongoing news) (thread in hip pre-op forum)
Metallosis: what is it?

I am assuming that corrosion problems at the taper part (where the ball attaches) are not very common. Is that correct?

You are correct.

Also, does a 38mm ball mean that I will have more corrosion?

Not at all

Lastly, I am a big guy, does that matter? Will I create more corrosion or wear the thing out faster?

Not in the least!

Although my recovery has gone well, I still feel some occasional sensations/discomfort in the thigh and hip. It can happen randomly. If I start on a walk, it may start a little bit, but disappears after a while. Can this be normal?

Just to dot all the i's and cross all the t's, let me ask you to tell me the exact site of your pain using this chart.

Please note the instructions in the smaller image

 

[TJCal]

Thank you @Poppet. I really appreciate your time and input. I will read the articles. Thanks!

Thank you @Josephine. I hope you are feeling better! I feel it is an honor and privilege to be able to be here and interact with all of you wonderful folks. You all really are angels for what you do.

To your question on discomfort location -

Things come and go, and nothing is really consistent.

This week I have felt some things at: CL6F, BL6F , CL2B and sometimes CL5F. Minor and random

A couple of weeks it was GL4F / FL4F. Again, random and minor. I would feel nothing after walking 10 minutes to an hour. I can bike 8 to 10 miles with no discomfort. Really not much at sleep or rest. I was just concerned because I heard of the "forgotten hip" and did not think that I should feel anything. That, and concerns about corrosion, created some anxiety. Let me know what you think.

Thank you again to everyone. Your kindness and generosity means more than you will ever know!

 

[TJCal]

Hi @Josephine. I forgot to mention that at my 1 year checkup the doctor said the x-rays look great and I had a friend that is a radiologist look at them also and verified that all looked well. Just some additional information in case you needed it. Thank you very much!

 

[Josephine]

so these are the areas of your discomfort?

I also need to ask you these question
I'm going to ask you some questions and it would be very helpful if you would answer each one individually in as much detail as you can then I'll come back as see where you are ....

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

2. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

 

[TJCal]

Hi @Josephine -
Not really feeling anything in the F, G areas this week. Mostly at CL6F and to the side of that. I should also quantify the discomfort as between 1 and 2 out of 10. I also sometimes feel it in my lower back after a day of standing or walking.

Well, for activity I work at a desk job , but I am out and about meeting with clients. I shop, go here and there. I either bike 8-10 miles a day or walk for 45 minutes in the evening. I live in apartment, so no yard work. I pretty much go and do what I need to do. Sometimes I will walk for an hour or two.

With regard to exercise, I mostly bike and walk. But I also do other following occasionally:

Straight leg raises maybe once a week (sometimes twice) - 3 sets of 10 each side
Side Leg raises standing or lying once or twice a week - 3 sets of 10
Rear Leg extensions standing once or twice a week - 3 sets of 10
I also occasionally do other things such as bridges, heel slides, lying lateral leg movements, knee lifts, etc. usually a set of 10. I also may balance on one leg for 20 seconds.

 

[Josephine]

Straight leg raises maybe once a week (sometimes twice) - 3 sets of 10 each side
Side Leg raises standing or lying once or twice a week - 3 sets of 10
Rear Leg extensions standing once or twice a week - 3 sets of 10
I also occasionally do other things such as bridges, heel slides, lying lateral leg movements, knee lifts, etc. usually a set of 10. I also may balance on one leg for 20 seconds.

For what purpose are you doing all these exercises?

 

[TJCal]

Hi @Josephine - I am doing the exercises to strengthen my leg. Although, when I went for my checkup my OS did strength tests and said all was good. I read somewhere (before coming here) that people are not aggressive enough doing PT after hip replacement and should be done 3 times a week forever. Sometimes the info is conflicting and confusing out there. Of course, that is why I am here. Thanks so much!

 

[alexthecat]

It's not necessary to continue doing PT exercises forever after THR. If you're normally active, that should be adequate. I'm more than 4 years post-op and haven't done PT exercises in years. My hip works just fine.

Sent from my XT1060 using Tapatalk

 

[Josephine]

That's is so much - loads of round objects! (I'm being polite!) In actual fact the opposite is true. I have seen more cases on here of chronic tendinitis caused by over exercising than anything else.

You can do gym work but those exercises are definitely what is causing your discomfort

Side Leg raises standing or lying, knee lifts can cause blue area problem
Rear Leg extensions standing, lateral leg movements can cause the yellow area problem

I suggest you take two months off all exercises except walking and see how things are then. And I mean two whole months, 8 weeks!

 

[TJCal]

Hi @Josephine- Very good. I will do it! Just to be clear, when you say gym work, does that mean everything but these exercises? I am glad to hear that you do not think that it is an implant issue.

One last follow-up on the other topic - So based on my type of implant, I do not need to request metal ion testing as part of routine checks, correct? My OS said no, but I really value your opinion too.

Thanks again for everything!!!

 

[TJCal]

It's not necessary to continue doing PT exercises forever after THR. If you're normally active, that should be adequate. I'm more than 4 years post-op and haven't done PT exercises in years. My hip works just fine.

Sent from my XT1060 using Tapatalk

Hi @alexthecat . Thank you so much for your input. I really do appreciate it. Have a nice weekend!

 

[Josephine]

In my albeit limited experience, gym machines don't seem to cater for those kinds of exercises! I was thinking things like treadmill, stationary bikes, leg presses (low weights!), maybe a rowing machine and all the upper body stuff you can stomach!

And no, I don't think you need to worry about the MoM issue. Good news, eh?

 

[TJCal]

Hi @Josephine - You (and everyone here) are just amazing! I can't thank you enough! I will follow your advice and trade in the leg raises and lifts for tricep presses and bicep curls. Thanks again, have a nice weekend, and I hope you are feeling better. Take care.

 

[Rebecca65]

I'm not sure if this in any way addresses your problem, and I am only 10 wks out of TRHR, but here goes. I have a cleaning business and was 5 years working with bone on bone. I have one of those jobs where unfortunately if you don't work you don't get paid. My body got used to limping around and hitting the bed immediately after work. I knew eventually it would have to end and I would somehow have to find a way..I am fortunate to have 3 sons, one of whom was able to help me out financially. That was difficult, as I've been alone and independent for many years. I think somehow I thought after that 2 months initial healing, I would be able to go back to work and problem solved. I didn't really think about the emotional part of having to depend on other people, and all the down time alone with just me and the pain. I have suffered many losses in my life and have spent many years in counseling and the words of a wonderful counselor have come back to me during this time. I suffer from emotional post traumatic stress and have been reminded that whenever I'm stressed my symptoms come back, and the way I handled that pain prior to therapy comes back. I can be triggered by something as innocuous as a smell. I've found that all the losses I've suffered in my life tempt me to focus on one thing I think is bothering me, when it is actually something altogether different. I have learned to be who I am and wait it out and eventually it surfaces. I'm certainly not a therapist, but grief comes out in many ways and takes many forms. Your hip sounds as though it is healed and I'm looking forward to the time I can walk a mile with only a twinge. Good luck to you and believe it or not your post has been very helpful to me....Rebecca

 

[TJCal]

Thank you @Rebecca65 for taking the time to respond and share your story. I found it very helpful. I am sorry for your losses. I completely understand your situation with regard to work, as I was bone on bone for 3 years while being self-employed, and had to work. You sound like a very tough lady and you are an inspiration. I really appreciate your thoughtful post. I look forward to hearing about your progress and wish the very best. Take care and have a nice weekend.

 

[Peaches]

Hi, @TJCal ... I am about 14 months out from my first hip replacement. I have been completely baffled by this "forgotten hip" concept I keep reading about. Obviously I have not forgotten I had the surgery or I would not be coming back to beloved bonesmart, which helped me SO much in the early weeks and months. I know for certain I will never forget bonesmart (a community truly unique not only in the people who post here and how frequently they post and respond and unique in the medical expertise from Josephine and the moderators). I've wondered so often about "the forgotten hip" that I have wanted to start a thread in the social room asking people what do they mean by that concept as I'm sure it must mean different things to different people. However, I sometimes think things get "lost" when they get posted over there, am not sure people go to that thread too often?

Anyway ... no, I have never forgotten I had the surgery (duh) and think about the new hip daily. By this, I don't mean I have a sensation or "feeling" that the implant is in there. I think about the hip when I walk because I think I am still blown away that it doesn't hurt and that it works so well.Maybe I can't believe and am still "testing" it? I also am frequently using the good hip as a benchmark to test the other hip, which has had periods of feeling bad and had me worried it's time for a replacement. I have a very bad back, too (not muscle pain; structural pain), so I think being conscious of the operated hip and how pain free it is just makes me not stress out as much as I would about the back. I keep thinking, well, at least I have one good hip and I am SO glad I had this surgery."

Like you, I also have developed some phobia about it. I was so busy recovery from the surgery and restrictions that I didn't think a lot about infections or dislocations. Now, I do think about it more than I thought I would. Infections especially. I don't know that that's a bad thing. I think it keeps me aware and cautious (in a good way). Maybe I'm trying to rationalize too much, too. Anyway, you are not alone in your feelings. I hope that's helpful. Take care.

 

[alexthecat]

I see my "forgotten hip" as being similar to my "forgotten dental fillings". Of course, they are there and I remember the details around when and where I got them. I don't spend much time thinking about them though. They don't impact my daily life at all and I don't remember they are there unless I have a specific reason to.

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[Josephine]

Alex, thank you for putting some kind of common sense approach to this term! The "forgotten hip" is a figurative term meaning people are pretty much back to their normal mode of life. it does NOT mean that we've done some kind of hypnosis on patients to make them forget they've ever had surgery!

I also think about my knee almost every day - every morning as I put my legs out of bed, look down at my knee and seethe scar, actually.

What is does NOT mean is that I have to think twice about doing things like walking anywhere, doing stairs, gardening, climbing up a set of steps, climbing onto a chair to put up curtains, etc., etc., etc.,. THAT's a 'forgotten' joint replacement!

 

[TJCal]

Hello @Peaches. Thank you for posting. Yes, I too am concerned about infection, so I am more careful than I used to be. Of course, a "forgotten hip" does not mean that you will forget that you had a hip replacement, but I think that it means you don't think about your hip much with any special concerns. That is not me yet. If I get a ache or a twinge, I get concerned. If a get a scrape or a pimple, I get concerned. I would like to get to a point where those issues are not a concern, but I think that I will always be more cautious than I used to be.