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THR 35 year old, THR revision surgery recovery

AdamP1985

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Hi guys,

I am new here, but have been reading the posts since December. They have been very uplifting and informative. I am posting because I am disheartened and worried about my recovery thus far. I am a 35 year old active male with no previous health issues before my initial left hip fracture that occurred on November 17, 2020. I did not go to the hospital until ten days after my accidental standing height fall. I thought that I just strained a muscle, but after x-rays it was determined that I had a displaced fracture on my femur neck. The surgeon decided to try and do a hip pinning (3 screw) operation. Unfortunately, that was unsuccessful, and after 2 weeks the femur neck collapsed. I was so disappointed, because I am actually in the Philippines, and do not have insurance. The news that I needed to have a total hip replacement surgery was shocking. Needless to say, I had no choice, and had to have the surgery if I wanted to correct the 3 cm leg length difference that developed.

I had my total hip replacement on Feb 5, 2021 by the top orthopedic surgeon in Manila, Philippines. He assured me that everything is going well, and that I am impatient with my recovery.

My question is about my limp. I waddle so badly right now, even worse than after the failed hip pinning. I am still using two crutches, and I do not really have much pain. I cannot do hip abduction exercises without struggling and without pain. So, basically, I am asking, is it normal to have a severe trendelenburg gait still after three weeks? I read all these success stories online, and I thought I would be walking without a limp by now.

Am I just being impatient, and need to stick to the PT exercises hoping that I will regain strength overtime and that the limp will be corrected with walking and exercises? Is it normal that after a revision THR that it takes a longer period of time to be able to walk without crutches? Should the waddling gait start to get better, and will I be able to regain my balance while standing on my left leg (the operated on leg)?

Thanks for any insight on this! I am also probably more worried because I am from Chicago but this bizarre accident happened to me in a foreign country, and I had to have this operation done here (plus the first surgery did not work).

I am pretty much just holding onto hope right now that I will be able to walk normally again in a month or two.

Thanks again!!

Adam
 

Layla

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Welcome! Thanks for joining us. It’s good to hear you’ve been uplifted here and found some helpful information. I’m sorry for your fall, the blow it dealt in accepting the need for a total hip replacement and that you’re feeling disheartened. Hopefully you’ll find some comfort and reassurance here through the support and encouragement of other members.

I am still using two crutches
This is not uncommon at only three weeks post op and it’s important you continue using an assistive device until you’re no longer limping.
I cannot do hip abduction exercises without struggling and without pain.
Then don’t do them right now. 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.

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 are in the very early days of a recovery that can last a full year, even longer for some. You’re young and healthy through your own admission. It’s understandable the shock you felt in learning you needed a total hip replacement. Understand that joint replacement surgery is one of the most prevalent surgeries performed worldwide. The outcomes of these surgeries have become excellent based on a number of techniques changing over the years. The implants are durable and long lasting, with longevity much greater than before offering an increase in the likelihood you’ll never have to experience this procedure again.

Please be patient with your recovery.
As you begin healing, 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.

Wishing you comfort and a big dose of patience as you move forward. Stay in touch, we’re here for support. :)

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
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. Here is a week-by-week guide

6. Access to these pages on the website

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.
@AdamP1985
 

Going4fun

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Three weeks in, I couldn't walk without a cane and a major limp.

Yes, it's totally normal to not be able to walk without a cane or a walker at three to four weeks. I got off the cane at 8 to 9 weeks. A friend of mine just had surgery with a top surgeon. She was off the cane at about three weeks to four weeks. But she had surgery a year earlier on the other hip and that time, it took six to seven weeks for her to get off the cane and even then, she wasn't walking long distances. The six to seven weeks wasn't "slow" and did not signal any problem. My eight to nine weeks didn't signal a problem, though I for sure worried that it was a problem.

You're just starting. You didn't have a cut in the finger that can be patched with a bandage. You have major surgery, cutting, slicing, hammering, stretching, inflaming tendons, nerves, muscles.

You really don't need to be trying to walk without a cane. There is no benefit from this if your body isn't healed. Walking with a cane is fabulous exercise and the best way to build up strength and balance and endurance.

How is your walking with the cane?

You know, I'm sorry, but a lot of surgeons (even some of the very best) have an overly optimistic view of recovery. Not sure why that is. But if you read on this board, you will see person after person reporting that they didn't have the right expectations for recovery. They are shocked they're still sore and stiff for weeks after the surgery. Shocked that they are not up and marching for miles immediately after surgery.
 
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Eman85

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I'd say if you've been reading the posts on here since Dec. you've read that 3 weeks is very early in recovery from a THR especially one done after a recent accident. Being young will be in your favor but it doesn't seem to make that big of a difference in recovery time.
 
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AdamP1985

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Thanks Layla,

You are the first person that has told me to stop doing things that are painful. I was trying to force myself to do these excruciating exercises, because I thought it was going to help. My therapist actually seemed to be really bad a forming a program for me. I told him that I needed to work on abduction, and then he started to assist me in the exercises that hurt me. I talked to my surgeon about this 3 days ago, at my check up and he said to forget about the therapist now, and focus on the small exercises that I learned in the hospital and on walking with the heel to toe movements.

I appreciate everyone's advice and words of wisdom. I know I am young and want to be healed up so quickly. Your information and advice is why I posted. It takes away my anxiety, and makes me believe that in time....I will get rid of this limp, and be able to walk to the store and carry groceries home again like I used to be able to do :)

THANKS AGAIN, and I am really blessed to have found a good support group here
 

Layla

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You’re welcome. I’m happy you found the forum and that it’s eased your mind.
I don’t know what I would have done without the support I found here early on. Lots of great members here ready to offer ideas, advice and encouragement. Stick with us....we’re here for you!
I talked to my surgeon about this 3 days ago, at my check up and he said to forget about the therapist now,
Best idea and hopefully you’ll notice a difference in stepping away.

Wishing you comfort and a peaceful weekend. :)
 

FCBayern

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You have to think about this recovery completely differently @AdamP1985. Most of us went into these surgeries having previously had various minor injuries that therapy and exercises helped us recover sooner from. You are not rehabbing a sports injury but recovering from major surgery. As one of our members likes to say "it's like getting hit by a car in a sterile environment". If you broke a leg, you wouldn't start rehabbing while still in a cast right? It can be hard to realize how long this recovery can be, but you definitely have a leg up (pun intended), at your age. You can't expect to bounce back overnight, and will have to be patient, but I'm betting your recovery happen faster than a guy my age. :heehee:
 

ForumUser

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Kumusta sa Pilipinas!

You are experiencing some anxiety - normal.

Getting one's normal gait back is usually a matter of disciplined walking - my wife followed me around for a couple of months and yelled at me when I limped or waddled.

PT - I would, based on my own experience, simply say no. It is, based on the experience of thousands, apparently, not important in the early days of recovery - this is a hip, not a knee.

Walk, elevate and ice, walk, elevate and ice, walk.

Skip the PT for a few months.
 
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AdamP1985

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Salamat sir :)

Thank you for the advice about the PT, and the encouraging words. I will make sure to tone down on all the PT exercises and make sure that I focus on walking correctly. Right now I can tell when I walk I am leaning to my left. This could also be because I waited 2.5 months after my failed pinning surgery till the THR. So, my mind and body are used to that limp possibly? I will definitely do the heel to toe walking and try to maintain a good straight posture, even though it is pretty hard right now and putting more weight on bad side is kind of painful.

I appreciate everyone's advice and encouragement on this site. It takes away a lot of my negative thinking and anxiety.
 

Going4fun

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Well I found that if I was using a cane, I didn't have to "focus on walking correctly." I just walked and got stronger. Later when you are healed enough to take some steps without a cane, THEN you can focus on walking correctly and all of that.

Right now, you're likely to be fine just walking with a cane. Your balance will naturally improve.

Just a thought: I am obviously not a doctor and I haven't see your walk, but I wouldn't call the walking of someone who is three weeks out of surgery ... a limp. Something about calling this a limp suggests that it needs to be overcome.

Well you will walk better but you don't have to really "work" at this. Just get out there walking.

One more time, are you using a cane?
 

djklaugh

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@AdamP1985 You may have already done this but I'll mention it in case you haven't. Are you wearing shoes that you wore frequently before your hip replacement? If yes then check the bottoms of the shoes. They might be worn down in that old limping pattern. And IF they are worn then either shift to shoes with no wear, replace soles and heels of favorite shoes, or go buy new ones. That old pattern could keep you walking in a not helpful way and can contribue to various aches and pains that you do not need.
 
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AdamP1985

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Hi Going4fun,

Thanks so much for your wisdom, and advice. I am using two crutches when I have to walk any type of distance that is further from the bathroom or to the fridge. Otherwise, I just use one crutch. My doctor said that I can start to use just one crutch (he said that this will be just as good as a cane for me, and that I dont need to purchase anything else). Would you suggest that I get a cane instead of using one crutch? I have noticed that when I use the single crutch that I am very crooked when standing, as I lean towards my strong leg. I am kind of nervous about falling over or slipping with a cane. As far as my walking goes, there is not much pain, but I am pretty sore if I go for a 20 min walk around outside thus far.

So, yea I am using one crutch sometimes and two crutches when I have to leave the house (which is very seldom). Usually I practice walking just up and down the hallway in my condo unit with two crutches. I was using one after two weeks from surgery, but then my doctor said that it is too soon because my surgery was more complicated since it was a revision and he had to correct the length issue with my legs.

I go to get my second consultation on March 17th, and get xrays to check the implant's positioning. He said that he will decide after what I should be using then. I assume he will say to continue using one crutch, because the way I am so off balance and cannot stand on the left leg solely, that walking unassisted in not really going to happen as soon as I hope.

THANKS AGAIN for you help :)
 
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AdamP1985

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Good idea Djklaugh, I have been using the same gym shoes since my failed revision surgery. They might be favoring the limping pattern. I have a new pair of shoes that I have not worn yet, so I will change to them when I need to walk. THANKS FOR THE ADVICE!
 

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Yes.. get new shoes with good arch support and use a four wheel Walker with seat. They are very handy come with brakes. Walking with heel to toe gait very important to train the body and brain of proper use with new shiny joints. In a few weeks it will all come without a thought.
that was the most important lesson I learned from a very difficult revision.
 

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Salamat,

I kept a day by day thread following my 14 May 2019 second hip replacement.


While healing is different for each of us, at 22 days I was pretty mobile without cane or crutches ... had to reread to confirm.

Can you tell us a bit more about walking?
 
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AdamP1985

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Well, I am supposed to be using two crutches still (I have an uncemented implant ceramic on ceramic), so the doctor said it is important to not put full weight on yet. So, I can walk easily and pain free while using crutches or one crutch. I know I am not supposed to be walking unassisted, but I wanted to give it a try in the mirror. It is a really bad trendelenburg gait, where I really kick my hip out one way and my shoulders dip the other way. The doc said that it will go away eventually and to not worry. I just dont like that it seems to be worse than it was before the surgery, when I had a longer right leg compared to my left. There is no way I can really walk anywhere without using crutches right now. I can waddle to the bathroom, it doesnt hurt, but the balance is way off and I think it might be doing me more harm than good (or I should say I know that it is not good to do this right now).
 

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Hey there. Gosh what a journey and overseas too. I'm 41 and pretty much 6 weeks post uncemented ceramic on ceramic. My gait has suddenly improved at about week 4-5 and now at nearly 6 is way better than pre op which was pretty waddley. I had osteo rather than an unhealed fracture though so you need to remember about the original injury too. I have just started the One Step physio type app that I was asked to join somewhere on this forum. Not sure if you'd be interested in that or if its available to you. Gives exercises and analysis of walk and gait. Quite interesting. Keep on using whatever walking aids you need too. .is definitely not gonna harm you and must keep you more balanced surely.
 

Eman85

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I see someone gave you the tip about new shoes. Every OS has a different plan, my OS didn't recommend crutches or even a cane he recommended hiking poles. I used a cane and a walking stick when I would venture out.
I found something that worked well for me. I would go to Walmart and park next to the furthest cart corral that had a cart. I'd take that cart and walk using it as a walker and I could concentrate on my gait at a slow pace. The parking lot and the store provided flat solid ground to walk on, I live in the mountains and my road and land are not flat. I could walk the perimeter of the store slowly and take breaks as needed leaning against the cart. The cart offered protection and good support.
 

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There is no way I can really walk anywhere without using crutches right now.
I can waddle to the bathroom, it doesn't hurt, but the balance is way off and I think it might be doing me more harm than good (or I should say I know that it is not good to do this right now).
You need to keep on using two crutches until you can walk properly with only one. Walking without support at this early stage is likely to slow down your progress towards walking straight. You don't want to form a new bad habit.

There is no need to feel pressured to give up the crutches, or to use a walker or a stick. Your surgeon has told you to continue with the crutches because they are providing the correct support at this time.

For those who recommend a walker - crutches are used by some surgeons instead of a walker.
 

Jamie

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Well, I am supposed to be using two crutches still (I have an uncemented implant ceramic on ceramic), so the doctor said it is important to not put full weight on yet.
Adam....if you are trying to walk without your crutches or using one crutch instead of two on an uncemented hip, PLEASE STOP! Your surgeon told you to not bear weight on your new hip joint for a reason. With an uncemented hip joint, your bone tissue must grow into the surface of the implant properly to make a good bond. Even small movements when you weight bear can disrupt that growth process. If you do enough of that, it's possible for the joint to weaken and come loose. If that were to happen, your hip would need a revision joint replacement. So, please....take it easy at least until you see your surgeon in March. Don't push things. Use both crutches and let your body heal. This is temporary and you will get better if you follow your surgeon's guidance 100%. When you see your surgeon, ask about walking aids and weight bearing. Then follow his guidance. Once you are cleared to fully weight bear, we have a partnership with an excellent company called OneStep. As part of our pilot, you will be able to use the app and have the services of a therapist and a personalized exercise program to improve your gait and strengthen your hip. This program is unique in that the app is able to constantly analyze your gait and track progress as the exercises help normalize it.

If you'd like to participate in this pilot, please tag me once you're cleared and I'll get you set up. There is no charge for this program. To tag me, you type my username with the "at" sign in front of it (no space)... like this ..... @Jamie . You'll know the tag worked when you enter the post because the tag will turn blue.
 

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