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[THR] 4½ months post op, pain, limp, popping noise<

Discussion in 'Hip Replacement Recovery Area' started by Mtnmama, May 2, 2016.

  1. Mtnmama

    Mtnmama Junior Member
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    I am almost 5 months post op, left hip replacement. I still have pain and weakness in my left leg. Some pain feels like muscle pain. I have a popping noise when I do leg lifts, and occasionally when walking. I am having difficultly sleeping because of the pain in my left hip, but I also require right hip replacement. Just can't get comfortable.

    I can ride my bike for about 20 miles and feel pretty good while riding but walking is a whole different story. Sitting is very uncomfortable so this is impacting my job. I went to 20 sessions of PT that was done in a warm pool but ran out of therapy through my insurance.

    The surgeon has taken x-rays and said that everything looks ok. I have no idea where to go or what to do but this is worse than the before surgery pain. Any suggestions would be helpful.

    Thanks
    Lori
     
  2. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Hi, I see you don't seem to have started a recovery thread. Lots of posts but all in other people's threads!
    I looked back to see if I could get a picture of your recovery but I couldn't.

    Anyway, you mentioned exercises: may I be so bold as to ask you about these? I'd like to ask you these questions if you don't mind, and it would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

    1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

    2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! :no-fin:)

    3. are you taking any pain medications? If so what, how much are you taking (in mg please) and how often?

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

    8. what kind of PT exercises and exercises at home are you doing? How much and how often?
    This is the most crucial question so please help me by using the format I have left as an example (which means please make a list and not an essay!)

    Exercises done at home: (enter number) of sessions each day
    enter exercise + enter number of reps and sets
    enter exercise + enter number of reps and sets
    etc., etc.

    At PT
    enter exercise + enter number of reps and sets
    enter exercise + enter number of reps and sets
    etc., etc.
     
  3. Mtnmama

    Mtnmama Junior Member
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    Thank you so much for your quick response. No, I didn't post about my recovery. It seemed pretty normal at first but I just have not gotten better. I hope it was okay to copy and past your questions and follow with my answers.

    1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

    I had a lateral approach.

    2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery! :no-fin:)

    My pain levels range from 3-8. It is most painful when I sit too long or when I lay down to go to bed.

    3. are you taking any pain medications? If so what, how much are you taking (in mg please) and how often?

    We have tried a variety of pain medications without much success. At this time, and for the last 2 weeks, I am taking 500mg of Naproxen twice a day, and Tylenol in between. I had been taking 5mg of Oxycodone but it made me very depressed so I had to stop. It wasn't that helpful for the pain.


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

    I do light housework, cooking, and shopping. I have someone do the heavy housework. My job consists of some desk work and driving to nursing homes and walking throughout the facilities checking on residents.


    8. what kind of PT exercises and exercises at home are you doing? How much and how often?
    This is the most crucial question so please help me by using the format I have left as an example (which means please make a list and not an essay!)

    Exercises done at home: (enter number) of sessions each day
    Walk dogs 1/2 mile once per day 4-5 days per week
    1 mile walk during the day at work 3-4 days per week
    leg lifts 15 once per day
    Clam exercise 15 per day
    Side leg lifts - I can't do this one yet but I make attempts
    2-3 mile light hiking once a week if the weather allows, with use of cane.
    20 mile bike ride once or twice a week, not much incline
    If I can't ride outside due to weather I go to spinning twice a week for one hour.


    When I make a list it looks like I do a lot but prior to surgery I did 10-15 mile hikes several times per week at high altitudes, shorter hikes after work, 60 mile bike rides and ran with my dogs. I have found without the exercise I get depressed. For two months I did practically nothing.

    At PT
    Currently no PT
    I did 20 sessions of PT, Warm Water Pool Therapy but my insurance ran out of PT benefits.

    I hope this answers your questions sufficiently. If I have missed anything please let me know.
    Thank you for your time!
    Lori
     
  4. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Okay
    You haven't told me how much Tylenol you are taking and how often. This is important if I'm to advise.
    Okay

    My comments in bold
    Exercises done at home:
    leg lifts 15 once per day, Clam exercise 15 per day, Side leg lifts - why? You are 20 weeks out, back at work and doing a healthy amount of walking! Plus the SLRs, clams and side lifts are just destined to give you ITB (ilio-tibial band) issues! I suggest you stop doing all these!

    Walk dogs ½ mile once per day 4-5 days per week
    1 mile walk during the day at work 3-4 days per week
    2-3 mile light hiking once a week if the weather allows, with use of cane.
    20 mile bike ride once or twice a week, not much incline
    If I can't ride outside due to weather I go to spinning twice a week for one hour.
    that's a fair bit of exercise! But it's the right kind so do carry on!

    What you did pre-op is irrelevant now! But no way do you need the ones I've crossed out as they are not 'normal' activity!
     
  5. Mtnmama

    Mtnmama Junior Member
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    I take 2 650mg (1300mg) twice a day, the first one 4 hours after the Naproxen and the second 4 hours after the first one.

    I am more happy to give up the exercises as you suggested! I seemed to me that I would need to strengthen whatever muscle is weak and prevents me from doing the side leg lifts but perhaps that will have naturally as I continue to do my normal actives.

    Thank you,
    Lori
     
  6. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Ah well you're not taking the Tylenol to best effect then. This drug only remains active in the system for about 4-5 hours, no matter what dose you take. Therefore it's better to take 1,000mg every 6 hours. And you don't need to stagger that and the naproxen. Take them both together! Otherwise your life exists of constantly taking pills! Very boring!

    And yes, you are correct when you say that normal activity - especially as much as you are doing! - will take care of any further strengthening your muscles require. Though to be honest, if you can spin for an hour, there ain't much wrong with them in my eyes! :heehee:
     
  7. Mtnmama

    Mtnmama Junior Member
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    Given that I stated that the pain is impacting my job and I'm unable to sleep I disagree that "there ain't much wrong with them". I limp, still use a cane and am in pain. Thank goodness that my surgeon was not as dismissive as you are when I saw him today. He was able to assure me he will get it resolved.

    Thank you for your time.
    Lori
     
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  8. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    I'm so sorry - by the time I got to that part, I'm afraid I forgot the start of your thread. I wasn't trying to be flippant or dismissive as much as encouraging! I do hope your surgeon can get it resolved.
     
  9. Hip Hip Hooray!

    Hip Hip Hooray! Post-Grad

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    I'm sorry to hear that you are having such a hard time. I think that you are causing the pain through too much exercise. I hope you don't mind me giving you some advice. I would stop the clamshells, all leg lifts, and cut down the hiking/walking. 20 miles on the bike also sounds very excessive to me. I know you said that you get depressed if you don't exercise, but hopefully you can find enjoyable activities that replace this need. It's also important to release any grief and emotional pain by crying, talking with someone, or writing in a journal. I believe if you do a very moderate amount of exercise, you can heal, and not have pain while walking or sleeping. If I did what you are doing, my hips would be burning and stinging. It takes a long time for the tissues to heal. If you aggravate the ligaments, tendons, and soft tissue like you are doing, it's likely that you will have chronic pain.

    Please take care of yourself. Many of us had to have this surgery because exercise was an addiction. I was so hard on my body as a professional dancer that I wore away all of the cartilage in both hips. I want to exercise more, but I don't. I've realized that doing my chores, walking a mile and a half on flat ground, and the very basic PT exercises is plenty. It's a different life after this surgery. I am now pain free, as long as I don't overdo. It's such a relief to sleep at night. I believe you can achieve the same results, but only if you change your workout habits. I wish you the best.

    Exercise to us can be like a drink to an alcoholic.
     
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  10. Mtnmama

    Mtnmama Junior Member
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    Thank you Hip Hip Hooray. I have cut back on everything and am only doing what is necessary without any change. I'll give it another week but after that I'll live with the pain if necessary in order to live my life doing what I love. I know 20 miles on a bike sounds like a lot to those who don't ride but it's only a 30-40 minute ride, at most. I had a MARS today and will get the results soon. The surgeon is concerned about a muscle tear or seperation. He has said that we'll work on this until I'm back to my previous activity level. After seeing him I'm feeling hopeful that there will be a resolution. He has worked with competitive athletes and has an understanding of the importance this is to me.

    I hope you're able to get back to dancing, at least at some level!

    You're right.....exercise can be an addiction, but a healthy one. :)

    Thank you again.
    L
     
  11. Hip Hip Hooray!

    Hip Hip Hooray! Post-Grad

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    Hi @Mtnmama, It does sound like a muscle tear or separation. Best of luck to you.
     
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  12. Mtnmama

    Mtnmama Junior Member
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    I wanted to post an update. It has been over a year since my first hip replacement. At 5 plus months post op I was increasing my exercise and my pain level shot through the roof. I could not sleep, I could not work, I could barely get through a day, going to the grocery store was awful. I had groin pain, pain down the front of my leg, pain when I walked, pain when I sat. Everyone's answer to the situation was to back off exercise but my reason to have the replacement was so I could resume hiking and biking at levels I enjoy. Luckily my surgeon realized something was wrong and sent me for a second opinion. The second surgeon was a sports medicine doctor and his PA knew right off what was wrong and sent me for a steroid shot in my iliopsoas bursa. The pain was immediately removed which was wonderful but also indicated that there was an issue with my psoas muscle. The second surgeon scheduled surgery for several months later as I had a trip to Alaska scheduled and we hoped the steroid shot would see me through and it did!
    The surgeon found a 10mm bone spur that had been left behind which was shredding my psoas muscle with every step I took. They repaired the muscle and lengthened my IT band. The pain was immediately gone after surgery!!! It has been 5 months and I have almost regained the strength in that leg. Two months after the surgery to repair my first hip replacement I had my second hip replaced. I still have a slight limp but am riding 20 plus miles on my bike and am hiking Colorado mountains again. I have a ways to go but will get there!
    I wanted to share my experience because I know there are others whose pain never gets resolved. I would encourage you to not give up.
     
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  13. Hip Hip Hooray!

    Hip Hip Hooray! Post-Grad

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    Hi @Mtnmama, I'm so glad to hear that you got that problem resolved. No wonder you were in so much pain. It's wonderful that you are hiking and biking again. Those Colorado mountains are just beautiful. Congratulations.
     
  14. Jaycey

    Jaycey Moderator

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    What a great update @Mtnmama ! Well done on getting that second opinion and being persistent! So happy you are finally seeing the benefits of your surgery - and getting your life back!
     
  15. Sunny girl

    Sunny girl Senior

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    Thank you for sharing your experience and for the invaluable update. It just goes to show that when something is not right, or persistent, the best route is to get a professional investigate straight away @Mtnmama. A good reminder. Opinions and advice can only go so far. The pain must have been terrible with a shard of bone left behind. So pleased you had a thorough OS who did the right thing by you.

    So you are three months post second THR and already smashing it in the ranges! Good for you. Your love of exercise and the great outdoors is a massive part of your life (as it was mine) and is inspirational for those of us who want the full experience back. I'm waiting on hip 2, so in LIMBo with my recovery and physical progress for hip 1. Hip 2 can't tolerate anything. Thanks again for your post - makes me think that it WILL be possible to regain my previous life.
     
    Last edited: Jan 23, 2017
  16. OUCH!

    OUCH! Senior

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    Thank you so much for coming back with this update. I'm 5 months out from hip replacement and 2 months out from knee replacement. My knee is starting do well and I would be able to do more, but I am still having so much pain from my hip that I am really getting discouraged. I am not as much of an athlete as you, but I NEED to get back out into the woods with my dogs. Its depressing to feel so limited.

    My PT today figured out my issues are likely my IT band but I also have pain in the front of my thigh/groin, so if things don't improve after some more work with the PT, I will go back to the surgeon.

    Your update helped me feel like I"m not going crazy. Thank you!
     
  17. oh2sew

    oh2sew Junior Member

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    Did (or would) a bone spur show up on an x-ray?

    I am "fighting" my OS with a similar situation. He is blaming my groin pain on the fact that I have a bad L4 disk (I don't have any back pain) Like you, the reason to have the replacement was so I could get back to the activities that I love. I keep thinking it is my iliopsoas bursa and/or muscle based on this article that I found:

    Iliopsoas inflammation causes pain in the groin, particularly when the knee is lifted up towards the chest against resistance. There may be a sensation of tightness and swelling in the groin, especially if the bursa is involved. The athlete may enter a cycle of pain where the pain disappears during training only to recur worse after exercise stops.

    I am so happy that you are back doing what you love! Congratulations!
     
  18. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    @OUCH! let me tell you - or rather remind you - that your hip could care less what you 'NEED' to do. It's a like a newborn baby - it only knows that it hurts.
     
  19. Mtnmama

    Mtnmama Junior Member
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    @ouch, @oh2sew I'm addressing both at the same time as I'm typing on my phone. Little keys. I had excruciating groin and thigh pain, lacked range of motion. The bone spur did not show up on an x-ray. My x-rays looked good and the original surgeon did not have a clue as to what was wrong but he knew something was. I went to PT, I tried pushing through the pain and I tried rest. Nothing worked. The surgeon that I was referred to knew right off what was wrong. The first step was a steroid shot in my illiospoas bursa. Having the shot was uncomfortable but not too painful, but by then I was in so much pain I don't know if any additional pain would have mattered. By the time I walked to the car I had relief! By the time I got home the pain was almost gone. The relief was tremendous. The shot was for diagnostic purposes more than pain relief. The pain relief indicated that my illiospoas muscle was being impinged or irritated and another surgery was in order. My surgeon, Dr. Haung, was able to do the surgery arthroscopically but the recovery has not been easy because of the damage to the illiospoas muscle. I still have a slight limp and minimal pain that increases with strenuous activity but I feel confident, and so does the surgeon (both) that I'll recovery fully. It's taken a lot of self-discipline and often moments of complete frustration to keep pushing myself! Don't give up! If your surgeon keeps saying the x-rays look good but you're not feeling right see a sports medicine orthopedic surgeon.

    @Sunny girl, good luck on the second hip! I did a 4 mile hike with my dogs yesterday. Nothing like Colorado sunshine for the spirit! I'm sore today but it's muscle soreness that actually feels good. Today I'm going to clean house and do yard work. For those of us unable to do our chores for a long time know there's joy in being able to! You'll get to where you want to be soon.
     
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  20. oh2sew

    oh2sew Junior Member

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    Thank you for your reply and explanation @Mtnmama. My surgeon (fortunately or unfortunately) is a sports medicine ortho. He does not even want to entertain the thought of it being the iliopsoas muscle (or any muscle for that matter) just because the x-rays are OK. Even at PT when they massaged the area, they told me that it was the pectineous muscle. I went to my naturopathic doctor and was talking about the symptoms. She immediately said that it sounded like the pectineous muscle. (Although both indicated that the psoas could be a possibility).

    I know that I'm only 9 weeks out, but am now wondering if it is too soon to seek a second opinion from another surgeon vs. waiting to see if PT can work it out.... I feel like I'm stuck because whatever the muscle issue is, it's tough to do any type of rehab - even if it's just walking.
     

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