THR 50 year old male's recovery

[toughstuff]

I’m 4 weeks out from a total right hip replacement. This recovery has been way tougher than I thought. It was a lateral approach with the incision basically parallel and a few inches below the belt line.

I still use Vicodin most days as stated by the surgeon for pain relief. (This scares me a little)
I have not used any assistive devices to walk since day 10. I can walk with little or no issues. My issue is muscle pain / soft tissue pain. I just can’t seem to get a really good day yet. I’ll have an ok day and then a really sore day. I keep being told this is due to being in shape and having good muscle mass. The team tells me that this creates a lot of tension and more effort needed during the repair and hence more pain.

I have read a lot on here already but I’m really in need of a few good opinions about when I will see the hip
Musculature calm down. 4 weeks feels like a lot of time. I try to just walk given what I’ve read here about PT and how it is counterproductive. Am I close to the muscles being healed enough to reduce pain? Thanks

 

[Layla]

Hi, Welcome to BoneSmart and Recovery!
Following you'll find the Recovery Guidelines. Please read the articles as you may find some beneficial info you've missed while perusing the forum. I'm sorry you're struggling and concerned about the Vicodin. Possibly it's time to touch base with you're surgeon again regarding exactly what's bothering you most and expressing your concern over the Vicodin. You're not alone in suffering pain or dealing with discomfort at four weeks post op. There was a lot disturbed beneath the skins surface during that major surgery and it will slowly ease as you progress through the healing process. I wish you comfort as you continue the journey.

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
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​

6. Access to these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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. @toughstuff

 

[toughstuff]

I’ve looked at the recovery graph.

Can anyone help me get a sense of when they experienced some real relief in the muscles of the hip?

The joint doesn’t bother me at all. It is my butt in the general area of the incision and my muscles high on the front thigh. I am extremely active and want to get back to that busy life. At the moment sitting around way too much for being 4 weeks out in my opinion.

 

[Layla]

I really sorry that I can't give you an answer on that, but I'm wondering if you've raised your concerns with your surgeon. Have you had your post op visit yet? Please consider calling and leaving a message for your surgeon's PA to return your call offering some insight if you don't receive any here.

Unfortunately you may have to lower your expectations. There's no rushing this recovery. It does take patience and we all find it difficult to muster it up at times. It gets long, boring and uncomfortable many days. But it is temporary and you will get through it.
I hope you have a good day!

 

[Layla]

Just curious, are you engaging in PT, or exercising daily? If so, you could be doing something to exasterbate the situation, rather than helping it. Something to ponder if you're engaging in that way...

 

[toughstuff]

I had a return at 2 weeks at which I walked in with no cane and he said you look great. I think it’ll take you more time than others to recover due to the muscle tone. This is counterintuitive to me but that was his statement. As far as the pain med, he is a huge proponent of using the pain med on schedule for 8-12 weeks until healing occurs. Something must have been cut off near the trochanter for access to the hip and then reattached because that is where I really hurt the most.

 

[Jaycey]

@toughstuff I am afraid your expectations are not realistic. At only four weeks out you should still be resting, icing and elevating. Perhaps you gave up your walking aids too early. Even that muscle and soft tissue pain can be eased by taking some weight off that new hip.

It is my butt in the general area of the incision and my muscles high on the front thigh.

Are you icing these problem areas. Icing for at least 45-60 minutes several times per day will decrease the internal inflammation that his causing this pain.

At the moment sitting around way too much for being 4 weeks out in my opinion.

Full recovery can take up to 12 months or more. All depends on how long you limped around pre-op and on the skill of your surgeon.

You will get back to your active life. Give that hip time to heal. It needs far longer than 4 weeks!

 

[toughstuff]

I did attempt the PT route but quickly learned how rough that was. That can really set you back a few days. That’s actually how I found this forum, I was searching about PT for hip replacement.

 

[Layla]

You can request your surgery notes if interested...

 

[Layla]

did attempt the PT route but quickly learned how rough that was. That can really set you back a few days.

Wondering if this is your problem? You've entered what we fondly refer to around here as the ODIC (Over Did It Club) and depending upon how you "over did it" you may still be dealing with the after effects. I'd ice as Jaycey recommended above, rest, and set PT aside for now. Let some more healing take place first. Like another month to two at least. Try it! What do you have to lose but the pain.

 

[toughstuff]

Layla,

Is your right hip pain free now?

 

[Eman85]

Take your downtime and read plenty of recovery threads on this forum. You're 4 weeks out, just the beginning, I know that's not what you wanted to hear. It's a lot of trauma and your muscles are going to slowly recover. At 1 1/2 years I still see improvement. I like the part about your muscle mass, I think Dr.'s use this both ways you're either too fit or in too bad a shape. It really doesn't seem to matter as far as the recovery goes it takes time either way. You'll see a pattern too, you'll have good days and do a lot and then for some reason the next day will be bad.

 

[Layla]

Layla,

Is your right hip pain free now?

Yes, pain free, but I'm 26 months post op.

I understand your impatience and discouragement to a degree, but it's very early days for you in the whole scheme of things. Hopefully you'll have this prosthetic in place for your lifetime.

 

[Going4fun]

I still use Vicodin most days as stated by the surgeon for pain relief. (This scares me a little)I have not used any assistive devices to walk since day 10. I can walk with little or no issues. My issue is muscle pain / soft tissue pain. I just can’t seem to get a really good day yet. I’ll have an ok day and then a really sore day.

@toughstuff, I also had a side approach, my doctor calls it anterolateral ... Sorry to hear of your frustrations ... I had to re-read your sentences above several times ... Because muscle and soft tissue pain and weakness and soreness afterwards (sometimes during) ... WAS my recovery. That is the recovery. Soft tissue is damaged, stretched, cut, pulled and all of that during surgery--no matter the approach. And it's the soft tissue that is healing. Yes, there is fusion of the device with bone going on ... but that process doesn't cause pain as I understand it.

So, if you're in pain after walking that means you're walking too much and/or you still need to use an assistive device. And welcome to the struggle of hip replacement recovery. The challenge is to find a way to walk ... that is good and helps us get some exercise ... but which doesn't produce soreness afterwards ... or major soreness afterwards. Some soreness is to be expected for far longer than four weeks. I'm 11 months in and I still can get some soreness.

Four weeks out is not in my view a reasonable expectation for walking smoothly without an assistive device and without pain. Now, there are the lucky lucky few among us ... and our brains tend to remember those stories when we read them online. But these stories are far far outliers. Just recently I know two people who went to two quite locally famous surgeons known for fast recoveries ... and both people have had to use the cane ... until about 8 weeks ...

Icing. Are you icing? Read Layla's links and the guidelines.

BTW: you don't help the soft tissue by exercising or moving too much. In fact, that simply slows down the healing and can lead to setbacks. I remember after 3 months going to the gym for elliptical and bike exercise ... felt OK during ... then major soreness afterwards ... which meant ... my body wasn't ready for that level of exercising. I had to back off ... actually this happened multiple times.

And don't pooh-pooh the benefits of walking with a cane. You can get a great workout with a cane. And then for stretches, you can hold the cane and walk a bit without it. But if you have a lot of pain later, that means you need to cut back ... Try using a cane all the time outside for a few days ... See how the muscles feel then ...

Good luck.

 

[toughstuff]

Thank you for your detailed response. The insight from all of you really helps.
The fast recovery stories do stick in your head. I thought for sure I’d have no issue because I’m in good shape. In reality maybe I am doing great but just not what I thought.
The healing graph does suggest some upticks now that I am entering week 5. If the soreness will just decrease to where an OTC will handle it I’ll feel much better about progress.
I look forward to more recovery stories.

 

[Jaycey]

The fast recovery stories do stick in your head. I thought for sure I’d have no issue because I’m in good shape.

This is a fallacy that many surgeons impose on their patients. Yes you might be healthier than the average patient. But it takes time for bones, soft tissue and muscles to heal. Being fit has no impact on this process.

From past experience the difference between week 4 and week 6 was significant. That's not to say it will be the same for you. But I walked into my 6 week followup appointments unaided for both hips.

 

[Going4fun]

@toughstuff just wanted to add ... I had the surgery to resume aggressive exercise ... So, in my research, I read a ton of stories from highly athletic people who had hip replacement surgery ... I don't recall much discussion at all about fast recoveries among these highly active folks. I have no doubt that being in better shape going in can help ... but you have to see the big picture ... 4 weeks after hip replacement is about 10 minutes into a marathon.

Later on ... months down the road ... you may see the benefits. Right now chill ... get the icing going ... check those recommendations in the links Layla posted ... Oh ... and kill off PT while you're having this pain ... let walking with the cane be the PT.

 

[Ptarmigan]

So glad you found your way here @toughstuff , and I am glad you raised a topic that’s valuable to so many people.

This suggestion works for some: you may want to search online for a video (maybe animated - it’s easier to comprehend) of the procedure you had. I’ve watched the video of the procedure I will have, and it’s easy for me to understand why a muscular dude might need longer to heal.

The other thing I hear you say is that you’re concerned about continuing to use Vicodin. Of course, it makes sense to go back to either/or your surgeon or your PCP, whomever is doing your pain management, and start a conversation about tapering off, when and how, non-narcotic drugs you can use instead, other pain management options, etc. I have already had this talk with my PCP. There may be options available to you now, if you ask. And once you get a plan in place, and know how tapering will work for you, it may be less of a concern to use Vicodin while you still need it.

 

[toughstuff]

I’m pretty sure when the pain has subsided I will have no issue giving up the pain med. Tylenol and Advil simply don’t cut it yet for me.

 

[Jamie]

There are alternatives to taking something like Vicodin for 8-12 weeks. A combination of Tramadol and Extra Strength Tylenol comes to mind and you might discuss that with your surgeon if you have any concerns about being on opiates that long. You will need to taper off for sure as your body does become used to the pain meds with time (not addiction....this is dependence and you can successfully taper off slowly). Some people opt to stop opiates cold turkey, but if you try that you'll likely have 3-5 days of feeling really, really bad before the medications are completely out of your system and you adjust to that. If you can make a switch to a "step-down" drug like Tramadol, that may work in your favor.

I have not used any assistive devices to walk since day 10. I can walk with little or no issues. My issue is muscle pain / soft tissue pain.

This part of your first post concerns me a bit. A lot of people work very hard to try and ditch their assistive devices, thinking they are "building strength" by walking without them. Actually, as some have mentioned above, it's the exact opposite in the early weeks and months of recovery. The aids (especially a walker) give you added support that enable you to walk properly from the beginning. You may go a bit slower, of course, but it's important that your gait reflects the proper walking technique of heel - roll to ball of the foot - then push off with the toes through each step. When you don't have to worry so much about balance and the risk of falling, you can really focus on your gait. This process with the walker builds early strength and balance. Both are critical for a good recovery. You don't have to use the walker all the time, but I suggest you pick it back up for those times during the day around the house when you want to work on your walking and correct gait. Be sure it is adjusted properly so that you are not bent over when using it. You should be mostly, if not completely upright. It's there for gentle stability as you move, not to lean on.