Bilateral THR 6 weeks post-op and concerned about slow progress

[Yvres]

I have just discovered 'BoneSmart' which looks like a very helpful resource packed with information. Six weeks ago I underwent a bilateral hip replacement.
Initially my intention was to replace my right hip joint only but, on the advice of my surgeon, I agreed to do the left hip in addition as the joint was also badly worn, though not giving the same level of pain as the right. My right hip was more complicated as the joint was described as 'protrusio' where the head of the femur is embedded deep into the acetabulum. The full surgery was completed inside about 3-3.5 hrs under spinal block.

Later on the same day I was given the opportunity to stand and walk a few steps. Standing seemed fine and I was pleasantly surprised, but the first step forward with my right leg initiated the most severe nerve pain I have ever experienced, bringing me to near faint. My pain threshold is generally very high, but this pain was way off the scale and far in excess of anything I have ever experienced. Needless to say that was the end of any further 'walking' that day. For the next several days I experienced the same level of severe pain making any walking completely impossible. I was medicated throughout with opiod analgesia, the side effects of which made me feel awful and besides the drug failed to control the pain. Advice from physiotherapists and surgeon were that the pain would ease and that they were not sure what it was all about.

Numbness was also prevalent on both the left and right outer thigh muscles. At about 5 days post-op I saw a different physiotherapist who suggested I walk with my legs further apart, this simple change of gait largely removed the shooting nerve pain and I was able to walk some distance. In his opinion the Lateral femoral cutaneous nerve was likely being squeezed and or pinched.

Back at home I have days when I think I am regaining leg strength and days when I seem to go backwards. It is very hard to gauge when or if I should push myself harder with passive exercises and walking. I try to remain as active as possible and rest when my body obviously needs it. The shooting nerve pain has now almost completely gone with just the occasional reminder which generally occurs with no obvious error on my part. There is what I can only describe as random nerve firing from my hip down to my knee on both sides. The numbness in my thighs continues to be a concern and for the most part and shows little sign of improving, though some days can be better than others. I use either sticks or 'smart' crutches if I go out of the house and nothing indoors unless I feel the need for support.

I stopped all opioid drugs after about 8 days post op, they seemed ineffectual in any case and for a period of 4 weeks post op took 500mg of paracetamol daily. For the last 2 weeks I have been on no analgesia preferring to be without. I'd be interested to hear from anyone who has any thoughts on my recovery or who has experienced similar post op symptoms, thank you.

 

[Mojo333]

Hi @Yvres
Welcome to Bonesmart and good to see a new Bilateral Buddy on board.

Please can you give us your date of surgery so we can add you to our Team Recovery Group and to your signature and it will help when you get advise.

Both at Once is tough these first weeks and these are still early days, my friend.
I had a brief moment the first day in the hospital post op when the pain was not managed, and that is some bad time.I'm sorry you had to go through that.

Numbness was also prevalent on both the left and right outer thigh muscles.

Yes, this was the case for me also....all is traumatized and trying to heal.

Back at home I have days when I think I am regaining leg strength and days when I seem to go backwards. It is very hard to gauge when or if I should push myself harder with passive exercises and walking. I try to remain as active as possible and rest when my body obviously needs it.

Great strategy, walking when and how far we feel up to it the first months will keep us from overdoing it.....hope you are icing when resting.

here is what I can only describe as random nerve firing from my hip down to my knee on both sides.

I had random zips, zaps, and zings as things began to wake up....not sure if this is the same sensation you describe but they got fewer and farther between and were almost all fleeting pains.

The numbness in my thighs continues to be a concern and for the most part and shows little sign of improving, though some days can be better than others.

The areas of numbness, for me, got smaller and when I thought around 5-6 months post op that they may be collateral damage....continued to improved until, now, all is normal.

All temporary, so take the slow and steady route. You will get there.
I am going to leave you our recovery guidelines so you can read through some helpful articles.

 

[Mojo333]

Here You Go:
All recoveries are different so make sure you listen to your body and find what works for you.
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 that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[Yvres]

Thank you Mojo, that is all very encouraging and reassuring. I remain positive. My surgery was on 29th June '21.

 

[Mojo333]

The first few months are trying.... You are a "Both at Once" Superhero!
This is All Temporary and Patience is key.
I'm on your Side!

 

[Eman85]

You have to look at it this way, you're only going to have to go through this once. most of us that have had 2 THR's have had to do the recovery thing twice. Think how hard it is to do it the second time knowing what you know now. Sounds like you're doing fine and as you progress you'll be glad you'll be once and done.

 

[Layla]

Hello and Welcome! Thanks for joining us. Something tells me you‘re a strong brave woman as you agreed to bilateral surgery. It sounds like you’re doing really well.

I remember the thigh numbness and it lasted for months, slowly shrinking until it was completely gone. in doing a little research a few months back I learned the following - Small sensory nerve fibers are cut with the incision. These nerve fibers run from the inside to the outside of the hip and cutting them causes the hip to feel numb after surgery. It is a temporary sensation that normally resolves over a period of six months to one year post op.

While healing you may experience sensations of tingling, pins and needles, itching, burning and even the feeling of a minor electrical shock. These are usually good signs that the nerves are spontaneously firing through the regeneration process.

Hope this eases any anxiety you have and helps you realize it’s normal and part of the process. Happy healing…I hope you have a nice weekend!
@Yvres