Revision THR 8wks post op - more pain than before<<

[Krista]

Ooh ooh, that sounds so great, @AMR1879! You are about 3 ½ weeks out now, and still early in recovery, so I am amazed that you didn't need walking aids today - how fantastic! Enjoy those kiddies and the pool and all the experiences that you will be adding to that list soon. Can't wait to hear about them!

 

[Jamie]

Good for you!!! I'm glad you're feeling stronger.

 

[AMR1879]

@Josephine Here are some pictures of my new hip, still not the best quality, I know. The Dr put in a DePuy AML 13.5 short offset stem w/a 1.5mm neck length and a 36 mm diameter Cobalt Chromium head w/exchange of a neutral Ultrex Cross-Link Polyethylene liner for the 52 mm cup. He said something about the AML type of stem being the best choice for the replacement. I don't remember what about the AML made it the best replacement stem. If the quality is okay enough to make a judgment, I hope you find this one to appear better than the first!! Thanks again for taking the time to look!

 

[GrannyC]

AMR, I have been following your thread and am so very glad to hear about your new hip! I really admire you for sticking to your beliefs and finding the right doctor. You have certainly been through far more than anyone should have to endure but it looks like you are now well on the road to complete recovery. I am sure it is hard for both you and your kids but you can do plenty of things with them besides the physical ones. Having the time to play a game or some kids like to have you read, is good as well. They have a mom to be proud of, that's for sure. Sending positive, healing thoughts your way and I wish you a speedy recovery!

 

[Josephine]

An uncemented hip but it looks like a good, tight fit the entire length of the stem

 

[AMR1879]

I'm glad you see a good fit. I am a little over five weeks post op now and the pain I felt with the first hip is no longer there, all movement, flexing, etc can be done without pain, it's great! Unfortunately, I have a persistent pain in my mid thigh that hurts when I start walking causing me to limp but it goes away as I move around. But I am still limping when I get up and start walking!! Just like the first hip but a now it's a different pain. I try so hard to walk normally but I just can't b/c it hurts too much. I mentioned it to my Dr and he doesn't seemed concerned. I'm having flashbacks of my experience after hip number one! I am feeling hopeless, I am starting to feel like I'm crazy, it feels like I will never be pain free. I am so tired of saying maybe the pain will go away.... it is very upsetting.

They have a mom to be proud of, that's for sure. Sending positive, healing thoughts your way and I wish you a speedy recovery!

Thank you so much for the kind words and well wishes!

 

[GrannyC]

When I went for my 2 month checkup, I told the OS I felt very stiff after sitting for a few minutes. I asked if it was from some exercise (although I've only done a minimal amt of exercise) or just healing from the surgery. He said it was from the surgery. I still notice it although I think it is getter better very gradually. I can't pinpoint where I feel it but somewhere in upper leg area. I'll get up and stand in one spot for a couple seconds before starting to walk usually. I feel the stiffness for maybe 6 to 10 steps and then it is gone. It's not quite the same as what you wrote but I'm wondered get if that, too, is just from the surgery.

 

[Krista]

@AMR1879, are you trying to walk without aids? At 5 weeks post-op many people cannot yet walk unaided without pain and/or a limp. It can take double that time or more. I know it has been a long time of pain and troubles for you, and it is hard to be patient. But there just isn't any way around waiting longer to see if this resolves, since it is so soon after your revision. I am hoping for the best for you!

 

[Irish Joe]

Amr1879.
I'm going to tag @Josephine so you can pinpoint it on her chart thingy.
I'm sure though its regular post op pain associated with you op.
You've been through quite a bit in the last year so this recovery could be quite slow. It sounds to me like start up pain which for me reduced considerably over time.
I'm with @Krista when she says to be Patient (she knows all about long recoveries).
You've had your last op on this hip in my opinion.
Time and Patience is prescribed.
Keep Positive as much as you can.
Joe.......

 

[Horseshoe]

Hi, look at you @AMR1879 aren't you doing amazing!! Glad this recovery feels better to you, this is what a thr recovery should be like, sounds like your new OS did a super job.

Walking normally will come soon, trust me, I felt the same way and recall throwing my crutches down in frustration. You've had multiple recoveries on this one hip and it's bound to test your mettle. You're over the worst part though; I recall that 6 weeks, 2 mos, 3 mos and 4 mos were significant benchmarks for improvement in my case.

@GrannyC , agree with IrishJoe, that stiff muscle pain in the thighs where the first few steps hurt could be "start up pain" which is completely normal. OS said it's from the retractors used during surgery that pull muscles away from the surgery site. Annoying as it is, it eventually goes away. Tylenol XS helped and sometimes I took Advil too as it was getting on my nerves. I also gave both legs a rubdown morning and night which seemed to help.

Good news is that one day it was simply gone and I didn't even notice right away, it just felt normal, think it was around 3-4 mos post op.

 

[Josephine]

I have a persistent pain in my mid thigh that hurts when I start walking causing me to limp but it goes away as I move around. I try so hard to walk normally but I just can't b/c it hurts too much.

I think your 'trying' is too much!


Sorry but I'm going to ask my questions again!

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

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 forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, 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

5. are you doing any exercises at home? If so what 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
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[AMR1879]

Hi guys! It's been a while since I posted an update. Things are generally going well, I am up to 2 miles a day walking around my neighborhood, however, I am not pain free yet. But the pain I feel is different than before the revision-it fluctuates from pretty server 7-9 pain when walking to an annoying 3-4. I am hoping this time it is soft tissue/muscular pain and not the new hip hardware. I just started working with a physical therapist to help me figure out how to strengthen the muscles and work through the pain when, the worst pain is in my lower back/upper butt. The PT thinks on my painful days I am having muscle spasms that irritates my a sciatic nerve causing the pain which can be frankly debilitating-I can't sleep at night, and during the day it is hard to walk b/c the pain runs down from my hip into/through my knee right down to my ankle. It is really awful, but then it goes away. I'm hoping PT is the right thing to do. My ortho surg supports it, but I'm curious how you, @Josephine, feels about it. I know you're not a big fan of PT. But how about now 11 weeks out? Ugh, I didn't realize I was almost 3 months post surg, shouldn't I be pain free?! I'm starting to think I'll always have pain, maybe I have nerve damage. I just give up trying to get back to normal. Anyhow, that is where I am at. Hope everyone who reads this is doing well!


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[Marvy]

@AMR1879 it sounds like you are doing quite well with having revision surgery not even 3 months ago! I think that 2 miles sounds like alot at this point! I'm sure that what you are feeling is muscle and not hardware or bone. It seems that sometimes doctors do not give credit to people for being "in tune" with their bodies. We may not be doctors or surgeons, but yet people do get a "gut feeling" when something is amiss and what it may be.

Do you think that with walking that far that maybe your gait needs to be analyzed - esp. since the pain is worse when walking? Just curious...

After reading your story, in some ways I felt like I was reading about me...

 

[KarriB]

I don't know a lot about hips @AMR1879 , but I've read about some people having that pain in their "butt". Check out this link to see if this sounds like your pain.

https://bonesmart.org/forum/threads/piriformis-syndrome.9837/

 

[Josephine]

I'm curious how you, @Josephine, feels about it

I'd be more likely to be able to have an opinion if you would answer my questions!!

 

[AMR1879]

I know, @Josephine I didn't get around to your questions before.... they are hard to answer bc my pain varies so much and to be totally honest I'm so tired of trying to analyze and describe my pain! But I'll do my best.

2. Pain right this moment: 1 - but I am resting. Sometimes a 2/3 in my upper butt/lower back if I'm sitting in a bad chair or laying in a poor position. If I got up to walk it would be a 2/3 on normal days causing me to limp, but on bad days when it runs from my hip down through the outside of my knee to my ankle, it spikes to 8ish with any movement laying down or standing. I am very tender to the touch over my upper butt muscles and all around my hip, but the pain feels good when the area is massaged. I often wish the Physical Therapist would use his elbow and get deep in there...why does that kind of pain feel good?!

3. Not taking anything for pain, still taking a very small dose of oxycodone bc I'm in the process of weaning off of them...the withdrawal I have experienced is awful! But the small dose doesn't do anything for my pain, unfortunately.

4. I am walking on the days I don't have the strong pain running down my leg, some days up to 2 miles! But I am often sore after those longer walks. Nothing else other than gardening, light house work, chasing (walking quickly) after my 4 yr old!!

5. PT sent me home today with some exercises to do.
To be done once a day for the first couple of days and increasing to two.
All done in two sets of ten to start out.
-clam shells, with a 1 second pause when open and a pillow between my knees.
-leg lifts out to the side standing using a table or chair for balance. This is hard to do when I am standing on my left leg (new hip side) and lifting my right leg.
-squats using the edge of the counter for balance and to also off set some weight, not breaking the 90/dropping my butt lower than my knees.
-calf raises
-calf stretches using the edge of the step or an inclined platform. Those I hold the stretch for 20 sec and do 10.

Same exercises are done at PT along with stretches and massage done by my therapist and icing. Next week I am on vacation so I will not be going, but will be doing the exercises daily and will pick back up w/PT twice a week when I return.


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[Josephine]

11 weeks

2. Pain right this moment: 1 - but I am resting. Sometimes a 2/3 in - it spikes to 8ish with any movement laying down or standing. I am very tender to the touch over my upper butt muscles and all around my hip

I understand. Can you tell me where your pain is using this chart?

3. Not taking anything for pain, still taking a very small dose of oxycodone because I'm in the process of weaning off of them...the withdrawal I have experienced is awful! But the small dose doesn't do anything for my pain, unfortunately.

Can you tell me more about the 'small dose'? How much and how often? And what symptoms you are having with the withdrawal?

So why don't you take Tylenol 1,000mg 3-4 times a day? It's quite harmless, an excellent pain med and doesn't conflict with the oxy.

4. I am walking on the days I don't have the strong pain running down my leg, some days up to 2 miles! But I am often sore after those longer walks. Nothing else other than gardening, light house work, chasing (walking quickly) after my 4 yr old!!

"I am often sore after those longer walks" - to what level of pain?

PT some exercises x1 daily the first couple of days then x2
clam shells x10 with a 1 second pause when open
leg lifts x10 out to the side standing
squats x10
calf raises x10
calf stretches using the edge of the step 20 sec x10

Same exercises are done at PT plus
stretches
massage

All of these are unnecessary and causing the pain you are experiencing.

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.

Plus, you are 11 weeks out so shouldn't need any more exercises anyway. I suggest you stop all the exercises and cancel the PT sessions. Saying no to therapy - am I allowed to?

 

[AMR1879]

My pain on the chart:
Some aching/radiating pain around a 2/3 in the square of VL2F, VL1F and TL2F, TL1F it is also tender in that area and around my side in that area and my lower back/upper butt pain which can be low at a 2 or 3 but can spike with certain activities to a 7/8. It moves slightly higher in the square area of RL2B, RL3B and SL1B, SL2B, SL3B and a little lower into TL1B, TL2B the whole area I mapped out is tender with some areas where just some slight pressure or poking can create a sharp pain that can hit a 10 and the whole area I mapped out feels like it needs some major massaging. Then there are the days when I have a level 8 pain that runs from my hip, down the outside of my thigh down through my knee into my foot. That is the WORST! I feel like a nerve is pinched and I need to shake my leg super hard to fix it.

I am on 20mg of oxy, I take 5 mg every 6hrs, next week I will drop to 15mg and then 10mg until I'm not longer taking it. The withdrawal I feel feels like my skin is crawling, like I'm tingling and I have the chills and cold sweats. I also feel like I am out of sorts and jittery. It is terrible! This slow ween seems to be working. At my max dose I was taking 15mg every 4-6 hours, so I am taking quite a bit less.
Honestly, I didn't think to take anything else like Tylenol, Tylenol and Ibuprofen never seem to make a difference in my pain levels.

My pain level after a long walk can be a consistent 3-5mostly when I get up and start walking...making my limp even more pronounced. I can't remember the last time I stood up and walked without a limp!

I just started PT, my aches and pains were already there. But you seem to still feel strongly that I shouldn't do any PT. How about massage?? I feel like I need to do something! Just having the PT stretch me out feels soooo good! I know your view of PT, that is why I was curious about what you thought about me starting now, 11wks post revision. I feel like I need to be doing something to work through the messed up muscles and tendons and scar tissue that my hip area must be riddled with after the 3 surgeries in a year! I did say no to PT right after surgery! It was my idea to start now, I'm just desperate to get rid of the pain and walking doesn't seem to be doing anything!

Thank you @Josephine for taking the time to help me!


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[Mojo333]

Hi @AMR1879 I'm glad Josephine asked you to nix the PT, especially those squats..seems like those could definitely be working on those spots, ouch.
Over the counter meds never phased any of my body aches prior to surgery, but per Josephine's advice, in the 1000 mg amount, it has been very effective now.
I waited almost 5 weeks before beginning PT, felt ready, and began noticing some pains, not even to your level..and scaled it back to mostly stretching. Even at 4 months out, gentle stretching and alot of walking - as I am back to work -is, in my opinion, all the strain my legs can take right now. Alot of my groin pain I believe was due to needing to stretch back out after years of bad gait and posture die to the hip issues. Just standing up straight pulled on that area. I didn't need to hyper extend those areas...took time for them to get out of whack and its taking time to stretch out.
The PT was confusing to me also, I finally just didn't do things that caused me grief afterwards. My PT was willing to accommodate my wishes and just advise me on stretches mostly.
Easiest way to see if that's what's causing it, don't do it for a while and see. Don't underestimate ICE for pain management even at 11 weeks with no obvious swelling. Ice us still my friend

 

[Josephine]

The withdrawal I feel feels like my skin is crawling, like I'm tingling and I have the chills and cold sweats. I also feel like I am out of sorts and jittery.

Oh that's withdrawal okay. Poor you!

I am on 20mg of oxy, I take 5 mg every 6hrs, next week I will drop to 15mg and then 10mg until I'm not longer taking it.

I think you may not be titrating off slowly enough. Our recommended schedule is

1 pill every 6 hours and 2 at bedtime
1 pill every 6 hours and 1½ at bedtime
½ pill every 4 hours and 1½ at bedtime
½ pill every 6 hours and 1½ at bedtime
½ pill every 8 hours and 1½ at bedtime
½ pill every 8 hours and 1 at bedtime
1 pill if you are really doing something active during the day and 1 at bedtime

It is usually better to wean off these meds over several weeks, not several days. But.....if you are still having pain, then your body is healing and you still need pain relief and since you are, maybe you need to rethink this.

Honestly, I didn't think to take anything else like Tylenol. Tylenol and Ibuprofen never seem to make a difference in my pain levels.

Well, I don't care for ibuprofen (NSAIDs) but with the Tylenol, it depends on how much you took. It's been my observation (on here) that US members tend to take one regular tablet and then say it does nothing. Well regular Tylenol is 325mg so that's never going to work. The proper working dose is 1,000mg 3-4 times a day. It's funny, because in the UK, our OTC "Tylenol" (paracetamol) is 500mg per tablet and no-one would ever take less than two even for a headache!

I just started PT, my aches and pains were already there. But you seem to still feel strongly that I shouldn't do any PT.

I do because I have seen so many members getting outrageous amounts of pain from it.

I feel like I need to do something!

I know you do but you don't have to. It's a fallacy that our US members seem to buy into with great enthusiasm. Almost like "I have to do something - THIS is something, I will do it"!

I know your view of PT, that is why I was curious about what you thought about me starting now, 11wks post revision.

Since you already have such prodigious amounts of pain, I would stress that this is entirely the wrong thing for you to do.

And I'm actually astonished at the amount and spread of pain you have!

I think that spread on the right in the yellow box is likely to be Trochanteric bursitis and/or Piriformis syndrome.
But that on the left, I have no idea. It could be referred pain from the TB and Piriformis. Maybe