THR A 39 year old's recovery

[whiteshoecovers]

I'm going to tag @Josephine to comment. Usually we tell folks to hold off a bit on wearing lifts as it is difficult for hips to realign when it is used. Hips do realign following surgery in many cases, but be aware it can take a few months before you notice it.

@Jamie Can you please elaborate on your statement above. It's my understanding that the purpose of my PT's heel lift is to encourage my hips to realign (again, the lift is on my non-operative, functionally shorter side). You make it sound like that would be counter productive.

 

[Jamie]

Normally the leg discrepancy is perceived and not actual. When a person has a bad hip, their body typically adjusts itself by tilting the pelvis to compensate for the mis-aligned hip. Over time, this feels very normal to the person as they walk and go about their daily life.

Then along comes a hip replacement which instantly realigns the bad hip to its proper location and suddenly the person feels off balance because the hip compensation is still present. It takes time, but the body will readjust and the hips will straighten out to a normal alignment. But, because it feels awkward or may even result in some soft tissue pain, people sometimes will immediately put a lift in the shoe. This may feel more comfortable, but it takes the hips right back to that out-of-alignment position and it cannot readjust to normal.

So, for most people we recommend that you not use lifts for at least 6 months (and maybe longer) to give your body adequate time to make the adjustment to your new hip.

However, you indicated that your leg discrepancy was due to pelvic rotation, I'm not sure if this guidance applies to you. That's why I have asked @Josephine to comment.

 

[whiteshoecovers]

Normally the leg discrepancy is perceived and not actual. When a person has a bad hip, their body typically adjusts itself by tilting the pelvis to compensate for the mis-aligned hip......

However, you indicated that your leg discrepancy was due to pelvic rotation, I'm not sure if this guidance applies to you.

@Jamie. Thanks for elaborating but I am still not clear. I don't see the difference between your first and last statements. If you pelvis "tilts" or "rotates", even with identically sized femurs and tibias, you will clinically present with a LLD, not just a "perceived" one. This is what is happening in my case, both pre- and post-op. I am interpreting "perceived" as the feeling of having a LLD with no clinical presentation.

 

[zauberflöte]

@whiteshoecovers I see both your point and Jamie's. I think there are people whose legs are actually different lengths due to surgery processes or requirements or God forbid mistakes. Your distinction is a good one, and you do present with a visible LLD. So did I, pre op, and my legs were actually perfectly matched. Post op I still felt the LLD but could put both feet on the floor tucked together while standing, so as the pain and "dangling good leg syndrome" were both gone, I read a bit on here and just ignored it. Before long I didn't feel it any more.
Has your PT messed with your pubic symphesis joint any? Mine did, pre op, and it was so badly out of whack that everybody in the room heard the pop when it realigned. He then taught me how to do it myself if needed. It's like playing Twister while lying on your back :lol:


My phone sent this using BoneSmart Forum, clever phone!

 

[Jamie]

The difference is most people's leg discrepancy results from pelvic tilt. You described yours as pelvic rotation. That would seem to be something different to me, but that is why I asked Jo to come and comment. She will know better than I whether your situation is different from what we normally see. Sorry that I didn't make it clear....keep asking questions if you have them!!

 

[Josephine]

I have refrained from posting here because I don't know the exact problem concerning this 'pelvic rotation'
I like to be honest when I don't know something!

 

[dede62]

@whiteshoecovers sorry you are still having pain issues. Didn't you recently have your follow-up with your OS prior to returning to work? If so, was there any mention of the hip alignment/rotation/twist?

I know my OS took xrays at the 6 wk mark (my appt before returning to work) as well at my 1 year mark. I have always had a bit of a twisted pelvis, and I did get relief (albeit not permanently) going to the chiropractor prior to surgery. It got markedly better after my replacement (and it shows on the xrays), but I (as well as many others) had all different kinds of new and existing pains for a while after surgery. I felt a difference in my op leg (a little longer) from the start but it decreased markedly over time (3+ months). At about 7-8 months, I started having problems with my non-op foot, and it wasn't until that period (near stress fracture, boot, crutches) that we ended up adding a very low lift (1/4") that I wear to this day. When I went in for my 1 year appt/xrays, I told the OS about the lift. He said that the xrays didn't show any LLD (since I wasn't in shoes and was full weight bearing), but he said if it felt better, then leave it in.

If you haven't already, do consider a phased back to work schedule. It has made a big difference in gaining stamina. Do consider some sort of pain relief during the day (even if your waking hours are just tylenol/advil combo, if possible), if you aren't already. How did that Norco change do for you and are you at least still taking it at night?

It's hard to hear, but don't get too discouraged, because it does get better. Really, it does. We are all wishing you well!

 

[whiteshoecovers]

5 week update:

It's still easier to see improvement on a weekly vs. daily basis. I'm walking better now but still using my cane. I can use my operative leg to go up and down stairs with only minial assistance with my cane. Sometimes I can get along without it around the house, but sometimes I can't. I went for my longest walk on Sunday (~2mi) and have had more pain since. This isn't soreness but an aggravating pain of the same character of my pre-op and post-op acute groin pain. I'll chalk it up to the roller coaster of recovery. I can more easily cross my leg to reach my foot to put on shoes and sock, and dry my foot when getting out of the shower.

I am supposed to be allowed to ride a stationary bike in one week, but I feel like doing so successfully is still more than one week away. I know I'll do it on my body's schedule and not some generic one set by my surgeon. Soon would of course be nicer than later.

 

[whiteshoecovers]

I'm having a rough couple days. I feel like I've gone back two weeks in my recovery. Pain with walking that I hadn't had for a couple weeks is back. I am sure it is due to increased activity and I am sure it will subside, as it already had once, but I just need to share that this sucks.

I am a bit of a special case, as my day-to-day pre-op pain wasn't terrible, just a nag. The deal breaker was that I could not be active at all, and that's my thing. So I haven't had that instantaneous relief of grinding bone-on-bone pain after surgery, and I will not be happy or satisfied with my decision until I can do back-to-back days riding my bike and hiking without pain.... which I know is a number of months out. So while my recovery may be progressing as expected, my criterion for success is probably a lot further out that most.

 

[zauberflöte]

@whiteshoecovers the pain after walking sounds exactly like what I got. At 8 weeks, I went shoe shopping at a self serve place. I tucked myself over my knees to tie and untie about nine pair of shoes. That tightly tucked position was my undoing-- no amount of ice at home could take away what was evidently tendonitis. Long story short, at 23 months I am still living with it, and should buy stock in various OTC pain med companies!! Walking hard and fast sets it off. It is "chronic", which is a dirty word on here :lol:
If you can stand to get your exercise needs filled by an arm bicycle, that could help your hip pain, maybe?
Your desires for what total recovery looks like are actually very similar to a great many people's, many of those 20+ years your senior, I should add!

My phone sent this using BoneSmart Forum, clever phone!

 

[whiteshoecovers]

@zauberflöte of what do you have tendonitis? Can you please describe your presentation and symptoms?

 

[zauberflöte]

"Evidently tendonitis" I gave myself the dx after several people in my hip cohort were officially dx'd with psoas tendonitis and "just plain" tendonitis. Reading through the library here was also informative.
How it feels is small, substantial aching points of pain, mostly in the same place, front of fold of hip. In bad, or impending bad, weather, the pain can stretch a few inches down my thigh. When my hip was very new, I felt it when walking normally up the very slight grade of my driveway. I could prevent it from happening by using the op foot tiptoe. I also have less rotational mobility than when the hip was newer. Inflammation, I am sure.
At 7 or 8 months, I sprang for some really excellent manual PT. She massaged the heck out of my scar, and said that my painful points exactly matched up with the adhesions (or whatever they were) that she had massaged away. She then released all those trigger points. The hip had more rotational mobility, and the pains were gone!
Till I got back into serious treadmill work walking. It came right back again, but I'd been resting 5 months already and couldn't bear the thought of more! I would love to have an on-call PT, but I manage it with OTC meds, which I'd be taking anyway for the other hip.
Another therapy I did was a couple of months of the psoas stretch where you hang your leg off the side of the bed. That was excellent, but one day out of the blue I found I'd gone too far, and created rather than relieved pain. So I have given that one a break.
Hope this is what you were looking for!


My phone sent this using BoneSmart Forum, clever phone!

 

[whiteshoecovers]

....and now I am totally paranoid!

I "feel" like I am having too much pain at this point (5.5 weeks). I do have a spot in my groin that is very tender to the touch: If I sit up in bed and slightly externally rotate my hip with my knee slightly bent I can find a spot just below the fold of my hip that is very tender to the touch. It is easier to find if I rest my knee on something in this position and almost impossible to locate this spot if I straighten my hip or leg. Referencing anatomy pictures, I would say the spot is at the very top of either my adductor longus or pectineus. I have a more clear reproduction of pain with resisted adduction that I do with hip flexion. So do I have a case of adductor tendonitis?

The next appt with my surgeon isn't until May 4, so I just called and will be seeing his PA tomorrow morning.

 

[zauberflöte]

@whiteshoecovers don't be paranoid!! Please!! You are only 5 1/2 weeks out, fer cry-yi! That is very early days, and very many people are still managing pain with the hard stuff at that point. You sound like you have a professional's grasp of anatomy, so put that to work on the extent of the major MAJOR surgery you had a few short weeks ago. Carpentry and machine shop class inside your hip through an incision that's possibly smaller than some of the tools used!
You'll find out what is really going on tomorrow morning-- glad you could get an appointment so quickly!
Keep us posted--
PS I poked around my groin area in the position you mention, and found half a dozen spots that are tender to a fair amount of pressure. On the un-op side there are some too. Go figure.


My phone sent this using BoneSmart Forum, clever phone!

 

[whiteshoecovers]

Saw the PA today. They took x-rays and everything looked "perfect". I basically got a song and dance about how this will take a long time to heal and if I am having more pain it is because I am doing too much, regardless of how much that actually is. When I specifically asked about tendonitis the answer was about the same: take it easier, rest and ice.

It's not like I've been terribly active: on and off my feet for a half day at work followed by couch and bed time once I get home for the rest of the day and evening. I guess my body is saying that is even too much.

I am getting very tired of this. It would help a lot if I could see the light at the end of the tunnel, but the fear that this is not the answer for me is growing every day now.

 

[zauberflöte]

@whiteshoecovers I am so glad your xrays are so good! Unfortunately for you, I am doing the Texas two-step with your PA there. It really does take a long time. Wisdom here and at my PT says, a year. My experience supports that. It was good at 4 months, great at 6-8 months, but wow, at 12 months when I looked at where I'd been 6 months before that I was astounded at the progress!
I hear you about how little activity you are doing, so here we insert another piece of wisdom: everybody's recovery is different. Our star Shugaplum (24 at the time), was back in the ballet studio with all her considerable extension restored at 5 months, but very few of us can claim that kind of story!
There IS light at the end of the tunnel, truly. The tunnel may be a bit longer than you originally thought, but full mobility and restored quality of life are waiting for you at the end.


My phone sent this using BoneSmart Forum, clever phone!

 

[whiteshoecovers]

6 weeks tomorrow and I still need my cane :-(

 

[copsham]

Hi @whiteshoecovers
I am 3+months post op. It does amaze me how the recovery process can be so great and then can hit a plateau which never seems to end. Sounds like you are on a plateau (and it is frustrating) but in my experience suddenly you move from the plateau and leap forward.
With my cane/stick I kept needing it and felt it would never end, was a bit of an issue in my head, then suddenly I was not using it. It happened when I was not thinking about it. I had the same experience with my pain meds too. So stick with it - there really is a brighter future ahead xx

 

[Great Aunt Janet]

Your husband sounds really sweet. Enjoy it. My wife is an Emergency Room Physician so unless I have a severed limb or am bleeding profusely (not just regular bleeding) then I get zero sympathy. She was even kicking me out of bed in the middle of the night that first week to let our dog in and out when she was a bit ill (the dog, not the wife). Also, her dishes started to miraculously be left out dirty as well her laundry when I was home recovering. I guess that was her way of keeping me active.

Loved your post in @hippityhop thread, just had to laugh at your description of the dishes/dog/sympathy stakes! Still giggling now - thanks for that piece of stand-up! Classic.

I do hope you find something to tickle your own fancy here in the forum or elsewhere so you can boost that positive stuff and keep on with your progress which sounds pretty fast from where I am. Have an excellent day, and if I could send you one of the cream doughnuts I am about to go purchase I would.
(replace steins with cake)

 

[Jamie]

Using your cane is not a sign of anything sinister or the mark of failure in this recovery process. It just means you're still healing and working on a proper gait. Please know that you ARE doing a lot. You went back to work very early and even those "half days" take a toll because they require that you get up, shower, dress drive to and from work and walk to your job....and THEN you begin that "simple" half day.

I think you are showing great wisdom by using the cane for as long as you need it. It's the best way to ensure that you'll regain your proper gait. So keep up with it until you are strong enough to walk with long strides. Then just carry it for those times when you need to "bump" someone out of your way.... They do come in handy for dogs and small children.