THR A 39 year old's recovery

[Hoppy Nanny]

I used my cane for some considerable time as I limped without it....but gradually I stopped using it and my gait is great...it is so worth taking time to get your body walking straight.....it all comes good in the end!
I think we all want that quick recovery....it is rather frustrating but I can honestly say I never think about my hip at all now...it's that patience thing @whiteshoecovers! X


Sent from my iPad using BoneSmart Forum

 

[whiteshoecovers]

Thanks for the notes.

It is frustrating to be well behind where you thought, and think, you should be, despite everyone's advice that I'm about where I should be and it's expected I feel this way.

I show a terrible Trendelenburg gait because of weakness of my operative side abductors. Frustrating since I did not present this way at all pre-op. Have started doing minor strengthening exercises for about a week now to work on this and see only minute improvement. (bridges, clam shells).

 

[zauberflöte]

I hear your frustration-- this is a good space to vent it, as we have all felt the same at one point or another.
Can you correct your gait by walking very slowly and mindfully for a few steps? Just as an experiment. I found, when I moved to cane from walker, that using the cane unbalanced me-- it was so unnerving that I only carried it for protection inside. I did master using the "light kiss on the pavement" method outside, but never actually put any weight on the cane while walking.
You know, I just remembered something. When my walks started to get longer, I noticed the horizon bobbing and swaying just a little bit. I knew it never used to do that! It felt like my torso was doing the movement, but who knows what really caused it. I was very careful not to overstep my correct gait. But-- one night, several months later, the horizon stayed level and straight. Out of the blue, one day to the next. So I'm guessing that was the disappearance of my lurching, which I'd not been aware of and had done no specific exercises to correct. I hope the same will happen for you!


My phone sent this using BoneSmart Forum, clever phone!

 

[MissMoo]

Hi there @whiteshoecovers. I know when I started walking outside with just a single crutch I became tremendously worried about my gait, feeling I was bobbing up and down on every stride. Posted on here about possible LLD and @Jaycey gave me a piece of advice that was an almost instant fix. She told me to really concentrate on walking heel-toe, heel-toe. Now, I know that you're describing something a little different but I wonder if this may help you too? I found the act of focussing very clearly on how I want to walk rather than how my brain thought my body should move was very successful and I never looked back.

 

[Jaycey]

(bridges, clam shells).

These are core stability exercises - not really of any benefit for the area you are trying to strengthen. I would just focus on walking and doing the heel, toe slow and steady method. I have been working on this since my RTHR. It's very hard to retrain yourself to walk with a proper gait. But it can be done!

 

[whiteshoecovers]

These are core stability exercises - not really of any benefit for the area you are trying to strengthen. I would just focus on walking and doing the heel, toe slow and steady method. I have been working on this since my RTHR. It's very hard to retrain yourself to walk with a proper gait. But it can be done!

Clams especially target abductors, and it is specifically weakness of my abductors that result in my Trendelenburg gait.

 

[HollyB]

Here are a couple of things that have helped me with my gait: walking toward a mirror and focusing on keeping the shoulders level. For me, I found that I relaxed about what I was doing with my legs and concentrated more on my posture. At first there was a definite limp but the more I concentrated on those shoulders and then tightened my abs, the less I limped. Once I was comfortable with that part of it I focused on tightening the buttock muscles ( my PT suggested this part as she told me these muscles are the "driving force" that propels the step). Finally I was able to focus on that heel-toe step. You may be more of a natural with your movements but I am no and never have been. I always end up breaking movements down into little segments. Maybe this could help you, though. I hope so.

The second thing I have done (per PT) is to put my hands on my waist so that the movement remains level and take 5 side steps in one direction and 5 side steps back. My understanding is that this movement, along with those Clamshells) gently activates those abductors. I did these side steps while I was still using the cane in the house by moving alongside the kitchen island. Again, for me, it was more about level shoulders,posture, and abs.

Speaking of that cane--I am finally at the point (it took me almost 3 months) to ditch the cane completely in the house. I still take my trusty cane with me when I'm out and about as a measure of protection from crowds. At this point I have no shame and I totally lost any modesty while in the hospital!

You take care of yourself and please know that I have been following you thread and comments in other posts and always find what you have to say either interesting, enjoyable, or both.

 

[MissMoo]

Yes, @whiteshoecovers

I show a terrible Trendelenburg gait because of weakness of my operative side abductors.....Have started doing minor strengthening exercises for about a week now to work on this and see only minute improvement. (bridges, clam shells).

I don't know who confirmed that you have this weakness but, you are quite correct, the muscles largely responsible for hip abduction are the glute med and max. So in this case an exercise, such as the clamshell or glute bridge would assist with this issue. I know there is a lot of negative press on this forum about clamshells, although I don't know the background, but I did considerable work with glute bridge-type exercises to regain some balance and strength and get my posterior chain firing again, with lots of eventual success.

All I can tell you is that, at this stage, everything seems to slow down to molasses speed, truly. The improvements start to seem miniscule and the niggles you pick up along the way all serve to make you feel like you're going backwards rather than forwards. I feel fairly certain that, not long from now, you'll see light at the end of the tunnel. For me it was when I started back to Taekwondo and, although I was (and still am) restricted in the things I can do, the sheer joy of being able to do the basic things without the jolting pain through my hip was a revelation.

So, "chin up chuck", as we'd say back home, the best is yet to come

 

[whiteshoecovers]

Thanks everyone for the encouragement, it really helps.

I am seeing very slow improvement, but as I do feel like I have the exact same pre-op symptoms (character and severity) AND that I am recovering from a THA. I am afraid this was a poor decision and will not relieve me of the pain for which I sought this route.

I see my OS for the first time since the surgery (7 weeks) on Monday, I'll update after that visit.

 

[MissMoo]

@whiteshoecovers I'm very sorry to hear that its feeling so bad. Please keep us updated with the outcome of your visit to the OS. If you really feel that you're still having just the same symptoms, that doesn't sound right at all. Maybe @Josephine can offer some insights at this juncture.

 

[whiteshoecovers]

I just had the follow up with my OS. I told him that I am still experiencing the same symptoms that I had pre-op and he was puzzled. He said, that while my hip did have arthritis, there must be a different source of my groin pain if I am still experiencing it at this stage. He suggest I see a Urologist to look at my pudendal nerve. This is especially frustrating because I had seen a pudendal nerve specialist previously and after a couple months of care with no improvement decided that was not the culprit.

 

[zauberflöte]

@whiteshoecovers grrr that is frustrating! Maybe time for a different urologist?


My phone sent this using BoneSmart Forum, clever phone!

 

[whiteshoecovers]

I believe it's my psoas: pre-existing condition severely aggravated by the surgery.


Sent from my iPhone using Tapatalk

 

[webbie73]

I believe it's my psoas: pre-existing condition severely aggravated by the surgery.

Oh that darn psoas. I am unfortunately very familiar with it. First hip I had horrible psoas pre and post surgery. I blame some of the post problems with an over enthusiastic PT who had me doing full leg lifts. The pain from doing those just killed me. After 9 months of enduring the pain I had a procedure to inject the psoas. That helped.

With the second hip I have refused any leg lifts or anything that will inflame the psoas.

I hope you find relief.

 

[whiteshoecovers]

8.5 week update:

I'm far behind where I thought I'd be by now. Still a lot of medial groin pain, more that pre-op and I have yet to reach my pre-op level of function. My THA surgeon (Kim) referred me to a urologist, and I've had long talks with my PT and original scope surgeon Brian White.

Urologist: If you had a problem that I could solve, you'd be dead by now.
PT: You were a mess pre-op, lets persevere and start over again getting everything working right.
Brian White: You've always been an enigma with how your hip pain presented. Looking back you should have a lot of confidence in all the steps you've taken. It was a bit of a leap to get the THA, but you did your due diligence and appropriately addressed all other potential issues. Your hip was a mess and was a big part of your problem. I'm not surprised you are having a hard time of it and that it will take you longer than normal to recover. You're not a typical patient and will not be happy until you reach a very high level of function, so that will take longer. I wouldn't start scratching my head until 1 year post op. Work closely with the PT.

Having said all that, I have been feeling a tick better over the last week and attribute it to doing more therapy. Here's to persevering.

 

[copsham]

Hi Whiteshoecovers,
It sounds like a compliment to be told you are not a typical patient (!) but then you need to be more creative in your responses and treatment plan. BUT it sounds like this past week has shown some development - long may it continue. As you said "here's to persevering"

 

[aprilc]

DUDE! You sound like me.. here was me at 3 months:

Why am I so different? I was in relatively good shape before the surgery although my activity level had gone way down. I'm 3 months post op, just read that someone walked 4 miles when they were at 10 weeks, I've walked about a mile 1/2 which has felt good but I also just walked around my school to get out of my chair and ended up hurting very quickly. I don't get why I'm not progressing faster and why I'm having all this soft tissue pain. I'm pretty sure I'm my own worst enemy but, come on, I'm 3 months post op - I'm not trying to do crossfit i'm just trying to walk around a city I'm visiting or my school or do some PT to strengthen my weakened muscles. What do you guys think? I need some words of encouragement here...I've stopped reading people's recovery stories because frankly, as soon as I see they are progressing faster than me I get mad and I want to go out and just say screw it and do what they're doing. I know everyone heals differently but I wasn't in a wheelchair before surgery, I didn't have anything crazy other than your standard arthritis from Femoral Acetabular Impingement. Why is this taking so long!!! UGH!!!! Thanks for letting me vent!

I actually bought at fitbit at this point in my recovery bc I kept walking too much - a fitbit to monitor my walking so I wouldn't walk - that's just crazy! But it worked, gave me a sense of what I had done so far and if I should go walk around costco or do a short walk with the dog or just go lay down. Read my recovery thread, 3 months is around page 8, 9...but the whole thing is me overdoing it, people telling me to chill, me overdoing it again in another way, people telling me to chill on and on and on. It's going to be a long time before things are "right" and the more you rush it the longer your recovery ends up being. I know what it's like to want to get out there and do things and it totally sucks being held back. Are you a swimmer? If you want to get that "I just worked out good" feeling see if you can do that, I hated pool walking b/c I am a swimmer and if I'm at the pool I want to swim but it did help with my gait and helped me feel (I guess?) my walking a little better. I did it maybe twice before swimming but worth checking out.

As I had to keep telling myself, it's a marathon not a sprint, so just take up knitting settle in for the long ride

 

[whiteshoecovers]

@aprilc thanks for the post here and on your own thread. The part about the tight abdomen has me hopeful that the guided shot will be successful. Again, my surgeon who is pretty renowned for being a technical genius, reassured me the cup is perfectly sized and tucked out of the way of my psoas.

10 week update:

Still struggling big time. I had spoken with my surgeon again and at his referral went to see a....

Physiatrist. He agreed that while I do have back pain, that's not the source of my groin pain. He said he was on-board with an approach of systematically injecting the structures in the area until we nail down the source. The first shot was to my ilioinguinal nerve because 1) I do get a buzzing in the area it innervates and 2) it's an easy one he could do in his office during my first visit. No luck. I spoke with him a few days later with the news and next up is the obturator nerve and iliopsoas/ psoas bursa, though we have to do that in a surgery center (I hate those places).

PT We where working on glute/quad strengthening but I had to call it quits. For the record, my routine was:
clamshells
side lying leg raises
some variations of the above two
bird-dogs
bridges
ball squats
leg extensions

Also, for the record, I was careful to recruit my glutes in all the above exercises and would get a serious burn and post work out soreness right where I wanted it. But I also aggravated terrible groin pain that never goes away. The squats and extensions where particularly bad while the side-lying work seemed fine.

Last time I did the routine (two days ago) I could barely walk back to my car from the gym. Yesterday I felt cripple but already today I feel noticeably better. We've decided to suspend all exercises beyond walking until after the shots and hopefully some relief. The PT has also referred me to a.....

Chiropractor who specializes in gait. She was pretty much in disbelief the first time she examined my feet and walked me walk. I don't know all the terms, but basically she says dysfunction from my foot causes my leg to internally rotate with every-step which puts tremendous stress on my hip and psoas. She has me doing some specific foot exercises but the main thing is that she has fitted me for custom orthotics that will post my foot just right so my leg remains straight throughout my stride. I should get them in about a week. I don't have a super high respect of Chiro's and this kind of diagnosis (all your problems come from your foot) is part of the reason why. But it's not like I've had great luck with real Dr's to this point so I figure I'll give her a shot, and if she get's it right I'll f$@%king marry her.

 

[aprilc]

Anxious to see what the injection does for you. ARe they not going to do it with an ultrasound? Both docs I've seen that use ultrasound do it right in the office. If they're not I would try to find someone that uses ultrasound in your area. It's like getting an MRI but cheaper - and not quite as clear - but they can see soft tissue. If you're going to the surgery center that usually means they're going to use an x-ray machine. It'll get the shot in the right spot but the ultrasound allows them to see so much more and they can move your leg and see how things are moving in there.

All the money I've spend on this ****...I could fund an around the world trip for me and my husband! And, a lot of it wasted money.

 

[webbie73]

Injection to the iliospoas is no picnic. I had it done after my first hip. It was done in the hospital under x-ray. They thread a thin catheter from the top of my hip down into my groin. Once they reach the imflamed area you will know it. A horrible procedure but it worked!!! Wishing you the best. FYI it was my right hip. My husband drive me even though they said I could drive home. My groin hurt so bad that I would not have been able to brake.