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[REVISION THR] Aditi's recovery thread

Aditi

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7/6/18 Left Lateral THR

TIP: Bring a plastic trash bag to the hospital for the ride home. Great video showing how to use a plastic bag to safely get into the car and pivot easily @ 12:57
WEEK 1:

Waking up in the middle of the night 4 or 5 times soaked in sweat even thought I’m way past menopause days. Sleep fitfully. When I awake I feel energized and elated – my posture is better and I’m in much less pain than before the surgery. My quad, IT band and gluteus medius are sore, common with the lateral approach. No appetite since the surgery except for Saltine crackers and apple juice. I have the irrational fear that I’m going to break my new hip if I put weight on it. The visiting PT assures me that I won’t. My left leg now feels longer than my non-surgical leg and I worry that they’re uneven. This is also irrational. It’s lovely to have both feet firmly planted and utilized, where I used to favor the left leg. I’m also amazed at the control and function I’ve already gained, where before I used to hurl myself from counter to railing to wall for support. So happy I’ve had this done.

WEEK 2:

I didn't expect how tired I'd be - especially cognitively. I purchased an ambitious stack of books ... but focus is an effort - decorating magazines are much easier. You Tube "Comedy Central - This is Not Happening" even easier Balance PT/OT exercises with ice/elevation, rest and sleep. Also, keep forgetting that every task is a huge production now - "I'll take a shower" is fraught with pitfalls, props, preparation, pragmatism and logistical decisions. Pain, like grief, is an amazing "leveler" - bringing every decision to its lowest common denominator, simplest components and my priorities shift greatly. (Sniff, sniff - yeah, that shower can wait. ;-)


I’ve found planning is a must – gather the shampoo/conditioner, washcloth, body wash, Glad press-n-seal, towel and anything else before the shower. Once my left leg is wrapped, I get in per the OT instructions and sit on a shower chair. I fill a plastic pitcher to wet my hair and body. Then I wash/rinse while seated, refilling the pitcher as needed. By sitting in the chair, I can take my time, not worry about falls and enjoy it. I also can place my heel safely on the tub ledge and shave my legs. Had the walker ready by the tub. Needed a nap after the “sit-shower”.


TIP: The hospital tape and bandages pulled the skin off my thigh when removed. This made taking off the Glad Press-n-Seal especially painful, so I put generic brand plastic wrap on first and then cover with Glad Press-n-Seal. I also cut it off with scissors rather then unwrap it, which was painful on my already irritated skin.


WEEK 3:

Physically, I'm in much less pain than I was in before the surgery. There's a lot of reeducation as my left leg was 1/2" shorter than my right for some time. My body doesn't know what to do with itself! Overworked parts now on stand-by and under worked parts called into action. So nice to be in a body-centered awareness instead of data analytics, systems administration as I am at work. Different data and different system - working the puzzle of recovery. Not driven by an Outlook schedule, managing pain dictates my day.


As mentioned in some of the other posts, my body lets me know when it’s ready for more. I’ll realize I left my cane behind, or moved with more ROM, balance or endurance than a few days before. I trust the wisdom of my body first. Frustrated by conflicting instructions – surgeon says I don’t need PT, his PA says make sure I perform the PT exercises religiously, visiting PT tells me I’m “in my head” when I ask questions regarding form and performance. I’m very grateful for this blog and the sound advice. Prior to surgery I hired a PT to create a “prehab” routine to strengthen my muscles so my post-surgery rehab would go well. I knew what to expect post-surgery visiting PT and outpatient PT. I’m glad I did it because the exercises are familiar to me and my body responds well to the movement.


I now have an appetite and focus on fruits and veggies and hydration. Digestion and elimination are back on track.


Getting restless and frustrated, which means my energy is up! Each evening my husband or a friend takes me out. Yesterday, a concert in the local park – we sat in the car. I also enjoy going for a latte or short strolls with friends. To ward off isolation, I make sure I call 2 friends each day and discuss things other than the surgery/recovery so I don’t feel defined by it. I find it also builds my social and focus muscles. I also make sure I get fresh air each day and connect with nature – birds singing, sun on my face, wind rustling leaves, people going about their day, kids on the swing set. It’s a balance to the “medical” and “clinical”.


There's humor everywhere! You can't make this stuff up. Yesterday, I had a delayed allergic reaction to the adhesive on the steri-strips on my incision (10" lateral procedure). They've been lifting over time like a line of Tibetan prayer-flags flapping down my thigh and then just fall off. Visiting PT slathered on a hydro-cortisone cream and told me to leave it to the air. I dozed off in the recliner and the doorbell woke me out of a narcotic induced nap. I caned myself to the door and pressed the "access" button for an impressive flower delivery from my employer. The woman saw I had a cane, let herself in and offered to carry the floral arrangement to the dining room table. She asked about the scar and I look down and was horrified and apologetic. I forgot I had no pants on - buck-wild from the waist down!!! "Honey, I've had 5 kids - there's nothing I ain't seen!" she said and then proceeded to discuss her daughter's pending knee surgery for 15 minutes while I tugged furiously on the hem of my t-shirt.
 

Mojo333

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Love it.
Double hippy super woman.:yes!:
Brings back memories:heehee:
Great to hear you are doing well.
 

Layla

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Welcome to Recovery! It sounds like you're doing well at three weeks out.
Please read the Recovery Guidelines below and pay special attention to the BIG TIP toward the bottom of the page. Stop back often. We'd love to follow your progress.
A great rest of the week to 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
5. At week 4 and after you should follow this

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. @Aditi
 
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Aditi

Aditi

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Struggling 11 months post-op ... has anybody else had a loosening of the femoral stem? I'm having tremendous thigh pain - especially going from stand to sit, sit to stand. I can walk a mile, stand and put weight on my surgery leg with no issues.

Complicating matters are that I've moved across country and had to establish care with a new surgeon. He's consulted with 5 other surgeons and all agree the femoral stem is "pistoning" or moving up and down in the thigh. My body is growing a "bone shelf" at the bottom of the femoral stem to stabilize it. I will need a revision surgery.

I have a consult (already had a second opinion - threw it out - recommended bone injections for osteoporosis, which I don't have, and the post-operative bone is growing, hence the little shelf)

1. What caused this?
2. How is a revision surgery going to make things better?
3. Is this going to happen again?
4. If it's pistoning up/down - is it pulling on the femoral head/liner and shell and loosening it?
5. Original surgeon says wait until the one year mark and get a bone scan. If the femoral stem is moving in the thigh, waiting doesn't seem the right choice.

Has anybody else gone through this? Any advice? I value first-hand, lived experience over medical advice, although both are relevant and important.
Thanks.
 

Layla

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Hello, welcome back. I'm sorry to see you're in pain and back on the forum under these circumstances. My heart goes out to you as none of us want to deal with complications. There are many stories here of loose stems followed by revision.

@prairienut and @inthebeginning are two that I can think of who experienced loose stems and have been on the forum recently. Since I tagged them, hopefully they will stop by to offer some support or share a bit of their journey with you. You can also peruse through some of the Revision threads if interested, following is a link - https://bonesmart.org/forum/view/hip-replacement-recovery-area.5/?prefix_id=19

I will also tag @Josephine the forum Nurse to stop by and answer your questions. It may not be today, because she had to step away from the forum briefly, but check back as I know she'll be returning soon.
We're here for you. Wishing you comfort and peace.
@Aditi
 

inthebeginning

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Hello @Aditi, sorry to hear about your recent loose stem discovery. Besides a THR and the loose stem, I like to try to find other connections with folks here. I'll let you know that I lived in Rochester, NH for a couple of years back in the mid 90's.

I had an anterior approach THR on my right hip back in Sept of 2013. It was due to an FAI CAM impingement. That means there was a bit of extra bone on my femoral head. Over time, that rubbed the cartilage clean and I was bone on bone. I had no idea that I had this deformity so I lived a normal active life and was unknowingly destroying the cartilage. The left does not show any signs of this and I am not getting close to arthritis at all on that side. At the one year mark post-op, everything looked great and doc said, "See you in a year!".

About 9 months ago, so 5 years post-op, I started having some pain down the front of my thigh that started in the groin/thigh fold and ran down the left inner side of my thigh and around my knee. I thought perhaps I had been riding my bike too much so I just wrote it off. It came and went for a few months but eventually got worse. I self prescribed some PT with my primary care doc's blessing. A good month of 2-3 sessions per week didn't really help. PT told me I should probably see my OS. Sure enough, one x-ray showed a lot of space around most of the stem!

OS said he doesn't see this too often but said it definitely had to come out. He had no real explanation other than my body had gone through some sort of 'biological response' to the stem. All pre-op tests showed no allergies to metals, so that wasn't part of it. We scheduled the revision and he went in and grabbed a synovial fluid sample to check for infection. That was negative. So we really don't know why.

My OS has been doing hips in the Denver area since 2003. He started doing the anterior approach in 2004. He said he would have a briefcase full of stems and cups and balls once he opened me up. He wanted to make sure he could replace whatever needed to be replaced in addition to the stem. I ended up getting brand new everything! The stem is longer because he wanted to get a good portion of the new stem into fresh bone. Reading his operative report, he found a lot of scar tissue and 'fibrous' growth around the cup as well as the upper part of the stem. He had to release one of the tendons up front that was hanging/impinging in front of the cup. Note: the first cup was a dual-mobility cup. He replaced it with a non dual-mobility cup. He felt that the excess of scar tissue and other grown near the front of the cup was causing too much impingement of the dual-mobility interface.

That's my story. It sounds like your new team has a good sense of what's happening in there. There's a chance you may never get the answer we both want, What caused it to loosen in the first place?

Good luck and keep us posted!
 
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Aditi

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Thank you @inthebeginning. I'm 57 and also lived with no cartilage for years, so I understand. I'm happy that your revision surgery went well. The Doctors all say "What did you do?" like I made this happen. That's why this is so frustrating - for the first 9 months after surgery I was biking, hiking and lifting weights again (all approved by surgeon and the PT worked with my Personal Trainer).

For the revision surgery:
1. Lateral, anterior or posterior?
2. How is the recovery different, in your opinion?
3. How are you faring now that you've got replacement parts in and past surgery?
 

inthebeginning

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So...I’m 53 by the way. I was very active out of the gates 6 years ago. PT within 3 weeks and back to work in 7 weeks. In fact, I ‘ran’ a marathon on an elliptical 6 months post-op. All doc approved, of course.
I was a runner before the first replacement. I’ve turned into a cyclist lately. I think I will try for a Century (100 mile) bike ride in 6 months!
For the revision surgery:
1. Lateral, anterior or posterior?
2. How is the recovery different, in your opinion?
3. How are you faring now that you've got replacement parts in and past surgery?
1. Anterior. He went right back in through the scar from the first.
2. Recovery, to me, is SLOW! Physically, the healing went as fast as the first. I wanted to get walking like last time, but in order to get the best bone growth and fixation I have to take it slow. I’m limiting my Fitbit steps to 5-7k per day. I normally hit 15-20k. It stinks, but I don’t want this one to go south!
3. I’m doing great! I kicked the pain meds in 4-5 days. I haven’t had to take a Tylenol since last weekend. I’m chomping at the bit to get active. My doc has cleared me to go to the gym and do some upper body weightlifting with care not to place any pressure on the hip. I do everything from a seated position.

Keep the questions coming!
 
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Aditi

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Well done you! Sounds like a good plan. Moderation, but i understand your wanting to get moving after so many years of restriction and pain. I see the surgeon tomorrow to talk about the revision surgery and hopefully will set the date. I'll keep you posted.
 

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Hello Aditi, I am another who needed a revision due to a loose femoral stem. No infection. No metallosis. Just a very loose stem after ten years of use -- so loose it fell out in my surgeon's hand during surgery. In my case, only the femoral component needed replacing and not the acetabular cup. I am now 4 months out from the revision and doing great. I'm back to most of my activites. Haven't tried a long hike yet, but feel as if I'm ready. The recovery took no longer than the first time around, and the best part is that the hip feels more solid and stable than the old one ever did. This has all been a pleasant surprise.

I'm 68 now. I had my first THR when I was 58. I was pretty active with it until the last year or so which is when I believe it started loosening. It got more and more unstable, and it caused three unexpected falls, none of which injured me but were startling nonetheless. The reasons given for why it loosened: 1) Bad luck, 2) [A remote second he emphasized] Possibly the original femoral stem was too small which greatly increases risk of loosening. No way to prove that, but the revision surgeon said that given the dimensions of the bone of my unoperated leg, I should have had a larger stem. 3) For some biologic reason, my bone did not bond securely to the stem. #3 seems doubtful considering the cup was securely bonded. The surgeon said he banged on it, and it didn't move! So it is most likely either #1 or #2. Let's hope my luck is better this time around.

The upshot is that I was distressed to learn I needed a revision, but am delighted with the results. The revision was done at the Hospital for Special Surgery in NYC by Dr. Bradford Waddell, a young surgeon in his late 30s but whose practice is growing quickly. I was referred to him by Dr. Jeffrey Westrich, one of the more senior surgeons there. I was a little nervous because I knew so little about the surgeon, but I put my trust in the referral and the reputation of the hospital.

I wish you the best of luck with your revision. At least when you have a loose femoral stem, there is no agonizing over whether to have surgery or not. It is a necessity!
 
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@prairienut @inthebeginning @Layla Thank you for your stories of hope and resilience. I had the consult yesterday. My new surgeon consulted with 5 colleagues around the country. I like his diligence and measured approach.

We're going to take a sample of hip fluid, do a bone scan and schedule the revision surgery.

He thinks the femoral stem is not the correct size. Concerned about the possible controlled break of femur, but he assures me this is a common procedure with excellent outcomes. He only does posterior surgeries for revisions, "more freedom and room to maneuver".

I'm told 3 days in hospital and recovery is 8 - 12 weeks. Heavy sigh! Beats going back to extreme pain, instability and loss of function though! Upside is I know what to expect and what needs doing post-surgery. He agrees with BoneSmart moderators on no PT and walking (with limits) is best for healing.

I'd appreciate any tips and lessons learned.
 

prairienut

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Aditi, Your reply reminded me. I wasn't aware ahead of time, but my surgeon put a wire loop around the top of my femur to prevent bone breakage during surgery because they work hard to get a tight fit between the implant and the bone. It is still there because he said there was no reason to remove it. It would also help prevent breaks during recovery. Sounds like a good plan to me!
 

inthebeginning

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@prairienut Great news for you!! I'm just at 24 days and absolutely bored off my butt! I totally understand needing to take it easier this go around in order to ensure a good bond. Just stinks as the weather gets nicer almost every day...the bike is calling me!

As you said in your reply for #3, my cup was well embedded but he replaced it due to a big buildup of scar tissue and a fibrous in-growth around it. He still is leaning on your #2 for why my stem loosened, a 'biological response' he calls it. Still have yet to pick his brain on exactly what that fibrous in-growth is all about. But that growth was impinging the soft tissue in front of the cup. He had to release a tendon or two.

My new stem is probably two inches longer! He had to beat it in so hard that my knee actually hurt more when i woke up! That knee pain only lasted a day or so. He said he wanted to really get that thing into some fresh bone!

@Aditi What approach was your first? Both of mine were anterior. Again, the biggest difference with the revision recovery is LESS, LESS, LESS! Much less walking than we were used to the first go around. My modified BS mantra of MICE (Meds, Ice, Compression and Elevation) so key. I was lucky enough to kick the hard stuff (Oxy) before I left the hospital. I decided that Tramadol worked well enough prior to surgery that I could use it when I got home. I stopped that after 4-5 days. I had the pressure cuffs and ice machine on 20+ hours a day for the first week. The kids had fun figuring out new ways to make ice cubes in any container they could!

We are here for you! As you get closer, lean on us here at BS!
 

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Mojo333

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I'm told 3 days in hospital and recovery is 8 - 12 weeks. Heavy sigh! Beats going back to extreme pain, instability and loss of function though!
I'm very sorry you are looking at revision surgery but you deserve a pain free hip life...
Lots of folks to cheers you on!:friends:
 
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@Mojo333 You're so right! We all deserve a pain-free hip life. It was such a shock to be in agony for 10 years, then pain-free, active and not having to think about it all the time (what an adjustment!), then all of a sudden - pain and instability again. I think the mental component is the challenge, but I've always been optimistic and the BoneSmart cheering squad is a constant source of inspiration, courage and resilience.

@prairienut, my revision surgeon explained the possible controlled break procedure using a model of a hip (I'm a visual/hands on learner.) and like your surgeon, will use wire around head of femur and two separate wires around the controlled break as well. Seems like sound logic to me and I like the idea of extra stability. Glad you're doing well. Send pictures of that hike when you get there!

@inthebeginning - My first THR was lateral. I had done 6 months of prehab with a PT to ensure all muscle groups were ready to support me after the surgery. My recovery went quickly and well. I tend toward impatient and overactive, but will take all your advice and really gear it back this time. Your advice on using a FitBit to track steps so you don't overdo it is sound. LOL re: the kids enjoying the challenge of making ice packs out of anything they could find! My husband is an engineer and I can just imagine ... Thanks for the advice.
 

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@Aditi It’s funny. You use the word ‘prehab’, I used ‘precovery’! It certainly makes a world of difference when your body is already tuned up and physically ready to support the log, I mean leg, after surgery!

For those of us that were physically active, the first few weeks of recovery can be tough. Especially after a revision. We have to make suite we take extra care of it the second time around to make sure whatever the heck happened to loosen it doesn’t happen again!

Sorry about the possible controlled break. I was lucky I guess when my doc pulled the stem out with “little to no resistance”. That makes me think if I was ever close to losing it leading up to surgery!?

Best of luck and keep us posted!
 
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@Layla Is the post-operative activity progression for THR the same for Revision Surgery? That list of links you sent to me after THR surgery was invaluable - including the post-op depression! Thanks.

@inthebeginning - We'll see when he gets in there. I'm hopeful that due to the amount of "pistoning" up and down - there can't be much bone/tissue growth around the stem. However, he's going to have to remove that "bone partition" that's growing below the stem for support (body is amazing isn't it?). My leg gave way yesterday as I was stepping over the vacuum cord and I wiped out in my living room - no harm done, but really startling as @prairienut stated in earlier post. What a wild ride!!!
 
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has anybody else had a loosening of the femoral stem?
Quite a number.
1. What caused this?
It's just loosening, nothing more than that. You can see some of the causative factors in this article Cemented and uncemented hips
2. How is a revision surgery going to make things better?
Because the stem won't be loose any more.
3. Is this going to happen again?
Hopefully not. You'd have had really bad luck if it does.
4. If it's pistoning up/down - is it pulling on the femoral head/liner and shell and loosening it?
Doesn't work like this, Aditi. The stem is not connected to the acetabular stuff. That's why it's mobile!
5. Original surgeon says wait until the one year mark and get a bone scan. If the femoral stem is moving in the thigh, waiting doesn't seem the right choice.
Well he doesn't know what he's talking about! And you're right - waiting is NOT the right choice.
For the revision surgery:
1. Lateral, anterior or posterior?
2. How is the recovery different, in your opinion?
Usually posterior because of more room and access.
Is the post-operative activity progression for THR the same for Revision Surgery?
Exactly the same. As is the "no exercising/PT" recommendation.
 

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Hi @Aditi
Do you have a date yet for having your hip revised? If so, please tell us when it is, so we can add it to your signature.

It is just your left hip that's been replaced, isn't it? We seem to have got a bit confused about the surgery you had last July.
 

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