THR Alexrd in recovery

[Alexrd]

Update
I’m hoping I may be beginning to get an idea of what my current problems are, and, hopefully, some possible solutions.

Just got back from seeing my first consultant surgeon who did my right hip replacement surgery. He immediately identified two probable explanations for my declining ROM, anterior hip pain and difficulty walking again without a limp and having to use my cane again for assistance to my right hip.
He suspects I have a leg length discrepancy of up to 15 mm, subject to confirmation with my most recent X-ray, which he’s not yet seen. Apparently, the discrepancy is immediately obvious from how I stand and despite the explicit reassurance my second hip surgeon gave that he’d addressed this. Hmmm!
I also now appear to have a large amount of scar tissue built up around the two arthroscopy incisions from my original failed FAI surgery ( but why it should suddenly have happened now and built up so quickly in the space of the last month seems unclear!). That accounts for the declining ROM and anterior hip pain when I go beyond 90°.
An orthotic should sort the leg discrepancy out, assuming my pelvis isn’t also tilting and contributing to the discrepancy. I’ll need lots more physio to calm things down and get everything back on track.
I’m reassured to finally get some answers and feel I’m being taken seriously. And assuming his hunches are right, there’s a clear way forward, which will take more time, effort and patience.

 

[Layla]

Hello Alexrd
I noticed, Jaycey, left you an article on Leg Length Differential early on in your thread, it gives a good explanation, if you haven’t read it yet. It’s encouraging to read you’re getting some answers and have hope that with a clear path forward, some effort and patience your issues will resolve. Best wishes! Please stay in touch and share your progress with us.
@Alexrd

 

[Layla]

Hello @Alexrd
Stopping by to wish you a Happy Four Month Anniversary!
Also wondering how all is going for you with the issues your surgeon identified. Hopefully things have improved since you last posted. Leave an update next time you’re here. We’d love to hear how you’re doing.

 

[Alexrd]

Thanks for your good wishes, and helpful reminder about the leg length discrepancy issue.
I’m far from convinced by my first surgeon’s attempt at buck passing to blame the second surgeon who did my left hip. He’s provided no evidence for his assertion about the discrepancy of 1 cm, and is (like the majority of UK consultant orthopaedic surgeons I’ve had the misfortune to meet) sadly lacking in basic communication skills.

I don’t believe a discrepancy of 1cm is significant enough to account for my ongoing symptoms, pain and lack of basic mobility, or that a definitive conclusion can be reached at (now) 4 months post op from my LTHR. I know and feel things are still settling there and, although I’m being hampered in my recovery from the second replacement by the problems with my first hip, almost all of my significant difficulties are attributable to my right hip.

I’ve had one deeply disappointing evaluation by a physio who had absolutely nothing of substance to offer and was very cursory in his approach. Needless to say, a second appointment was not required.
A second physio consultation was more promising, at least, I hope it was. A much more thorough physical exam and carefully tailored tests based on actually listening to my account of my confusing and complex symptoms. What my dismissive consultant attributed to scar tissue from the failed arthroscopy surgery on my right hip, appears much more likely to be an inflamed and unhappy rectus femoris!

I worry that a consultant surgeon couldn’t, or couldn’t be bothered to diagnose it correctly, and/or was too quick to deflect any criticism towards his previous and subsequent surgical colleagues, rather than attempt to diagnose the presented problem of his patient.

There may be other underlying muscular and tendon issues resulting from the original arthroscopy surgery and the complications this may have presented to the surgeon in carrying out the actual replacement. This is the first time anyone has suggested this to me and I’m frankly shocked and disturbed that at 11 months post op this is the first time anyone has taken the trouble to listen and attempt to give me a coherent explanation and preliminary diagnosis.
If you’ve got any particular expertise around rector femoris issues and suitable treatment options and exercises, I’d really value some additional advice please.

My initial research suggests ice, rest and perhaps very gentle stretching might help it settle now. I’ve cut back on all attempts at strengthening and rowed right back from walking, even with a crutch, because it provokes pain and limping after just 5-10 minutes. Does that sound right?
Thanks, as ever, for this community, it’s expertise and support.

 

[CricketHip]

@Alexrd You sure have had quite to runaround, haven't you? I'm so sorry you are struggling through this with physicians who don't seem to give your situation enough thought and concern.

Is there a possibility of going to a new surgical office that has no association with your current office?
Unfortunately it seems that many surgeons don't want to even consider any issues until a full year of healing has passed.. you are getting closer to that date but aren't there yet.
My thoughts would be to experiment and alternate heat and ice and see what feels best for you. If it were me, I would want to be very careful with any stretching, unless it's a very gentle and easy stretch.. muscles and tendons can get really sore and touchy with an aggressive approach.
I am going to tag my colleague @Pumpkin and have her read through your thread, she may have some better advice for you.

Take care and try to keep your chin up.

 

[Pumpkin]

@Alexrd,
Sorry to hear you are having continuing problems.

The Rectus Femoris crosses two joints, the knee and hip. If it is tight it can cause groin pain.
To stretch your Rectus Femoris you can start with lying on your back with your legs hanging off the end of your bed. You should feel a gentle stretch across your hip.
Once this becomes easy. Again on your back along the side of the bed, let you right leg off the side of the bed, your foot on the floor. You should feel a gentle stretch across your hip.

It would be best if a Physiotherapist showed you how to stretch your hip gently. They can check your form and be sure you are stretching correctly.

For walking, try two crutches and take some weight off your hip when walking. Hopefully you leg will feel a little better.

All the best in your search for solutions,
Chris

 

[Alexrd]

Thanks for your helpful comments and advice, my new physio did show me the gentle stretch you’ve described, based around the Thomas test, I think?
I’m using a heat pad for my lower back pain, and that provides some relief. I’ve also started icing the angry muscle on the middle of my thigh and on the side of my hip, which again seems to be helping. I’d not thought about going back to 2 crutches again; it seems like a big step back, but I might try that next time I go out. I’m going to take it very easy for the rest of the week and have no need to go out again really until I see the physio again next Thursday.
I’ll update after that.
As ever, I’m really grateful for your help.

 

[Magsmom]

Oooof I can empathize with the infection worry. My THR was Sept 13. But I also had my left knee replaced in October 2019. Since then my knee was always swollen and warm. My blood markers (CRP and EST) did not indicate any infectious activity. But the best way to find out for sure is to have some fluid aspirated from the joint and then culture it. Mine did not grow anything after 2 weeks.
Maybe that’s an option for you? ( it didn’t hurt, just felt odd).

Good luck!

 

[Alexrd]

Infection is a worry, so it’s always going to be at the back of my mind if I develop a temperature in the future, but my blood results suggested there was no evidence of infection, which did put my mind at ease, Magsmom.
My bigger issue remains dealing with the angry hip flexor muscles in my right leg, which don’t seem willing to be calmed down by anything I’m trying at the moment, Lol.
I guess I’m just going to have to be more patient and see if very gentle guided stretching with my new physio does eventually lead to improvement. I’ve not just stalled in my recovery, it feels like I’m going backwards and I fear what this will do to complicate recovery for my left hip.

 

[Schaargi]

Oh my gosh, the angry hip flexor plagued me for weeks with my first hip. It gets overworked and is difficult to calm it down. I had to back off of it completely, treating it like a baby, for weeks before it trusted me again (yeah, I tend to personify body parts and household items).

While it's frustrating, there isn't much you can do except baby it so it is ready to handle the load again. So sorry! I've been there!

 

[Alexrd]

Quick update

I had my second physio session yesterday and we tried some slightly more intensive hip flexor stretching, with passive resistance, if that’s the correct terminology?

It wasn’t painful, but it certainly wasn’t comfortable and was quite exhausting.

I’ve definitely been quite sore and stiff today, so have been resting and icing mostly. The physio tried to explain more about tendinopathy and more recent understanding of what the pain mechanism is.
It sounds like inflammation is no longer a significant factor, at least not after any immediate trauma or injury, which wouldn’t apply in my case. It seems to be explained as a result of chronic over-use and thickening of the tendon and loss of flexibility/pliability, if that sounds right?


The explanation seems to tally with my right leg having to work harder than it was ultimately able to when seeing my left leg/hip through the initial 3 month post op recovery. But I’m not sure where this actually leaves me now?

I get the impression that there is no guaranteed quick or even long term “fix” for this, and recovery could take 3-6 months, with possibility of relapse. Steroid injections are no longer recommended as they can actually compromise tendon tissue health. Surgery may be an option, but only as a last resort if more conservative treatment proves unsuccessful. And if they can actually pin point which areas of the tendon(s) might benefit. Surgery certainly doesn’t have any appeal at this point, my faith in surgical “solutions” couldn’t be much lower at this time, I’m afraid.

I still worry that the initial treatment of minimal activity and very gentle stretching and no strengthening is setting me up to fail with my left hip replacement recovery. How do I try to juggle what’s best for both hips now?

If anyone’s got some advice, I’d be really happy to hear from you.
Thank you all and good luck on your recovery journeys.

 

[Mojo333]

@Alexrd
Sorry your post looks like it's been hanging a bit.
Hopefully some members who have experienced similar issues can see this and contribute.

It sounds like inflammation is no longer a significant factor, at least not after any immediate trauma or injury, which wouldn’t apply in my case. It seems to be explained as a result of chronic over-use and thickening of the tendon and loss of flexibility/pliability, if that sounds right?

This is my understanding of the difference between tendonitis and tendonopathy.

I get the impression that there is no guaranteed quick or even long term “fix” for this, and recovery could take 3-6 months,

Unfortunately, this is the case as many athletes have had to take sabbaticals in order to resolve tendonopathy...

After a period of rest, I understand that the final stage of rehab for tendinopathy includes strengthening and flexibility exercises. Your PT will help determine the best rehab path for you, but it's important to understand that beginning any exercises before the tendon has healed may make the problem worse, so it's essential to follow your PT's instructions.

I'm sure this hurry up and wait approach is frustrating.
I am hoping it can begin resolving and you can incrementally progress activity so that you can strengthen both legs.
We can get back to where we need to be even if we lose a bit while we heal.

Wishing you a peaceful Sunday!

 

[Alexrd]

Thanks for your feedback, much appreciated. My physio cancelled this week due to sickness, and I can’t get a slot until the 23rd, so plenty of downtime before my next session. I’m doing the very specific gentle stretch every other day, as it just seems to aggravate my symptoms at the moment. Looks like I’m in this for the very long haul.

 

[Mojo333]

I’m doing the very specific gentle stretch every other day, as it just seems to aggravate my symptoms at the moment.

Would you mind sharing which stretch this is?

 

[Alexrd]

It’s based on the Thomas test.

 

[Alexrd]

My physio recommended another stretch too, I just can’t do it, as it’s just too painful for my knee, even with a thin pillow to cushion it.

 

[Alexrd]

If anyone can suggest similar stretches to try, or a way to modify the kneeling one above, I’m open to any suggestions, thank you!

 

[Mojo333]

Perhaps you can try this very gentle stretch or check with your PT...

Another one I used as I couldn't get on and off floor easily was placing one leg on a stair. Make sure you have support nearby like the railing.
Squeeze your glutes on your back leg, brace thru the core, and sink into a stretch for the front of your hip on the back leg.

 

[Schaargi]

Hi @Alexrd

I injured my tendon after my first hip replacement and found those stretches too intense at first. Here's the modification my PT gave me (I don't have a picture but can describe it).

It's based off the one where you are pulling in one knee while the other leg is hanging off the table.

Try it on your bed, floor, or couch, but without your leg hanging. Leave your leg straight, pull your other knee in, and tuck your hip under (pelvic tilt) if you need more of a stretch.

Try that. It doesn't help at all if you are too aggressive with your stretches. It just keeps aggravating it.

Hope this helps.

 

[Alexrd]

Thanks for the suggestions of some alternative gentle stretches, much appreciated. I’m finding things are easing off a little bit, but the last thing I want is to aggravate things further. I’m doing very gentle stretches on alternate days and just pottering round the house. I haven’t left the house or driven since my last physio session on 28th October, but may have to venture out very locally for some essentials tomorrow or Wednesday. It’s very frustrating, but I don’t want to prolong this any longer than it has to be. Hopefully, this is helping me heal enough to allow me to resume some kind of more active recovery shortly.