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[BILATERAL THRs] Al's New Hips<

Discussion in 'Hip Replacement Recovery Area' started by ATC, Feb 16, 2019.

  1. ATC

    ATC new member
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    Hi All-

    I am 54 years young and had bilateral (both hips) anterior replacement on December 10th 2018. Left hip was really bad for years and decided on surgery after right hip started to act up. I'm a sucker for a 2-for-1 deal so opted for the bilateral lol.

    Surgery went very well, I exceeded all expectations and went home the following morning. Normal recovery pain, but followed the meds regiment and was controlled (pain meds, anti-clot, anti-inflammatory).

    Had a scare at one week when visiting nurse removed the dressings as they pulled off the underlying mesh (outer incisions glued) and the right incision opened up somewhat. Reclosed and went on an antibiotic precautionary.

    At home therapy went well. Was way ahead of the curve. Never even used the cane, went from walker (about a week) to walking. Did notice toward end of home PT (2 weeks) that right hip was lagging behind left. Therapist at that point felt that right wasn't behind, but that maybe left was just that far ahead.

    Started outpatient PT at 3 weeks. Seemed ok, just favored the right hip.

    First post-op visit with the PA at 4 weeks. X-rays looked good. My complaints at this point were the numbness in the thighs and considerable pain still in right outside hip, worse with movement- walking, stairs, and knee lifts. Left hip (again this was the bad one initially) felt good as new. Numbness was explained as closeness to nerves at incision points and that it would most likely return to normal. Right hip pain was attributed to inflammation, and they put me back on anti-inflammatory.

    Physical therapist was suspicious, as we never got past the rudimentary exercises due to right hip. Her first concern possible infection, and recommended I get a blood test to rule out. I called the Dr’s office but they refused to order the bloodwork as they didn’t feel it was necessary. I went ahead and got it done on my own. There was luckily no sign of infection, but at almost 7 weeks my red blood cell count along with hemoglobin were still low (how long does it take to regenerate post-op?).

    Pushed and got an appointment with the surgeon. Didn’t think it was a mechanical issue, attributed the pain to bursitis, and gave me a lovely cortisone injection that he said should provide relief in a day or two. Ceased PT until further notice. Not sure why but the injection made it far worse- I couldn’t walk more than 100 yards without having to stop due to the pain. Felt like a horse had kicked me in the hip. Also noticed that the pain was extending to the front top of the thigh, and deep in the buttock area.

    Went back again and he put me on a 6-day steroid treatment (6,5,4,3,2,1). With the 6 pills the first day I felt like superman! Except for some localized sharp pain, it felt the best it had since the surgery. This was short lived however, and as the days wound down, the pain came back, and I’m afraid that the liberties I took while it felt good made it actually worse. Also with right foot planted any type of twisting causes a sharp pain in the hip area.

    Last visit with the Dr on Feb 14 and explained the feelings. I am going for an MRI on Feb 20, with a follow-up the following day.

    I am very frustrated and somewhat depressed. Have heard so many good things about this procedure. As of right now, I am nearly as bad off as I was prior to the surgery but with the opposite side.

    Appreciate anyone’s help and insight. I am more than happy to reciprocate where I can.

    Also want to give a shout out to my lovely wife who has cared for, supported, and put up with me selflessly throughout. In my opinion the most important “medicine” on the path to recovery is a good support system at home.
     
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  2. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Love that! :heehee:

    Hi, Welcome to BoneSmart and Recovery. Thanks for joining us.
    Everything sounded so good to begin with until your discouragement started building. I sense your frustration and don't blame you for feeling somewhat depressed. It's great you have a wonderful support system in your wife.
    The good thing is you're being pro-active with more testing scheduled. I'm not a medical professional so I'm not able to offer advice but I'll tag our resident expert who's had 50+ yrs experience in Orthopedics to get her thoughts.

    I'll also leave the Recovery Guidelines of which you may still find some info useful at two months post op.

    You'll find an abundance of support and encouragement here so please stick with us. We'd love to follow your progress and cheer you on as you move forward.

    Wishing you peace of mind, comfort and answers.
    @ATC

    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 discomfo
    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
    6. Access to these pages on the website

    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.
     
  3. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    ATC, I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
     
  4. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi again,
    It's good Josephine is on top of things because I told you'd I'd tag her and noticed I forgot :hissy:
    So very sorry!
    @ATC
     
  5. Debru4

    Debru4 senior

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    It sounds like you are feeling pretty concerned about the pain you are having. Many of the pains you have described sound pretty common following hip replacement, especially when you had two hips replaced and double the trauma.

    I'm a bit curious why they ordered steroids and a cortisone injection so early in your recovery? Did your surgeon think the PT and exercising you had been doing might be contributing? Did they suggest going back to ice, rest, and the protocols you followed originally? Sometimes progress is uneven, and since you describe your early recovery as going so fast, maybe what's happening will take care of itself. Good luck with your MRI.
     
  6. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    Hi and welcome "two for one" pal!
    Please reply to Josephine's request to ask you some questions.
    I think she will be able to give you some great insight after she assesses your situation.
    But i will give my initial thoughts...
    Too much too soon. Just because we can, doesn't mean we should. It never seems to hurt until we've overdone it.

    Very normal to have these symptoms for Months after surgery...my left hip that progressed more quickly but stairs and knee lifts are bound to cause more pain!

    It took over 6 months for most of numbness to dissipate...the small patches left after that I attributed to be collateral damage I could live with. By one year, it too was beck to normal.

    Very likely...almost for sure.
    Those hips need to heal and icing and elevating is part of that.

    Add to it, the subsequent therapies for what I see as normal healing issues and pain from overuse ...not complications.


    Unfortunately, as wonderful as this surgery is (it is!) The aftercare instructions are likely to be flawed and vary wildly. Bonesmart got me through my recovery with great advice and support.
    Do let Josephine know you should like her input as she has decades of experience with joint replacement.

    Hopefully you'll be back on track very soon.
     
  7. ATC

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    Thank you all for your prompt responses.
    I did ask them if I was perhaps I was being unrealistic in my expectations to this point, and was never told I was. To your points, maybe this is normal? But I don't know that-
    Debru- Thanks for your comments. My physical therapist was concerned something was wrong, as we could not move on to any resistance exercises. We were icing all along. Dr gave injection do to bursitis diagnosis as he could "push the pain button" on the outside of the hip. Steroids I believe to clear up any other inflammation, but not sure.
    Mojo- Thank You for your insights! Makes me fell somewhat better (I think LOL).

    Josephine, fire away with any questions. Appreciate all of your assistance!
     
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  8. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Here y'go then!

    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

    1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

    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 factor in 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. are you icing your painful area at all? If so, how often and for how long?

    5. are you elevating your leg. If so how often and for how long?

    6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

    7. 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.
     
  9. ATC

    ATC new member
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    Here you go:

    1. bilateral anterior approach- Dec 10 2018

    2. no pain sitting/at rest. Walking can range from 2-6, from dull thudding pain to sharp shooting pain . Stairs 4-8, sharp pain. Bed usually 2-5, sharp when changing positions- annoying pain in the thighs in area of numbness.

    3. Tramadol 50mg- sparingly, maybe 1 every 2-3 days usually at night.

    4. Stopped icing when PT stopped, maybe two weeks ago. Was icing 6-8 times a day for 10 minutes at a time.

    5. Only elevated at night.

    6. Try to be fairly active. I am working form hope. Helping out with house chores e.g laundry, dishes, garbage,etc. Try and go out to the store to do some walking about.

    7. Here goes- basically walking and early stage PT exercises. PT was 3x week- halted at 8 weeks
    Walking- try and do half mile 2x daily or as far as possible
    standing straight-legged leg raises- 3 sets 10 reps each leg
    standing hamstring curls- 3 sets 10 reps each leg
    standing knee lifts- 3 sets 10 reps (alternating legs)
    standing straight leg out to the side- 3 sets 10 reps each leg
    standing calf raises- 3 sets 25 reps (together)
    side-step glide- 3 sets 5x 8 step down and back
    stand-from-sitting- 2-3 sets, 15-30 reps as tolerable. (Hard time with this one as hips were so bad prior muscles were very weak from years of under use - have come a long way!)

    was doing a little exercise bike but was asked to stop

    Also working in some upper body but don't "think" has any effect on the hips

    More than happy to answer anything additional. Again appreciate all your help!
     
  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    That's a lot of pain for 10 weeks out!
    That's actually not enough but I suggest you take Tylenol 1,000mg 4 times a day at 6hrly intervals to a maximum of 4,000mg per 24hrs.
    Okay but you accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day. And elevate when you ice!
    Okay

    Perhaps you forgot about - or missed - this recommendation in amongst your Recovery Guidelines (post #2)
    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.
     
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  11. Debru4

    Debru4 senior

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    I recall that you are having an MRI soon. Please let us know what they find. Hopefully since you are still so early in your recovery, it won't be anything that rest, big time ice, and acetaminophen won't help with! Fingers crossed:)
     
  12. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Best Wishes for your MRI tomorrow.
    Let us know how it goes...if you care to share. If not, we understand.
    We're here for you.
    @ATC
     
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  13. Hip Hip Hooray!

    Hip Hip Hooray! post-grad

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    I am shocked at all of the exercise that you were doing. I also had bilateral anterior THR surgery. I was given Tramadol and Percoset after my surgery. I took them alternatively every two hours. I iced and rested most of the time. They just gave me basic exercises in PT, and I did the minimum amount. Had I done what you are doing, I am sure I would have been in terrible pain. There's plenty of time. To me, you are WAY overdoing it with the exercise. I hope you get your pain managed and heal.
     
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  14. ATC

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    Josephine- Thank you for your responses. I feel too much pain as well for this time, especially when compared to the left side. I try and avoid the meds, but will give it a shot, along with the icing. As far as the exercises, just trying to do the minimum we were doing in PT. Don't want to stiffen up.
    Debru and Layla, than you for your support- I will surely let you know how I make out!
     
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  15. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    :wave:Al.

    Me too!:flabber: To a carpenter, everything's a nail. To a therapist, more is better...not so in this case.

    :thumb:

    Agreed...I was pushed to do more than I was ready for and all it does is continually aggravate healing muscles.:umm:

    You are going to stiffen up..comes with the territory and all those exercises will cause swelling and tightening so can be a vicious circle.
    Just do the easy walking. Stand up and stretch ...lift your arms high to relieve some pressure off back from alot of sitting. A few stairs a few times per day to keep things moving.
    All should be done with moderation.
    We Cannot work this recovery...it really needs time.
    And do ice after activity and whenever you can, really.:ice:
    All temporary and keeping it all slow will speed up the healing!
    Take it from those who know.
    You will get there.:tada:
     
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  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    I understand but this is incorrect thinking. Doing all those exercises are what causes the stiffness and pain.
     
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  17. ATC

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    OMG, what a time with the MRI! Got chased around to three different centers because they required a MARS protocol with MAVERIC (may mean something to you guys) apparently to "tone down" the existence on the implants in the views. First two couldn't do, and here in NJ we had some snow fears going on so was afraid they were going to close early. Started at 8:30am, finished at 7pm!!
    Saw Doc today, not sure you can see the pic I uploaded. I think it is the correct view, but apparently the "brightness" around the stem, and similar halo-ing around the cup (brighter in other views) seem to indicate that the parts are not adhering properly. Said good news is few times he's seen it he hasn't had to go back in.
    As of now total cessation of exercises, limit walking and use the cane at all times.

    So to all of you who said it was too much, looks like it was too much! (don't tell my wife I admitted anything LOL)

    Next follow-up is 4 weeks, I'll post and let you know my progress between now and then.

    Thanks again everyone!
     

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  18. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    Oh My Stars....a 10 1/2 hour MRI excursion....I bet you were DONE.:dead:
    and...You are officially on timeout.:ice: I guess you have that figured and I will be sending good vibes for all to sort out without intervention:praying:
    Re the MRI, Very interesting...I googled it.
    GE Healthcare has introduced a new MRI technique that improves imaging of soft tissue and bone in patients with metal joint implants. MAVRIC SL, as it is called, helps reduce artifacts caused by the presence of metal in both in-plane and through-plane dimensions compared to conventional MR techniques. On regular sequences, metal implants cause severe distortion, making it impossible to assess the soft tissue directly around the implant. MAVRIC SL allows for MRI to be used to monitor for adverse reactions, such as inflammation, in the immediate vicinity of the implant.
     
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  19. Hip Hip Hooray!

    Hip Hip Hooray! post-grad

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    Oh dear. Well at least now you know why. I hope he doesn't have to go back in...so glad you are resting. Please keep us posted.
     
  20. Debru4

    Debru4 senior

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    That MRI sounds like quite an adventure, but I'm really glad you were able to get such a high quality one that gave you some good information. Bummer that the parts aren't yet adhering properly, but good news that you found out in time and there is a strong likelihood that rest will do the trick.

    Had to laugh at your "admission of guilt"---takes a strong person to do that, but the folks on here all get it! Many have had to admit the same thing, and for any who haven't, it's only because we heeded the warnings of the others.:heehee:

    My surgeon had done a great job of preparing me not to think of the hip the same as other replaced parts that do need PT or lots of extra effort in order to heal. Even then, I doubted him, and asked the people on here what they thought about it, and most promptly told me to listen to my doctor. Even those who did PT were adamant not to do it to the point of any pain, or to overdo.

    So now that you have been put on "forced rest" you'll have a chance to "go slow to go fast" this time! Keep us posted on how you are doing. (And none of this....:dancy::spin:)
     

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