THR An Opportunity to Enjoy Life Again

[Sukuma]

It snowed yesterday, so I remained at home as I was worried about slipping outside on the snow. It rained overnight and today it was warm, snow melted, so safe to venture outside.

SWIM TIME!!!!

I was little hesitant, unsure how it would go. I can cope with one crutch now which makes things alot easier, and took it to the poolside with me after changing. The pool staff were ok for me to leave it leaning against some railings by the steps. I decided to take things easy and stick with pool walking, along with leg movements forwards, backwards and sideways to start with. There was a mild ache, not pain, just the muscles telling me that they are having to work against the water. I walked back and forth, avoiding other swimmers and felt my confidence growing.

I am an avid swimmer, but because of this, I was so conscious that I could do sudden movements that would not be a good idea, so wanted to make sure that everything was fully controlled, until I was convinced that I wouldn't do something silly. I held onto the side of the pool and practiced kicking my legs, while pondering how my crawl means rocking from side to side - would that mean my legs crossing over which needs to be avoided - or perhaps not? I walked around again, then decided to go for it, arms doing the breast-stoke, keeping my legs straight behind me, attempting to crawl kick, but it was a struggle not to fall into a breast-stroke kick, so gave up and switched to crawl arms for a short way in the shallow end. It kind of worked, but did make me think that it would be difficult in deeper water to make sure I didn't do breast stroke kick. I suspect alot of this is just confidence, as I am a competant, controlled swimmer - my over active imagination running away with me. I repeated this a couple of times, before deciding it was enough for the first time, as I wasn't sure how my hip would react to all of this. I had been in the water for 40mins.

Everything else was fine. A shower, changed, now able to put my shoes on, dried my hair and drove home!

What a RESULT!!

I was chuffed. It's another step towards getting my life back. Not the normal swimming I usually do, but it's a start. No complaints from the hip - yay! It was also the first time to get out the house on my own to do an activity.

As thepuckhead said " It's also a real confidence booster to realize what you're capable of in terms of just getting around independently!" I Completely Agree!!

 

[thepuckhead]

Yay yay yay!!!

You were much smarter than I was and focused on the water walking - really glad to hear it went well. We will get back to our regular stuff, even though I know it may be hard to imagine right now, but we'll get there. I'm kind of enjoying the adventures now of getting around with all my "stuff" and people at the gym are either freaked out and run away (oh noes!! A walker! Scary! It's contagious!) or they give me a big old look of respect for the perseverance. Earning our stripes here, for sure.

Cheers and thanks for posting the happy update!

There's no sticker board, but I think you definitely need this in your thread now:

 

[Gloucestergal65]

@Sukuma - I didn’t get outside yesterday either because of the snow. In the end it was really more a bit of wet sleet and no worse than when I went out today.
I’m doing hydrotherapy at the moment with the physios from the hospital where I had the operation done but even after two sessions I feel much more confident and am now looking around for a pool to go to so that I can start swimming again. I haven’t been since before Covid and lockdown so I’m looking forward to getting back to it regularly.
Small steps towards confidence, overcoming the anxiety of anything new.

 

[Newhip_Pol]

Hi, There are conflicting messages regarding swimming breaststroke, hip flexibility and swimming after THR. This article from 2015 supports the view of my surgeon and my experience but then I am not an athlete and my swimming is slow and not textbook. Looking forward to getting in the pool again this time around and I will be swimming breaststroke.

International Online Medical Council (IOMC)

International Online Medical Council journals provide an efficacious channel for researchers, students, and faculty members to publish works while maintaining excellence in medical research.

www.iomcworld.org

"100% of hip arthroplasty consultants would advise patients to swim breaststroke, compared to 18% of other health care professionals. No healthcare professionals have seen a case of dislocated THR following swimming breaststroke, and there are no reported cases in the literature."

 

[Sukuma]

"100% of hip arthroplasty consultants would advise patients to swim breaststroke, compared to 18% of other health care professionals. No healthcare professionals have seen a case of dislocated THR following swimming breaststroke, and there are no reported cases in the literature."

Thanks. Yes, I had seen this. Given that there has been some research on this, it is strange that there isn't a consistant message about it from the medical profession.

 

[Caison113]

Yes, it would be weird if a "frog kick" would result in dislocation so easily. My guess is that it's easier to say "don't do it" and feel safe, rather than risk allowing it and have that 1% dislocate (which might have occurred regardless for other reasons). I suppose if you got an extreme angle in the kick maybe it kicks out the ball from the socket, but seems unlikely to occur in the vast majority of cases.

 

[Eman85]

I don't think there can be a consistent message as all of us are different. If you read posts on here there are as many people dislocating from sitting on a couch as falling or twisting. Since all of our bodies are different and how we approach different activities varies it would be hard to have a consistent message beyond don't do that. Understanding why there are restrictions and why they say don't do that is the important thing, then you can do those things later once healed.

 

[Newhip_Pol]

Many surgeons now have no restrictions at all from day one for most patients (despite what some physios say) on the basis that prevention of dislocation is more related to increased size of femoral head, better understanding of pelvic dynamics and positioning of the implant and improved quality of soft tissue repair compared to 25 years ago than it is to limiting any movement by the patient. Of course, there are exceptions and some patients may be more at risk because of individual factors and thus require some restrictions. Trust your surgeon.

 

[Mojo333]

I was given no restrictions, but I certainly placed quite a few on myself... I am still often amazed at how some folks have their hip replaced and want to jump right back into tennis, weightlifting, breast stroke swimming, or whatever more strenuous activity within weeks of their surgery.
Have their HIP REPLACED....like, old hip socket out, prosthetic hip put in.
I was impatient with the process and the boredom of recovery but I just wanted to be able to tie my shoes, walk comfortably, and work well, and go home and get a full night's rest.
I have swam (swum, swimmed)and even breast-stroke, hiked a pretty tough trail, played badminton (Im awful), work long labor intensive days, and play hard on the weekend.
I really didn't mind waiting for almost a year to get back to the harder on the hips stuff.
I was just happy to let that hip heal and strengthen and tone slowly so these can be my forever hips.

 

[thepuckhead]

With regards to breaststroke/frog, what I learned from my PT was that, if you do a proper whip kick, it pretty heavily rotates the hip (inward or outward, I always get those backwards, haha!), which your soft tissue may not be ready for, especially if you do a lot of it at first -- then you have both a big range of motion stretch and repetitive motion that can leave you with soft tissues that may have unpleasant things to say afterward.

However, a lot of recreational swimmers don't do a true whip kick (I'd include myself in that group). I do more of a side kick, so it's not as much rotation. I never trained as a swimmer, so nobody ever harped on my proper whip kick. The "false" whip kick is less pressure and stress on recovering soft tissue, but freestyle and backstroke may still be easier to do while you're recovering.

As always, I think, it's up to your body, your comfort level and should always take into account any input from your care team.

Incidentally, I have a whole new respect for serious water walkers. I was walking along the lane, la dee dah, and, next lane over, here comes this woman power walking so strong I was stumbling around in her wake. I felt like a floating swan toy bobbing around in the wake of an ocean liner. Serious stuff. I will never, ever roll my eyes at the idea that you can't get strong and fit any old way your body chooses to move.

Oh, and thanks, @Mojo333 for that darned word and grammar conundrum. Swim/swam/swum and drink/drank/drunk and lie/lay/lied/laid. YARRRRRGGGGGGH!! I looked it up. Didn't help. Memories of seventh grade English and attendant hissy fits. I swim. I drink. And I....well, I sit down or go to bed.

 

[Sukuma]

8 week Post-Op Update

I visited a local Physio this week to review my walking (different from the hospital physio). The physio gave me a few pointers, encouraging me to ditch the crutch and just use a walking stick outside. She corrected my gait, which I had got a bit confused with, due to the leg length discrepancy that was messing up the way I was walking. It means bending my knee more on my operated leg , however I was feeling pain where the quads meets the knee. In addition to all the exercises I am continuing to do on a daily basis, she added in to practice balancing on one leg. I am in a routine with the exercises and with particular exercises (such as leg lifts) I look forward to finding out what is different today from yesterday, is the exercise easier to do?

So for the next 48 hours I have been following her advise. The knee pain disappeared within 24 hours, it was really bizarre. I had been quite worried about it, as the muscle ached alot when I put my weight on my knee and the pain just to disappeared over night once I just got on with using the knee as I should. At every opportunity I have been practicing standing on one leg and now walk around the house without a stick and very comfortable in doing so. I am walking outside with a walking stick instead of crutch and practice walking some parts of the walk without the stick, which I can do but still find it challenging. My hip muscles are still not strong enough, start to hurt and I limp. Pain appears at the front top of the thigh when I exercise (feels similar to a sore fresh aching bruise), which disappears after a while when I am at rest. I had bad arthritis for many years, my joint had restricted movement, so it's not surprising that it's taking time for me to get the hip muscles working properly - though it is a little frustrating at times. I clearly still have weak hip muscles that need time to build up some strength, even so, every day I can feel little changes as I get stronger and I do get excited about it.

Sleeping is still terrible :(. I still can't sleep comfortably on my side, so still on my back which doesn't work for me despite doing it for 8 weeks. My op leg doesn't hurt at all at night, but the arthritic pain in the other leg kicks in early in the morning, though if I had taken ibruprophin the day before it's fine.

I returned to work this week on reduced hours. I am very fortunate to work for an organisation who care about their employees, so able to have sensible conversations with respect as to what I can and can't do, able to spend time on my rehabilitiation, by moving around on a regular basis and exercise.

 

[Layla]

This is a wonderful update! I am happy for you. Lots of progress. As far as seeping goes, something that helped me get comfortable with sleeping on my back was an excess of bed pillows. I pretty much surrounded myself with them and sort of still do. Laying my head on a comfy pillow, or multiples if they're soft, and having different pillows of varying firmness really helped me, It felt like I was in a cocoon. You may consider giving it a try.
Thanks for sharing such an encouraging update. I am sure many will benefit from it in the future.
Happy Saturday and Happy Two Month Anniversary!
@Sukuma

 

[Sukuma]

I love the idea of pillows and I use four of them at the moment that I use to either lean against or put my legs over, but perhaps need a couple more. Thankyou.

 

[Gloucestergal65]

I also surround myself with numerous pillows and live snuggling into them while sleeping in my back. And handy for stuffing under the knees on an achey back night.

 

[Layla]

Happy Three Month Anniversary!
I hope you have a great week!
@Sukuma

 

[Sukuma]

3 month update.

Wow, there is alot of change from 6 weeks to the 3 month mark.

I am now regularly walking 10,000 a day and able to take my dogs for a 2 mile walk, though I do try to find a log to sit on for 5 minutes at the 1 mile mark. I take a walking stick with me, to make sure my heal to toe movement is as it should be and not lapse as I tire.

The aches and pains are reducing. I still get stiff when sitting for a while, but the length of time before this happens is lengthening. The thigh pain has gone, but still get pain with my hip flexors, particularly when walking, minor lower back pain after a walk and sometimes at night (usually the day I have done my exercises) my leg aches and a little bit of nerve pain - nothing I worry about, as I view it as on going healing, which in time will go.

As I expected, I still have leg length discrepancy, that hasn't changed. I am alot more stable in dealing with it, as the operated hip muscles have strengthened, so enabling me to remove limping when using a shoe lift. I can walk without a limp without the shoe lift, but, with a bended knee on the operated leg as it's to long to straighten it without bopping up and down. I know its difficult to properly measure and it could be completely inaccurate, but this does give an indication. When measured against a wall while standing on my non operated leg I am 159cm and when standing on my operated leg I am 162cm. Prior to all of this, standing on both legs, my height was 160cm. My surgeon tells me the height difference is due to height loss on my non operated side as I have considerable arthritic damage there and also says that my pelvic movement on the non operated side is poor, so is not adjusting the pelvic tilt. So this in addition to an angle occuring on the non operated leg between the pelvis and femur, lifting the leg slightly (which happens in arthritis) an apparent leg difference is occuring (though he did introduce 6mm with a long neck for stability reasons). He is referring me to someone who can measure this properly for orthotics, plus I would feel alot more comfortable when I have a better idea as to what height I should be using. At home, I use a low shoe lift walking round the house, but lift it when I go out for walks.

Walking still feels odd. I had arthritis for well over 10 years and very poor hip movement for well over 5 of those years, if not more, so it's not surprising it's taking time to adjust to the new position. I can feel that the leg stretches out more, the hip is straight, rather than at a slight angle between the hip and femur when walking, so I can stand up alot straighter with my bum flatter and its this that is putting a strain on my hip flexors as they are adjusting - meanwhile my other leg remains in the original position. It's wierd feeling the difference between them. I can see this on video's of me walking, only because I know its there, but anyone else watching them would see reasonably good walking. I am hoping in time that this feeling will reduce as I get more use to it. This should change when I have the other hip done aswell, but not ready for that at the moment.

Onwards and upwards - still more habilitation needed, doing my exercises every other day and walking as much as possible - loving it!

 

[Newhip_Pol]

Great progress. Congratulations

 

[dapplega]

Great update. Question, and apologies if it was covered earlier. Are you likely to have your other hip replaced too? If so, I'm assuming your surgeon would be able to correct any LLD?
I read with interest your PT experience. For my first hip I didn't do any PT until the 6 week mark (mainly I think this was due to miscommunication between me and my surgeon plus I had been reading the forum here and was comfortable with just walking). I just walked everday and did some light exercise they gave me at the hospital. My recovery went fine and at 6 weeks I started PT and went back to the gym. Now, during the lead up to my first THR and for the last five years I have also had very tight IT band and quads. I thought it was due to running to much (I was doing about 5 miles a day but I'm not a light runner and it was a plodding 5 miles ;)). I stopped running after first THR but kept going to gym and added stationary cycling but nothing could loosen my tight IT or quads. Fast forward five years to my left THR and my IT band and quads have remained tight often waking me at night. This time I started PT right at the 2 week mark and was doing many of the same exercises you mentioned. I told the therapist about my IT and quads and she said they are overworked because my glute muscles are so weak. I was a bit surprised as I've been going to the gym but she added with arthritis, especially if you had it for awhile, your body can stop firing muscles in a protective response and this leads to other muscles over compensating. Makes sense to me so I will continue with these clam shells and glute strengthening exercises. I guess my rambling point is we all own our recovery and can be successful with different approaches whether that be just walking and progressing slow for the first couple months, or starting PT to build muscles that may be dormant. From a strictly THR recovery standpoint both approaches have worked for me. Best of luck in your continued recovery.

 

[Sukuma]

Interesting point you are making dapplega about the PT exercises. I am getting pain in my lower back and the top side of my thigh after standing or walking for a while - I am now wondering what is causing this . I also get the top thigh pain on the outer side of my non operated hip, so also wonderi whether this is related to the IT band. The lower back pain is probably in part due to the leg length difference and in part to arthritis actually in my lower back. Your point about muscles compensating for others is so true and it could be going on for a very long time without us being aware of it. My glutes are definately weak and its really taking alot of time to try and build them up despite the regular exercises, so I have to keep reminding myself, they were not working properly for a very, very long time. I cry with frustration with it, worry that I will never get the strength back , but the reality is 3.5 months is not long and I just need to keep working them. I have been trying to keep up the walking, but finding my arthritic hip is now complaining during the night, so whilst my desire is to be out walking, the reality is that at the moment it's just not feasible. Both legs and hips are taking a big strain at the moment. I really do feel it when walking as the effort I have to put in is alot more than before. The operated leg is working correctly, but has weak muscles whereas the unoperated one isn't functioning as it should. I can clearly set this in my video'd gait. My partner has been videoing the gait to help measure any changes over time.

Yesterday I had a bio mechanics review and the conclusion was I have 3cm leg length discrepancy. He used a varity of different ways of making the estimate, so its interesting that matches what I thought it was (I didn't share this info beforehand). The conclusion was also that the femur length is the same on both sides, and it is the left tibia that is slightly longer. When I sit with my knees bent, my left knee sticks out more, though I certainly don't remember it being like that before the Op - maybe a pelvic tilt compensated for it. So...it is likely that the left side has always been longer, but without pre op measurements, hard to really know. What I do know, it that pain in my left knee started over 14 years ago (along with lower back pain), I changed my gait deliberately and the pain moved to my left hip. I also had uneven wear on my shoes - I saw a foot person then, but didn't really get a satisfactory outcome of it all, I just couldn't work out what profession to see. At that time, I saw a NHS orthopedic surgeon who identified I had mild hip arthritis (14 years ago), but brushed me off as if I was a complete timewaster (in my early 40s), it was awful. To add to this, I had knee ops when a teenager, due to being knock-kneed, so again this could all related back to uneven bone lengths. But, I will never know, as I don't have the information.

At some point I will have the right hip replaced. I doubt it will completely fix the 3cms, particularly if my left tibia is indeed longer, but it should help to reduce the difference. The right hip has got progressively worse since the operation, I still have most movements. During the day its ok, the pain arrives under the cover of darkness and there are some moments, when I need to be careful how I actually move my leg in case it locks - weird as during the day and during PT excercises it's fine, its mainly at 3 o'clock in the morning when its decided it's time for me to be awake, not sleeping!!! My surgeon won't guarentee anything, which makes me very nervous of the outcome, "it is what it is" - surely it won't be worse? For now I am holding out, as just can't face the thought of going through all this again, but I do suspect that I'll have it done by the end of this year.

I do find all of this very hard emotionally to cope with - my poor partner is having to put up with alot, I am lucky to have a very caring man tolerating me. I am planning to see a rehab lady this week - she has recently gone through the procedure herself and got into the profession of helping put programmes together for people who have had hip replacements. I swim, walk and do the PT exercises, but in reality I think I am (well, I know I am, as my partner moans to me) doing far to much, so need some help in spacing the activities out better and making notes as to what to focus on, for slight improvements over time, and not to get stressed out about it.

 

[dapplega]

I'll be your PT international work out buddy I'm going to commit to these glute and core hip exercises to see if they make a difference. Regarding your other hip, my recommendation would be to get it done. It sounds like it is already an issue and you've confirmed the arthritis. Get it done so your body can baseline. Otherwise the compensation will continue and it will just take that much longer. I know another surgery can be daunting but in the long run it hopefully is just a blip on the radar. Regarding doing to much, listen to your body, if what you are doing hurts, or soreness lasts more than a day then you are likely doing to much. If not, you likely are at a good level. Keep moving forward, one foot in front of the other (heel to toe)
Best of luck to you in your recovery.