THR And now the healing begins

@CricketHip and @Eman85 Thank you for the hypothetical star! I appreciate the advice I receive on BoneSmart. I have lamented more than once that I did not know about BoneSmart until after overly aggressive physical therapy had damaged my right knee after TKR. The members who give advice have been there, done that. I had gotten caught up in listening to Chris about his PT program for me and needed the advice I received yesterday to pull me away from the brink. Both of you reminded me that muscles need to heal first. Duh.
I have read all of the articles and information by Josephine and others concerning knee and hip replacements and recovery therefrom. I have found it to be invaluable. The wonderful reminders I received yesterday helped me get back on the right recovery track. Thank you.
Now I’ll get that lovely nights sleep.
I think he may be pushing me just a bit too far, so I will discuss that with him in our session tomorrow.
I’m thankful that you’re open to considering this. It will likely benefit you in the long run. My best advice is for YOU to be in control of the PT sessions and be clear with, Chris, on that from the beginning. You will do what you’re comfortable with, but no more. I like to compare early THR recovery to sustaining similar injuries through a car wreck, as opposed to the “controlled trauma” you recently endured. If your injury was the result of a car accident, would you be concerned with working out at this point, or healing first? Something to ponder…

I hope you have a great day and enjoy the weekend as best you can at this point. :)
A while back there was a PT that was scheduled for a THR, I don't remember them coming back and posting their experience. I'd say any healthcare workers that have a joint replacement might have a different view on the recovery.
@Layla As I was reviewing my physical therapy yesterday, I realized that I think my right knee has become more swollen and stiffer since Chris incorporated heel slides into the program. I think my recovery is going quite well except for that. Big red flag. I woke up last night with significant pain in both of my hips and legs. I iced them at 3:30 this morning for 20 minutes, then iced different parts of both another 20 minutes. I had a considerable amount of relief, but was awakened again by stabbing pains in my right hip about 7:45 am. I got up from my lift chair and started my day as the pain abated. Chris had me do heel slides and abductions with both legs in our session on Wednesday, and I did them twice as directed on Thursday. I am definitely removing heel slides and abductions from my PT program. I will continue to do the other components of the program while constantly assessing them and their impact on my body. I have been doing some of them past the point of comfort just to get the required ten repetitions. No more. When I think I’ve done enough I will stop and not think that I need to do a certain number. Thank you so much for your input that is helping me to better monitor my PT program.

@Eman85 Interesting observation. I would be interested in how a healthcare worker views their recovery experience and if it is viewed differently than by a layperson.
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I’m sorry you were dealing with some significant pain overnight. Hopefully today feels brighter.
I’ll leave an article written by BoneSmart’s Nurse Emeritus. She was involved in orthopedics for 50+ yrs. You’re probably familiar with some of her articles if you’ve searched the site. I‘m including one in case you missed it -

Also, in regard to icing, which may go against your PT, or surgeon’s advisement, I did some research awhile back and this is what I found -

Icing for up to twenty minutes only is what most of us have heard or been advised to do following an injury. Following joint replacement, ice is a critical part of pain management and should be used not only on the joint, but any surrounding areas of discomfort for as often and as long as you're comfortable doing so, always placing fabric between your skin and the ice source. Icing helps bring relief from the soft tissue trauma and internal swelling. Icing is a great natural pain reliever and best of all, it's free. While some care providers do put a maximum time on icing, others suggest you ice as often as you see fit. Icing after therapy, exercises, or prolonged activity that challenge ROM and endurance should help ease any discomfort, or preventively keep pain at bay. You may find relief through icing for weeks to months post op.

I iced almost non stop and I’m thankful that I was blessed with a straightforward uneventful recovery. I can only hope and pray that if I ever need my other hip replaced, I’d be as fortunate. I truly believe you need to be in the drivers seat with your recovery. It’s your body, you’re the only one that can judge how you’re feeling and many of the medical professionals who advise never experienced a joint replacement or recovery themselves. I find value here, on the forum, in relating with others who were healing right along with me, or ahead of me. Along with the advice of your OS and PT, stay connected here through reading others updates and using the resources provided Then…listen to your gut and use your best judgement.
Sending a healing hug with wishes for all the best.
Forgive me for labouring the point, but sometimes I just can’t stop myself….

I know how hard it can be not to do the PT exercises. My physiotherapist after my first hip was such a nice young woman, I really didn’t want to hurt her feelings. My fortnightly sessions with her were my only follow up apart from one brief meeting with my surgeon at 6 weeks, so she was a hugely important source of advice and reassurance. And she seemed so experienced and knowledgeable- she worked full time with joint replacement patients, had multiple qualifications, she must be correct surely? So I started off doing everything she suggested. Then I came on here and whined about my pains and people warned me off. But I kept having goes at the exercises, whining, being warned, stopping, then thinking the therapist must be right, starting again…

I don’t really understand how it was possible that she didn’t know best, but she didn’t.

This time I got in first and told the lovely young man assigned to me that I had figured out from my first hip that exercises too soon were not for me, but I would value his feedback on my progress. It has been easier to do as we met on Zoom. I tell him how I have progressed over 2 weeks, he is encouraging, makes suggestions, and I ignore them.

It did take a bit of a leap of faith. Maybe the nerves wouldn’t wake up and I would never be able to do a particular movement again? But every now and then I gently try out one of the rejected exercises, and miraculously my hip has figured out how to do it all by itself, without pain or difficulty, now it is ready.

I am a great believer in PT exercises in their place, which is after the major healing is finished. And in fact I have now had an IRL meeting with my physiotherapist and I am doing his prescribed exercises. But cautiously building up to his recommendations, and at 12 weeks post-op. Day 9 is much too soon IMHO.

Sorry, rant over!
All therapy programs are not bad or harmful. I started home pt on Day 3 post op. My therapist ascertained that I was able to use the walker properly, that I was getting up and moving at regular intervals, that there weren't trip hazards in my home, that I was able to use bathroom facilities, that I could access my bed and properly position the abduction block and/or pillows, that I was doing the safe and simple exercises that prevent blood clots, and he helped me to get my log leg moving again, since having those 'dead' nerves and muscles causing a malfunction presents a fall hazard.

Subsequent sessions focused on balance and regaining enough strength to do simple things like getting into and out of a car, and navigating stair steps.

After months or years of impaired movement, our bodies adapt in ways that can be unhelpful to proper motion and gait. "Just walking" may work for some, but if someone is walking with a hiked hip or limp due to muscle contraction, some therapy can help to restore balance. Sometimes people need help in relearning to engage core muscles to support their sore tired backs. The old song about the "knee bone connects to the thigh bone; the thigh bone connects to the hip bone; the hip bone connects to the back bone" has special significance to us with joint replacements. Not everyone easily relearns those connections on their own, and therapy can help.

In my experience, none of the many physical therapists I've had over the years encouraged, let alone forced, me to do anything that caused pain. However, it was *my* responsibility to alert them to pain or difficulty so that they could modify or eliminate problematic exercises. It was my responsibility to remember who is paying whom for help, and who was going to have to deal with repercussions of too much too soon. That who was me. Or I. Definitely not them.

I think everyone need to find their own path, and what serves some won't serve others. Especially when, as on this board, there are so many differences is age, ability, fitness, activity level, surgical trauma, and conditions at home. There aren't absolutes like Nobody Needs Physical Therapy or Everybody Needs Physical Therapy. Good/bad experiences for some don't necessarily translate to good/bad experiences for all.

I'm gonna be a pill and not apologize for the rant :nah: But I'm gonna wish and hope for all on this journey to have safe and swift recoveries by whatever path they take:praying::thumb:
I didn't have any "formal" PT with either hip. My OS warned me not to go to PT as they would hurt me. The office did give a handout of exercises and the PT at the hospital made us do them before we were discharged. With my 1st THR I had great control, no log leg and I could do leg lifts the day after surgery. So I went home and did the exercises on the sheet and I did over do it and have pains from it especially if I added in any advanced exercises. When it came time for my 2nd THR it was a different story, I couldn't lift my leg and it didn't want to do anything. At the hospital PT I couldn't do the exercises and I had seen them bully people the first go around. I'm not a little guy and they caught on quick I wasn't going to force anything. I skipped the exercises routines with my 2nd. Funny thing the end result was the same. My body didn't forget how to walk, bend ,stretch or lift me up. I'm past the point of training for anything. I just want to be able to do my regular life stuff.
Basically all that subie mentioned in the first paragraph of her post above are things I mastered at my surgery site before being discharged. I went through the commonly prescribed post op exercises with the PT and received print outs to take home as a reminder. I received guidance on how to access a bed and a vehicle. If I recall, a nurse walked with me to the bathroom for the first time and after that, I was on my own when I needed to use the bathroom. I will add that my husband was at the surgery site with me, since it was predetermined I‘d be staying for 24 hrs. It was a requirement that you have someone with you overnight, even so, they did periodically check in on me. I was never alone, which was a comfort. Pre-op, I received information cautioning me about tripping hazards in the home, naming the most common, which as adults common sense tell us.

Certainly not all, but some PT’s are very convincing at promoting what they feel is necessary to a successful recovery and sadly not all patients have the confidence to be assertive enough to refuse to engage in certain movements, often assuming the PT knows best. I am not opposed to PT, I attended three sessions myself at three weeks post op, but decided it wasn’t for me. I do believe Physical Therapy is unnecessary for many THR patients, especially before 6-8 weeks post op in most instances.

Each member does need to make this decision on their own and that’s why we don’t preach absolutes here. It’s understandable that PT benefits many, others find they don’t need it.

The important thing @wander03 is that you decided that you will only do what you’re comfortable doing and no more. With that, I wish you success and perfect healing.
That's part of the differences and variables. What's needed for a 70-something is likely different from the needs of a 50 or 60-something.
Each to their own, there isn't an Everybody Needs or Nobody Needs in my opinion.
A suggestion - my surgeon gave me the choice of pt venues, those being hospital based, independent, or the facility that is part of the health care group that his practice is in. I think I had a good experience based in part by choosing the last one. All the pts there knew what each OS in the group favored as far as procedure, etc. They were able to access each others' clinical notes also.
So perhaps it would be helpful for new hippies to ask the surgeon if they have a preferred pt practice if the surgeon suggests or orders pt.
Might keep everyone on the same page.

Happy healing, all!
I started writing in reply to @Layla’s first post and was interrupted by a telephone call. By the time that conversation was over, there were four additional posts. And there was another one added while I was writing. So here I go. Some things will be in response to multiple posts.

@Layla I re-read the article by Josephine that you included and all of the linked information. I always get additional information when I read something again. I’m splitting the difference on icing. I use it longer than twenty minutes sometimes.
Chris seemed to be a bit taken aback by my pushback today. I told him my knee was stiffer and more swollen after the heel slides and abductions and that I was not going to do them anymore. He looked a bit stunned. He said we have to keep doing them or we will lose the progress we’ve made. I said the heel slides hurt when I did the first one and I don’t intend to do anything that causes pain. He thought for a bit and came up with a standing routine as opposed to the laying down routine. He is concerned about coming up with a program that works for me.
We went into my kitchen, and I stood in front of a cabinet. I rocked up on my toes ten times, then rocked back on my heels ten times. I then barely bent my knees like the beginning of a squat ten times. Then I did a quarter squat ten times. Then I moved my leg to the side to a point where I was comfortable, brought the other leg in, and continued that the length of the counter. Then I led with the other leg and did the same thing back to where I started. i repeated the last exercise. That is all the exercising I did during session today.
Chris was concerned about the pain I had last night. As we talked after the exercising, I said that I held my knee back for ten seconds after he inquired if I did. Then he asked to see the list he had given me for exercising and said he should have added that I was not supposed to hold my knee back, so it was his fault. He said of course my knee will be traumatized! All of the heel slides I had done before were supposed to be held for ten seconds, so I did not know this was supposed to be different. Chris wants me to do the exercises another time today and to text him tomorrow and let him know how my knee reacted to the exercises we did today. I don’t know if I will do the exercises again today; I may decide that I want to know how my knee reacts to doing them once. Chris said he wants to make adjustments if needed tomorrow. I iced my thigh and knee for about 45 minutes after Chris left.
I know Chris has my best interest at heart, but he is a physical therapist first and foremost and truly believes the routine he comes up with will be the best for me since I tell him about any problems as we go.

@Klassy i certainly do relate to not wanting to offend your physical therapist. When Chris started working with me on October 11, I had suffered the excessive physical therapy complication from PT at Baptist Health. He has worked diligently to try to help my knee and to prepare me for the THR. He was limited in what he could do for my right knee because my right hip had collapsed and would not support my weight. So he eventually focused on deep muscle massage to prepare my right leg for the THR. He has never had a case like this before, and he was concerned about treating it properly. I would like to be able to take a week or two hiatus from therapy, work with walking and other everyday activities, and be able to keep Chris as my therapist. But I know I can’t do that, so I need to figure a way to work out a therapy program with Chris that will work for me. I need to convince him that scaling back the therapy until my body is healed from the surgery will be beneficial.

@subie2021 I have walked with a limp for well over three years, so my leg muscles and my core muscles need to be strengthened for me to be able to walk without assistance and to support my back so that I can stand erect. The added complication of the muscle trauma around my right knee because of overly aggressive physical therapy has made the situation more challenging. That is why Chris has worked to lengthen and strengthen my leg muscles and to strengthen my core muscles in preparation for my THR. But he could only do so much since my right leg would not support me. i know I need PT to remedy these problems, but I am doing quite well in recovering from the THR. I think I would be walking with minimal assistance in the very near future were it not for the unresolved problems related to my knee situation. So striking the right balance is important.

@Eman85 i would like to think that I could forego PT and everything would work out okay. And it might. But my physical therapy is paid for by Medicare, so I can’t quit therapy and decide to do it later and it be paid for by Medicare. That is why Chris and I need to figure out the right balance of exercising for therapy.

@Layla Based on my recovery to date, I think I would need a minimal amount of physical therapy for recovery if I were recovering from the THR only, and I look forward to demonstrating that after my second THR on June 27. However, since I have to complete recovery from the TKR that I had on July 19 along with recovering from my THR, my situation is not quite as simple. I know some people have not had and are not having as rapid and non-eventful a THR recovery as I am having, so I feel very fortunate in that respect. Now that I have decided to take ownership of my physical therapy and insist That Chris work WITH me instead of his just telling me what to do, I think I am on the way to complete recovery. At least I hope so. :)

@subie2021 I agree that what I need as a 78-year-old is different in some ways than what is needed by a 50-year-old. That was one of my major objections to the PT at Baptist Health. They appeared to use the same PT program for me as they did for a 23-yesr-old athlete. I do not think that is appropriate. I am not a typical 78-year-old, of which I am glad, but I think certain concessions do need to be made.
I chose my OS because he uses the anterior procedure and he was highly recommended. Being in a new hospital in which only orthopedic procedures are performed made using him more appealing. I did not have a choice of patient venues like you did, but I am very happy with my choice.
UPDATE: I was re-reading posts and realized that your reference to pt. venues was to physical therapy venues, not patient venues. I had the choice of using outpatient PT at the hospital, home PT from the hospital, inpatient PT at the hospital (although I probably would have not actually had that choice since I was doing so well), or another PT facility. I could have used outpatient PT at Elite, but I chose to continue working with Chris from Elite at home. Since my OS is directly employed by the hospital, using the hospital’s PT would have been using my OS’s PT. I understand that the hospital’s PT program is very good, but I decided to continue working with Chris. I’m glad I reviewed the posts because my comments about venues didn’t make much sense.

I am pleased that I received so many different viewpoints in this matter. They gave me lots of food for thought. Thanks to all of you. I think the different viewpoints are one thing that makes BoneSmart such a valuable website for information. Onward and upward.
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You’re very gracious. It’s admirable. While you may currently have the time to respond to us all because you’re in early recovery, I hope it didn’t feel overwhelming. You received quite a number of posts, all in short order. Your detailed responses are impressive. I don’t know if I had the patience that you seem to have at this point of my healing journey. I feel confident that with your new outlook and plan to do only what you’re comfortable doing your recovery will progress nicely.
A peaceful evening to you.
@Layla Thank you. I am semi-retired (mostly retired) and am currently not allowed to drive because of my surgenies, so I have plenty of time. I live alone with my cat Willabelle, a black Manx rescue, so there is no one, besides Willabelle, making demands of me. I really appreciate the posts. When people make the effort to share their experiences so that I can apply that knowledge to my situation, I think a detailed response is appropriate as long as I have the time to do so. When I start driving again, I will probably be out and about a great deal. But BoneSmart has become a welcome addition to my life, and I am enjoying the exchange of ideas.
I just noticed that you are in Minnesota. I have a dear friend who lives in Prior Lake. MN. I hope to visit her late this summer or next summer.
I wish a peaceful evening to you, also.
Whooo @wander03 , never mind the knee and hip exercises, we have given your posting finger(s) a real workout!

It sounds like you have a good plan for making the set up with Chris work for you.

I don’t think I had realised that you live alone. I admire you for coping so well by yourself - well, I am sure Willabelle is good company, but she won’t be much help in fetching and carrying. I assume!

Best wishes for continuing progress.
Hi @wander03
We’re happy that you joined us as you’re healing. I also enjoyed the exchanges here in my early recovery. It was comforting to hear from those who were healing right along with me as well as those that were further along. Applause to you for taking this on alone, with the help of, Willabelle, of course. :kitty:Thanks for sharing your progress. Let us know if you have questions and hopefully we can advise.

Prior Lake is not too far away from me, although I’m not super familiar with the area.
Hopefully you’re able to keep your plans to visit your friend this Summer, or next.
Happy Saturday to you!
I just remembered something from my recovery and I honestly do not recall if I received the tip at my surgery site from a nurse, or here on the forum. What I did was use a plastic bag under my heel for the heel slides, while lying down. It allows for easier movement while still allowing you to go through the motion.
Tip for the day :wink:
@Klassy i have lived alone for decades. My children are 53 and 50. My daughter has been coming down most Saturdays since my knee surgery on July 19. She lives about 60 miles away. She took me to the hospital for my surgery, picked me up the next day and spent most of the day with me, and is taking me to my post-surgery appointment with my OS on April 7. She did the same things related to my knee surgery.
My son comes over and puts out the trash and recycling containers when needed and will do other things that I request.
My sister came over every day for about five weeks after my knee surgery, and she helps out now when I need her to do so.
My ex-husband’s wife has been a real help before and since the hip surgery. She takes me to appointments when needed and picks up prescriptions and other things when I ask her to do so.
So, I live alone and manage most of the time on my own, but I have people who help me when needed. It works well for me.
You are right about Willabelle. She is generally good company. I rescued her about six years ago. She is a typical Manx in that she is totally devoted to me. She doesn’t have much use for other people. And she is useless as to fetching and carrying.
@Layla I really had no choice other than to take this on alone. Since I have been self reliant “with a little help from my friends” for many years, I fortunately cope quite well. The tip to use a plastic bag for heel slides is an excellent idea. Thank you for sharing it.

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