THR Anterior Approach Walking Guidelines

[Bfam85]

Hello again Doug. You are truly being proactive in your recovery....good for you.

Without question, walking on hills, but especially on sloping sideways roads and lawns, are not good. My PT confirmed that when I was still under her care. That most definitely could be the cause of your discomfort early on. For me, when I am feeling pain or strains, etc., I always need to play detective to figure out why I have the aches, so that I can remember to avoid that action in the future, or at least for now.

Please remind me; has your surgeon told you that heel lifts would be okay for you to use? Would they be temporary?

Finally, I am very interested in what you shared as far as LLD, weak glutes, etc. I continue to have weak glutes. In fact, my right hip (which is now over 5 years old) was the worst of my two hips and it still has less muscle back there than my newly replaced hip. There is always a tension of pressing too little or too much with exercise for me.

 

[djacksonsf]

Hi @Bfam85 ,

Adding to what your PT said, I think any movement that puts more stress on either hip is problematic, and when I moved to my new neighborhood I had no clue about this because I'd only ever walked in flat areas. Asymmetrical motion - whether caused by LLD or walking on uneven surfaces - is known to irritate the SI joint, at a minimum.

The heel lift is a temporary measure to stabilize the pelvis until I can get the tight muscles causing the LLD to relax more. I've gotten conflicting input from my OS. Initially, I was told the LLD would resolve in 3 months, but that it would be concerning if I were still in pain after that time. Back then, I was told I probably wouldn't need a lift. When this was still a problem a month ago, I was told that due to my prior hip dysplasia, it will take up to a year for soft tissue to adapt to the realigned hip. No surprise there. My OS hasn't weighed in on using the lift, but my PT agreed that adding 1/8" could help with some of the symptoms I've experienced. Right now, I'm solving for getting past this acute period in which everything was upset and settling into a stretching and strengthening routine that evens things out for the long term.

Regarding the muscular imbalance, I feel it too. When I clench the glutes, the volume on the operative side is probably 1/3 less than on the other side. This is not uncommon because glutes, external rotators underneath them, and muscles that abduct the hip in general atrophy in the period leading up to THR. Unless those tissues are strengthened after THR, the body just recruits other muscles and tendons to do the job. I think LLD makes it worse because the longer leg is always flexed, adding stress to quads, hamstrings, IT band, piriformis and SI joint.

I don't have a solve other than gently trying to increase glute strength and function in a targeted way. I'm doing this by starting with the gluteus maximus, which has responded well. My PT believes that by building a base of strength gradually, stress will be lessened on the muscles that aren't ready to be strengthened right now (like the external rotators). It feels like starting from scratch, but it makes the most sense to me.

Hope this helps!

-Doug

 

[cstinchcomb]

Hi Doug, thanks for your good wishes. I have a surgery date -- 18 May -- but I have only maybe 50% confidence that it will happen then.

solving for getting past this acute period

I think this is just the right approach. Once things settle down then you'll be in a more virtuous circle upwards. Great news that your forced rest actually worked! Consider using the ice | heat | pain meds for longer than you think you need them. Strengthening is the long term goal, but without annoying everything; seems like a knife edge right now.

Sciatica, ugh, that takes a while to resolve even without the complication of a new hip.

 

[djacksonsf]

Consider using the ice | heat | pain meds for longer than you think you need them.

Yes indeed @cstinchcomb , because I want to do everything I can to avoid going backwards. I'm driving to a flat area to walk instead of walking the neighborhood. It's so easy to underestimate the impact of swelling due to irritation - whether that's because of LLD or overdoing it. I think that drove a lot of the neural symptoms - both lateral femoral and sciatic.

Great news about your surgery date!!

 

[Bfam85]

We have similar stories....With hip [HASH=58]#1,[/HASH] I was feeling so good that I began Pilates, the gym, the bike, etc. and wound up with an awful tendonitis, with the pain centered in the groin area. It took literally months before it completely cleared up, gradually with time.

From reading your info here, having the anterior approach probably has more nerves, tendons, etc. cut in that area, so it makes sense.

What I would say to you is that you are still very early out from your surgery and we are to give it a full year for all the deep, soft tissues to heal. My surgeon told me that even after one year, the body continues to heal.

 

[FCBayern]

Sideways slopes bother me also @djacksonsf. They actually have since my ankle replacement, when I walk around my neighborhood I always tend to step up onto the drive ways which are flatter the the sloping sidewalk leading to the drive. It does tend to help some, but I don't have the complications of hills, it's VERY flat where I'm at.

 

[djacksonsf]

Thanks @Bfam85 and @FCBayern ,

I guess the biggest surprise for me is that these symptoms turned out to be tendinitis because the level of disruption they caused was crazy.

I'm glad to be on the mend. Just need to figure out the right balance between staying active/gently strengthening and not stressing the tissue out.

Going back to a comment that @Eman85 made about the way the anterior approach is sold, I do think that when only very loose guidelines are provided by the OS anyone who is active is at risk to experience the same kind of thing. You feel flexible, strong and rested three months after surgery and then add something seemingly reasonable to your routine that upsets everything.

-D

 

[Clipper]

@djacksonsf - My PT measured my LLD at 2 cm (~3/4"). This caused my pelvis to tilt down on the short leg side, which caused the base of my spine to tilt from vertical. Th LLD also caused an up-down, up-down, motion in my gait. I had my short leg shoes altered by a shoe shop where they added 3/4" to the entire sole (not just the heel). This cured my gait and my pelvis is now horizontal and my spine is vertical all the way to the base. Hills and slanted pavement don't bother me.

I encourage you to have your LLD measured by a trained PT or OrthoMD. If the LLD is real, the shorter leg will NOT grow longer.

I had physical therapy for 6 weeks after each of my hip replacements and started walking 1 to 2 miles a day within a month. Aches and pains eventually went away after about 6 months for me. Celebrex helped at times. I also encourage you to do physical exercise to build muscle mass back in in your legs, arms, stomach, etc. Your body will let you know if you overdo it.

Good luck!

 

[djacksonsf]

Thank you @Clipper!

It's helpful to hear about your experience - the pelvic imbalance/altered alignment you describe is something I believe has contributed to a lot of my symptoms, especially as I became more active in the past 6 weeks. I'm slowly getting back to walking more and am pleased that the core strength exercises haven't upset things. Little by little, I will rebuild the strength and flexibility needed to recover completely.

All the best to you!

-Doug

 

[Bfam85]

You are absolutely right, Doug. After Hip [HASH=58]#1,[/HASH] I asked the OS what I shouldn't be doing right now....he said you can do anything with no restrictions because of the anterior approach... Maybe he was being just a little prideful there, but I certainly was very careful for the first couple of months.....that is, until I did do whatever I wanted and hurt myself!

Happy healing. Tendonitis is nothing to ignore. Thankfully, time is the great healer in this instance.

 

[CricketHip]

Hi Doug! I'm curious whether you have considered signing up for JRAD, scheduled for May 9th? I'm thinking you may find some good nuggets of information, listening to the surgeons etc.

I always learn something from signing on when I can. There will be a schedule of the events posted soon to help ensure you can catch things more relevant to your concerns or interests.

Glad you are feeling better, patience is key with tendinitis.. frustrating but true.

 

[Aline]

Hi Doug it’s been a minute since I have been on this forum I am still dealing with illopsas muscle on my right side 10 months later.... I had a cortisone shot in February and now my pain swelling have returned so I go back to surgeon on Monday... on left side they had to release my IT band and put my kneecap in place last November and now that side has finally doesn’t bother me After 11 months! Hang in there... Aline

 

[rockinchica88]

Hi Doug it’s been a minute since I have been on this forum I am still dealing with illopsas muscle on my right side 10 months later.... I had a cortisone shot in February and now my pain swelling have returned so I go back to surgeon on Monday... on left side they had to release my IT band and put my kneecap in place last November and now that side has finally doesn’t bother me After 11 months! Hang in there... Aline

I feel your pain on this one. I had to have my psoas lengthened during my hip reconstruction. Sadly the reconstruction failed, but the lengthening helped immensely!

 

[djacksonsf]

Hi @CricketHip and @Aline , I’m so sorry for not responding earlier. Something is up with my notifications - I didn’t get a heads up there were new messages. I remembered that @cstinchcomb had a surgical date this month and logged back on to see if that had happened (I was hoping so).

@Aline it’s good to hear you’ve gotten some relief, but I’m sorry you’re still in pain. Tendonitis is a slow road, I’ve found. Luckily things are slowly improving and I am able to strike a balance between strengthening and discomfort. So far so good. Thanks @rockinchica88 for the good thoughts - hopefully by summer things will even out.

@cstinchcomb how are you doing?

@CricketHip is there any documentation on the forum I missed?

-Doug

 

[cstinchcomb]

Hey Doug,

I hope you are doing well, and that your ODIC symptoms have subsided.

My surgery is scheduled for next Tuesday, 26 May, at Sequoia in Redwood City. All of the pre-surgical teaching etc. have been canceled, aside from a COVID test that I'll need to do (hopefully drivethrough) 3 days prior. We've been seriously locked down here for months so the likelihood I've got it is pretty close to zero. Since this is my second hip, I kinda know how it will go.

I put air in my bicycle tires yesterday (nowhere to hang or invert it, don't want it to sit on flat tires) ... I'm so ready to have this be done and be on the healing up side.

Truly all the best, thanks for asking

 

[CricketHip]

Hi Doug.. it's good to see you on here.. and that you are seeing some improvement with your hip.. it's a slow journey when there's tendinitis involved, for sure.

@CricketHip is there any documentation on the forum I missed?

I'm not sure what you are referring to, did you mean something specific? Due to elective surgeries being postponed, it's actually been quieter than usual, here.

Continue to take good care of yourself! Looking forward to the day that you post that your hip has become the forgotten hip.

 

[djacksonsf]

Hi @CricketHip , sorry for not being more specific. By "forum" I meant JRAD. I missed it and wasn't sure whether any information from it was posted anywhere.

-D

 

[Layla]

Hello @djacksonsf
Just a FYI because CricketHip is not online right now, but I see that you are. There will be videos available in the weeks to come. Lots of great information. I think you’ll agree once you watch them.
Have a great day and holiday weekend!

 

[CricketHip]

I'm sorry you missed the JRAD, but not to worry! They will be posted for replay, it just takes several weeks to get it ready to go. It was really good this year. I hope you watch it when it's available.

I was able to get on my bike and ride again today. It's so nice to feel normal, whatever that is these days! I hope you are feeling normal, too.

 

[djacksonsf]

Many months later, I'm back to wish you all a Happy New Year. Your support helped so much with my recovery, and I hope you are all doing well!

It's been just over a year since my procedure and I feel great. With COVID, my biggest challenge has been getting away from working from home long enough to exercise properly, but the issues I worried about earlier have resolved.

After strengthening my glutes and backing off on hill walking until I could really handle it, I no longer have tendonitis. I now walk the hills and on uneven surfaces without a problem.

The same goes for LLD. I wore a lift for a few months, but the connective tissue around my hip gradually relaxed enough so that I barely feel a difference at all.

As many said earlier on when I was worried about doing too much too soon, the mental part of the recovery can be just as challenging as the physical aspect of it. By July, my 6-month check up revealed good bone adhesion and no implant movement. My next check up is in January, and I'm hopeful it, too, will be a nonevent.

Cheers,

-Doug