THR Anterior Approach Walking Guidelines

[Hip Hip Hooray!]

Hi Doug, I had both my hips replaced at the same time with the anterior method. I was also surprised at how quickly I was able to walk unassisted. I think it was after seven days I accidentally walked to the mailbox and forgot my walker. I didn't use a cane. I didn't need one.

My surgeon told me to work gradually. If you have pain, often it will be after you add the new activity, not during the time when you do it. The icing and rest will help.

I did the basic pt exercises, and only 10 reps. I slowly worked up to 30 per day. I found them really helpful. I didn't do any of the ones that Josephine says not to do. I did like the simple ones, though.

You sound like you are on track. It can be a challenge not to overdo; there is plenty of time. I bet your recovery will go very smoothly. I was advised by Dr. Matta to think of my chores at home as PT at first. I really liked that mentality.

 

[longtimechemist]

I have experienced some burning in or under the scar at various stages in my 9 or so weeks post THR. No idea what it is, but I’ve put it down to the healing process of the deep soft tissues.
It seems to happen just before I get some of the feeling back in the skin near the scar.

 

[Layla]

Welcome! Thanks for joining us. I don't have anything to add today to the helpful advice you've received. Apply it along with what you've learned from your previous surgery recoveries and you're on your way! I look forward to following your journey. Best wishes for a nice weekend!
@djacksonsf

 

[djacksonsf]

Hi, I was wondering if there are any guidelines for sleeping on the operative side.

It will have been 3 weeks this coming Tuesday, and I've tried lying on that side once or twice without any ill effects. When I was discharged from the hospital, the PA said I should wait a few weeks, and mainly spoke of how sleeping on the operative side would affect the bruising/discoloration around the incision. All the bruising and discoloration is gone, so it's just the steri-strips and the scar that are left.

Similarly, what about restrictions on bearing all my body weight on the operative leg? I ask because I took Hip Hooray's suggestion about using housework as PT and sometimes wind up on one leg or the other. I move carefully and deliberately, and haven't had any problems in doing "normal" things around the house.

Thanks in advance for the input!

-Doug

 

[leejaa]

I was not comfortable laying on my operated side but did for short periods after about a week just for a break in position. Once my staples were out (mine was a posterior approach) I could like on that side for longer periods. Now at 6 weeks, no problem lying on it. I was full weight bearing so I at times had all my weight on the operated leg with no issues.

 

[FCBayern]

@djacksonsf at my two week checkup with the PA he asked if I had tried sleeping on the operated side (I had not). He said it was fine to do that and that I should be trying it. At 4 weeks some nights I find it just fine and others it gets uncomfortable after a half hour or so.

 

[djacksonsf]

Thanks leejaa and FC - this is helpful. I see the PA again on Friday for my post-operative check in. I'll try lying on that side this week and see how it goes leading up to the appointment.

One thing that surprised me about my experience at Stanford is that I've not seen the surgeon since the procedure and there's no plan to integrate him into post-op visits. Perhaps this is how care has evolved since the last time I had a less impactful orthopedic procedure, but the norm seems to be that the surgeon's team - not the surgeon - is on point to answer questions - and that the team communicates mostly via app-based email.

I'm confident the surgeon did a good job, but one of my issues going into the surgery was hip dysplasia. My surgeon was the only doctor of the three I saw prior to choosing him to point it out, so I just assumed we'd talk about it - and how the surgery went in general - afterwards.

Similarly, one of my concerns coming out of the procedure was difference in leg length. After reading up on this, it appears the perception of a longer operative leg diminishes with time and as surrounding tissue relaxes into position - and that true differences in leg length are rare.

Is it unreasonable to think that these interrelated topics merit a live conversation with the surgeon? When pressed, the surgeon's team said my legs will be measured radiographically because of the dysplasia, but I'm pretty sure that either I will have to interpret the test outcome myself or a PA will explain it to me.

Has anyone else had a similar experience?

Thanks,

-Doug

 

[FCBayern]

Doug,

Kaiser takes a similar approach with follow up, both my 2 week and 6 week check ups are with the PA. I think that's fine as long as everything is going smoothly (well maybe not smoothly, there is nothing straight line about this recovery) But I would hope the surgeon would get involved if you are having issues.

 

[Eman85]

My OS came and visited in pre-op and we talked about what he was going to do. He called my wife as soon as he came out of surgery with me and she was in the waiting room. On my first hip which had screws in it he was in to see me in post op so we could discuss how it all worked out and he had the x-rays on his phone to show me. With my last one he came to see me the morning after in the hospital room and we sat and discussed how it went. In 2 THR's I've dealt with 3 people from his practice, the OS his surgical nurse and his registered nurse. I have a patient portal to use for communication and phone #'s also.
I chose him and his practice for their way of doing things. I do not deal with PA's or CNA's, just me.

 

[leejaa]

I saw my surgeon (who has done my other 3 joints) pre surgery to answer any last questions. He also saw me in the hospital in the AM on the next day to discuss surgery and any questions I had. For my 4wk post op I saw the PA which is OK since I had seen her before and trust her. However, the 6m check will be with the surgeon himself. I actually saw the PA for my first appt on this hip just because I knew what the problem was and wanted to get moving on scheduling surgery and to get to see my OS would have taken 4-5m for an appt. As it was I had a 6m wait for surgery.

 

[Layla]

Hello and a Happy Monday to you!
My OS visited with me briefly before surgery to do the let's both write our initials on your op leg routine, then I never saw him again until I was three months post op. Thankfully, I liked and trusted his PA, but in reality feel it would be nice to see the guy who did the cutting, lol.
It's your Three Week Anniversary already tomorrow. I hope it's happy and your week is a good one!
@djacksonsf

 

[djacksonsf]

Thanks for the responses - all are helpful and I'm happy to be starting my 4th week post op. I did try sleeping on the operative side on and off last night and it wasn't painful. I did notice part of my foot went numb, so I'm sure more healing needs to take place before everything evens out.

I've found the PAs to be more focused on moving me through the process than answering questions. I can appreciate the need to allocate high-value resources - surgeons - in a way that maximizes their ability to help more patients. But for me, there's a "care" part of healthcare that happens when you speak to your doctor live, especially when there are topics with nuances that email just can't address. I'll see what this week's post-op appointment is like and go from there.

As always, thanks for all the great support!

-Doug

 

[Jaycey]

I did try sleeping on the operative side on and off last night and it wasn't painful.

Just keep trying. Put a pillow between your legs. It insures that top leg doesn't fall to the bed while you are sleeping. And it is also very good for your lower back.

 

[Elf1]

I agree, email can be nice for quick little questions but when it's something a bit more serious/important, I prefer to see the doc. PAs and nurses are great for most things, had one doc I couldn't stand loved the PAs but again, sometimes you want to see the doc. Let us know how your post-op appointment goes.

 

[beachy34]

I guess I'm lucky with my OS. With both surgeries I saw him after in the hospital and then again at my post op visits. I did see his PA in the hospital too, I think twice after each surgery and I only stayed the one night.

Doug, it sounds like everything is going very well for you. With my first hip in January, I had a much faster recovery and was up walking with little assistance quickly too. Hope you continue on your current recovery path.

 

[djacksonsf]

I did try sleeping on the operative side on and off last night and it wasn't painful.

Just keep trying. Put a pillow between your legs. It insures that top leg doesn't fall to the bed while you are sleeping. And it is also very good for your lower back.

Thank you, Jaycey. Do you happen to know when it’s generally safe to sleep on the stomach? I was told to avoid that position, but I’m not sure how long “belly sleeping” should be avoided.

Thanks,

-Doug

 

[Jaycey]

Were you given any restrictions post op? I would wait at least 6 weeks before attempting sleeping on your stomach. The reason being the awkward movement when you are trying to get in and out of that position.

 

[FCBayern]

Six weeks was what I was told for restrictions on movement to prevent dislocation. I would agree with Jaycey (who knows way more than me) that six weeks would be a minimum before I tried stomach sleeping.

 

[djacksonsf]

The only restriction I was given was to avoid externally rotating the leg or putting myself in a standing position in which the operative leg was significantly behind me - e.g. a lunge. When I asked the PA about sleeping positions, he didn't say anything about sleeping on the stomach, but did caution against sleeping on the operative side due to the pressure it would put on the wound.

Jaycey, I think your explanation makes good sense, but I'll check in with the PA on Friday. It's a different PA than the one I spoke to in the hospital, so perhaps the information provided will also be different.

Meanwhile, I'm walking pretty normally and feel comfortable taking stairs - albeit slowly - as I normally would (alternating legs).

Happy 2020 to all,

-Doug

 

[Eman85]

There's info on the net about anterior restrictions. Basically the opposite of posterior which makes obvious sense as the pull the femur out the frt. instead of the back so that is the way it would most likely dislocate. If you think about your leg rotation to the outside as you roll to sleep on your stomach that is why it might be questionable. The infamous golfer's bend which is how you pick things up if you have posterior is another anterior restriction.