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THR Anterior Approach Walking Guidelines

FCBayern

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Doug, pretty sure you just suffering from soft tissue that's still healing and wasn't happy with the reach you made. Plus as you said the muscles have probably atrophied some at least, I know for me both hips and legs need the muscles built back up, pre-surgery the pain was such that I just wasn't moving much. Continued icing will probably help, but time is the only thing that will really heal it.
 
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djacksonsf

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Thank you FC,

I was in the same boat regarding exercise prior to the surgery.

With this, one of the things I noticed was a sciatic response. Perhaps the soft tissue that sits on that nerve is compressing it because it's swollen and that's what I'm sensing. It's more noticeable when I'm seated.

I feel like Jack Lemon in the China Syndrome - something's different and I just can't put my finger on it. I'll keep icing and stay on gabapentin to see if that helps.

-D
 

CricketHip

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Hello! Great news about an extension of your time off. Taking the time now and going slowly with your activity progression will pay off handsomely later on. :thumb:

I had a similar set back and just continued to ice and rest as much as I could. It sure sounds like you irritated the already irritated soft tissue. Hang in there, time is a great healer... and :ice:.
 
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djacksonsf

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Thank you Cricket! It's raining here today, so it's pretty easy to rest. The icing I've been doing appears to have helped a bit. Did you stop your exercises completely until things improved?

-D
 

CricketHip

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Yes, I did stop any exercises that I had been doing. I went back full time on the cane, too. I didn't want to walk without it as long as I was limping.
It was very discouraging for me, so I can relate to how you are feeling. There are many members on here that have been through a set back.
It's good to hear that the ice is helping.
.Time and a big helping of patience :flwrysmile:
 

longtimechemist

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@djacksonsf
I’m at nearly 3 months post-op following posterior approach.
I have experienced the same when putting weight forwards onto the operated leg only. It felt like a pulling sensation in the muscles. This has gradually worn off during month 3 to the point where I can now lean onto the operated leg without any problem. I’m still avoiding going too far, though.
 
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djacksonsf

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Thanks Cricket and Long,

I appreciate the input. What's concerning me is that the aches associated with this have lasted nearly a week. They aren't significant enough to be considered true pain - maybe .5 on a scale of 10 - but they persist despite rest and ice.

Sometimes I feel a twinge in the abductor near the groin after standing up; other times something deep in the buttocks objects when sitting and the operative leg feels a bit weak; sleeping on the operative side now causes different sensations than before the reach, when I put all my weight on the operative leg with my torso a bit outside and forward of the hip.

I'll continue to take it easy, but am wondering about whether it's worth asking my care team about it. From what they described, this type of weight bearing shouldn't have caused the implant to move, but it's just different from what I've experienced so far.

-D
 

Eman85

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Always worth asking but it sounds like something many of us have gone through. I can make a move that will give me a twinge in my left hip and it's been almost 2 years on it. It's having to pick up the slack now that I've done the other and it's not happy.
At 3 mos with my first hip I pushed it too far. It took 3 weeks of taking it easy to get over it. Sitting and icing is the cure.
 

longtimechemist

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Mine took most of month 3 to sort itself out. I just kept up with the walking every day and allowed it to get better at its own pace. I used ice sometimes too.
 
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djacksonsf

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Thank you for the input! I did reach out to my care team and was only told not to take NSAIDs by the nurse on call until I pass my 6-week mark next week. Given the concerns about using them, I'll stick to ice and heat.

The other nice thing about the 6-week mark on Tuesday is that I can take a bath afterwards. Immersing the area in hot water will probably help a lot.

I also have the follow up in 2 weeks with the surgeon. Until then it's rest, heat and ice.

-Doug
 

CricketHip

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Sometimes I feel a twinge in the abductor near the groin after standing up
I am trying to place where you are having the pain, I don't think there are any abductor muscles on the groin side, the inside thigh area? Those are your adductors, which definitely seem more affected by the Anterior approach. It makes sense, too that they would have been irritated by your sudden misstep.
Good to hear that you touched base with your Care team. Sometimes you just need to hear their take on things.
Once you irritate the already soft tissue, it can take a while for things to calm down. This is why we compare the recovery to a roller coaster. Most of us have the frustrating experience of a "one step forward/two steps back" at some point. And you are still early in your recovery.

I wish for you a very relaxing and restful weekend with your ice pack.. hopefully it begins to ease up soon. :ice:
 
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djacksonsf

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Thanks, Cricket. You’re right - ad-, not ab- ductor. Here’s why I’m concerned:

Until last Sunday, I had virtually no pain. Even sleeping on the operative side was fine. Now, any pressure on the operative hip results in a low level of pain. I feel this when I touch the area around the implant after sitting on that side, so it’s more than the butt and the groin.

In addition, when the hip gets irritated there’s pain down the leg. One of the truly wonderful things about the surgery is that the pain that used to radiate down the leg - and was bad in the knee in particular - was gone. Now it’s back, albeit much less intense.

Paradoxically I have no limp and no pain walking. This makes me wonder if it’s really a soft tissue problem, or if the Implant moved. I just don’t know enough to tell the difference.

I’ll talk to someone about it next week. As you say, sometimes you just need a 1:1 conversation to get someone’s take on what’s happening. I traded emails with a nurse today but didn’t actually speak to anyone.

Thanks for listening,

-Doug
 
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djacksonsf

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I think I figured some things out, but will still talk to my care team tomorrow. Sharing in case anyone has a similar experience -

When I was reaching up and turning slightly to the right with my arms above my head (same side as operative hip), the soft tissue that stabilizes the hip had to work harder than it was ready to at 5 weeks. Even though it was for maybe a second or two, reaching upward without the support of both legs caused some additional stress on things like the piriformis and iliofemoral ligament. The latter is one that I believe is cut using the anterior approach, and the former is one that I've had problems with in the past.

Collectively, I think the tissue that forms the hip capsule was stressed/strained, and that's what I'm feeling now. The mild leg pain and weakness, as well as the numbness in the butt after sitting too long, are signs the piriformis is upset. The discomfort deep in the groin and on the outside of the leg around the operative hip may indicate that other stabilizers are irritated as well.

There was no movement restriction for this kind of motion, and it didn't happen suddenly. It was a reach that required stretching in a way that turned out not to be ideal. But...no dislocation. I'm guessing that affected muscles, tendons and ligaments that stabilize the hip are well attached to whatever they hold together by 5 weeks, so I'm hoping this is just a bump in the road for the hip capsule healing process (which I understand take about 4 months in total to complete).

Regards,

-Doug
 

Jaycey

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When I was reaching up and turning slightly to the right with my arms above my head
New hips hate any kind of twisting motion. Some surgeons actually restrict twisting for at least the first 6 weeks. Sounds like your hip was quick to complain.

Hope this settles soon!
 
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djacksonsf

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Yes, when looking into this I noted that some sites include restrictions about twisting. The only restrictions I had from Stanford were for external rotation and having the operative leg too far back (e.g. anything approaching a lunge). Besides that, I was only told to listen to my body.

I definitely heard it.

Based on my experience, seems like the restriction on twisting is designed to avoid overly stressing the stabilizers. It's been a week, and it's gotten a bit better, so there's that. If the mild leg pain and weakness are piriformis and other soft tissue pressing against the sciatic nerve vs being caused by hip instability, I should be ok.
 

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I found icing - actually sitting on a gel ice pack help ease my piriformis issues. Also very gentle hamstring stretches from a seated position. Start very gently if you do these stretches. Very often the hamstring is very tight and stiff post op.
 

Eman85

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It's incredible how many movements are tied to the hip area. I swear there is a muscle that runs from my right shoulder to my right butt cheek. If I bend my leg at the knee and reach down to where my shoulder drops it cause a pulling feeling in my butt down my hamstring. I've also done a little work which taxed muscles and my op side is tender again. I don't know about twisting but pivoting on the op leg can be bad putting pressure on the joint. That's one of the warnings for golfers to be careful or not use cleats.
 

CricketHip

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Hi Doug! I'm glad you were able to think about your movements and find some reasonable explanation for your soreness and pain. Sometimes, that's all we want, is to have it make sense and then we begin to ease up on our worrying.
You are correct in that the piriformis can tense up and create some pressure on the sciatic nerve and mimic sciatica. Icing the area will be most beneficial.. I would suggest a gentle massage, too.
The gluteals and piriformis area respond well to that. I took a tennis ball and placed it between a wall and my butt ( while standing) and gently rolled out those sore spots. The key word is gentle. Then more icing. :ice:
 
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djacksonsf

djacksonsf

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Thanks all! This was weight bearing on the operative leg, so I don’t know if that makes it a pivot or a twist. It’s what happened when the torso turned slightly away from the centerline while reaching upward. The feet were still pointing forward.

Either way, I’m sticking to heat and ice and trying not to put direct pressure on the joint or buttocks. Even sleeping on the non-operative side helps.

I’ll let you know what the PA says after I connect with her tomorrow.

Again, thank you!

-Doug
 

Mojo333

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Hope all settles down soon...easy to get anxious when these hiccups pop up.
It's incredible how many movements are tied to the hip area. I swear there is a muscle that runs from my right shoulder to my right butt cheek.
:loll:
 

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