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THR Anterior Approach Walking Guidelines

Well, not much luck connecting with a live person, which is disappointing. The nurse who received the email said the PA was busy with other patients, but did solicit feedback from the team. What she sent back was mostly along the lines of "this is normal at 6 weeks" because all of the areas I mentioned were either affected by the surgery or involve muscles that work together to stabilize the hip.

Can't disagree with that, but my concern was that until now I haven't had any of this kind of pain, even when sleeping on the operative side. I don't think the implant was affected, but I do think the supporting muscles, ligaments and tendons were and just want to make sure nothing is damaged and that they heal correctly. Sometimes there's a sharp pain behind the hip when standing or in bed, so it does make me wonder. There's always a dull pain in that area.

I'll follow up with the doctor on the 31st, show him what happened, get his take on things. We're the same age, so hopefully the communication will be better.

Regards,

-Doug
 
I do have a question: one of the concerning things is that I feel a pinch on the outside of the thigh about half-way down after sitting. It lasts for a second and then goes away.

Many of you have written back to say aches and pains are to be expected, but this doesn't feel muscular. Worth mentioning to the surgeon?

Regards,

-Doug
 
Always worth asking the surgeon about anything that concerns you. I would keep a list on my phone of things to ask as they popped into my head post op and pre op just so I could get my answers and not forget anything.
 
I've had pinches on the rt. on the left I had piches,zings,zaps and all kinds of feelings. Still get the occasional pinch on the rt. even now. I have a pain on my rt outer thigh now from a little over doing and still get the ever popular pain in the butt. Sitting with my polar pack as I type this.
I'm adding this Fri morning sitting here and I've got a pinching feeling in my rt hip.
 
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Thank you! I think a couple of overdoing it things happened all at once, but I believe most lingering symptoms point to the piriformis.

I say this because I was internally rotating the operative leg when I reached to the right with my torso and that would stretch the piriformis, if I’m not mistaken. If the piriformis was already tight, doing that while standing probably added more load to the muscle.

The groin pain stopped and so did the mid-thigh pinch, so that’s great.

Cricket, I’ve been icing and using a heating pad or taking baths. I did try gentle massage but that irritated it. Did you have that experience, too? Leaning forward when I sit also bugs it if I keep my back straight instead of being lazy and slumping.

Regards,

-Doug
 
Just had my nearly 2 month check-up and everything is fine. The x-ray showed no signs of anything but a solid recovery. I explained what had prompted my concern to the surgeon, and he couldn't say exactly what had caused the pain - but that it definitely wasn't the implant.

We talked about PT because he noted I still have a slight limp, most likely due to weak muscles around the hip. We both felt it made sense to focus only on PT that helps me walk better, but agreed that PT should be undertaken very judiciously so as not to interfere with what the surgery accomplished. Echoing what has been said many times over on this site, he noted that the hip is not a joint that requires much PT other than walking...

Passing all this along in case someone else has a similar experience.

Regards,

-Doug
 
Hello, Happy Friday @djacksonsf :wave:
It's nice to read you had an encouraging (soon to be) two month post op visit. I hope it put your mind at ease. Thanks for sharing an update. I didn't look through your thread so please excuse me if you're reading this for the second, or fifth time, lol. It is recommended you use an assistive device until you're no longer limping.
A tip -
Try heel-toe walking when / if you're limping. Let your heel hit the ground first followed by toes. It takes a concentrated effort but I believe you'll notice a difference. Give it a try.

I hope the good news of the day is just the beginning of a wonderful weekend!
:SUNsmile:
 
Thanks, Layla!

My mind is definitely at ease. When I described what happened, the PA said that the rotation I did wouldn't have affected the implant, and the doctor confirmed that with the x-ray. Whew.

There was no mention of using a heel lift or assistive device, and I think that's because the limp is due to the feeling the operative leg is a bit longer. It's not caused by pain, and the limp goes away if I take bigger steps. Everyone said the feeling of a different leg length should go away in a month or two - about the same time some of the sensations resulting from realigning the hip to correct dysplasia will dissipate.

Happy weekend to you, too!

-D
 
Here's a bit more info I've learned through my time here -

It's not uncommon to feel there is a difference in leg lengths after THR.
Your leg can feel shorter pre-op due to a loss in cartilage. During surgery, the surgeon makes every effort to make the legs as equal as possible.

It is advised to wait at least three months post op before making a final judgement on Leg Length. Often the discrepancy is not a true difference, but can be attributed to tight muscles, a pelvic tilt, at times even arthritis in the spine. Most cases resolve with stretches, exercise and time. In the rare situation of a true difference a shoe lift may be prescribed, but in most cases no treatment is necessary.
 
Hi Doug
I had both hips done one in May one in June and I am still working part time I was aggressive with my PT early in and pushed myself too hard Thanksgiving week I had to get my IT band cut and released and kneecap put back In place on left....which I personally think this happened with LHR and now on my right side I am having cortisone injections in my right Illipsosa bursa it is very painful and I have a hard time walking I had anterior on both hips
All my doctors kept telling me I’m in healing process and now 7 months later I am dealing with muscle issues...everyone so different just listen to your instincts and advocate for yourself
I see so many benefits on the other side of this it has been well worth it despite my setbacks
God bless May you heal well
Ailene
 
Hi Ailene,

Thank you for sharing and I'm so sorry to hear that you've had these painful muscular/bursa issues!

I guess we find out how intricate and amazing all the supporting tissues are when they act up after the surgery. You're right, though, that there are many advantages - and time will help each of us benefit from them.

I wish you a less painful road ahead and continued healing!

Regards,

-Doug
 
Hi Doug,

I had my left hip replaced in 2014 (in Denver). Now we're on the Peninsula, and it's time for the right one to get done. Could you pass along the name of your surgeon?

--
A few notes on limping and gait training, just in case it helps you feel/walk better.
My surgeon's PA asked me to use my crutches for the first several weeks. I didn't really need them after the first couple days. The purpose was gait training. I was limping pretty good before the surgery, and it took some time to re-train my body to walk normally. After I was done with the crutches, when I walked or hiked for exercise (not to the grocery store) I used two hiking poles for quite a long time. That also helped with my gait, and (so I read back in the day) burns 40% more calories than walking alone. The poles are also fun for mountain hiking, and for super fast walks in the Baylands.

All the best for a smooth road ahead :)
-neli
 
I love hiking poles post op. They really help me keep a good gait and good for my upper arms too. I also go walking in my back fields and they give me extra stability and prevent me sliding or tripping on the uneven ground.
 
Hi Neli,

My doctor was Michael Bellino. It's a few months' wait to see him, so you may want to start that process now.

-D
 
Thanks Leeja and Neli,

Are there gait training exercises I can do? I ask because my doctor agreed PT would be beneficial if it’s focused on improving how I walk. I start in 2 weeks.

Regards,

-Doug
 
  1. Pull your navel toward your spine. Your abdominal muscles will form a girdle of stability, and your movements will be more controlled
  2. Consciously engage your butt and thigh muscles.
  3. Walk with your toes pointing forward.
  4. Make sure you relax your shoulders. ...
  5. Hold your head up high
  6. Concentrate on hitting heel first and rolling on to toe.
  7. You can elongate your stride after muscles are more stable and gait improves
 
Hi Doug,

@Mojo333's directions look really good. I'm not a PT or anything, just a fellow hippie.

If you have crutches, you might want to start with them, even though I think you are beyond the crutch stage of your healing process. There are some videos on "Nordic Walking" that show how to use the two poles to help you achieve the goals listed above. It took me a while to get the hang of it, but now both the poles and the crutches seem to 'remind' my body to do the right thing. At least up until the last month or so; now I need the support. Two crutches --> better form than one crutch. I have never found a cane to be that helpful, but I suspect that whatever you practice with can work well.

After my surgery, support was not really required; walking with the crutches helped me walk slowly and mindfully with correct form. Walking with the poles helped me walk faster and properly; I don't know how it would have gone without the pre-training with the crutches.

This took some real concentration on all the aspects of walking with great posture, but it really paid off.

Truly all the best,
-neli
 
Thanks Mojo and Neli,

I’ve improved a lot just heel-toeing it with good posture. Since I've been doing this, I don't sense a limp and the new hip feels more like a part of me. I was at the market today and squatted down to get something out of a bulk bin and there was....nothing. No pain, no stiffness, nothing.

There’s still some tension around the incision, but it feels great otherwise. I had scheduled PT back in December for this week "just in case" and plan to go to the initial intake on Thursday. I'll see what they have to say - whether they suggest anything to improve my walking. And, of course, I won't do anything to jeopardize my recovery.

Best regards,

-Doug
 
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