THR Anterior Approach Walking Guidelines

[djacksonsf]

Hi,

I'm 58 and looking for guidance about how much to walk after anterior THR.

My surgery was on 12/10. For the first week, I mainly walked around my house, but ended the week walking around the block. No pain, no swelling, no need for oxycodone and I discontinued use of the walker because it started getting in the way. I did have some pain above the knee and the sensation that the operative leg was longer, but that's gradually going away as I believe my body becomes accustomed to the realignment that resulted from the THR.

The second week, I walked a bit more outside, always at a slow pace and taking stairs one at a time. Got plenty of sleep, ate really well, etc. Throughout this time, I've been doing exercises prescribed by my doctor - tightening the muscles around the knee, tightening my butt, dragging the heel of the operative leg towards my butt, abduction while on the floor and mini squats. No pain or ill effects from any of this.

Yesterday - the 2 week mark - I walked more than 2 miles on a flat surface at a slow pace. I feel a little bit sore, but nothing to complain about. I asked my doctor about it and his team told me to listen to my body. While helpful, this answer isn't very specific.

My body seems to be telling me I'm doing a good job, but I just want to make sure that I'm not doing anything to upset the implant. Some literature seems to indicate that movement promotes bone growth. Other content cautions against too much movement or weight bearing. I've also seen information posted specifically for recovery from anterior THR that says people in good shape can walk as much as a mile a few times a day at the 2-week mark.

I'll be off work for another month, and just plan to gradually increase my distance based on my tolerance of the additional activity.

Does anyone have feedback or input?

-D

 

[ForumUser]

djack,

Sounds like you’re doing great.

Had a friend who recovered quickly from THR anterior op ... till he t boned a deer on his bicycle He waaaay overdid it from day one ... and did set his recovery back a bit.

Anterior approach does seem to offer a bit earlier mobility in some folks ... not all, though. By third week or so the two ops have comparable recovery. However, since recoveries are so different, data still not clear.

Read back through my recovery thread ...inside first week, outside second week, overdid it on Day 11 and not back on track for 4 days ... setback because I was pushing too much - doc said may pulled an interior stitch. No damage, just pain.

By 21 days was doing a few blocks couple times a day, driving, etc. Pretty easy ramp from there to mile and then multi-mile.

Drove three days to Colorado at six weeks ...multi-mile walks daily and flights, airports and fishing in Canada at 12 weeks, long flights yo EuRO and lots of mikes at 26 weeks.

Everyones‘s recovery is different ... Following my issues at Day 11, I eased back a bit and went more linear on improvement.

Tylenol, ice and elevate - I did this several times a day for almost three months.

 

[Going4fun]

Welcome.

Sounds like you're recovery is going well. I'll see if I can help with some of your guidelines.

Paying attention to your body means if you have serious pain and soreness during an activity or afterwards (and pain can appear a day or more after doing too much), then you need to slow down. We're talking the pain that when it comes on, you think, "Oh this ain't good." We're talking pain that sorta scares you and doesn't go away simply because you try to ignore it. If it helps, Pain you immediately want to take medicine for and that tells you, "don't go out and do that again!"

If you are walking and feel only mildly sore afterwards, then keep going. Your body is not signaling a problem. We all heal differently ... and in fact people here who have had surgeries on both hips will report one hip heals differently and at a different pace than the other. That's why surgeons have to keep their guidance kinda vague and general--pay attention to your body. The pain that indicates you're doing too much will be pain that the next time you try to walk ... will interfere with your ability to enjoy the walk. It might be excruciating pain ... It will be a clear signal.

You're not going to harm the implant through walking. For the first three months, you want to avoid high-impact activities like running, which can harm the implant if done too soon. And the running to avoid isn't jogging across the street for a few seconds to get out of the way of traffic. The implant can handle that.

When you overdo things at your stage, it's not really the implant that will be harmed. Rather, it's your soft tissue, the tissue the surgeon, cut and pulled and stretched ... and the nerves that were aggravated ... all of that will create pain. And this pain can set back your recovery. But that's not the implant.

And yes, the anterior approach requires pretty much the same healing timeline as the other approaches. You can go to threads on this board with people undergoing the anterior approach who suffer the aches and pains of people who went through other approaches. My sister had bilateral hip replacements via the anterior approach in September 2019 and she's had a slower recovery than she anticipated. She is a former nurse and she ordered her surgical report. She was telling me how the report indicated use of various retractors to pull back this muscle or this tendon and that to insert the device.

Sounds like things are going well for you. You will know when you've done too much. We all do that at some point. Your body will scream. You won't have to go hunting for whether or not you overdid it. The news will announce itself loudly and clearly. What you want to be careful about (what tricked me and others) is the following. You report going for a two-mile walk with little pain ... Well you might do the same tomorrow and feel pain ... that's a sign that you don't want to walk 2 miles everyday. Or ... you might feel, "hey, let's try for three miles the next time," and you end up in pain.

Two miles in just two weeks! ... That's great, and you're reporting only some soreness. Are you using a walker or a cane or walking unassisted?

 

[djacksonsf]

Thanks Going and Forum for responding so quickly! I appreciate it.

Going, to answer your question, I’m walking unassisted - no walker or cane. It feels natural at this point. The leg sometimes feels sluggish or there’s a minor pain, but mostly it’s fine.

Stairs still present a challenge, but I’m in no hurry. The operative leg was so rigid before the operation that the muscles that help stabilize the knee had really atrophied. That’s the main reason for PT, but that’s more than a month away.

Today, I took it easy and that also felt good. Walked just a few blocks. Good to know that walking a lot won’t upset the implant - that’s a relief!

Wishing you the best,

-Doug

 

[Eman85]

Let's just say you're in probably the top 1% from your description of your first 2 weeks. Guideline in my hip handbook is 300ft in weeks 1-2 with assistance like a walker or cane. Return to work for most is 3 mos.

 

[Going4fun]

Wow, walking without assistance two weeks in ... you're rocking and rolling! ...

Great to vary up a "reach" day (walking further than before ) followed by a light day.

 

[Debru4]

It sounds like you are doing really well with walking, and resuming daily life activities. Good for you!
If I were to make a prediction, I would say that what is going to catch up with you will be if you decide to pursue PT and fall into believing you can go at as fast of a pace as you have the walking progression. There is a huge difference between walking, which really addresses far more of our muscle groups than most people realize, and targeted, intense PT. So I would caution you to go easy on things like the squats that you said you are currently doing, and if/when you start PT, be super careful. Your recovery so far has been a dream recovery, and yet with the wrong PT exercises you could be set back further than you can even imagine. I also was able to walk, do stairs, resume daily activities, and ditch the pain killers and assistive devices quite quickly. However, at the advice of my surgeon, and others here on the forum, I did not do any targeted PT to support my recovery. I also never had a major setback as so many have described. You sound like you are on top of things and plan to be strategic about reentering work, etc, which is wise.

 

[djacksonsf]

Thanks all!

Deb, I agree. I think PT for what was diagnosed two years ago as simple impingement with this hip accelerated the deterioration of my cartilage.

That’s why I’m being extremely cautious with any exercises. The squats are very shallow, and I’ll approach the PT with healthy skepticism.

Thanks for the reminder to think strategically. It’s easy to get carried away on a sunny day and walk too much. It’s a much bigger deal if that happens in PT.

Best regards,

-Doug

 

[Debru4]

Exactly, Doug! As I said, it sounds like you are on top of things......but I still felt I had to issue my cautionary reminder. As you said, overdoing on a walk is a whole lot easier to rebound from than overdoing with PT---once you've damaged that soft tissue again it seems to take twice as long to settle back down.

 

[Jaycey]

I asked my doctor about it and his team told me to listen to my body.

This is the best advice anyone can give you. There is no specific timeline to this recovery. Any literally every THR recovery is different - even on the same person.

I'll give you our guidelines for this recovery. You will see walking plays a major role in this rehab.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[ForumUser]

djack,

Just opinions, below.

My assessment of the experiences of hundreds of people in threads here, is that PT is not just unnecessary, it could be detrimental. This doesn’t mean that careful stretching and muscle strengthening isn’t a reasonable thing to do. Many report slides, slow stretching, non weight bearing exercises to be helpful.

Whether it is poor training, or just overly aggressive PT professionals, thread after thread, experience after experience, seems to indicate immediate post op PT is potentially unwise. Some threads are also pretty distinct horror stories of damage caused by PT. My sense is that PT folks, being young and fit in most cases, see the world differently ... and, may not fully “get it” ... they also could be viewing knee replacement surgery in the same context as hip replacement.

Another thought - guy to guy. Men seem to have an another issue ... thinking they are stronger, faster, better than they are - and, can’t help themselves in the need to compete. This isn’t about testosterone ...this is about recovery from major surgery. Some of the men posting sound a little nutty in their absolute belief they can be the first, the best, the fastest ... if they just push a little harder. I learned the hard way ... you will find many stories like mine.

I’ll go one further, I probably got lucky on my last recovery ... lucky in that I didn’t fall, twist, etc, while I was walking, driving, etc. There are stories of falls, twists, overworking, exercising, etc that resulted in discolorations, loosening of the prosthetic device, etc ...all of these stories are heartbreaking, but they happen.

Again, just opinions based on my recent experiences, and reading the many experiences of others.

The moderators herein are great ... their concepts and advice are based on thousands, if not tens of thousands of experiences, and, in most cases, their own, as well.

 

[Jaycey]

 

[djacksonsf]

Thanks Forum,

I've actually had other orthopedic procedures - meniscus clean up on both knees and bone spur and tendon work on both ankles - so I know the importance of taking it slow. Not having had this procedure, I didn't have a reference point to draw on, which is why I came here. Plus, most of what's posted on the internet is not about the anterior approach and recovery from it.

As I mentioned to Deb, I agree about PT and overdoing it in general. Those are lessons you can't easily teach someone who is eager to get back to reasonably normal mobility. I appreciate everyone looking out for me in that regard - reminders are always appreciated. FYI, I had minor setbacks with my ankle surgeries, so I know what that's like - the wondering if you've damaged something, the waiting to see if the issue resolves, the beating yourself up for not being more patient, etc.

When I mentioned PT in my initial thread, I should have been more specific: I am more focused on the knee than the hip. The cartilage damage on the right knee - same side as this hip replacement - is more significant than on the left, and I've had PT for that before and done really well. I want to stay ahead of any further deterioration of the knee, which means strengthening the muscles around it.

I take your point about well meaning therapists - young, eager, flexible, arguably unable to understand what joints feel like later in life when they've been compromised. But I've had a lot of PT and a lot of therapists, so it's not my first time at the rodeo (so to speak).

I only wish there had been a resource like this when I had my ankle and knee procedures nearly 20 years ago. It's invaluable to learn from others' experiences, and to get great input. Back then, I was relying primarily on input from the doctors, most of whom were not the best at communication - especially after the surgery.

All the best,

-Doug

 

[Elf1]

Just want to say ! You've already gotten a ton of great advice and you seem to have a good plan of action. And it seems you've learned from your previous mistakes during previous rodeos and aren't in a hurry to repeat them. That is very good!

 

[djacksonsf]

Yes, but it's always good to be reminded!

 

[CricketHip]

Hi Doug and welcome to the forum! You seem very level headed in your approach to this recovery.
Plus you've had some excellent feedback on here, so I'm just here to say hi and encourage you to remain as level headed as you currently are as you progress forward. You are doing so well and must be so pleased!
You are correct when you say that it is good to be reminded to take things slowly. So keep reading here on the forum.. lot's of good articles and member stories.

Happy Holidays.

 

[Mojo333]

and glad you've joined us.
I had both hips replaced via the anterior method...AMIS, minimally evasive, according to the professionals. I don't know what they deem minimal
Hip joint pain was remarkably eradicated completely, though it took a few days before I realized it.
My quads were extremely tender and sore and at two weeks out, I found short walks often were way more helpful than longer ones.
Also, uneven ground could stress my legs unduly so I paced down the halls, porch, and carport.
Listen to your body...your best guide.
Make sure you follow up walks with resting, icing and elevating.
All temporary and all well worth it in the end.

 

[djacksonsf]

Thanks Mojo, that's helpful - and what I've found to be the case as well. Flat surfaces are better than hills, although I've found that the soreness above and on the outside of my knee has dissipated significantly as I've gradually increased distance. I took two days off from any intentional walking this week due to rain and also because I just wanted to rest, so I'll probably go on a few short walks on flat surfaces again today now that the sun has returned.

I have noticed two new things this week. 1) I occasionally get some sciatic nerve pain in the operative leg. I'm thinking that's because the exercise I was given of squeezing my butt has irritated those muscles. The pain doesn't last - it's just a quick sensation - and I took some gabapentin prescribed by the doctor to address it. 2) While on my back in bed this morning I stretched as I normally do in and felt a burning/stinging sensation under the incision. Perhaps the stretch, which is nothing out of the ordinary (but maybe elongates the body more then when standing), stressed one of the internal stitches. I checked for any discoloration and found none, so I'll just mention it to my doctor's team in email.

Has anyone else had these things happen?

-Doug

 

[Mojo333]

I took two days off from any intentional walking this week due to rain and also because I just wanted to rest, so I'll probably go on a few short walks on flat surfaces again today now that the sun has returned.

This is the way to do it. Some time On, some time to recoup.
Burning incision...yep...butt squeezes might be able to wait a bit until things settle.
You won't lose anything by giving it some more time.
I didn't!!!

 

[Going4fun]

You're extremely early on ... you're going to feel all kinds of aches and twinges ... and yes, in your knee. I felt stuff in my foot and knee for going on six months.

You're very early ... all kinds of sensations will be happening.