THR Anterior Approach Walking Guidelines

[djacksonsf]

Thanks! That's good input. I think at the earlier stages (eg now) they just don't want any jogging because the implant is still integrating into the bone. Even then, I'm guessing a short jog of a few feet to catch a bus this week or next is not going to upset the apple cart. Since everyone is working from home now, it may not even come up.

-D

 

[Mojo333]

Honestly, I wouldn't attempt jogging "on purpose" even of it meant giving yourself extra time....I know you are aware.
Getting our confidence back is also part of this equation and honest trepidation may be our mind's way of protecting our body.
Easy does it, because if we can get this recovery right...I feel like I did...we will be back to our lives!
You've done great so far...its going to be a great summer!

 

[Eman85]

I've did a little running on my first hip,pretty early on getting away from some bees. It was just reaction and didn't have time to think until afterward. Felt good to know I could do it and had no problems.

 

[djacksonsf]

Thanks Mojo and Eman,

For me some of the trepidation comes from having a bad outcome after a routine nasal surgery. When that happens - and it's still happening - any new change brought on by surgery is a bigger deal than it ordinarily would be and any interaction with a doctor is different, too. I've had orthopedic procedures in the past, but nothing as big as a hip replacement, so this is new territory and it comes right after something that definitely didn't go as the doctor had indicated it would.

I think the muscle stuff is settling down, and I don't plan on doing any running of any kind ;-)

The leg length discrepancy persists, so hopefully PT helps with that. It's to the point now where the other hip is hurting unless I stand with my legs well apart, and I am also at the point when this should be going away - according to my doctor's team - if it's a perceived discrepancy instead of an actual one. If it doesn't improve in a few months, I'll reengage with the care team and see what's what.

Happy daylight savings to all,

-D

 

[Layla]

Hello and a Happy Wednesday to you. Happy Three Month Anniversary too!
I hope you’re having a great week so far and continue to enjoy progress. I’m sorry to hear your non op hip is bothering you at times. Hopefully PT will help as you mentioned. Please stay in touch and let us know how all progresses.
@djacksonsf

 

[djacksonsf]

Hi all,

Hope this finds you safe and sound in these challenging times. I was wondering if anyone had experienced LLD for an extended period - here's why:

I am continuing to walk and do a few of the PT exercises now that the butt pain is largely gone, but the leg still feels long and the quad is pretty tight, especially above the knee. The outer, upper part of the thigh is also slightly painful, or there's a jolt of pain along the outside of the leg when I shift positions. When in motion I notice this mainly on stairs, and I haven't really had that in the past. It's also painful to sleep on that side, and that's mainly right around the joint.

Is this how LLD manifests if it doesn't diminish with time?

Thanks,

-Doug

 

[djacksonsf]

@CricketHip encouraged me to post here to share what's going on, and so I do so with a bit of chagrin. Much as I try not to, I am now reaching rewards status in the ODIC. I feel like an idiot, because I've managed to irritate multiple things at once. Some of it was the move, some from walking in my hilly new neighborhood and some from moving pots on my patio two weeks ago. Leg length is also playing a role because the operative leg has to flex more at the knee when walking.

@Aline , I now understand a bit more about what you are going through. I'm getting strange sensations in my leg - sometimes the entire thing and sometimes just the thigh. It's like a jolt in certain positions or when shifting weight. My right butt cheek still hurts and now the hip flexor/psoas tendon is acting up in the groin after today's walk and trying to stretch it gently this morning on the bed.

I spoke to the PA and the physical therapist last week and both felt that it was some kind of inflammatory cycle I need to break by reducing the amount of walking and taking ibuprofen. So far, that has had limited success. I did nothing for two days except heat and rest and just walked a little today.

As @Eman85 said in another thread, the challenge is to prevent yourself from thinking that you've damaged an implant, but that did cross my mind and I reached out to Josephine just in case. The PA said it would take a lot to shift the implant, so there's that.

Tuesday will be 4 months. Had I not moved houses so quickly, I think I'd be on a different path now, but as @cstinchcomb said, we cannot undo the past. Still, I sure wish I'd done the surgery after the move so that there wouldn't have been so much disruption during month 3 of the recovery.

Regards,

-Doug

 

[CricketHip]

Good for you, Doug!! You couldn't control the moving issues and there are MANY of us who've bought a membership in the ODIC club.
I like what the Doctors advised.. ice is a natural anti inflammatory and will help with the ones that you are taking orally.

It really would take a lot to shift an implant. That is a nice way to word it!

Take care, try to rest and relax and avoid those hilly walks!!

 

[Pumpkin]

I did nothing for two days except heat and rest and just walked a little today.

Ice/cold might be better to get the inflammation down, heat can increase inflammation.
Josephine is retired from BoneSmart, our implants are very strong and extremely hard to damage, most likely your soft tissue is irritated and inflamed.

 

[djacksonsf]

Thanks @Pumpkln , I just switched to ice. Re: implant durability, I was also worried about too much activity too soon adversely affecting the bone growing into the implant. I've read that the first 3 months are important for that.

My 2-month xray - before all this happened - was perfect. Hoping the next one will be too, even with the stresses of ODIC. It's just that when aches and pains become persistent instead of resolving, sometimes you tend to think worst case.

Here's to a good week for all!

-Doug

 

[FCBayern]

I think you'll find relief after some time off from as much activity especially adding ice and anti-inflammatory @djacksonsf. I do think it would be difficult to actually harm the implant without really doing something crazy but the ODIC waits right around the corner for all of us. I'm sitting on ice as we speak after working on a project putting new base boards in our guest bathroom. Haven't felt any real pain from the activity, but definitely some fatigue so better safe than sorry. Sometimes it's hard to remember that at nearly four months we are still early days in recovery.

 

[djacksonsf]

I hope so, and you're smart to ice before there's a problem. Your point about this still being the early stages of recovery is a good one. I think the risk is that even if you feel good, the soft tissue isn't ready to support activities you don't feel are overly physically challenging, and because the muscles, tendons and ligaments aren't back to normal strength it can put stress on the new joint.

The buttocks pain has gotten a little bit better depending on the position I sit in, but the leg still feels tight and odd. Could just be from walking too much, but I think it's a cumulative thing. I normally sleep on the operative side and noticed the outer thigh from the hip to the knee hurts when I do that. If I roll onto my back, the discomfort goes away. Changing sleeping positions can be challenging, but I'll give it a try.

 

[FCBayern]

The soft tissues are definitely an issue. I know for myself everything was pretty weak due to the length of time it was so painful to get around that I just didn't for a long time. It's going to be a while until the muscles are at a normal level of fitness.

 

[djacksonsf]

Yes, just hard when you go from not sore at all to sore and tentative. Fingers x'd.

 

[cstinchcomb]

Ah jeez, sending best wishes that this too shall pass. Your 2 month xrays were good, that seems like a very good sign. It took me a year to really be back to normal. We moved house about 14 months after my surgery, we got movers but I did a lot of packing and up and down all those steps, and that was really OK at that stage of the game, but I was still worried. So 4 months out, still early days.

One more thing, on your quad soreness. My quad was really traumatized, took quite some time to heal up.

 

[djacksonsf]

Thank you @cstinchcomb ,

I think there are several things going on:

1. Piriformis/glutes are definitely upset. That could explain the weird leg sensations, pain sleeping on the operative side and pain behind the hip.
2. IT band irritation could explain the pain above the knee and on the outside of the thigh and twinges going up stairs. I think that's due to the longer operative leg, which is probably the product of the hip capsule tightness/irritation that's gotten worse instead of better.
3. Psoas could explain the throbbing inner thigh pain I felt last night when I tried to sleep on the other side. It went away as soon as I shifted positions. Going to try going back to sleeping with a pillow between my legs.
4. Not sure what's causing the discomfort/pain immediately to the outside of the joint.

I'm sure this is all the product of moving from a flat area to one where there are hills everywhere, and of doing too much during and right after the move. Between the time I moved and the shelter-in-place order, I commuted to the city for two weeks or so, and this involved going down a steep hill and back up it at the end of the day.

With the longer leg, I could tell the motion was different. It was an effort to heel toe that leg and the shorter leg felt pretty flat-footed in comparison. Also did some walks in the neighborhood to get the dog out and look around. Perhaps the lesson is that an accumulation of things can add up quickly to an uncomfortable situation that you don't feel coming on.

Hoping that with rest, ice, heat and ibuprofen this settles down. I guess I've at least made some good use of shelter-in-place by doing self-diagnosis-in-place.

Regards,

-Doug

 

[Fit4Family]

Good Morning Doug, @djacksonsf

I have read through your whole thread. Hoping your move is what stirred up all the pain. Resting is excellent advise. Twisting, lifting and stairs can really cause different muscle groups to get angry. I was advised against, clam shells, squats, bridges and marching above 90 degree angle. (Might be unique to revision, not sure) Like you, my knee on operated side got weak. It is improving with purposeful, heal toe walking. Walking really is the best exercise. It will help with the perceived leg length discrepancy. Mine is longer as it helps with hip stability after revision. I no longer notice the difference. I have a desk job, and will also say, sitting can really be a pain in the butt area. I set a timer (30 minute) to remind me to get up. Easy to forget while on calls or typing.

Sleep may very well be adding to your pain, hips can sink as we sleep on our side. Even with pillows. Might be more than your ligaments and tendons want to do right now. It’s still early days in your recovery. I mostly sleep on my back still. Annoying but really helps with pain around hip.

I have followed your thread and will keep checking in. Best wishes Doug,

 

[Layla]

I guess I've at least made some good use of shelter-in-place by doing self-diagnosis-in-place.

This is funny! You’ve certainly kept your sense of humor in all of this. I think you received some really good advice above.
Following is an article on LLD if you haven’t already read it in the BoneSmart Library -

Leg length differential - LLD

Leg Length Differential Even patients with equally long legs after a total hip replacement may perceive their operated leg as longer immediately after the operation. The patient may feel that one leg, usually the not operated leg, is shorter, although both legs are equally long as the...

bonesmart.org

In regard to side sleeping...I still use a pillow between my legs at almost 3 yrs post op.
I would suggest you try that again for sure. Obviously it doesn’t always stay in place throughout the night, but I do find it more comfortable than not using one.

I hope your discomfort eases soon. Take care, stay safe and well.

 

[djacksonsf]

Thank you, Sarah @Fit4Family , for reading through the entire thread - very nice of you to take the time to do that!

I've been resting all week and things have improved a bit. Less butt pain, fewer weird sensations in the leg. Maybe that's because whatever nerve was upset - the sciatic or other - isn't being as impacted by swelling in that area. If the buttocks really calms down, that will be a good sign those tendons and ligaments are relaxing and on the mend. The knee and outer thigh stuff is what it is - just have to give it time. I'll try walking on my block, which is level, to make sure I benefit from moving around.

@Layla , thanks for the reminder on the pillow. I'm going to try that again, too. I think that when you feel good during recovery, you forget that you really aren't past the point when these small things can help if you have a setback. And, big-picture-wise, it's easy to increase activity in a way that can have an unintended cumulative effect you just don't expect - and one that can be difficult to get out of ;-)

Again, thanks both for the great input and stay safe!

-Doug

 

[djacksonsf]

P.S. One thing that seems to help is gentle stretching on my bed. Figure 4, quad stretch while on my belly, stretching psoas by pulling non-op knee up to chest with both arms while op leg is allowed to relax off the side of the bed, IT band stretch while lying parallel to the edge of bed.

The last one is done lying on my non-op side with that leg tucked underneath and the op leg is then allowed to stretch under its own weight off the side of the bed. Also, as @CricketHip reminded me, self massage with a tennis ball in the buttocks is great. So is using a rolling pin to gently work out kinks in thigh muscles - and it's easier than with a foam roller, which means getting into the correct position on the floor.

These things are making the leg less tight and more flexible gradually. Sharing in case it's useful to someone.