THR Anterior Hip Replacement: 6 weeks Post Op

[wahoou]

Hi all,

I stumbled on this forum this weekend while researching hip recovery sites.

As background, I am a 58 year old former competitive tennis player (played competitively at college and after) and now a Pickleball convert! I thought I had tweaked a hip flexor during a Pickleball match last September as I had pain in my right groin. Saw a chiropractor who took x-rays and mentioned that I might need a replacement down the road. Was referred to a Sport's Physician who specializes in hips who does an ultrasound and sees an inflamed psoas bursa and gives me a cortisone shot which sadly does nothing. Finally, I head back to see him after the holidays as the pain is worse and I am limping. He orders an MRI and the results were extremely surprising to both me and him.

He expected bursitis or tendonitis (as did I) but it turns out that my labrum was torn and shredded in several area with lots of ulcers and virtually no cartilage left in the right hip. Turns out, that I had an extremely arthritic hip which I had no idea! The doctor said a torn labrum often presents as groin pain. Before the groin pain/Pickleball match, I had stiffness in my hip (tough time putting on socks and shoes) but no discernible pain to speak of. I scheduled surgery straight away.

I am 6 weeks post op and I wanted to thank you for contributing to this forum! I checked out the standard links regarding recovery as I have been having physio once a week and making okay progress. But the last session (last Friday), the therapist really "attacked" my ITB and glute muscles. Anyway, I have had persistent nerve zingers starting from my foot and progressing to my shin since then. I did have zingers from time to time before then, but they became worse/intensified after the last physio session.

I was a little disheartened frankly as other people I know who have had this surgery told me it was a breeze regarding recovery. I have not found it that easy but maybe I was pushing myself too much re: walking. I am planning to take it much slower the next few weeks. As an aside, after the operation, the surgeon told me that I had the "most dense" bones of any women he had seen for someone my age (and he has been practicing for 25 plus years!) He said, "Lucky you, but it made my job far more difficult as a surgeon!" I suspect he really had to bash my bones (lol) during the operation and I probably have a lot more soft tissue damage than most.

I will see him next week and will have an X-ray to ensure the prosthetic is still in the correct position and my bones are being to fuse to it. Was really relieved when I read the posts here about recovery; each person's experience is different! Many thanks again

 

[Mojo333]

@wahoou
to the forum.

Can you please provide the date of your THR and which hip was replaced?

It can be really hard to find a good balance during recovery...I struggled with all the information from various sources but found
the advice here the most helpful.
I am back to a busy active life almost 6 years post BTHR, and love my new hips.
Slow and steady is definitely the best way to heal.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines could help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

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 these​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this ​

Activity progression for THRs​

6. Access to 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.

 

[Caison113]

Welcome @wahoou to the club no one wants to be a member of! My sense is your competitive nature got the better of you as you want to "do something" to make yourself heal better/faster. I can definitely relate. I have ITB pain since the surgery and really want to attack it, but I also know I can't start digging into that area too hard yet (I'm almost 7 weeks post-surgery, posterior).

This is my second hip so I can compare and contrast a little. I had really no issues with the first hip and really progressed fast, albeit with an achy other hip that I knew was just a matter of time before I had to get it replaced. I am too somewhat disheartened that this recovery isn't going as fast as the other one (although compared to many, I have no reason to complain). I've been going back to kickboxing (albeit without any kicks) the past couple of weeks and it's been great, but I have to take it easy.

PT is really overrated when it comes to the hip and you hear many more stories of PT setting people back than it somehow miraculously speeding things up. Doing "nothing" is the hardest message to give many people, including myself, and I'm just telling myself that a couple extra weeks of "nothing" could really lead to many more years of "something." Get back on that ice, elevation and rest routine. Still be active but you really can't rush the healing process too much. Good luck!

 

[wahoou]

@Mojo333 I had an anterior replacement of my right hip on Feb 6, 2023. Thanks for your support and links; I already perused the articles and they are very helpful!

@Caison113 Thanks for your comments and thoughts about PT! I am going to try and take things much more slowly and give my hip a chance to heal! Will be curious to hear what my surgeon says next week after my x-ray and evaluation...

 

[Mojo333]

Glad you checked the articles out.
Everyone seems to know someone or knows someone who knows someone who has had a hip replacement, but the truth is we have recovering to do... not only from the surgery but from the realization we have a prosthetic hip and from the years prior to THR (when I soldiered through and seems I was in denial about my limp, and limited ROM)

I am going to try and take things much more slowly and give my hip a chance to heal! Will be curious to hear what my surgeon says next week after my x-ray and evaluation...

Splendid plan...
and that reassuring post-op appointment did a lot to relieve some of my anxiety about the ongoing surgery discomfort.

 

[Eman85]

If you read enough posts on here you'll know what your OS will say ahead of time. He'll say eberything in the x-ray looks good and don't do anything that hurts. You can also see where just about every therapist thinks we all need to be on some fast track or we'll never walk again. I don't know what you mean by a PT "attacking" your IT Band and glutes. Just me but I wouldn't want any PT handling me if hat's what they did.

 

[wahoou]

@Eman85 I was using hyperbole to be fair. But let's just say, the session with the physio was painful to say the least! The one good outcome is that it drew me to search online for hip recovery sites and I found this one! What a resource/trove of info and wish I had found it sooner...

I will definitely tell her/the physio to take it easy next session and explain the pain I encountered after the previous "intense" session. What I have found most useful on this site is that one doesn't need to walk or do much while the hip recovers (and maybe less is more?) Well, too much walking/exercise probably isn't a good thing!

I took it easy on Sunday and Monday and the nerve "zingers" have subsided quite a bit today. One day at a time as they say...

 

[Layla]

What I have found most useful on this site is that one doesn't need to walk or do much while the hip recovers (and maybe less is more?) Well, too much walking/exercise probably isn't a good thing!

It is not necessary to exercise your injured hip to promote healing. The controlled trauma sustained through THR will heal on its own. Often though, we're impatient and want to move the process along. In doing so we run the risk of struggling with pain and setbacks stalling the healing process. The best therapy for recovery is walking, but not to excess. Start slowly increasing time and distance incrementally in an effort not to overdo it. Give yourself the TLC you deserve and reap the benefits of a successful recovery.
Have a great day, wahoo!

 

[Eman85]

If they didn't handle you what exactly are they having you do. Many of the PT's have patients doing exercises/movements that are in no way beneficial to THR recovery. Why? those of us on here have no idea other than it's something they were told, usually not by an OS or a THR patient.

 

[myglasshalffull]

Welcome, happy you found us, you will get so much good and positive feedback here. I'd say, read a good book, crochet an Afghan, watch Netflix and enjoy the rest!
My first 4-6 weeks I 'd make coffee, walk around my dining table 10x's one direction then switch directions!
Lots of Netflix watching and talking to friends on the phone and of course visiting Bonesmart everyday!
Keep us posted and don't do anything in PT that hurts.

 

[wahoou]

@Layla Thank you for the great advice!

@Eman85 The only exercises I have been given are the bridge (to strengthen glutes) and some core exercises. I told the physio that I had some shin and ITB pain and so she worked (deep tissue massage) on the ITB and my glute but I think it was too vigorous in retrospect, as I experienced a lot of nerve zingers the next day...

@myglasshalffull Thanks for your words of encouragement! I need to dig up some Netflix series which I haven't watched yet!

 

[ThrInOntario]

I had my second post op appointment with my surgeon today in week 6. For me, he is advising against physio because of the extensive work he had to do to fit the implant. Instead, I walk daily, and in two weeks can add elliptical machine work and body weight squats. His opinion is that physio work may irritate the soft tissue, which is already tasked to accommodate the new hip.

Physio may not be for everyone.

 

[Eman85]

I have been given are the bridge

You have been given one of the not recommended for THR recovery exercises. Many have been given bridges to do, most gain nothing but pain from it. I'm sure others will be along to concur.
My OS told me if I wanted to go to PT he'd send me but warned me they'd hurt me, I passed on PT.

 

[Layla]

Eman is right about Bridges.


Bridges like this? If so please be careful because they can cause generalized tendinitis particularly in quads, glutes and hamstrings.

Maybe it was the Bridges causing the reaction and not the massage.
Here is an article of interest - BoneSmart philosophy for sensible post op therapy

 

[wahoou]

I cancelled my remaining appointments with the physio and will review with the surgeon next week (will have an x-ray taken before the consultation)! Thanks for all of your thoughts/advice; I really appreciate it!

PS... I rarely did the bridges (I am not the best patient/student...lol!). I really think it was the "intensive massage" and/or the surgery which set my nerves awry. We'll see what the surgeon says but from what I have read, there's not much one can do re: nerve zingers/sciatica pain. Hopefully, it will run its course sooner than later...

 

[wander03]

After my first THR, one year ago today, also anterior, I had an in-home physical therapist who had worked on my ITB and quad that had fused together. I had a TKR, also on the right side, 7/19/2021, and Chris became my PT after another PT program caused a great deal of harm to my knee by overly aggressive PT. Chris started with light, superficial massage and over the weeks and months progressively deepened the massage. I think his massages before my THR were instrumental in my relatively uneventful recovery from my RTHR. When Chris did the massages, he said he would not be able to do them for a while after my THR because of the healing process.

I had read that there is often nerve numbness on the outside of the thigh after a THR using the anterior method. I still have that numbness in my right thigh, but I am aware of it only when I touch my thigh. Because of the more rapid healing and lack of discomfort with the anterior approach, I think the numbness is an acceptable trade off. I do not have the numbness in my left thigh after that THR. Interesting.

It sounds like you are on the right track concerning PT. The first thing I learned from BoneSmart when I discovered it about nine weeks after my RTKR was to not let any PT do anything to me or do anything to myself that causes me pain. Discomfort is acceptable, but not pain. I think that made a great deal of difference in my recoveries from my THRs.

I agree with @Eman85 and @Layla concerning bridges. It was more than six months after my second THR that my PT included bridges. They were added then for strengthening of my quads, glutes, and hamstrings.

Onward and upward!

 

[wahoou]

Hi all, I have an update! I spent the afternoon at the hospital; I had a 7 week check up with the surgeon and he took a new x-ray. He tested my range of motion; looked at my gate and ran other physical tests. The good news is that my hip looks great; the bad news is that he suspects a bulging disk in my back which has caused sciatic pain (and it's getting worse by the day!). He runs the Hip surgery department at Schulthess in Zurich, Switzerland and was able to get me in for an MRI this afternoon. I met with another doctor afterwards as they had the results straight away. (A side note here: God LOVE the Swiss and their efficiency! If I was in the US, this would take several weeks at best!) It turns out that I do have a herniated/bulging disk which is putting pressure on my sciatic nerve. They will schedule an appointment with a neurologist ASAP (Hopefully tomorrow or Friday). In the meantime, they sent me home with Tramadol to help with the pain until the neurologist can give me an injection (cortisone and lidocaine I think? Not sure...). I think the plan will be for me to work with a physio afterwards to address the disk issue. The stretches/exercises should work from what I have read but tough to do when one has radiating sciatic pain...lol! All in all, great news as I see a light at the end of the tunnel...

PS...Sciatic nerve issues are very rare with initial hip replacement (more common with revision surgeries or for those who present with hip dysplasia before surgery) from what I have read and the surgeon concurred. The surgeon apologized to me for the pain during my examination as this is/was not typical for majority. I really appreciated honesty and I suspect I had really dense bones and they had to manipulate me more than usual during surgery which created the disk issue. That said, to quote my late Mom, "It is what it is!" I am relieved I have a diagnosis now as I typically have a really high pain threshold. This sciatica is/was getting worse by the day...

I am very motivated to work with a PT and do what ever is necessary to relieve the disk issue... Beyond thrilled to finally have a diagnosis; was worried that something was wrong with the implant/prosthesis. Thanks for your support! This site has been a godsend and trove of info for me; only wish I found it sooner!

 

[benne68]

@wahoou So sorry to read that you've been diagnosed with a bulging disc. I can attest to how painful that can be. Twenty years ago, I herniated the disc between L4-L5 while skiing and, even after it "healed," I suffered with sciatica from that bulging disc.

PT was very helpful initially, but you can't really repair a bulging disc without surgery. I struggled with sciatic pain for years. I tried massage, acupuncture and assorted other treatments. What eventually helped me resolve the problem was yoga. I've found the gentle stretching relieves the pain by reducing the compression of the vertebrae in my low back. Something you might want to keep in mind for the future.

Good luck!

 

[wahoou]

@benne68, Thanks for your response and ideas regarding sciatica. I have read that disk issues, in some cases, can resolve on their own accord with PT and exercise. But I gather every situation/person is different. I think there is a window re: bulging disks and a lot depends upon treatment during that window. Have you ever tried a Chiropractor? Many are rubbish but some are very good and can be quite effective for stubborn disk issues. Thank you for suggesting yoga; I am strong but not that flexible - sad but true. But, I think I need to improve flexibility for long term health. Interesting, in that many of the exercises for bulging disks involve yoga poses. "Bird dog", "Cobra Stretch" and "Child's Pose"...

Just found out, that I have an appointment tomorrow morning with a neurologist who will run some tests and maybe give me an injection in the affected area so I can work with a physio and do exercises to relieve pain long term. We shall see...

Thanks for reaching out; I appreciate it! I am more optimistic now that I know what the issue is and very relieved it is not a hardware issue...

 

[lanstan]

People think that one cant do you if you are not flexible but that is who helps the most. Try a gentle yoga class and tell the teacher your problem. Of course ask your doctor if it is OK in your situation. Hope you get relief!