THR Anterior THR

[desertrat]

I had anterior right THR 3 weeks ago, on 12/12. I'm doing pretty well I think. In the hospital 24 hours, only took serious pain pills (vicodin) for 3 days and not very many - been taking an occasional tylenol since. I used a walker for about 5 days and have been walking with a cane since then. Still have sore, weak thigh muscles but steadily getting better.

Like I've seen posted here, I was told to walk for therapy and if I overdo it and have pain, take it easy for a day or two. I seem to need extra sleep - I suppose that's part of the healing process, so I sleep as much as I need. Are other people experiencing this? I started doing very easy workouts on my Total Gym.

I've read through several threads on this forum and I feel bad for the people having problems. Hopefully mine will remain smooth, but I'm taking potential problems as a caution. I did something really stupid on New Year's eve - I knelt to the floor, realized it was a mistake and got right back up. It was a brain glitch/senior moment I guess. Instead of supporting myself on nearby furniture, or asking for help, I powered my way up. My right thigh strained and my hip popped loudly and moved a little I think - probably came close to dislocating it. I got queasy and light headed and had to lay down for a few minutes to recover, so don't do that, lol. That's the only real problem I've had so far. I was cleared to drive after two weeks, at my post op appointment with the surgeon.

This forum is very informative - wish I'd found it before the surgery.

 

[SurreyGirl]

Ouch! I did something g similar in the early days getting out of a friends car which was low and pinging something that took a few weeks to resolve.

Looks like you have your recovery sussed and Bonesmart is brilliant for advice along the way.

Just pace yourself and do lots of icing - it really does help!

 

[Jaycey]

I knelt to the floor, realized it was a mistake and got right back up.

Yikes! New hips do not like that at all. You are very lucky you got out of this position without any damage. Please take it easy and let that new hip "bed in".

I'll leave your reading list here for you to refer to throughout this journey.

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. Here is a week-by-week guide for Activity progression for THRs

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.

 

[Mojo333]

I seem to need extra sleep - I suppose that's part of the healing process, so I sleep as much as I need.

It is...
Read the article Jaycey left above about Energy drain for THR.
Body needs all the energy for healing at this point

I started doing very easy workouts on my Total Gym.

I would leave off of this activity...especially since you had that little mishap.
The Big Tip listed above will be your best advice as you get through the next few months.

Hope today is a Good Day !

 

[Layla]

Hi, Welcome to BoneSmart! Thanks for joining us and Congrats on your new hip.

It sounds as though you're doing really well and because of that, please move slowly and carefully for awhile. The kneeling mishap is an example of something that could have gone very wrong. Thankfully you're okay.
Reading you got queasy and lightheaded was scary. Glad you recovered quickly.

I agree with Mojo333 on the Total Gym, it may be a bit early for that. Following is the Activity Progression from the Recovery Guidelines, Jaycey, left you above in case you haven't had a chance to read it -
http://bonesmart.org/forum/threads/activity-progression-for-thrs.13187/
It's nice to use as a rough gauge of your activity level.

Stop back often. We'd love to support and encourage you on your healing journey.
A great Thursday to you!
@desertrat

 

[desertrat]

Well, I guess my surgeon knows what he's doing, not prescribing any PT. I was surprised by that at first but see why now. They said just walk, and gave me a few things to do while lying down. I read the activity progression and I've already done most of that (oops.) If I overdo it a little one day, I take it easy the next. Never have believed in the "no pain/no gain" philosophy. Since I had the anterior approach done, I think the recovery is generally a little faster. I'm not restricted on bending forward or crossing the centerline - just can't push my leg back and turn my foot out at the same time.

 

[Jaycey]

Since I had the anterior approach done, I think the recovery is generally a little faster.

Not really true. These days most surgeons are not imposing restrictions no matter what approach is used. But most of the hype around anterior is marketing. The recovery is really no faster and the end result is the same - a shiny new hip.

 

[Debru4]

@Jaycey---it's interesting to hear you say that marketing/hype is behind the increase in anterior THRs. A friend recently told me she had heard the same thing from her surgeon, and went for the posterior approach.

I really liked/respected my surgeon---his ratings are excellent. He far preferred the anterior approach, and I did that, with no regrets. Like @desertrat, I've been under the impression that the recovery process was a bit easier/faster.

Another friend has had 4 revisions, and had no choice of approach.

It seems like each of our recoveries took a different path as a result of the surgery, but we've all ended up in the same good place. Is this more a reflection of a doctor's skill with a certain approach and their preference? Why do you feel the anterior approach is being hyped and marketed? I don't disagree....just don't understand how that plays a part. Thanks for sharing your thoughts

 

[Jaycey]

Is this more a reflection of a doctor's skill with a certain approach and their preference?

It is ALL about the skill and experience of the surgeon. Their preference on approach is based on experience and the level of access they need to address the hip joint.

Why do you feel the anterior approach is being hyped and marketed?

It is positioned as a faster and easier recovery. In reality the speed or ease of recovery is based on how your own body reacts to the procedure. We see plenty of members who have had anterior approach have a slow and sometimes painful recovery. And unfortunately these members end up disappointed as they were promised a fast and easy recovery.

 

[SurreyGirl]

This is very interesting.. Again, many of my friends were pushing the Anterior approach to me but my OS was positive that he really needed good access for positioning and that my weight was against me re Anterior. So I had very mixed feelings about it. But life is getting back to normal now - I am just glad I had it done finally.

 

[Eman85]

Anterior,posterior it doesn't matter if they go through your bellybutton. Buy a whole chicken and try to dislocate the leg joint. Sorry to be graphic but that's what they do to us, including cutting bone and hammering and screwing in parts.
I'd put the total gym on hold and follow the guidelines. Why screw up a major job like this because of impatience to do what?, prove you're healing a week faster?

 

[Layla]

While we're on the subject...
My OS only utilizes the posterior approach, I've also heard, correct me "anyone" if I'm wrong, that if better access is needed during anterior surgery, for any number of unknown reasons, they'd close and access via posterior approach. Anyone else hear this? @Josephine can tell me if I dreamt this, or made it up That would make me wonder if that's why some OS's stick with posterior...
@desertrat

 

[desertrat]

Yikes, I wasn't told about that - I'd think they would have to inform you of that possibility ahead of time. My surgeon uses a special table (Hana I think) which make access easier. I did just read that if the femur is fractured ( they do hammer on your femur, ugh) it is more difficult to repair with anterior and a second incision might be needed.

 

[desertrat]

I'd put the total gym on hold and follow the guidelines. Why screw up a major job like this because of impatience to do what?, prove you're healing a week faster?

The total gym allows me to do very gentle squats at an incline so low I'm going through the motions with very little resistance - just moving the legs basically. My knees have some trouble too, mostly my left and I need to work them a little - walking isn't enough. They've been feeling weak when I get up and down from sitting. I'm really not straining the hip at all. Plus I can work my upper body without involving the legs. I'm not pushing myself, don't want to undo all this.

 

[SurreyGirl]

I did read somewhere on the forum that someone had gone for the lateral or mini posterior approach but on the day the OS decided to do the posterior!

Thinking about it, the incisions are different but the prosthetic will be relatively standard apart from materials so the difference is in the size of the incisions and what muscles were polished aside or cut to achieve the objective?!

 

[Josephine]

I've also heard, correct me "anyone" if I'm wrong, that if better access is needed during anterior surgery, for any number of unknown reasons, they'd close and access via posterior approach.

Certainly not! No self-respecting surgeon would ever do a thing like that, not if he wanted to retain his license! He could possibly change his mind prior to the anaesthetic being started but he'd have to get his patients consent first.

 

[Mojo333]

I had, as you can see by my signature, bilateral anterior as that is what my brilliant surgeon was trained and confident in.
I did not make the choice and though I feel there were certain short-term advantages..long term healing I think is pretty much the same.
If anything, the short term benefits may lead one to feel they should be doing too much too quickly.

Given the proper time to heal, all should be good for the long haul.

 

[Debru4]

Great discussion everyone! Always interesting to hear different experiences/perspectives. With the availability of X-rays, MRIs, etc. it would seem if they had questions prior to surgery they could utilize these to help make the decision prior to the surgery. Sounds like that's what SurreyGirl's doctor did

I would also think that once the pricey, special Hana table was purchased there would be an incentive for the surgeon to keep doing the anterior approach. And the more surgeries/more experience they each have at their favored approach definitely increases their confidence and success rates, which in turn affects the patient positively as well.

Based on my personal research prior to my surgery I was hoping to have the anterior approach, but I sought out the best surgeon in my area, without knowing his preference. For me, I was pleased he specialized in anterior, as it has been a very positive experience.

Everything people have shared about using caution and not overgeneralizing about the approaches, or recoveries is so on point! Thanks all!

 

[Debru4]

desertrat--I guess I am not understanding the need for the Total Gym, especially since you had pulled something early on with your floor move. The things you described sound a bit rigorous for three weeks out.

Are you a person who has exercised religiously prior to surgery and want to resume the habit, or are concerned about getting out of shape?

Just wondering, as it seems that there is still the potential to injure yourself. Your comment about taking it easy after you overdo only works if you haven't seriously pulled something......this forum has so many comments by people who ended up set back for weeks or longer because of pushing too hard. My biggest "push" in the first couple months was to increase my walking and return to doing all the daily life tasks I could. I feel like it paid off, and I find myself quite "fit" at this point, although I'm not yet trying to use gym equipment.

 

[desertrat]

I had, as you can see by my signature, bilateral anterior as that is what my brilliant surgeon was trained and confident in.

As I said to someone else on this forum, you are tough having both done at once! I don't know how you did that. My left hip isn't ready anyway - not bone on bone yet but not much space left between ball and socket, and range of motion is greatly decreased.

Do they always wait until it is bone on bone? Just curious if there are other circumstances.

I think my surgeon does the anterior approach because he really believes in it. He's very highly regarded - I researched him before I went to him.