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THR Anterior THR

JLD

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Had my anterior total hip replacement done May 12, 2020. Thought I'd share what I did before and what I experienced after surgery. First, I'm 57 (58 tomorrow) male with a long history of playing sports. Had hip pain for 3 years. super active in that I play tennis 3 times a week, golf once a week (walk the course) and workout 4 times per week. Ended up bone on bone with my left hip, including bone spurs.

1. Anterior is the way to go. My ortho primarily does posterior but I wanted anterior. So much better. So few restrictions. can't recommend enough. hospital personnel and PT folks were so surprised at my immediate recovery.
2. Pre surgery I got my legs, core and hip muscles in extra great shape (that is the key)
3. Post surgery. Used a walker first day post op. Used a cane second day post of. Walked unaided since day 3. PT 4 times first 2 weeks. Stationary bike since day 5.
4. Do your exercises 3 times a day.
5. walk as frequently as you can.
6. Ice is your friend (constantly ice the first 7 days). elevate your hip slightly.
7. Gravity is your enemy. When not walking, rest. let it heal.
8. My recovery. Had swelling and bruising first 9 days then it dissipated. Only taking Tylenol, gabapentin and aspirin. By day 10 I reduced dosages. by day 14 I'm down to minimal use. incision healed first 6 days. had nerve and muscle pain first 7 days. pain fluctuated and migrated to different parts. I learned that healing is not linear but it does trend up.

Take-aways:
1. do anterior
2. get in great shape presurgery
3. ice and elevate
4. walk slow and often. when not walking, lay down
5. do your exercises 3 times a day. You will see that by day 14 you can do almost any leg/hip exercise with minimal pain.
6. see how you feel and try to back down the pain meds if you can. this gives you a better idea of your pain, the degree and location.

Day 19 i'm doing light weightlifting, a lot of stationary bike and 3 times per day PT exercises. Goal is to be biking by week 4, golf by week 6 and tennis (doubles) by week 12.

Good luck. It's sooo worth it.
 

Jaycey

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Welcome to BoneSmart!
My ortho primarily does posterior but I wanted anterior. So much better.
Just to clarify for our newer members - anterior is not necessarily "better". It's just a different approach that surgeons use. And these days there are rarely any restrictions imposed on any approach used. Glad it worked well for you @JLD .
Do your exercises 3 times a day.
Hips don't really need a lot of exercise. What you found out about walking is spot on. Walking is the best rehab for hips and then not to excess.
see how you feel and try to back down the pain meds if you can.
This may have worked for you in the early days but for many pain medication is needed for months. Take your pain meds until you start forgetting doses. That is the sign you are weaning off them. You need your pain controlled to increase your mobility.
Day 19 i'm doing light weightlifting, a lot of stationary bike and 3 times per day PT exercises.
Very early days to be doing all this. Please be very careful. New hips do not like lifting and all that activity could put you into chronic pain. Bursitis is also very common post op for those who push the activity.

I'll leave you our recovery guidelines. You might want to read the chart representation of recovery and the activity progression (item 5).

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
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

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.
 

Layla

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Hello and Welcome to BoneSmart. Thanks for joining us!
It seems you’re doing really well. I’m happy for you. Given the description you shared of your pre-op activity level it sounds like you went into surgery in relatively good physical shape, all aren’t as lucky for varying reasons. I also hoped for the anterior approach due to all I heard before I became involved here, but I chose my surgeon first through several good references from sources I trusted. My surgeon only performs the posterior approach, so posterior it was.
With that said, my recovery was no different and even better than many of the accounts I’ve read here. I didn’t have any restrictions and felt I did really well.

hospital personnel and PT folks were so surprised at my immediate recovery.
I feel this could be misleading to those who’ve yet to experience their surgery and are reading here. Naturally there is physical damage that occurs through the controlled trauma of a THR that takes many months to completely heal from.

Post surgery. Used a walker first day post op. Used a cane second day post of. Walked unaided since day 3
While we do read of those who quickly ditch assistive devices because they have the confidence and physical strength to do so, most choose otherwise for safety reasons and also balance associated risks they may be experiencing from a medication they’re on. It is a wise choice considering the consequences of a slip / fall causing a painful dislocation in the very early days / weeks of recovery.

Do your exercises 3 times a day.
This is not necessary for all.
I didn’t do any exercises after three or four days of the exercises the hospital PT gave me before discharge. At three weeks post op I attended three PT sessions and quit, deciding I wasn’t interested. Again, my recovery was a good one in my estimation and I’ve read many recovery accounts here over the past three years.
incision healed first 6 days.
Possibly it’s closed and looks decent, but it’s not completely healed below the surface in less than three weeks time.
You will see that by day 14 you can do almost any leg/hip exercise with minimal pain.
This is not true for all. We arrive at this surgery in varying degrees of degeneration. Many limping and using an assistive device to get around for lengthy periods of time before surgery. No two recoveries are alike, not even with the same person.

Day 19 i'm doing light weightlifting, a lot of stationary bike and 3 times per day PT exercises. Goal is to be biking by week 4, golf by week 6 and tennis (doubles) by week 12.
These are ambitious goals and while I wish you the best, I equally hope you don’t overdo it and become sidelined stalling your recovery. Good luck to you.

Congrats on your new hip! I hope it serves you well for many years to come. :)
 

JannieC

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JLD, you definitely are a superstar. As others have said, everyone is different. I actually did a lot of core strength exercises and PT prior to my anticipated surgery next week. I was told that strengthening around the hip area is the best thing you can do. Unfortunately, when I started staying home in March I got lazy and also my last cortisone shot wear off so I haven't consistently kept up with what I was doing prior to covid-19. I'm going to have the physical therapy person come to my home for the first couple of weeks but I've read all of the caution on this forum about doing a lot of that. My personal physical therapist that I've been working with on and off for the last 5 years would definitely take issue with NOT exercisIng.
 

Going4fun

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Wow, someone is in great shape and it sounds like you're having a smooth recovery. So wonderful to hear.

There are highly skilled anterior-approach surgeons and mediocre anterior-approach surgeons. Each approach has its own challenges, nerves to avoid damaging and so on. In the past ten years or so, all approaches have faster recoveries than decades ago, including posterior. I found many posterior-approach surgeons whose patients rave about the speed of their recovery.

Sounds like you had success with "anterior." I would credit your surgeon. No technique implements itself and all techniques have learning curves. Most joint specialists choose one approach and try to master that approach. There are some that can skillfully do multiple approaches but really most seem not to even try that.

Anyway, congratulations.
 
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JLD

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Folks, I was just communicating to you my experience pre and post surgery and my condition prior to surgery. Of course, everyone is different and should listen to their doctor PT and body. I Thought it would be encouraging to those similar to my situation that are contemplating the surgery that there is hope and good news and no need to get worried or depressed. Listen to your body.
 

Layla

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:wave:Good Morning and a Happy 58th Birthday to you!

I apologize if my response to your initial post came across as contradictory. Your recovery is remarkable, but not the norm. While it may be very encouraging for some to read your update, it may cause others to question whether they’re healing properly, or if they should be further along on their healing journey. It is the latter group that was on my mind as I responded.

In recovery you’ll find those who excel, those who progress more slowly but steadily and those who find it a slog possibly hampered by complication.

Many are tired finding sleep elusive, or foggy brained due to Opioids. A great number have no appetite and feel physically weak because of it. Others feel miserable due to constipation. Some are plagued by higher pain levels and many experience Post Op Blues. While we caution members not to compare recoveries, it’s in our nature to do so.

My response was to counter a few things I felt were inaccuracies and reassure those reading and feeling inadequate that all recoveries will not be like yours. Not all have the ability to go into surgery in great physical shape. The activity level of many has been hampered by a deteriorating joint. Those who put trust in a surgeon over a surgical
approach, may find their surgeon doesn’t use the anterior approach which I already mentioned was the case with me. We need to trust the skill of our surgeon and realize that no matter the approach, the result will be the same in the end.

Thank you for your words of encouragement in your last post to those waiting on surgery to remain hopeful as they contemplate their own recovery. I hope you will continue to share updates, support and encouragement to those following behind you.

Best Wishes for a great week as you celebrate your birthday today and your three week anniversary tomorrow. :)
 

Hipster45

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Awesome to hear you are doing so well! I had bilateral hip replacement May 15, also in pretty good shape prior to surgery. I am 21 days out and walked a mile yesterday, planning to start some recumbent biking soon. I feel fantastic except for the tightness and tingling down front of thigh..(anterior approach also). PT and dr all say normal. Curious if you are also experiencing this?
 
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JLD

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I did have tightness and pain. Also, my pain migrated many times the first 7-10 days. I focused on rest, ice and elevation. Good news is that muscle and tendon pain got better each day. Stationary bike helped with movement. Right now 23 days in my tenderness and weakness is solely in the area where the prosthetic was placed in my femur. Everyday I’m just trying to strengthen hip adductors, glutes and core. Been doing super light quad and ham machines. Started biking a few days ago. Let me know your update in a week or so. Good luck!
 
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JLD

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Layla. My comments were not inaccurate. My comments were based on my personal experience. I accurately described how I was going into surgery and my recovery thereafter. Of course, everyone has a different experience. I thought it was important to share mine. I will tell you that anterior for me was very beneficial. I do believe that all 3 approaches require roughly the same amount of time for the prosthetic to “grow” into the femur, which takes many weeks. However, I will tell you that I do believe that the anterior approach allows the short term healing process to recover much more quickly than the other two approaches as it is less invasive.
 

cstinchcomb

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Sounds like you are doing excellent. I definitely think that the fitter one goes into the surgery, the fitter and faster they come out the other side. Please keep us posted on your progress.

That being said, it takes time for the soft tissue to heal up and the bone to grow into the new hardware. So we are all somewhat fragile in the early days.
 

CricketHip

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Hi @JLD Glad to read how well you are doing! We all heal differently and at our own pace. You are definitely ahead of the game and that makes me very happy for you.
Be careful and enjoy your new hip!
 

zauberflöte

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@JLD it does sound as though you are having a very easy time of it! My hips are both anterior, same OS, he does about 400/year. My two recoveries were quite different! But it is a fact that for each hip, the folks in my cohort I was jealous of (for recovering more quickly) all had some form of posterior or postero-lateral approach.

I seemed so bound and determined to join the ODIC (overdoing it club) that now, at seven and three years later, I have soft tissue issues. I am living with them because I'm too lazy to look into them. I'm currently recovering from a non-joint surgery, and I've promised myself that I don't want the kind of late-onset setbacks that I gave myself with hip no 1!

As we all keep discovering, everyone's hip is different!
 

Layla

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Layla. My comments were not inaccurate
Inaccurate, misleading, inexact, off target...I guess I could have chosen any one of these words in making the two points below in particular. I mean no disrespect...simply making a point, or looking for clarification if you’re willing.

hospital personnel and PT folks were so surprised at my immediate recovery.
Wouldn’t you agree this is misleading? In reality, you’re still not recovered, even now at 25 days post op. Full recovery takes months if not a full year, or even longer for some.

incision healed first 6 days.
Please explain what you mean.

It sounds like you’re doing really well and that’s wonderful. I’m happy for you, but in an effort to make sure pre-op members reading here aren’t mislead by your account, I feel it fair to point out that it will take much longer than six days for their incision to completely heal and their body to fully recover.

I hope all goes well for you as you continue the journey.
May the Summer of 2020 be one of your best!
 

Layla

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Happy One Month Anniversary!
Wishing you a great weekend and all the best moving forward. :)
@JLD
 

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