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THR Apprehensions Before Surgery

EditorER

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My right hip replacement, with bone grafting, is four weeks from today. I had my left hip done 5.5 years ago. I have/had severe acetabular protrusion in both hips, resulting in a great deal of bone loss. After my left hip replacement my surgeon said the bone was translucent. With this right hip, the first surgeon I saw said he wouldn’t do the surgery—he was afraid of breaking through the socket bone when reaming out the joint. The surgeon I eventually chose is confident in doing the surgery (he is fellowship trained, older, and has done many surgeries) and plans to do a bone graft to strengthen the socket.

My anatomy has been abnormal since birth. I’ve been pigeon-toed all my life. I probably should have had a brace as an infant, but my very young parents in rural Indiana did not notice the dysplasia. A doctor saw it in my walkIng gait around age two and I wore casts on both legs for a few months, followed by lots of orthopedic shoes until my teen years.

Arthritis was diagnosed when I was 37. It changed my parenting, which I regret. I did not play with my kids as much as I wish I had and I let my husband take over the bedtime and book reading routines so I could avoid trips up the stairs. I focused on not putting mileage on the hip joints, which allowed me to get to 55 and now 61 before surgery—but I gave up a lot of play, sport, hikes, walks, and other activity along the way.

When I had the first replacement by a fellowship-trained surgeon with a stellar reputation, using the anterior approach, I expected to feel terrific afterward. Sadly, that has not been the case. The surgery was difficult—the joint was incarcerated and it took a long time to free it. I lost a lot of blood and had two units transfused. “Normalizing” my anatomy put a lot of strain on my muscles, nerves, and tendons. I did not get up on the joint until the day after surgery. I stayed two nights in the hospital. I was embarrassed to have urinary incontinence in the hospital and for weeks afterward. Physical therapy was stressful and no matter how hard I tried and how much the therapists urged me to try harder, it was about 8 weeks before I could raise the operated leg even 1/4 of an inch. While the new joint is doing fine, and I am grateful for that, it appears I suffered nerve damage. The operated leg still has tingling and burning along the outer thigh and the entire quad area feels heavy, like there is cement in my leg. There is some muscle atrophy and those quad muscles are prone to cramping. I still have to use some extra oomph to get up the stairs. Every year I see a bit of progress—but I never in my wildest imagination anticipated that my leg would still be as weak as it is today.

To further complicate my recovery, I had a lot of back pain. Adjustments were made to my walker and cane heights. I was told to use the cane much longer than is typical. I think I used it for three or four months. Nothing helped. I was referred to a neurological surgeon who did an MRI and diagnosed facet disease and arthritis in L4, L5, and S1. My husband and I both shed tears at that diagnosis. There is no such thing as spinal replacement surgery. That diagnosis led to pain management and various day surgery procedures to treat nerves along the spine. Those helped a little, but not a lot. I was able to walk only 10 minutes at a time before having to stop and reach down to my toes until the backache eased up. Finally, I took up Pilates and after some months I strengthened my core enough to take some pressure off my lumbar spine and I was able to reach my 30-minute walking goal. That felt great—except that my left leg still felt like it had cement in it. But at least I was moving. I’ve kept up the Pilates to this day and it really helps.

This past summer my right hip began “talking” to me. I knew I couldn’t put surgery off much longer. X-rays showed slowly advancing further degeneration. With all the COVID lockdowns, this fall seemed the ideal time to “go under” for a while. After interviewing several surgeons, most of whom said “whoa!” WHen they saw my x-ray, I finally scheduled surgery for November 17 with the surgeon who felt confident he could do the replacement.

Yet, I have serious apprehensions about another surgery. What if I end up with two weak legs? How will the already weak left leg support me when it has to be the “good” side? What if the minimally-invasive posterior approach I will have this time results in sciatic nerve damage? Will I ever feel great and scamper up a mountain path or walk for miles on the cobblestone streetof European cities (or even walk briskly around my own block) or will the spinal issues still keep me from being as active as I’d like to be?

Time will tell. I just wish I could look forward to this surgery instead of dreading the recovery and having fear for the possible negative outcomes. And I wish I could get that left leg stronger and that it would feel like a normal leg again.

It’s funny what we worry about it. Last time around, my biggest fear was cutting out and throwing away my body parts. This time, that doesn’t bother me at all. My biggest fear this time is nerve damage—something not even on my radar last time. Chances are, everything will turn out fine. But I think it is only natural that I have concerns and am going in with my eyes wide open. I’m struggling to find any optimism or hope that things will be so much better once I get through surgery and recovery. I kind of just expect them to be marginally better and will be grateful if nothing is worse. Not quite the euphoric expectation I’d like to have, but maybe my low expectations will lead to pleasant surprises in the end. Let’s hope!
 

Jaycey

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@EditorER your history sounds very familiar. I was born with dysplasia and it was not diagnosed until my left hip collapsed. I too have lower spine issues and had decompression due to severe sciatic pain.

First - do keep up with the Pilates. Core stability is key to addressing lumbar spine issues.

Your concerns about surgery are shared by many. I think you will find that once that second hip is replaced your body will adjust to the new way you carry yourself. Since you have had many years of weak legs - yes it will take awhile to regain your strength. But it will happen.

My spinal issues are chronic. My strategy is to keep moving. I also use a TENs machine if the sciatic pain increases.

I guess the most important thing is do you trust your surgeon? Don't forget that for your surgeon this is their day job. They do these procedures every day, several times per day. Discuss your concerns with your surgeon and the team who will care for you. They will do everything they can to keep you comfortable.
 

Schaargi

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@EditorER I also have nerve damage. I am 5 months out. I started with trying to get my knee to respond to my brain signal. When it finally twitched in the doctor's office, everyone cheered. When I finally got to the point that I could lift my leg off the bed, I injured my hip flexor doing so (I overdid it in my excitement). I can now almost straighten my knee sitting in a chair and can walk 30 minutes due to a spectacular physical therapist. Tomorrow is my last day of physical therapy; they are releasing me because they really can't do more. I'm on my own for home exercises and strengthing my leg, which does feel like it has concrete in it. I have had small weekly improvements and hope that they will continue and that I will be able to notice them enough to be motivated and keep working.

There are very few of us with extensive nerve damage. We are the only two on this forum currently that I know of. There is a handful of people from previous years. I understand your concern. It's terrifying but very rare.The chances of that happening your second surgery are astronomical. I believe that when I have my other hip done (it's inevitable), there is no way that could happen twice.

So I am rooting for you and want you to let that complication go and not worry about it!

Many of my PT exercises focus on my surgical leg-- quad stengtheners and a lot of balance exercises. I think your other leg will step up, so to speak, and become stronger as a result of having to take the weight. That could become a way for your concrete leg to wake up and take the heat for the team!

I can't speak to the spinal issues, but I hope I have helped relieve some of your nerve damage fears. You are not alone, and this forum is a great place to be.

Your Pilates work has surely helped your body prepare for this surgery. I hope to be able to do Pilates soon. It is a fantastic form of exercise that does so much for your body.

Keep us updated!
 
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EditorER

EditorER

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Thank you for the encouragement, especially about the nerve-damaged leg stepping up when it is needed. And the letting go of the fear of more nerve damage.

I’m off ibuprofen and onTylenol now that surgery is just a few days away. Tylenol does very little for me. I’m realizing that I have more underlying pain than I thought. It will be good to get that hip fixed and be more balanced internally.
 

Parsley Sage

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Good luck with your surgery @EditorER . Unfortunately mine for the same day was cancelled by the hospital due to Covid concerns. I will be thinking of you!
 
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EditorER

EditorER

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Oh, @Parsley Sage, I am so sorry to hear that! If you don’t mind my asking, where do you live? To be in pain, to have prepared, and now to have to wait is really awful.

Cases are on the rise where I live, but hospitalizations are low. I got my COVID test yesterday (negative) and am now isolating at home until surgery. I sure hope surgeries are not canceled here.

I am thinking of everyone who has surgery coming up yet in November and hoping your procedures are not canceled, go well, and that you can enjoy counting your blessings on Thanksgiving Day with a few loved ones in your household.
 

Celle

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Tylenol does very little for me. I’m realizing that I have more underlying pain than I thought.
Tylenol seems to do very little for pre-op pain but, surprisingly, it is often a very effective pain killer after surgery.
 

leejaa

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Best wishes for your upcoming surgery and a smooth pain controlled recovery. I hope we see you on the shiny (recovery) side when you are up to posting. Have a peaceful week end.
 

Parsley Sage

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@EditorER I am in Ohio. The only hospital that stopped elective surgeries in Ohio is mine--Cleveland Clinic. Very frustrating but I keep remembering that I'm not one of the poor folks in an ICU bed because of Covid.
 
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EditorER

EditorER

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@EditorER I am in Ohio. The only hospital that stopped elective surgeries in Ohio is mine--Cleveland Clinic. Very frustrating but I keep remembering that I'm not one of the poor folks in an ICU bed because of Covid.
I hope you are able to get surgery rescheduled soon and that you are not in too much pain while you wait.
 
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EditorER

EditorER

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I am curious about the sleeping position restrictions after the minimally invasive posterior approach. My first hip replacement I had the lateral approach and I absolutely could not sleep on my back. I hated waiting at least three weeks before I was allowed to try sleeping on the non-operated side. I’m hoping that with the posterior approach, side sleeping would be allowed, if not encouraged. I have not been able to find this answer anywhere. What has been the experience for other hip replacement patients?
 

Jaycey

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I had mini-posterior for my LTHR and was required to back sleep. Every OS is different on this. Best to clarify with your surgeon on the day.

All the best tomorrow!
 

Layla

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Hi there :hi:
Stopping by to wish you all the best tomorrow and comfort as you wait.
Will look forward to following your journey on the healing side once you’re resting comfortably at home. See you on the bright side soon! :)
@EditorER
 

Mojo333

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Thinking of you and sending healing hugs in advance @EditorER
Look forward to seeing you on the Healing Side.:friends:
 

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