THR At 6 months & improving with great PT

[DEL2020Jul-11]

My right hip was replaced with a posterior approach. I had several years of OA pain before I decided to have surgery. My thanks to all of you, who have helped me through this difficult time. I also would like to wish the best for Josephine and to say that her wisdom is extremely appreciated!

Here is where I am now:
1) My worry that something will go wrong with my implant is less with time. These include worries about dislocation, infection, loosening of stem and cup, etc. From my personal experience, and from reading many of your stories, it seems I have a lot of company in the worry department.

1A) I believe that there is no guarantee of success with any surgery, no matter how well you prepare. For those who excitedly report that there is nothing to fear, I disagree. I only hope everyone recovers and I appreciate my improvement over time.

2) Posterior approach was the best option for me, as that is what my surgeon did. For me, again just my personal opinion, I would never choose a surgeon who does the anterior approach. There is a small chance of cutting the femoral nerve, which controls the motor function of one's leg.

3) While I am happy for those who have less pain after surgery, I had different pain, often worse pain for many months following surgery and poor sleep (I finally learned to position a pillow under my thighs, so I could adapt to sleeping on my back).

4) Physical therapy saved me. My tissues were extremely 'upset' by being cut and stretched and did not settle down. My close friend had her hip replaced 3 weeks before me, also posterior. I realized I was having trouble recovering when I asked her what she did about the stiffness on the side of the hip, which I had constantly, all the time, and she replied, "What stiffness?"

5) I have been in outpatient Physical Therapy for 4 months (wearing a mask, as does my PT). Now, my stiffness is resolving, my gluteal strength is almost back to normal, my gait is fluid, and my range of motion is good except for external rotation, but it is getting there. My PT has specialized training in manual approaches, and has also done PNF, which is a technique of proprioceptive input, stimulating the nervous system, which gave me back my trunk rotation and activated my gluteal muscles.

6) Without help from PT, no matter how much I tried to do heel to toe walking, I did not improve my gait because I felt no connection between my gluteal muscles and my heel strike. A total disconnect until several months of therapy.

7) Feed back to my PT was essential, as for the first two months I could not do the kind and number of exercises that he prescribed, due to pain, weakness, and fear. We worked it out, I did less than he wanted, while he did a great deal of hands on work (called soft tissue mobilization) on my tight, restricted, sore, painful tissues.

8) By 5 months plus, I can do all the exercises and feel my body being restored. It includes lots of bridges, but I tweak the position by providing support for my upper body with pillows (to take strain off my lower back).

9) My post-operative course has been difficult, at times truly awful. But, my pre-operative state was also awful. I am grateful for the chance to have my life back, which for me is to move. While warned by your wonderful forum not to overdo, once I could walk more than a mile, I was eager to go 2 or 3 miles. I gave myself a whole bunch of tendinitis, in multiple places, in both legs (when I am tired, my opposite leg starts to do more of the work). Again, thank goodness for my gifted PT, who rolled his eyes when I asked if he thought i had given myself tendinitis by walking too far, too often. My PT and I got my inflamed tendons under control. While I have to space out my longer walks, I can go 4 or 5 miles, on some reasonable trails a few times a week and for me, this is everything....

 

[Mojo333]

Glad things are improving and you'll be glad to know there are most certainly more improvements to come as long as you can stay patient and stay out of the ODIC (Overdid It Club) This can be a tricky dance...finding the line between enough and too much...was for me.

My confidence in a great outcome also grew as time went on.

My only preparation for my surgery was realizing endstage OA was limiting my life, causing me horrid pain, and absolutely no way to get any sleep as I could not get comfortable at all.
Sleeping on my back was not fun either during recovery...I had a bilateral surgery and it was over 6 months before I had consecutive all night sleeps.

Picking a good surgeon and letting him do what he thinks is best and using the technique he is trained well to do is essential.
My OS was expertly trained in anterior, and I have been super pleased.
Complications are possible with any approach.

I dropped an aggressive PT early in my recovery, but found a great one at about 5 months out who helped me with ongoing gait issues and some SI joint pain. Glad you found one who is able to help you too.

We are also recovering from the years of bad alignment, gait, etc. along with the surgical trauma. This is usually a time thing.
Keep the faith as slow and steady is the best way to get through this recovery.

 

[DEL2020Jul-11]

Thank you, dear Mojo, for your great response and for your consistent message that healing takes patience and improvement continues over time. Thank you, Layla, for liking my post

Yes, I am keeping the faith. Prayer and faith are central to my well being. After a very rocky start (my surgery was done out of state, and the flight home 4 days later was brutal) and many months of constant stiffness with a poor gait (as I poured over all the threads, I only saw intermittent stiffness, not described as being there all the time), I am now gaining back some confidence.

Mojo, It is so good to know that you found help at 5 months with a good PT!

For those considering PT: It is hard to know if one should have outpatient PT, who to select/what kind of PT, and when to have treatment. I will just mention that my OS did not suggest PT, but if her patients need PT, she does not want them to start until several months after surgery, perhaps to let the bone grow into the implant without concern of disturbance from anything too strenuous.

Surgical approach: I agree there are complications possible with every approach.

Kind of a funny story (well now, not at the time). Before my posterior surgery, I had a phone call with a friend of a friend, a person who had two successful anterior hip replacements. She started the conversation with the wrong assumption that my surgery would be anterior. She said that it was great I was not having that awful, muscle damaging posterior approach. Well, I had to tell her that my approach was going to be posterior and it was a rather short conversation.

Looking for an OS: It can be challenging. My suggestion is to please consider asking specifically about possible serious surgical complications, the hospital's infection rate, the surgeon's infection and complication rate, and number of surgeries done per year. If OS does not willingly disclose that information, I would move on.

Over Doing: At four months after my surgery, I started to take walks and did ramp up the mileage too quickly. I was surprised by the amount of tendonitis I gave myself by walking a couple of miles a day. At first, I was scared that I had disturbed my implant, but in reality I had strained a lot of soft tissue by doing more than my hip could manage.

My PT explained that since my hip stabilizers (especially gluteus medius) were weak and slow to regain strength, my hip muscles were not strong enough to do what I was asking. The rest of my leg muscles, sometimes on both legs, tried to compensate, but were strained in the effort.

A tip for those who have given themselves tendonitis. In addition to being helped by my PT's manual work on my sore legs (and reducing my activity, while continuing to strengthen my hip muscles), I switched from my walking shoes and started wearing my light weight hiking boots. I had not thought of wearing hiking boots for a one or two mile walk in my neighborhood. In just a week, the extra support from the boots helped my tendons to significantly calm down!

Personal note: Like many, I do not know what I would have done without all the information, guidance, personal stories, and support that i found by reading BoneSmart. That is why I decided to post, in case any of my experiences could help someone else go through this process of major surgery and recovery.

 

[Layla]

We thank you for sharing an update on your recovery, the good and the not so good. Your kind words in regard to the forum are appreciated. We’re happy you found support through reading other members recovery journeys. I’m sure the realistic account you provided above will benefit some in the future. Thankfully after a few set-backs you’re doing well now. May it long continue.
Wishing you a lovely Summer 2020!

 

[DEL2020Jul-11]

Thank you, Layla! You are very warm and caring in your comments. I thank you and @Mojo333 for your good wishes and good advice!

If you can, please change my TITLE to:
At 6 months & improving with great PT

I am so grateful to BoneSmart and respect all of you and your experiences and views. I recognize that some people do not need PT. Then there are people like me, who have a difficult post-surgical course, because my soft tissues reacted strongly to the surgical trauma and became constantly stiff, painful and restricted. So, it was not only set backs that I have faced, it was unending stiffness (which is pain, I learned that from Josephine!). I also had a large LLD, which my PT thought was permanent. I am delighted to say that my LLD has diminished significantly, from the work I am doing and my PT was pleasantly surprised.

And, it was not just any PT who has really saved me. I switched from a PT group were they barely touched my aching, stiff leg, to my PT of the last 4 months. This professional has a special certification in manual therapy (this is additional training for an already licensed PT, referred to as CFMT, certified functional manual therapists.

I have been an athlete most of my life and a past sports accident probably resulted in my right hip becoming damaged. It is one of my greatest joys that I have regained my mobility and I am on the road back to hiking and am enjoying a real gait during my daily walks of several miles. As Mojo said to me, I am working on finding the right balance so that I enjoy with out re-activating the tendonitis that developed when I began to take my walks.

Meanwhile, my regular outpatient PT sessions are essential for me to reach my goals of reducing my pain/stiffness, re-building my hip and body strength and re-gaining as much range of motion as I can.

 

[Pumpkin]

I have changed your title to At 6 months & improving with great PT.
Happy to hear that you have found a PT with the education and training that has benefited you, and allowed you to return to your active life.

 

[DEL2020Jul-11]

Thank you, @pumpkin, for changing my title and for being happy for me!

PHYSICAL THERAPY CLARIFICATION: I have read several threads where PT (including within just days or weeks of surgery) involves squatting, movements/exercises with weights around ankles, bands around legs, marching with high knees, and standing on the operative leg, while abducting the other leg. I hurt just thinking about doing this, especially early on.

This is not what I am doing!

As my PT worked manually over many sessions to help my soft tissues recover from the surgical trauma, I have worked on doing exercises to strengthen my hip muscles (especially gluteus medius), improve my range of motion, and re-establish my stability on different surfaces (I was surprised how much proprioceptive awareness I had lost in just a few months). As I heal, I am able to do more repetitions correctly, and what was impossible a few months ago, is now possible and I feel stronger and more limber after doing a set. Yes, when I could only do three bridges, I could not imagine that months later, I would be doing 30 bridges and feeling better for it! What a process and learning experience...

FINALLY, I can stand on just my operative leg, without pain and without weakness.

PROGRESS: I do not take healing for granted and it has been hard for me to deal with the unknowns involved in recovering from a major surgery. The LLD I had was significant and my body felt so stressed and unbalanced. I was given opposing advice about using a shoe lift (OS said no and PT said yes). I made my own shoe lift, not very thick so that I was compromising, but it was just enough to help me feel less unstable. My reliable PT did not think it would resolve and was pleased when he was wrong and measured to see only a minimal difference. Oh, I no longer need my home made shoe lift.

GRATEFULLY, I realize that today's long, brisk walk may leave me a little sore, but that last month, when I tried that same walk, my body could not figure out how to move effectively and for my efforts, I was left with bouts of painful tendonitis!

REQUEST: For those who are reading this and are further along in recovery, if you feel inclined and think it will be helpful, please share your insights about recovery. Thank you fellow hippies

 

[CricketHip]

I have enjoyed reading your updates on how your recovery is going. Thank you for taking the time to include such specific details. I hope many new members can find your thread and have some reassurance.
I specifically liked your input with your PT therapy, especially the comparison between the two that you used.
I also had Anterior with both of my hips and I think the key is finding a very experienced surgeon who has completed many many successful anterior surgeries.

So! You are well into enjoying your summer.. so happy with your progress. Please update again as you continue into your first year?

 

[DEL2020Jul-11]

Thank you so much, @CricketHip! I replied to your wonderful comments with a post on your most recent thread.

For anyone who is interested in how my PT is going, today was a big day for me. After four and half months of hard work in PT, I have regained my hip extension! For months, when my PT would see how far back my hip could go, I was stuck at 0 degrees and to get in that limited position hurt. Today, I went to 4 or 5 degrees without discomfort!

How this translates to the quality of my life is that when I walk, my hip extension allows me to naturally push off my right leg for a fuller gait (also very helpful for getting up hills). For many months, I could not walk in a heel to toe fashion because my gluts were inactive and my hip extension was restricted. So, this is really a victory for me!

So, I continue to work towards my goal of regaining my external rotation. I still struggle with putting on my shoes/socks, but it is better than last month. My PT says this is a tough one, and we will persist...

 

[CricketHip]

Good morning! I found your post on my thread and thank you for your kind words!
None of us really know what our recovery will be like until we get into our own personal recovery, even then no two hips will have the same experience, but you are seeing some great results. You must be thrilled with your most recent accomplishment with regaining your hip extension.
It sounds like you had some significant struggles before your surgery and like you said, it plays a big role in the bouncing back portion afterwards.. some of us bounce easier, some of us don't.
You asked about the next 6 months--
I found that the second part of my recovery year continued to have surprises, some times not good ones due to possibly overdoing things, or even doing some crazy slip on a slippery surface.
My biggest memories of my second half of a recovery year were realizing that things had improved and I didn't actually think about it. It just was and then I would be walking and grinning from ear to ear.

Everything continues to get easier, and as mentioned many times before-- I'm sorry but I will repeat it again, patience is required

So happy that you are beginning to see that your efforts are generating some great rewards!

 

[DEL2020Jul-11]

Dear @CricketHip,
Your reply was just what I needed to hear! I love the image of you walking, without thinking about your hips, and grinning from ear to ear!

Yes, I am learning to be more patient with myself and the process of recovery. One of my obstacles for many months was my substantial fear of something happening to interfere with my recovery, which was reinforced by my not bouncing back well from surgery. It seemed to me that my slow painful recovery, reinforced the fear I experienced. It was a long time before I set down my forearm crutches and started to trust my leg again.

My OS is very conservative when it comes to posterior restrictions (it was 3 months for me), very concerned with over activity causing problems with the implant, and yet did not seem to understand that the source of my constant stiffness/pain was how my body's soft tissues reacted to the physical trauma of surgery (I was told that most of my pain should resolve by a month, at the most 2 months, in reality it was closer to 5 plus months). In addition to my OS's position, I read about the need to avoid micro motion of the implant, especially as it settles and the bone grows into it, and I literally took this to heart, avoiding any activity/movement/exercise that I thought was too stressful.

For me, the right PT became as important as choosing the right OS. I have confidence in his moving my hip joint, as I know he knows what he is doing and knows how to help me regain my range of motion and strength.

I give my physical therapist credit for adjusting to my slow pace. I would say, at times, I have totally frustrated him, giving loads of feedback on what I am not ready to do yet (both in sessions, in my exercises, and in my daily activities). He would say what was holding me back was my fear and I would say, yes, and that is the way it is right now, but there was also a compromise on my part, by doing some of his requests in a limited fashion for months and then gradually becoming healthy enough to do more and more.

Fast forward to about three weeks ago, and there was a big leap in healing of my tissues. I am surprised by my recent progress, physically and mentally. I remember the fear, and I am careful (no overly steep uneven terrain for me), but I am comfortable doing some of the hills and hikes I did before my natural hip worsened. I have done a lot of work, slowly and gradually, and am now stronger.

Again, thank you for your support, advice, and your correct 'take' on my situation.

 

[Layla]

To varying degrees, I think we all fear something going wrong with our recovery. Especially if it’s our first joint replacement when its easy to feel apprehensive about everything.

I also experienced the posterior approach, but with zero restrictions. Recovery protocol also varies from surgeon to surgeon. I was cautioned to move slowly and if anything hurt, stop. I have read of others that have experienced posterior approach with no restrictions, but because so many did follow restrictions, I loosely imposed them on myself.
I figured it couldn’t hurt. I guess my point is, the great majority fare the same, with or without restrictions. This is certainly no reason to disregard your surgeons directive...only interesting to ponder.

I‘m sorry your recovery has been painful. It’s unfortunate you were given the one to two month timeline as a gauge for when pain should be gone. I’m sure once two months time passed and you were still dealing with pain, you were afraid you weren’t healing properly. It sounds like your PT is very patient and willing to take the time to help you regain confidence in your recovery.

It is wonderful to hear you’re pleased with your progress both physically and mentally. Recovery can take a full year and even longer for many, noticing improvements all along the way. It sounds like you’re doing really well now and I‘m quite sure it will only get better and better. Please continue to update, we‘d love to follow your progress.

A wonderful weekend to you!

 

[zauberflöte]

I have to chime in on the "pain gone by 2 months" issue. Such was not my experience At All. First hip, I gave myself tendonitis at about 9 weeks, and spent a couple of years working around that. Seven years later, it's still there, but only as a nuisance. My first recovery had a long series of "I can't believe it's even better now" moments that went on for over two years. Second hip's timeline of improvement was maybe about 16-18 months. But I can still teach them both new tricks, which may count as improvements?

Your deliberate recovery method will serve you well. I understand your fears-- I was a hypochondriac with my first hip, drawing pictures of this and that pain, wondering what was normal, what was bad... for the second hip I guess I was experienced enough to remember that the first one had done this too but was safe and strong at four years old, so I'd tell myself, don't worry, just grab another ice pack!

So at 7 and 3, both hips have survived major falls in their first years, including landing smack dab on them with some force and/or stepping into potholes stiff-legged, with the jar to the joint that comes with the scenario. All followup xrays have been fine. My OS discharges you at 7 or 8 months with no need to return if both he and the patient are happy. If OS is happy, so am I!

 

[DEL2020Jul-11]

Hello @Layla,
I very much enjoyed and appreciated your thoughtful response, and thank you for sharing your personal experience and validating some of my fears and frustrations following my December hip replacement.

These two statements were especially healing:

I’m sure once two months time passed and you were still dealing with pain, you were afraid you weren’t healing properly.

To varying degrees, I think we all fear something going wrong with our recovery.

But, no one is 100% correct all of the time! You gave me a little laugh when you described my PT as "patient." Actually, he likes to be in charge and expects his patients to follow his orders! Because of his talent, experience, and outstanding training in manual treatments, I persisted in communicating to him about my inability to do all he expected. Over time, we improved our therapeutic relationship by both of us compromising, and as you know, I am relieved, excited, and delighted with my progress.

I wish to thank you, for your empathic responses, each one of you are gems! Also, my thanks to all who have 'liked' my posts, which is a new experience for me, as this is my first time posting on a forum.

Over the past six months, I had considered starting my own thread. Finally, I felt ready to share, in part to return the favor of learning from others (as I read many many threads to educate myself), but also in my attempt to resolve some of my feelings about having a major orthopedic surgery (my only surgery), followed by a harder than expected post surgical course (my OS told me that she did not expect me to have any trouble with my recovery...).

Good health and happiness to all of you, gratitude for your good deeds, and you are all in my thoughts and prayers for well being.

 

[Layla]

I was a hypochondriac with my first hip, drawing pictures of this and that pain,

This cracks me up
I think we’re all temporarily insane while in recovery, lol.

 

[Layla]

This is the best recovery drawing -

 

[DEL2020Jul-11]

I was a hypochondriac with my first hip, drawing pictures of this and that pain,

This cracks me up
I think we’re all temporarily insane while in recovery, lol.

YES!!! @Layla and @zauberflöte, this is so true - couldn't be said any better