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THR Boxmaker's RTHR

Check with your surgeon's office and see if they have recommendations of a physical therapy company closer to your area. Seems there are quite a few companies that have multiple locations, at least where I am there are. Or ask them to give you a list of specific questions you might ask so you know if you're on the right path.
 
Hi @Boxmaker1917
We have had a lot of members who have had SuperPath approach, and it appears (as with all other approaches) there are a myriad of OS suggested recovery protocols for PT.

Even with SuperPath, soft tissue is certainly disturbed and at not quite a month out will certainly be sore.
Your parade of Therapists these early weeks (especially using weights this early) have likely just kept the soft tissue angered.:sigh:
In my opinion, your could use a break from all but walking and gentle stretches.

Soft tissue massage including strumming (perpendicular massage technique) might be helpful after things settle.

Though massage can be beneficial, the stage of tissue healing must be taken into account. Acute injuries (even injuries sustained during hip replacement) or inflammation (which I certainly still experienced at one month) should probably not receive STM.

It was hard for me to just walk and heal...as I was anxious about the travelling aches and niggles....
but with time and patience.... things continued to improve.

Soon. I will celebrate 5 years post op bilateral hip replacement and am still hip happy and painfree.:chuckmarch:
Stay patient, dear Boxmaker.... you will get there.
 
Hi, Mojo and thank you for your response. I researched as many post-op suggestions as I could find for SuperPath surgery. I have not encountered any that differ from those suggested by my OS. The only variance seems to be when to start them. I have ditched the weights and comfortably can walk a mile. (I don't want to push it too much further than that.) I can't balance very well but am comfortable in a yoga "tree pose," so I think I am ready for additional stretching. My issue will be finding and vetting PT's who are willing to go against what may be their training and follow my doctor's protocols. I am open to any suggestions on that front other than just to start calling and asking.
 
Hi, everyone! Just checking in.... My surgeon's office (on the other side of the state) send orders and a protocol to a local PT. I saw her for the first time yesterday and was quite pleased. This PT was not familiar with the SuperPath approach, but did research to learn more. She also had a few questions about the doctor's protocol and asked whether it would be ok for her to call him for clarification which I also liked.

In the meantime, she changed some of the exercises, added a couple and showed me how to "strum" my adductors! The new exercises seem very easy when doing them, but I feel some discomfort in my hip a couple of hours later. This tells me that the new exercises are doing something for muscles and soft tissue areas that were not addressed previously.

I currently walk a mile on flat ground every day. My PT advised against increasing the distance until my leg lengths even out. Her concern was that I inadvertently cause new problems with my non-operated hip. I thought that sounded like good advice.

I am delighted to read about the successful recovery of others who had surgeries around the same time as mine. It sounds like everyone is doing well. Yaaaaaaay!
 
Happy to hear you were able to find a PT that would work with your surgeon's protocol. Hopefully you're icing when you're feeling that discomfort after the exercises.
 
Indeed I am icing -- and using ice packs made from water an alcohol according to the directions found on BoneSmart!
 
I am nearing 4 months after a THR done via the SuperPath approach. I've been booted from PT for being well beyond what they could justify for Medicare & insurance to cover. I am in no pain and my gait is almost normal.

I currently walk two miles a day and then do an hour and 15 minutes of PT exercises almost every day. I attribute much of my range of motion and strength to the PT. BUT.... The one area that still is of concern my operated leg continuing to feel longer than my unoperated leg. My surgeon and PT agree it's caused by a tilted hip rather than an actual difference in leg length. They all thought this issue would be resolved by now, especially since no muscles or tendons were cut during my procedure.

I've noticed that sometimes, my exercises cause muscle pain. I've noticed that when I experience muscle pain, the "difference" in the length of my legs seems more pronounced. Hence, my question of whether too much PT is impeding this aspect of my recovery. I certainly could alternate the days on which I do certain exercises so that I am doing them all -- just less often. Of course, I skip the exercises that I know are causing pain.

I know that leg length often resolves itself with time. I assume that has to do with strengthening and stretching the affected muscles and soft tissues. This is the only area where I seem to be "slower" in recovering than both the surgeon and PT think I should be. I am a little concerned by that although I know it often takes long than four months.

I am a full-time lurker on this site but I haven't seen any suggested link between leg length & PT; or leg length & muscle pain. I would appreciate learning of others' experience here, as well as your opinions and advice. Thank you in advance!
 
Hello Boxmaker,
It seems you’re making some decent progress with your recovery! Thanks for sharing an update.

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting.
Please post any updates, questions or concerns about your recovery here.

Regarding the Leg Length Differential,
We normally advise giving it 3-4 months as it can take that amount of time for things to balance. If at that point, you are still concerned we suggest you visit a reputable podiatrist or PT for a measurement.
Here's an article from our Library in case you haven't read it.
Leg length differential - LLD.
Boxmaker1917 said:
I've noticed that when I experience muscle pain, the "difference" in the length of my legs seems more pronounced. Hence, my question of whether too much PT is impeding this aspect of my recovery.
Click to expand...
While many do well with PT, in most instances it’s not really needed for THR recovery. You many want to skip all of the PT exercises for a time and just try walking for exercise and see if you notice a difference in the pain you’ve described. Hopefully it will help. :fingersx:
Stay in touch and let us know how you’re doing. I hope you have a good week. :) :-) (:
 
Layla, thank you for your response. I have read the BoneSmart library article on leg length differential (more than once!) which is very helpful. In addition, I have found my PT exercises quite beneficial and the reason why my strength and ROM are as good as they are.

My surgeon found more damage to my hip than he expected. He also decided to use a "ball" that was one size up from that he ordinarily might have selected to ensure against dislocation. (I do several different activities at the gym.) I suspect my muscles and tendons were stretched a little more than I expected.

My question was not about pain caused by PT and I am sorry that I did not state it as clearly. I would not eliminate PT exercises although I've cut those for which I may not yet be ready. I was curious whether others have experienced a correlation between perceived leg length and overdoing something. The latter might be walking, riding a bike, resuming physical activities (yoga, pilates, light weights), etc. Did "pushing" it seem to have a negative effect on this particular area (perhaps causing temp inflammation)?

As usual, Layla, you are a wonderful resource and always generous with your time and advice. Again, thank you.
 
@Boxmaker1917 Maybe it would help if your therapist could video your gait on both a crooked day and a straighter day and compare the way you carry your shoulders and trunk. In my experience with apparent rather than true LLD, and a rotated pelvis, the muscles on the high hip side were tighter, pulling my pelvis up, while the opposite was weaker and looser. When I was physically tired I went into default droopy mode. I had no idea about any of that and didn't realize how crooked I was. My PT gave me exercises to even things out, and even gave me sessions on a traction table. The exercises stretched muscles on the high side and strengthened the ones on the other side, as well as lots of general core work.
You didn't mention having anything done like standing xrays to determine that your bones are truly cose in length, including your femoral necks. That might be something to consider, as well as asking your therapist to assess you for scoliosis which might hike your pelvis on one side.
The whole hip-pelvis- LLD thing is so chicken or egg, it can be hard to sort through. Good luck with getting everything evened out.
 
Subie, thank you for your response. My pelvis dipped toward my operated leg side even though my leg is longer on that side. Most of my PT exercises were aimed at correcting that. I no longer feel the difference in leg lengths when I walk although my PT team still see it. He thinks my legs are different lengths and that is the issue. However, he measured my legs externally from the ankles, which is not the most accurate.

My surgeon checked my leg lengths and believes they are equal. He thought the pelvic dip would resolve itself between months three and four (after surgery on Dec 13, 2021). Not yet. Hence my questions about whether all of the exercises that I've faithfully done to correct the hip tilt (and which PT thinks I have) were done too diligently. BTW, I've also done a week of just walking three miles a day and that did not help with either the hip dip or my gait -- or my leg length questions!

So, just checking the BoneSmart knowledge bank for suggestions and what others have experienced.

Thank you again for taking the time to respond.
 
Thank you for your kind words. I’m sorry I misunderstood you.
I hope you have a lovely Spring / Summer 2022 as you continue to gain strength and grow steadier on your feet.
Hugs :friends:
@Boxmaker1917
 
Hi, everyone! I now am 4.5 months post-op and close to where I thought I should be. I have continued with most of my "maintenance" PT exercises which I was advised to continue through mid-May. Since I was experiencing hip pain in BOTH hips, I knew I was doing two much. The only change I could identify since "completing" PT (i.e., getting booted from PT since I would no longer be covered by Medicare) was having increased my pre-exercise walk from two miles to three miles.

I cut back to two miles and a week later, no pain in either hip. I also have started to add a couple of hip stretches of my own (which I did previously in yoga) and I believe have increased my ROM and strength, as well as flexibility. The one area that still needs a LOT of work is my balance. It is decent on a stable surface but not so good on a foam pillow (recommended by PT).

I also measured my leg differential which I know was caused by a tilted pelvis. I did this by standing on stacked magazines until I felt weight and length were equal between both legs. Not especially scientific but.... That is now approx 1/4" and I think probably will improve over the next few weeks.

So, I am making good progress but I am astonished that walking less seems to be the primary contributor. I mean, what's the one thing every doctor and PT wants you to do within hours of surgery? Walk! What is the one exercise they want you to do if you can't do anything else? Walk! Yet for me, maybe not...?

Again, I am astounded and welcome your reflections, explanations, suggestions and advice! As usual, my thanks to this wonderful group!
 
Congratulations on your continuing good progress.

Your experience that walking 2 miles is fine, 3 miles not, fits with the Bonesmart guidelines for hip recovery …
Jockette said:
… the best therapy which is walking and even then not to excess.
Click to expand...
Of course, the tricky part is knowing what is “excess”. I guess it varies with person and stage of recovery. It seems that you have successfully identified the distance that suits your hip for now.
 
@Boxmaker1917 Your update sounds very promising. You are thinking things through and making adjustments, which is a very smart approach. Good for you!

I like your description of checking on your LLD, and if accurate, you are making progress!

This recovery thing is a real process, isn't it?
 
CricketHip, as much research as I did prior to surgery, I sure had -- and have -- a lot to learn! Unfortunately, I probably have a "rinse and repeat" coming up for the other hip in a year or two. I know each recovery is different, but I hope I remember enough of what I've learned on this round!
 
Oh, you will remember and then the best part is that you will have your recovery thread here to re-read to help remind you of things you forgot.
Many of us referred to the first hip's thread and it's very helpful.
 
Hi, everyone! I haven't posted in quite some time and I want to take this opportunity to thank you for your wisdom and suggestions along the way.

I saw my orthopedist last week and was officially released from care. I will see him annually to monitor my new hip and to watch for any issues with my unoperated hip. I told him I was a little disappointed in the length of my recovery and that I had not attained the "milestones" I expected after SuperPath surgery. He had an interesting response:

First, he said that my legs had about a 1 mm difference in length -- that's all. He felt the problem was that I waited far too long for surgery and there was much more damage than he anticipated. It simply was going to take a little longer to recover because I had more to recover from. What he suggested was to go back to the gym with NO restrictions on anything, including yoga moves to which he previously took a wait and see attitude. My doctor believes my whole body needs readjustment from having compensated for a bad hip for so long. I have only been at the gym a few times and need a lot of muscle strengthening. However, the .25" discrepency in leg lengths is not quite gone but already significantly less, as is some residual pain in my hip.

I also asked about my other hip. Orthopedist #1 said both hips needed immediate surgery. Orthopedist #2 told me to wait as long as I could for surgery and to put it off for at least 6-8 months. He thought I would need my other hip done in a few years.

My surgeon went over my latest xray with me in great detail and said he saw NO evidence that I need surgery on my left hip and probably never would. However, he would monitor my "good" hip during my annual visits in case there was a change and could advise me whether to wait or not.

In short, a very welcome visit to see my surgeon and well worth the 3.5 hour drive to get there. (There are only six surgeons in my state who do SuperPath surgeries and I feel he is the most qualified.)
 
@Boxmaker1917 that sounds like an awesome visit with your surgeon and agree the drive was well worth it. Sounds like he gave you some great advice about your recovery. We always say every recovery is unique to that individual and you also need to take into consideration what damage had been done prior to the surgery.

Great news about it not looking like you'll need to have the left hip replaced anytime in the near future. And I really like the comment about your entire body needing to readjust from old habits. I think you have a keeper in this surgeon! :cheers:
 
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