THR Clipper's Recovery

[Clipper]

Anterior LTHR 1st thing Mon (around 8 am), 4-APR-16. Open up to sew shut time was 55 min. Woke from GA around 10:30 or 11:00. Not much pain that I remember. I was in my recovery room around 12:30. PT came around 1:30, got me up and helped me walk to a chair where I stayed until midnight. While sitting I dozed off 3 times for 2 hrs each time. For leg cramps while sitting they gave me morphine. Was then helped into bed and I slept until 6:30 am. There were several IV fluids going in all the while.

PT came again after breakfast and I walked with my walker to the gym. Several exercises later I walked accompanied by the therapist around the loop a couple times. The PT was impressed I walked 500 steps. After resting I walked some more unassisted for a total of 1400 steps, or about 0.4 miles. The pain medicine and excitement that I could take long smooth steps led to excessive exuberance. Wed morning my left thigh was swollen up the size of a watermelon. I think someone should have stepped in and slowed me down. I've been icing ever since and it seems to be working.

I was very impressed with the facility which is very new. The 2nd floor is dedicated to OR surgery, and the fifth floor to recovery. What worries me is the contradicting advice from the different experts we talked to. When and for how long to wear these TED stockings is an example. the experts said on in the day/off at night; on at night/off in the day; and don't take them off. Unless someone convinces me otherwise I'll leave them on until my follow up visit at 2 weeks.

Another example is the dressing for the surgical wound. The Ortho Surgeon was adamant that the dressing be changed at discharge, and not touched until Friday (96 hrs post-op). If the wound was dry on Friday, he specifically wanted the dressing removed and kept off (staples to be removed 14 days post-op). The health care nurse assigned to my case insisted she change the dressing today (48 hrs) and inspect the wound for drainage. The wound with staples was dry with no redness, but there were sores and blisters away from the wound (1" or more) that were oozing some liquid. It's apparent to me the dressing and antiseptic liquid it presses into the skin is causing the sores and blisters. She wants to change it again tomorrow. I have e-mailed and called the surgeons office explaining the situation but I get no response. I will let her remove and inspect the wound again tomorrow, and if the wound looks like it did today (to me), I will refuse to let her put a dressing back on. She will be very upset and accuse me of various things. She is of the opinion she knows better than the Dr. That's the plan unless someone here (or the Dr) convinces me to do otherwise. I never expected these kinds of problems.

Aside from the swelling and tightness, recovery seems to be going fine. A little pain in the thigh. I'm tapering off pain pills and walking without a cane or walker sometimes.

There are other less troubling conflicts. Blowing off this smoke is therapeutic! Thanks BS!

 

[Jamie]

Welcome to recovery and congratulations on your new hip! It does sound like you are doing very well so far even with all the contradictions in treatment. I know that must be very frustrating for you.

If it will ease your mind any, there is no one perfect way to do recovery. Each surgeon and medical professional has their own ideas and practices. But....your surgeon's desires should trump your home nurse. In fact, she should be working with the surgeon's office regarding your care or with your GP at a minimum. The nurse really is not the one creating the orders....she has general instructions from a doctor (or should have) and then she reacts within those guidelines. Just remember that you are in charge of your care and you have the right to request that she contact your doctor before proceeding.

The TED hose were designed for use by patients who spend most of their time in bed to lessen the chance of a blood clot in the legs. If you are active throughout the day (walking short distances, going to the bathroom, making small meals, etc.), you really shouldn't need them. Some doctors still prefer their patients wear them; others have done away with them. So, do what makes you feel most comfortable.

The wound is another matter. Here you do need to follow your surgeon's guidance. If it's draining, it should be dressed properly. Some people develop allergic reactions to the tape or other dressing materials used. This may be what is going on with you. It would help if you could post a photo.

In the meantime, here are some recovery articles for you to read:

First are the BoneSmart mantras ....

- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a therapist (PT) - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lie down!

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
Activity progression for THRs
Home physio (PT)
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?

 

[Hip Hip Hooray!]

Congratulations. You sound like you're doing really well. The swelling concerns me. I hope it's better now. I found that they wanted to push me in PT, too. There's plenty of time. I'm sorry to hear that there are conflicts going on about the dressing of your surgical site. That's stress that you don't need. Take care of yourself. Everything they teach on this site really works.

 

[YoungHippy]

Welcome to the recovery side my surgery was Monday as well.

 

[Cynthia777]

Welcome to recovery!
My OS required the TED stockings and these ridiculous pulse gadgets that clicked my shins every minute for two weeks, only to be removed while showering. He's pretty liberal, as I had no restrictions other than the stockings, one aspirin a day and no baths until the incision is fully healed. I had the liquid bandage (can't remember what it's called), but I developed a rash from it, so they won't be using it next time. I also had a reaction to the tape they used to hold the gauze on. My hubby went and purchased a latex free tape which helped solve the problem. My rash was kind of blistery at first and seemed to be spreading, so my PCP ordered a cream that had a combination of cortisone and some type of anti-fungal property in it. It took the rash right away.

 

[Josephine]

It's apparent to me the dressing and antiseptic liquid it presses into the skin is causing the sores and blisters.

That's entirely possible. I get a skin reaction, with blisters, to Steristrips so have to tell people not to use them.

That's the plan unless someone here (or the Dr) convinces me to do otherwise.

I would agree 100% with your plan. Many surgeons such as cardio-thoracic and general, tend not to use dressings at all, just alight spray of Opsite, a plastic wound cover. One surgeon I worked with would declare there was nothing better than "God's good clean air". Of course, it's debatable if you would get that in hospital these days but at home, it's probably safe as houses and the superficial skin is usually well healed within 48hrs anyway.

When and for how long to wear these TED stockings is an example. The experts said on in the day/off at night; on at night/off in the day; and don't take them off. Unless someone convinces me otherwise I'll leave them on until my follow up visit at 2 weeks.

I wouldn't wear them at all. There is enough documentary evidence out there to show they aren't worth the money paid for them! TEDs Negative Research: Lancet 27th May 2009

There are other less troubling conflicts.

Such as?

 

[Toddlermom]

Venting is perfect and very therapeutic! This is a great place to do it. My thread is filled with...'oh my!!!!' Or 'what in the world?' It is always good to have a team troubleshoot with you. Or even just validate that it is normal to worry about that. Welcome to recovery!!! Feel better-

 

[Clipper]

This is the surgical stapled wound 96 hrs post-op (today). The sores around the stapled wound were caused by the reaction of my skin with the bandage and antiseptics used. I don't think this is uncommon. These sores ooze clear fluid even thought the wound is dry. I suspect the surrounding sores oozing fluid wouldn't exist for me without the bandage. My surgeon wanted the bandage left off while the home health nurse sees fluid from the sores and insists on changing bandages daily. Today she wanted to change the bandage without cleaning with anything such as alcohol, but I insisted she do some cleaning before putting on the new bandage. She wiped the area with Is Alcohol. Can anyone see any logic to changing the bandage without first cleaning the wound and surrounding area? I don't get it.

I would appreciate someone recommending an antiseptic/antibiotic/other solution to spray or wipe on the wound and surrounding area when the bandage is changed? I haven't received a reply from the OS's office.

 

[Jamie]

You are better off using a saline solution to clean an open wound if you use anything at all. Your incision looks really good and it shouldn't need anything. But as long as the surrounding wounds from the tape are weeping, you should keep a bandage over the area. It is changed frequently when wounds are discharging and the purpose is to keep a clean, absorbent covering on them. Keeping things clean and dry makes healing take place faster, so no creams or liquids are needed as long as there is no sign of infection. It would be okay to wash the entire area gently with saline solution as long as you (or the nurse) dries it completely before reapplying the bandage.

 

[Josephine]

The sores around the stapled wound were caused by the reaction of my skin with the bandage and antiseptics used.

Actually, it's not the antiseptics at all. If it was, the blistering wouldn't be confined to these outlined areas which denote the edges of the wound dressing adhesive. It's actually, and sadly, not that uncommon and caused by the person putting it on applying traction - a stretch - to the dressing. A warning about this is in the leaflet enclosed in every box of dressings, but like most of the rest of the population, staff almost never read this literature! I would also point out that the rest of the wound looks perfectly normal and healthy.

I know about this blistering because I had similar thing from Steristrips which were incorrectly applied in exactly the same manner.

These sores ooze clear fluid even thought the wound is dry.

I suggest your nurse is right - leave it well alone and if she uses dressings, make sure she lays them gently on the leg and just pats them down, nothing more. But in actual fact, having no dressing at all will be the best. There is nothing better for such skin lesions than being exposed to God's good air! It gets the blisters dry much more quickly. Washing them with anything only keeps it moist.

 

[Krista]

That is so true! I had blood drawn recently and the phlebotomist stretched the bandage tightly over the cotton ball onto my skin, and when I took off the bandage I saw horrible sores like yours, @Clipper. I have never had that reaction before, and I don't recall ever having a bandage stretched like that either.

 

[Clipper]

Thanks @Josephine and all! The resources on this site are 2nd to none! We've been cleaning the wound with alcohol wipes followed by spray on saline solution (called 'saline wound wash'), wiping dry with gauze, then air drying before putting on a new bandage. The ooze is getting less and less and I will leave the bandage off completely when the ooze stops (hopefully in the next couple days). All hands are washed with chloro hexidine and sterile gloves are worn. Staples to be out Tues, Apr-19. The surgical wound measures 4".

Still some swelling but pain is minimal. I sleep 9-11 hrs/night (very sound sleep). I've been taking two 15 mg oxycodone's and two 500 mg tylenol's per day which seems to be plenty. Also asprin, alleve, etc twice a day. Walking feels good but I limit myself < 1/2 mile per day (1,500 to 2,500 ft and no more than 500 ft at a time). Starting to exercise more day by day. Yesterday I was able to get up on one of my tractors and mow around the house. To my surprise operating the clutch with my left leg and new left hip presented no issue at all (first OK'd by OS of course). I felt relieved to be able to accomplish this. I expected recovery to be a lot harder and much slower. I'm very pleased and grateful to all involved in my recovery to date (yes, this includes you lord!). I may now consider having my right hip done sooner than later as a result of this experience.

One point worth mentioning, in my discharge papers I noticed the Dr. had ordered a 90 day prescription of Celebrex. I was able to call the mail order pharmacy and get this prescription canceled. This prescription was never discussed with me and the side affect warnings seemed extreme. I'm now glad I did that.

 

[Josephine]

I will leave the bandage off completely when the ooze stops

It will dry more quickly if you leave the dressing off now.

Yesterday I was able to get up on one of my tractors and mow around the house.

You really shouldn't be doing things like that at only 9 days out. You are still in the early stages of healing and just because you can do these things doesn't mean you should! Activity progression for THRs

 

[Clipper]

I had all 22 staples removed today (4" incision, 15 days post-op) and they were replaced with stretch strips which should fall off in time. I left the bandage off of the wound for the past couple of days. X-rays and wound all look normal. Today is the 5th day in a row I've walked a little over a mile (without aid), no more than 1/4 mile at a time. I'll start outpatient phys therapy next Tues (Apr 26th).

My goals are to tie my own shoes, put on socks without a tool, clip my own toenails, and play golf again. I get really tired around 9 pm and sleep 10 or 11 hrs a night. That's more sleep than I ever had pre-op.

@Josephine, after surgery they put the bandage over my wound before all the swelling occurred in my thigh. I suspect it's possible the amount of swelling that occurred after the bandage was in place could have caused a lot of tension on the skin and hence the sores seen in the photo. Thanks for your insight and experience in these things.

 

[Josephine]

No problem! Glad you have an answer.

they were replaced with stretch strips which should fall off in time

Oh pull'm off after a week! This is a very American peculiarity which really puzzles me! There is no magic in Steristrips. If left to fall off on their own, they just accumulate a huge amount of fluff, detritus and other gunk looking and feeling really disgusting. In the UK, these strips are removed after 7-10 days. After all, the wound is fully healed and sealed when the staples are removed so why bother? It's just a 'belt and braces' mentality anyway!

 

[Clipper]

Yesterday marked 1 month since LTHR (anterior). I go to outpatient physical therapy for an hour twice a week and walk about 1½ miles a day, ¼ to ½ mile at a time (no aids). I also do push-ups, sit-ups, leg raises 2 or 3 times / week.

Staples were removed 15 days post-op and I removed the Steristrips 8 days after that per Josephine advice. I stopped pain meds after 3 weeks. OA in my right hip becomes more evident as my left hip improves and I'll probably get RTHR around Nov 2016. I'm very grateful recovery has been uneventful so far.

 

[Josephine]

@Clipper please don't make my name a tag when it's just mentioned in the course of conversation!
You are more than welcome to tag me any time you want my input, of course, but I get more than enough tags as it is (10 today!) without getting unnecessary ones! Thanks everso!

 

[Cynthia777]

Great update @Clipper! So happy for you!

 

[Clipper]

I just reached 8 weeks post op and all seems uneventful so far. Surgeon said all looks fine and "we'll see you again in 1 year".

PT twice a week has helped me regain some leg muscle strength. Hard to believe how very week my legs had become due to ever decreasing mobility after several years of increasing OA in the left (mainly) hip. I think another month of weight training for my legs will help a lot. In addition, I still walk 1 - 2 1/2 miles most days and do other exercises. Looking forward to the day when I can swing a golf club again. I need to also work on improving my balance. Standing on one leg for much over 10 seconds is a problem and standing with my eyes closed takes a lot of focus. Hopefully that will improve with leg strength.

Best of luck to all bonesmart members!

 

[Clipper]

Now 7 months post op (LTHR) and all is well. I walk a little over 2 miles every day and over 300 miles since LTHR in April.

OA in my right hip causes pain when I'm approaching 2 miles of walking. Some days there are other pains in lower back and L buttock where I have to sit for a few minutes and then the pain goes away as I walk more.

Right hip replacement is scheduled for Nov 14th. There is not much pain in that hip but the range of motion is very limited. So this operation is about gaining mobility so I can do things like tie my right shoe, clip toenails on that foot, put socks on, etc. I'm 66 and it will only get worse from here on out. Surgeon says the OA looks pretty severe. I pray I'm making the right decision to go through with it. I would really hate being crippled down the road.

The left leg was made 3/4" longer than the right leg during the first surgery (measured by the PT after). I use a pad in my right shoe to compensate some. When replacing the right hip, the OS said he will make the right leg the same length as the left. That sounded good to me.