THR Concerned 6 months post op

[Car Guy]

Hi , I just found your site and really like what I see . I had anterior THR on Nov 3 2020 . Recovery was going great with very limited pain and good mobility progression . 6 weeks after surgery I fell off the cliff , barely able to walk . The surgeon recommended no activety for 3 weeks and a very slow return to post op exercises but not really sure why this situation happened . The PT hinted that perhaps I went at recovery too quick .

On Jan 1 2021 I went back to exercises and walking slowly and progressed great until a week ago when I fell off the cliff again . My last PT was Feb 17 and they told me not to over do my rehab and that I was doing fine and they didn't have to see me again .

I have never felt that I pushed my recovery but for the last week I can barely put any weight on my leg and have to walk with crutches . I am DEEPLY concerned about this situation and have seen the GP and seeing the Surgeon for the 5th time since surgery this week .

A week ago I was doing a 45 minute routine that I had done for years prior to surgery and spent 2-4 hours a day wandering around my shop just trying to keep my sanity and walked about 1/4 mile a day with NO issues . I have ony used crutches for about 3 weeks post surgery and after my two turn back episodes .

Read a post on this site about some others that have had the same issue and have had revision surgery . HOPING thats not in the cards . With all the Covid shut downs ,I have no one to turn to and looking for any advise and would greatly appreciate replies from anyone who has been down this road.

Not sure if I am pushing recovery or surgery was not a success ????

 

[Jaycey]

@Car Guy Welcome to BoneSmart!

What type of exercises were you doing and how much (reps) before that 6 week mark? Same question but just prior to your most recent setback? What is the "routine" you were doing for 45 minutes?

Six months is only half way through a process that can take one year or longer. Sounds like you may have be far too aggressive early out. And if you took the "working through the pain" approach it often results in chronic pain.

I'll leave you our recovery guidelines. Although you are six months out this information might highlight the approach that should be taken.

Hip Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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​

elevate​

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

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Car Guy]

Thanks for your reply , as I stated I never felt that I over did my routine as I was told not to do . My routine involves slow stretches held for a 5 count with 20 reps and I always felt better after my routine than I did before I did it . I never stetched to the point of discomfort either . Exercise list includes : knee straightening from a sitting position , sideways leg slide , knee and hip bending , mini squats , straight leg raises , side leg raises , hip flexion , hip abductions , knees to chest , bridge , clamshell and knees to inside of body to floor , all done lying on my back on the floor . This routine has also helped with back mobility as well . I have not exercised for a week now and only walk with crutches as out of nowhere my operated area can cause extreme pain and I am concerned about falling down . I have not used ice or pain meds for over 2 months and up until a week ago I only had very mild ,occaisional bouts of discomfort which were usually gone after a good nights sleep . Just trying to figure what the problem is and the best solution ?

 

[Jaycey]

Exercise list includes : knee straightening from a sitting position , sideways leg slide , knee and hip bending , mini squats , straight leg raises , side leg raises , hip flexion , hip abductions , knees to chest , bridge , clamshell and knees to inside of body to floor , all done lying on my back on the floor

This is way too much for a new hip. You are not in training. You are recovering from major surgery. I get the lower back issues - I have the same. But trying to do all this on a recovering hip is just too much.

I would stop all of this. Focus on ice and elevation - getting this chronic pain under control. Use medication if you are still in pain.

When all this has settled, start slow. Forget about whatever routine you had before your op. You need to start very slow and build up only based on what that hip can tolerate.

Read the articles I left for you. They highlight the level of activity through this recovery.

 

[Eman85]

It sounds like after the first incident resting and stopping exercises made the problem go away. I'd try it again. The hardest part of when it hurts is determining if it's soft tissue or the implant screwed up. With my first THR I overdid it at 3 mos and it took 3 weeks of ice and rest to get back to where I was. I learned my lesson and kept the recovery to stretching and walking. With my second I was very mindful and didn't have any setbacks. My experience was the exercises did nothing more than cause pain especially in the first 6 mos to a year.

 

[Celle]

Hi @Car Guy ,

Full recovery from a THR takes a year, so you're only half way. There's still plenty of time for improvement.

I agree with Jaycey. Your hips and back don't need all those exercises, so stop doing them and just use your hips normally, during your ordinary Activities of Daily Living (ADLs).

Did you take note of the BIG TIP included in the Recovery Guidelines?
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.

 

[Car Guy]

Thank you all for your posts , I will listen to your advise and take it easy for a while , hopefully can return to a reasonable level of activity .

 

[Mojo333]

Good advice given and good on you for deciding to see if "those who know" might help you get through these tough times.
Too much too soon can result in alot of annoying issues including tendinitis which can take months to alleviate.
Sending all the best healing vibes, @Car Guy

 

[Car Guy]

It has been 3 weeks now since my setback , have done VERY little other than elevate ice and walk just a bit with no improvement . My GP and I have talked about all the negatives that could come which is very DISTUBING to say the least , he is thinkinging the implant is either lose or defective . Waiting for a CT scan to verify concerns but I can't walk in the house on some days and even being able to put weight on my operated hip can cause pain sometimes but not all the time . My Surgeon has very little concern about my issue and if it weren't for my GP I doubt much would be happening ,apparently some Surgeons don't care if issues arise they only get paid in the operating room ???? Very deflated right now , a fellow I have known for years had his surgery done by the same Surgeon on the same day I did and he jogs occaisionally , while I can't walk . Realize every patient is different but UNFORTUNATELY I am convinced my surgery was a total failure and my GP is hinting at that as well . Any ideas where I might find a GOOD Revision Surgeon

 

[Eman85]

I wouldn't cash in my chips just yet. I'd want the CT scan and definite verification before thinking the implant came loose.

 

[Jamie]

It's not helpful that your surgeon isn't being forthcoming with you about what may be causing your pain. It is extremely rare for an implant to fail, so I would be surprised if that's the case. However, it is possible that you've overworked your new hip in the early (first 6 months) days of recovery. That can cause a cycle of pain from very angry soft tissues.

I know 3 weeks seems like a long time for you to be taking things easy, but if it is a case of overworked soft tissues, it can be months in getting better. Please don't give up and continue to follow this program of just gentle bends and stretches for 5 minutes or so several times a day along with some short walks on level ground or inside the house. Add lots of icing and elevation too. If it hurts, don't do it quite yet.

It also might be time to start searching for a different surgeon to take a look at your hip. Unfortunately I don't have many resources in the Canadian healthcare system, so you may have to do a lot of calling or emailing yourself to find revision surgeons. Even if you don't need a revision, this is the type of doctor you want because they are more experienced at dealing with problem recoveries. Below I've listed all the doctors I know of in Canada. I hope you can have some success getting in to see one or more of them.


Toronto, Canada

Revision surgeons for hips and knees:

Dr. Jeffrey Gollish
Sunnybrook Health Sciences Centre - Holland Orthopaedic & Arthritic Centre
43 Wellesley St. E., Suite 315. Toronto, ON M4Y 1H1
(416) 967-8730

Dr. Markku Nousiainen
Sunnybrook Health Sciences Centre - Holland Orthopaedic & Arthritic Centre
43 Wellesley St. E., Suite 315. Toronto, ON M4Y 1H1
(416) 967-8730

Ontario, Canada
Dr. Richard W. McCalden
London Health Sciences Centre
Western University
London, Ontario, Canada
Speaker at 2018 ICJR workshop on problem hips and knees

Vancouver, British Columbia

Dr. Hooman Sadr
St. Paul's Hospital
Footbridge Clinic
221 - 181 Keefer Place
Vancouver, BC V6B 6C1
Phone: 778-945-6756

I know you are worried. Not being able to walk without significant pain would cause anyone to be concerned. Keep pushing to find a surgeon who will offer help and suggestions for you. In the meantime, continue to take things easy for at least another 6 weeks. Don't hesitate to come here and talk with your BoneSmart family. Even if people can't offer precise things to help, just talking with people who understand what you're feeling and going through can help dramatically.

 

[Car Guy]

I certainly hope I can find a Surgeon that I can talk to . My surgeon didn,t even put me on a priority list for my CT scan , that's why I am frustrated . NOT sure of what's going on NO one to talk to . Thanks for your reply ,that,s why I joined , my GP is in the process of looking for a Revision Surgeon in Canada that we can consult , I have to get another opinion from someone that is concerned . Might even try to consult one of the doctors that you have forwarded . I might seem a bit paniced and I AM but I'm not in a good place right now . I have registered for this Saturday,s Forum and hope I can receive more info ,especially if some doctors are part of the forum .Likely difficult to diagnose over the net but still a BIG help . THANKS

 

[Onestepatatime]

@Car Guy I was reading through your thread, and wondering if you got results. My advise to you is get a second and third opinion. Surgeons do not like to revisit their own work, I have experienced this several times and had a few pain management docs tell me that as well. It stinks when you feel the surgery did not go as planned. Been there done that.....Keep us posted.

 

[Car Guy]

Thanks for your reply, I have now been put on the URGENT list for my CT scan and as soon as the results are available that will determine my next step . My GP agrees with you totally about the surgeons and their reluctance to admit a surgery has gone bad . My Gp will get me a referral to as many specialists as required , he is talking about sending my case to the Mayo Clinic ( if required for consultation and advise ) . I WILL NOT just jump on the table , cautiously concerned only . Will advise

 

[Celle]

My GP agrees with you totally about the surgeons and their reluctance to admit a surgery has gone bad

I don't think it's just that.

Surgeons can get into a mind-set where they cannot see how anything could have been done differently. That's why it's a good idea to get a second opinion from a surgeon who specialises in problem hips and who has no connection, either professional or social, with your current surgeon. That way, you'll get the benefit of a completely independent opinion from a surgeon with experience in sorting out hip replacement problems.

Sometimes one of these surgeons can spot a problem and suggest a solution that has eluded the original surgeon.

 

[Onestepatatime]

I would love to be able to go back to my revision specialist at HSS and say Yo, I ended up needing another revision when you reassured me nothing was wrong. And why he chose a cup that was too big for my body and ended up impinging my Psoas. Three other surgeons saw the issue, but not my original revision surgeon. I still do not understand. I am so glad I persevered until I found a surgeon who felt very confident he could fix my mess. We need to just be our own advocate and have the patience to find the right surgeon and answers.

 

[Car Guy]

Just wondering how the forum tommorrow is going to work ? I am a computer dinosaur so please keep it simple .

 

[Car Guy]

Also wondering the time Frame and duration . P.S.T.

 

[Jamie]

@Car Guy .... I'm so sorry that I didn't see your posts about the JRAD conference. Were you able to log on and attend? If it didn't work out, don't worry....we'll be here to help you through whatever is ahead for you. It sounds like you have a great GP on your side and that is VERY helpful.

 

[Car Guy]

Just wanted to post an update ,had a CT Scan and met with my GP . He threw a wrench in the gears completely ,according to my CT scan my hip is not likely the problem ,the report indicated my problem was LIKELY coming from my lower back ,mainly my sciatic nerve ,which is LIKELY causing my hip issues . Next thing they want to do is a steroid injection to ease the sciatic pain and possibly an MRI ( which I thought I couldn't get because of my T.H.R. ) I am extremely pleased they are suggesting no Revision Hip Surgery at least for now . I have asked for a referral to the best rehab facility in the province which is supposed to be forthcoming . I wanted to THANK everyone for their support and feed back with this issue . I am entering into another unknown realm with the sciatic and I had that issue 33 years ago when I had my L-4 /L-5 disc removed . Have never really had major back issues since that time but not sure whats next in my world . Would really like to be able to walk properly again , will post again down the road when a definite diagnosis is made . Thanks again Car Guy