Revision THR Continuing thigh pain from failed osteointegration?<

[Josephine]

I believe the consequences of another failed integration are more severe than the consequences of HO.

Absolutely!

 

[Layla]

Hi Terry,
Will be thinking of you tomorrow.
Wishing you comfort, peace of mind and praying for a perfect outcome.
Let us know how you're doing when you're able. We'll be here.
@TerryB_TX

 

[TerryB_TX]

@Hipster63, do you mind my asking what post surgery PT, if any, you were advised to do?

 

[Hipster63]

@Hipster63, do you mind my asking what post surgery PT, if any, you were advised to do?

Initially, the PT was very basic. After about 4 weeks the surgeon (not Dr K) advised me to go to an outpatient PT clinic. I did that for 4-5 mos. Then I finally found Dr K and he sent me to PT at MH West. Awesome group by the way. The initial PT was the normal routine for a hip replacement patient. I had a lot of pain from the fall I suffered and the basic exercises only helped a little. I lost a lot of range of motion, quad muscles atrophied and had nerve damage. A lot to deal with, perhaps too much for a PT assistant. I'm not a huge believer in PT but for me I needed the help. MH West PT had the knowledge to help me get past some of the roadblocks I was suffering from. Nothing was painful and they worked with what I could do physically.

 

[1stSurgery]

@TerryB_TX, I just read your entire thread and wow, I am joining in with everyone else here to wish you the very best for tomorrow and inviting you to cast your worries and doubts aside. You are fearfully and wonderfully made, our bodies respond and react in such high caliber ways that we can't even duplicate the mechanics. You've been through the wringer and are about to come out the other side. Keep focusing on the positive outcome, the miracle of this procedure when it works, and it will, the 99% which you are about to join, and keep focused on staying calm. In lead-up time to surgery, do whatever calms you and surrender that trust to your well researched surgeon and higher powers! You've got a BoneSmart cheerleading squad here rooting for you. Breathe deep -- you've got this!!

 

[chalcedonian1]

@TerryB_TX Glad for you that you will soon be on the other side, working on getting to where you could only before dream you might ever be.

As you know I am just about 7 weeks ahead of you and the first few weeks really do fly by. There is such a good chance this will work out well, and you deserve to feel better. Sending only best wishes and we are all looking forward to hearing from you as you recover!

 

[Mojo333]

Thinking of you today and wishing you all the best!
I will fuss at you later about musing on PT before you even get this done
I will be sending good mojo that all will go spectacularly, and that you will be a patient recovery patient!
See you on the healing side!

 

[TerryB_TX]

Well I’ve made it out of surgery and am back home as of last night. First day post-op was rough with low blood pressure/dizziness, sleeplessness, and terrible acid reflux. They decided to keep me in hospital for one additional day and I felt much better the second day.

The revision surgery was about two hours. The OS said definitely loose stem and he was able to get it out with some, but not excessive effort. The only thing remaining from my original THR is the cup. Stem, ball, and ceramic liner, replacing original plastic liner, are all new. Surgeon checked my psoas tendon and decided no surgical release needed. He did reduce offset which he thought should help both IT Band tightness and psoas tendonitis. He also restored about 5 mm of leg length which I had lost due to downward migration of the loose stem.

Comparing my posterior original THR to my anterior revision, soft tissue trauma seems now concentrated in the front of thigh rather than buttocks area. This seems to make recovery (at least so far) more comfortable. I do have quite a bit more nerve irritation manifesting on the front of the thigh that I did not have with posterior approach. Gabapentin prescribed to help with that.

Pain is manageable. I’m doing one Norco (hydrocodone with 325 mg Tylenol) every 4 hours. I’ve packed my hips in ice almost continuously since I’ve been home. The Ossur cold therapy unit is wonderful for that - thank you for the tip @chalcedonian1. Main issue I’m dealing with is swelling and mobility, but that will improve with time. @Mojo333 , I’m minding the Bonesmart protocol regarding PT. I was quizzing @Hipster63 because we have the same OS. OS initially told me non-weight bearing for six weeks, but after seeing quality of bone and fit of prosthesis, he’s now adjusted to weight bearing as tolerated. @Hipster63, I’ll be curious if he does something similar when you have yours done in the next few weeks. I think his way is a good idea so you make home preparations for worst case in event it becomes necessary.

I’m to stay on walker till 2 week follow up. Much less aggressive than original THR surgeon who’s office told me he’d like me off the walker in a day or two and I was free to do elliptical at one month. As far as PT at home, I’m now only doing the ankle pumps and quad squeezes. I may add a few more later, but I am walking around the house every hour or so during the day. I’m planning to stay away from the gym and pool for six weeks, and waiting at least three months before attempting elliptical or bicycle.

So now I’m just waiting for the final verdict on bone fixation. Surgeon seems confident this one will take. I have confidence in him and am hopeful. Thank you all for your prayers and well wishes. Don’t know if I could have done this without all of you.

 

[Mojo333]

Oh my stars.. that sounds splendid! I am so glad to hear from you and also send my sincere wishes that your pain is managed and that we've got this all in the bag this time!!!!!

I know I am gaining a reputation as the resident but it is truly out of concern and a nod to common sense that all those soft tissues, muscles, ligaments and the like need time with all of our body's healing energy focused on getting over the trauma of surgery.

So happy to hear you are done, @TerryB_TX . This will be your story, but I am hopeful that your happy ending is coming in due time...
Rest, ice and be happy.

 

[chalcedonian1]

@TerryB_TX Glad to hear you are icing all the time--I am STILL using the Ossur and my hip is definitely thanking me. I experienced very little swelling I think as a result of using it.

Glad to hear you will follow BS protocol too on PT. I had to go to a 4 hour meeting tonight where no one knew about my surgery, and I walked around with no walking aid and no limp, and I was just fine. I might pay a little tomorrow as that seems to be how this works, but I was not in pain---amazing.

There is hope, I am still waiting for full bone integration, too, but so far, I am glad I had the revision and I hope you will be too. Patience is the other key, and not falling into despair when there is a slight setback, as progress is just not a straight line! Keep us all posted as you heal. Congratulations!

 

[Mojo333]

I had to go to a 4 hour meeting tonight where no one knew about my surgery, and I walked around with no walking aid and no limp, and I was just fine. I might pay a little tomorrow as that seems to be how this works, but I was not in pain---amazing.

It is amazing. So nice to read your post and hear you doing well.
You deserve it.

Patience is the other key, and not falling into despair when there is a slight setback, as progress is just not a straight line! K

You have that just right!

Hope your weekend is wonderful

 

[Hipster63]

@TerryB_TX - glad to read your update. I've been wondering how you were doing. The nerve pain in your thigh worries me - as I had so much pain from my first surgery. Hoping I don't experience that again !! Did you have a choice of pain meds? I've had several conversations with Dr K about it. The Gabapentin really depressed me, so not sure what else can replace that for nerve issues. Is your nerve pain a shooting pain or very localized? Good news he said light weight bearing as tolerated. Depending on my bone quality, I'll either be on crutches or not! He is not replacing the stem, so good news there. But if he has to use screws to anchor the cup, then crutches it will be. I met with Dr K's PA this past week. I asked if a manufacturer rep from the device would be in the OR and he said yes. Or at least that is what I think he meant. I find that interesting and comforting. I think I remember him saying he has many devices at his disposal at the time of surgery. It sounds like Dr K considered and checked everything during your surgery. I like that he didn't ignore your Psoas. Mine still acts up so hoping Dr K checks it. Thank you so much for your posts. I'm terrified going into this but know it needs to be done. By the way, how was the hospital experience? When I was in for the hip aspiration last week, it was positive. Keep us updated if you can

 

[TerryB_TX]

One week post surgery and doing well so far. Most of my pain is still concentrated in the front and outside of my thigh. I think it's a combination of muscle trauma, pain from swelling, and nerve irritation. My original surgery was posterior. This revision was an anterior approach. I hope most or all of the pain is normal for anterior surgery. I guess only time will tell, but I'm feeling optimistic.

I'm beginning to experiment with my pain meds. I have been taking 10/235 mg hydrocodone/Tylenol every 5 hours. Today, I'm trying to go without the hydrocodone and use only Tylenol.. The hydrocodone makes me so sleepy. I'll probably continue using the hydrocodone at night for a few more days. Bed time is when the pain is at it's worst anyway.

I'm being careful about the PT, doing only the simple, easy stuff recommended by the hospital therapists...butt squeezes, ankle pumps, short and long quad exercises.

@Hipster63, I think most of my thigh pain is muscle/swelling rather than nerve pain. I'm not really qualified to distinguish between the two, but the localized, short duration, zinging/electrical type twinges I assume to be nerve related and those stopped after a few days. I was on Gababpentin at the time, so that may have helped reduce the sensations. I never had any discussion with the OS about pain med options, but he strikes me as someone who would be willing to work with you on that.

Like you, Dr. K told me that he would have "all options" available to him at the time of the surgery - different manufacturer's prosthetics, different configurations, and even bone cement, which he viewed as a last resort. He told my wife after surgery while I was in recovery that he did check my psoas during the procedure. He said he reduced the offset a bit and expected that to take care of the issue. I can say that at least for now, I can flex my hip a little without that pain. However, I can't do a full straight or bent leg lift yet because of muscle weakness and front of thigh pain, so I don't believe I can fully test the psoas tendon yet.

My experience with the hospital was very good. The hospital PT staff was also great. The orthopedic nurse who ran the replacement class also checked in on me and he was very helpful with advice. I would use him as well for additional opinions and options with respect to meds and recovery plan.

I had a lot of anxiety ahead of my surgery, just like you. I managed to box those anxieties up and ignore them in the weeks leading up to the surgery. All my concerns and anxieties were still there, but I consciously chose to not indulge them. I was not always successful, but successful enough to not let the anxiety make my life miserable in those weeks. My rational mind had accepted that this revision was the only way forward, there was no choice, and I had take the odds of success as they were, not as I wished them to be. The surgery, for me, is a milestone that has to be passed on the way to final resolution. Will this surgery finally relieve my pain and disability? I hope to have the answer in another couple of months. I've tried to make the choices I think will maximize my chance of success (early acceptance of the problem, choice of surgeon, activity level post surgery, etc). I could not have made those choices without input from all the great people on the BoneSmart forum. It seems that you are making the choices that are right for you, that will maximize your chances of success, and that's really all you can do.

 

[Mojo333]

Most of my pain is still concentrated in the front and outside of my thigh. I think it's a combination of muscle trauma, pain from swelling, and nerve irritation. My original surgery was posterior. This revision was an anterior approach. I hope most or all of the pain is normal for anterior surgery.

Was exactly where I felt it...I had anterior BTHR.
Zings and zaps...ditto.
Diminishing slooooowly but Surely!
Keep the faith...

 

[Hipster63]

@TerryB_TX - so good to hear you are doing well. Are you icing for the thigh pain? How often? I didn't do enough of that my first go round but I know better now. What exactly is "reduced the offset"? The prosthesis or the muscle? The zips and zaps of nerve pain continued for 6 mos with me - so hoping I get your your results Thank you again for your posts. I especially appreciate you sharing how you approached your surgery. I'm a nervous wreck and need to find a way to deal with the fears.

 

[TerryB_TX]

@Hipster63, I ice 24/7, literally. I don't go an hour without being hooked up to the ice machine. As long as there is some fabric between your leg and the pad, I don't think it gets cold enough to damage the skin. At least it did not mine. Just take care till you get accustomed to it.

One other thing regarding the Ossur cooling pads that I did not know till after opening everything up, is that the pads are single patient/single use. That means they are not designed to store for a long period between uses. I believe it's because you can't drain the water completely from them due to internal baffling. If it sits in storage too long it is likely to start growing mold, mildew or bacteria inside the pad.

I suppose you could flush the pad with chlorinated water but the chlorine would likely deteriorate the material over an extended time. Out of curiosity, I tested my pad out a few weeks before surgery, then got nervous about bio contamination. If I had to do it over again, I wouldn't put water in the pad until a few days prior. This just may be a lot of needless worry on my part, but I didn't want to take chances with infection.

By reduced offset, I mean a reduction in the lateral offset of the femoral stem from the hip joint. In essence, it reduces the distance between the femur and the pelvis. It's done, I think, by choosing stems with different length necks (the ball is attached to the end of the stem neck). If the OS is not changing the stem, he may not be able to reduce the offset, since I think the stem/neck configuration is a single unit. I would, of course, defer to @Josephine, on all of this. I have no medical qualifications, so she will be able to give you the correct answer to your question.

I don't know how to advise you regarding the fear and anxiety leading up to the surgery, other than to say most, if not all of us, go through it. Certainly mine was much easier with the original THR because I was blissfully ignorant of what was in store and the risks seemed (and truly are) small.

However, coming to the realization and acceptance of the need for revision surgery, my head was in a constant state of turmoil. I could barely put a coherent thought together. Once I accepted what must be done, I was able to put most of that fear and anxiety aside. Like I said, not always, but enough to continue to function.

I think we are all stronger than we think we are. We just do what needs to be done. You'll find many stories of courage, grace, and perseverance on this site. They are all stories of inspiration, each unique in there own way. I found my inspiration following @chalcedonian1. Her story, challenges, and concerns were so similar to mine. Your surgery will be here in just a few short weeks.

Do the things you enjoy to distract your mind from the fear. What is left then is the recovery and healing. I'll be following you to see how you're doing and wishing you well along the way.

 

[Josephine]

By reduced offset, I mean a reduction in the lateral offset of the femoral stem. If the OS is not changing the stem, he may not be able to reduce the offset

Absolutely correct, Terry!

The stem and ball look like this

 

[Mojo333]

Won't quote your whole former post, but want you to know that is beautifully stated...all of it.
And our attitude and fortitude, I truly believe, are invaluable for a "sane" recovery.
We are stronger than we know, some because there are no other choices I suppose.
But kudos to you!

 

[Alitm]

Just finished reading your thread @TerryB_TX . What a journey you have been on. Your sharing of your information is so helpful to others, to those of us waiting and those of us who are post-op. Thank you very much for sharing. Wishing you positive healing and comfort in your recovery from your revision surgery.

 

[Mojo333]

Hope your chilled out and feeling better !
Slow it goes, I know but all to a good end, right!
Hope you have a good weekend Terry.