Revision THR Continuing thigh pain from failed osteointegration?<

[Mojo333]

I do hope you are keeping the ice on as much as you possibly can.
I'm sure it's getting old now...but my quads were really my main source of swelling and tenderness...Ice and more Ice!
Hope you have a "chilled out" weekend!

 

[Layla]

Stopping by to say Hi this morning.
Hope you have a great weekend, Terry, as you continue healing
@TerryB_TX

 

[TerryB_TX]

@Mojo333, @Layla - Quads (and perhaps IT Band) are still swollen and sore, but I'm continuing to ice and elevate and pain is getting a little better every day. Back on one or two Tramadol a day in addition to the Tylenol, so that helps.

You have a good weekend too!

 

[Hipster63]

@Hipster63 , I agree with@lovesstars. I wanted out of the hospital as soon as possible. I had to stay an extra night due to low BP and dizziness first day post op. Infection prevention protocols at MH are state of the art, but it is still a general hospital and not an orthopedic only hospital, so there is risk. I also felt more comfortable in my own home and did not miss the multiple visits throughout the night to check vitals, etc. I think as long as you’ve got a reliable caretaker at home, you’re better off doing your recovery there.

I will have care at home - husband. And yes, I will be more comfortable at home. My first hip surgery was such a nightmare and one I am still recovering from. I feel like Dr K, his team and MH are my last hope to resume a normal life again. So maybe that's where my crazy reasoning is coming from

 

[Layla]

Just stopping by to wish you a Happy One Month Anniversary!
I hope you're having a good week and all is progressing nicely.
Stay in touch, we'll be here and we love reading your updates.
@TerryB_TX

 

[Mojo333]

One month...cabin fever and still ever healing...that's how I remember it.
Hope all is well with you!

 

[TerryB_TX]

I'm now just about one month post op from my THR revision. I've just graduated from a walker to a cane, per my surgeon's instructions. First day of cane use resulted in some new stabbing pain in the groin and upper thigh, but by the second day, that was gone. I'm still nervous about the cane because my pre-surgery instructions were 6 weeks NWB. It was changed immediately post op to weight bearing as tolerated. I just don't want to do anything to aggressively and jeopardize the stem integration. I'm putting more and more weight on the operated leg and it seems fine. No unusual pains in the thigh like before surgery with the loose stem, and I feel like I can walk almost normally. I'd say I'm cautiously optimistic. I hope to have confirmation of full integration at my next appointment with the surgeon on October 10.

I'm still taking 4,000 mg/day of Tylenol and two or three Tramadol 50 mg a day. Tomorrow I start weaning off the gabapentin, going from 600 mg/day to 300 mg/day for 3-4 days, to nothing after that. @Josephine, I saw your Gabapentin titration schedule was much more gradual and over a much longer period. Are there symptoms I should look for that tell me my schedule is too quick?

The burning nerve pain is essentially gone now. The only pain I'm left with now is the occasional groin, hip and deep glut pain which is, I believe, normal for this stage of my recovery and easily tolerated with the meds I'm using. My one concern continues to be the outer thigh pain with knee flexion. I can now flex my knee comfortably to almost 90 degrees. Beyond that, I get significant pain along the outside of my thigh near my knee and about 5-6 I inches up (IT Band or vastus lateralis muscle?). When I flex my knee, this part of my thigh gets hard as a rock, with the muscles feeling tight as a bow string. Almost like I can't flex because the quad muscles/tendons aren't long enough. I suspect it's due to persistent swelling of the quads. I continue to rest, ice, and elevate, but progress is slow. I try gentle stretching by flexing to the point that the pain starts to ramp up, but I'm not sure if this is the right thing to do. Will this accelerate or slow the flexibility of my knee?

I have an apparent LLD, but I know it's too early to make a final judgment on that. My OS is very experienced and highly regarded, so I doubt I'll wind up with any real, significant LLD.

Worst of this recovery is fighting my impatience and boredom and the feeling that I'm wasting weeks and weeks of my life doing nothing productive. Now that I'm off the hydrocodone, I'm able to focus enough to read again, so that is helping a lot. Also, have plans for a nice dinner out this weekend for my wife's birthday. I've been too proud to go out in public with the walker, but I don't mind going out now with a cane. I'm anxious to get back to he gym and back in the pool again, but I know I have many weeks to go before that can happen.

 

[Josephine]

Are there symptoms I should look for that tell me my schedule is too quick?

My titration was ultra slow - snail's pace. If you get any symptoms like that, I'd be most surprised!

The only pain I'm left with now is the occasional groin, hip and deep glut pain. My one concern continues to be the outer thigh pain with knee flexion.. I can now flex my knee comfortably to almost 90 degrees. Beyond that, I get significant pain along the outside of my thigh near my knee and about 5-6 I inches up

That is a very clear description of ITB (ilio-tibial band) issue. Don't forget the IT band is an immense muscle with lots of fascia (a tendonous sheet of fibrous tissue) spread over the entire length of it. See this

the feeling that I'm wasting weeks and weeks of my life doing nothing productive.

Weeks and weeks? You're 4½ weeks out, my dear! That's like wondering why a 4 month old baby isn't walking or talking yet! And you're NOT 'doing nothing'! You are healing which takes a lot of hard work (in the form of patience!) and energy (in the form of calories!).


I'd really like to offer you some structured advice (again) but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[TerryB_TX]

Yes, of course @Josephine. I've noted changes from last response in red. Let me know if there is additional new info you need.

1. Anterior (revision - all components except cup replaced, 20 Aug 2018)

2. Pain Levels
Front of Hip: 0-2, aches a bit with use, very tolerable with meds
Outside of knee and up 5-6 inches along outside of thigh, no pain when knee is extended or flexed up to about 90 degrees, rises to 5-6 when flexed near 90 degrees or more
Outside of mid-thigh up to hip, minimal pain, tingling and numbness only

3. Pain Meds
Gabapentin 1x 300 mg per day (total 300 mg/day), will continue for 4 more days (down from 600 mg/day)
Hydrocodone/Tylenol (10 mg/325 mg), discontinued
Tylenol 2x 500 mg, every 6 hrs, (total 4000 mg/day)
Tramadol 50 mg, 2-3 per day, typically once or twice during the night, once during the day

4. Icing 12-14 hours a day with cold therapy unit and cold packs, at least for 60 minutes at a time, sometimes continuously for 4-6 hours (at night while sleeping)

5. Elevating toes above nose 10 hours a day (while sleeping or resting in bed)

6. Activity is limited to short, 5-10 minute walks around house, 4-5 times a day. I make my own breakfast, unload dishwasher, get up and walk for bathroom breaks, meals, many short strolls around the house to relieve boredom and stiffness, - no change from previously, though now using cane instead of walker

7. Exercises at home - none, No additional PT at home or outside

I believe you are absolutely right that it is my IT Band. Should I be doing light stretches yet, or is it still too early? By light stretches, I mean simply flexing my knee up to and a little beyond onset of pain. I'm doing no foam roller or other standing "leg cross-over" type IT Band stretches.

Weeks and weeks? You're 4½ weeks out, my dear! That's like wondering why a 4 month old baby isn't walking or talking yet! And you're NOT 'doing nothing'! You are healing which takes a lot of hard work (in the form of patience!) and energy (in the form of calories!).

I understand. With the first failed surgery and the subsequent revision, it's just been such a long time (years now) that I haven't felt disabled, and I'm desperate to get back to my hiking and climbing. I guess I need to focus on healing my attitude as well as my hip.

Thank you for all your help and advice.

 

[Josephine]

2. Pain Levels 0-2, 5-6 when flexed

Okay

Gabapentin 1x 300 mg per day (total 300 mg/day), will continue for 4 more days
Tylenol 2x 500 mg, every 6 hrs
Tramadol 50 mg, 2-3 per day, typically once or twice during the night, once during the day

I'd suggest that you take the Tramadol with the Tylenol in this kind of routine

Of course, you can miss a dose here and there and/or jiggle the timetable but the essence is that you need to take something on a regular basis for the next 3-4 weeks and see how it goes.

4. Icing 12-14 hours a day with cold therapy unit and cold packs, at least for 60 minutes at a time, sometimes continuously for 4-6 hours (at night while sleeping)

Very good!

5. Elevating toes above nose 10 hours a day (while sleeping or resting in bed)

Excellent!

6. Activity is limited to short, 5-10 minute walks around house, 4-5 times a day. I make my own breakfast, unload dishwasher, get up and walk for bathroom breaks, meals, many short strolls around the house to relieve boredom and stiffness - now using cane instead of walker

That's okay

7. Exercises at home - none, No additional PT at home or outside

Glad to hear it.

I believe you are absolutely right that it is my IT Band. Should I be doing light stretches yet, or is it still too early?

Much too early. I suggest you visit a chiropractor for some deep massage therapy though.

I'm desperate to get back to my hiking and climbing. I guess I need to focus on healing my attitude as well as my hip.

Honey, you're barely 5 weeks out. I suggest you set your 'desperation' aside for the time being. It's not helping you!

 

[chalcedonian1]

@TerryB_TX I was actually laughing a little bit at your last full paragraph about healing your attitude...thanks for writing that and I can understand, and I do share, your frustration. Your determination to get this right and your wish to return to a full life are in a slight conflict right now. But you must know you are only 5 weeks out from a "major car crash", after having suffered for a year from a previous "major car crash" from which you never fully healed, and you need to give your poor body some time to recover! Using a walker for so long was probably somewhat emotionally debilitating, as that doesn't conjure in your mind a picture of someone who gets out and about hiking vigorously in the hills. But maybe you can think of the Olympic athlete who crashed and burned whilst doing moguls, and needs a walker for 6 weeks to be able to get back on the slopes--and does. A more satisfying mental picture for sure.

You do sound like you are indeed recovering, which five months ago was only a pipe dream, and probably your deepest desire given the pain you were experiencing and then the fear of another surgery. Nothing will accelerate this process, I am afraid, so please do give yourself and your body some slack! Anyone on the forum who is about to undergo revision surgery would love to be in our positions I think, as we have already gone through our second surgery and now we are chomping at the bit to resume an active life, an impossibility in my case for well over 3 years. When I had read posts by others after I learned I needed a revision, e.g., stating 'how much better they felt after their surgery', I NEVER thought that would be me, my hip was a fail and it would never change. But so far, so good for both of us, and please, may our frustration with a not-so-fast healing process be our worst issue! You really are doing great, I give you kudos for recognizing your own impatience and not giving in to it, and remember you are barely 5 weeks out. And there will be a moment after a full day when you will suddenly say to yourself "whoa, did I really just do all that in one day without pain?"-- I know, because it just happened to me and it cancelled out the frustration of the slooooow past 10 weeks (admittedly I don't have this experience every day, but I've got to admit "it's getting better, a little better all the time"). Keep up the good work and healing!

 

[TerryB_TX]

@chalcedonian1 , I agree with you 100%. I am improving week by week and just a few short months ago this was the best case scenario I could have hoped for. What a blessing that the pace of recovery is my biggest complaint! I am grateful for that and am resolved not to do anything rash or stupid to jeopardize my progress.

I have just passed the 5 week point post-op from my revision surgery. Most seems to be progressing well. My hip pain is adequately controlled by Tylenol and occasional Tramadol 50 mg. I've now move from walker to cane and that has improve my disposition considerably. I'm still tentative about putting full weight on my new hip, not because of pain or instability, but because I want to avoid disrupting the bone integration process before I get x-ray confirmation that it is complete. Even so, I've found myself actually forgetting to use my cane for a few steps, which I take as a good sign.

The biggest issue remains the tightness in my lateral quads and IT Band, and the consequential inability to flex my knee normally. I can now get to about 90 degrees, perhaps a little more before being limited by the muscles/tendons in my thigh. I'm doing a little light ITB massage myself, but not finding very significant improvement in flexion yet. This limitation makes it very uncomfortable to sit upright for any period of time. The combination of 90 degree knee flexion and 90 degree hip flexion is really difficult. I went out to dinner over the weekend for the first time since my surgery and was very uncomfortable sitting in a chair. I had to get up and walk around a several times through the course of the meal.

I've not found any mention of this knee flexion limitation on any of the BoneSmart threads I've read yet. This issue came as complete surprise to me. Has anybody else experienced this or seen mention of it anywhere? I'm anxious to know how long it will take to resolve.

 

[Hipster63]

@TerryB_TX Hi - keeping up with your recovery process. Good to read you are on the road back to normalcy, however long that might take. I understand that IT band pain you are dealing with. I had it for months after the first surgery. But I couldn't be sure it was due to the trauma of the fall or the actual surgery. My pain presented as searing, stinging pain. The physical therapists were always encouraging me to flex, massage and ice. Honestly I don't know what helped, but I only have some limited pain now (rather, before this surgery) Hopefully your issues will resolve over time. My pain from this surgery is minimal - I was shocked! If I didn't have the no-weight restriction I think I'd be walking on a cane by now. But who knows what I might feel when I take those first few steps. I never took the Gabapentin. The nurse in MH said it was ok. I hated that stuff the first time - I had wild nightmares and thoughts. I'm down to a few ES Tylenol a day and maybe 1 at night. I ice often and elevate. But I need to adjust my elevating - my techniques are not cutting it. Did you attend the mandatory PT classes at MH? I went twice. I have the phone app from Dr K's office. My daily check-in Thank you for sharing your recovery. I know our surgery's were quite different but it's comforting to know we are in good hands with Dr K.

 

[TerryB_TX]

@Hipster63, It sounds like you're progressing really well, and quickly. I wouldn't be surprised if you're released from the NWB restrictions early, but don't do anything different from what the surgeon advises!

Yes, I did the PT class at MH the day after my surgery and then again the following day, prior to my release. However, I've opted to limit my home exercises consistent with the BoneSmart guidelines.

I'm now 6 weeks post op and doing quite well. I have almost no pain in the hip when walking or standing. The pain only comes when I sit upright for too long with my hip flexed at or beyond 90 degrees. Then I get a dull ache in the front of my hip. I'm still also having limitation with knee flexion, but it is improving week-by-week. My quads and IT Band are still very tight.

I've been elevating mainly at night when I'm in bed trying to sleep. I have a stiff foam wedge pillow on which I put another regular fluffy pillow and lay my leg on top of that. It gives me about a foot of elevation of my foot above my head. It's the most comfortable position for me, though it's not really comfortable. My back aches by morning.

I've just now stopped icing and elevating at night. I haven't been able to sleep very well for about a week and trying to get back to my normal sleeping position (on my side). I dread going to bed every night now because I know it's going to be hours and hours of laying there trying to sleep, getting frustrated, getting up to read or wander the house - essentially doing everything but sleeping. The quad/ITB tightness doesn't burn, but aches quite a bit, making it really difficult to get comfortable in bed. The onset of sleepless nights coincided with my getting off the Gabapentin, but I have no idea if they're related. Hopefully you won't experience that. Though I don't elevated much anymore, I still ice quite bit during the day.

I didn't know about a phone app. Thanks for the tip. I'll take a look. My next appointment is on Oct 10, so I'm hoping to have questions about the bone integration, knee flexion, and IT Band answered at that time.

Wishing you continued success with your recovery!

 

[Josephine]

The biggest issue remains the tightness in my lateral quads and IT Band, and the consequential inability to flex my knee normally. I've not found any mention of this knee flexion limitation on any of the BoneSmart threads I've read yet.

Are you kidding? I seem to do nothing BUT answer questions about it! The IT band tendinitis is the culprit because it is a huge muscle that goes from above the hip to wrap right around the knee! This means that it impedes flexion majorly!

 

[TerryB_TX]

@Josephine , thanks for the feedback! My experience with lateral thigh pain was after my first THR and subsequent loose stem. I thought that it was IT band. That’s what I was told by the OS and his nurse practitioner. I think it was, at least in part, because it was relieved (temporarily) by massage and foam roller. What I’m experiencing now is much different - really just limitation in knee flexion and little or no pain unless I’m bending my knee too much. Also, it’s a much different sensation in my thigh. I had no idea the diversity of possible symptoms from the same root cause. It guess it makes sense given the size and function of the IT band. It’s reassuring to know that I’m dealing with just this one, common issue.

 

[Layla]

Continued best wishes, Terry.
I'll bet you're anxious for your appt on the 10th.
You'll have to let us know how it goes.
I hope you have a nice week!
@TerryB_TX

 

[Josephine]

What I’m experiencing now is much different - really just limitation in knee flexion and little or no pain unless I’m bending my knee too much

Yes, the IT band will do that!

 

[TerryB_TX]

A quick update for those who may be interested...

I'm now just short of nine weeks post-op from my THR revision. Over the last two weeks I've seen a dramatic improvement. Swelling is way down, though still some residual on the outside of my hip and upper thigh. The IT band tightness is no longer restricting my knee flexion range, but it remains tight. I'm expecting it will loosen more once the remaining swelling is gone. I've got a little bit of apparent LLD which I hope is not real. Time will tell. I'm essentially pain free and taking only occasional Tylenol. I get soreness on the outside of the hip or in the groin area if I move wrong or if I bend over at the hip too much - like when I got down on the floor to do some under-sink plumbing repairs last week or yesterday when I replaced the pool chlorinator and connecting lines. Until a few weeks ago I couldn't imagine ever being able to do that type of activity again! What a great feeling to be useful and productive again after months of laying around! It sure improves the attitude.

My revision OS's PA checked the x-rays at my 6 week follow-up and said everything looked fine. Of course I'd heard that before from my first surgery, so I viewed and discussed them in detail with him, looking for the black halo around the stem that signifies a loose prosthetic. There was only a greyish halo in part that he claimed was incipient bone growth which would become denser and stronger with time and was no cause for alarm. He said the stem this time was a good fit, fixed, and should not loosen. I've had none of the persistent deep thigh pain and instability that characterized my initial failed THR. so I'm optimistic. I go back in mid November to get final confirmation of integration.

Since my 6 week checkup, I've been swimming regularly up until the last weekend when the temperatures dropped and I've been walking about a mile every other day or so. I'm doing only upper body weight lifting at the gym. I've got an appointment for Oct 31 with a physical therapist specializing in THR's who was recommended by my OS's office. At that time I hope to get a program to start rebuilding the strength in my legs. I intend to be slow and careful with this to avoid developing tendonitis, bursitis, and other soft tissue problems.

I'm finally able to get a decent night's sleep. I attribute this the reduced pain and swelling, but probably more important is the resumption of more vigorous physical activity instead of sitting around the house all day.

Over the last couple weeks I've made a step change in forward progress both mentally and physically. Appreciate all the support and counseling along the way.

 

[alexthecat]

I'm glad you're improving and I hope that continues. You've certainly earned it. Keep us posted.

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