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[REVISION THR] Continuing thigh pain from failed osteointegration?<

Mojo333

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We certainly have been wondering how things have been going...I was almost afraid to ask since you haven't been on much.:unsure:

Everything sounds very good @TerryB_TX :ok:
You've got this.
I bet all gets better and better!
Hope your weekend is sweet!:SUNsmile:
 

Layla

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Thanks for updating, Terry. All sounds so encouraging.
I couldn't be any happier for you. It's been a long journey.
It's wonderful to read of member's excitement in doing simple tasks once again.
May it only get better for you!
@TerryB_TX
 

chalcedonian1

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@TerryB_TX I couldn't be more thrilled for you. Sounds like you have made significant strides in your recovery! Being more active does make me more tired too and that is a welcome feeling. I don't like feeling so unproductive myself, and sitting around doing nothing is just depressing. I am glad to hear you are "puttering" around the house, too, getting down on the floor under the sink, etc. -- I needed to look under a bed for an item and was so pleased to get down on the floor and back up again, and then back down again--sounds silly, but it is the small things that count, right?

Glad you are sleeping better as well. So far as the LLD, I hope it is not significant. I know that many of us have it naturally, and the perception I had after this revision was that I did have LLD but I don't have that perception any more, though honestly I couldn't tell you when it dissipated but it was within the last 4 weeks for sure. I just stopped noticing it!

BTW, just fyi, my surgeon does believe in my taking antibiotics for dental work for the rest of my life--I was going to follow that protocol with my internist anyhow in case the surgeon was of the opinion I didn't need them, but given that I am a revision (and have a "certain" personality :)), he believes in not taking chances and that it is important for my mental well being, too. BTW, I am still not taking any NSAIDs, and will not until a full year after my surgery (Aleve helps with other osteo-arthritis pain, but I am just taking Tylenol when necessary). Glad also you are taking it easy when working out to avoid soft tissue pain, I know you've said you have a tight IT band already, and inviting problems with other surrounding tissue would be most unwelcome.

I hope for a continuing upward spin for you!
 
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TerryB_TX

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Went to my Physical Therapy assessment meeting yesterday. This PT was recommended by my revision surgeon and specializes in joint replacement. I was very impressed by his knowledge and approach. He did a very thorough assessment of my ROM and strength. He also confirmed what I suspected... I likely have a real LLD of about 1/4 to 3/8 inch (6-10 mm), but he doesn't want me to start using a shoe lift yet. This is disappointing, but if everything else works out, it will be a small price to pay.

I'm still having weakness in my psoas muscle and soreness in my psoas tendon. It's not as severe as it was pre-revision, but that may be because I haven't used it much yet. The PT recommended stretching and strengthening exercises. The strengthening exercises are designed to avoid psoas contractions which he said would only aggravate the problem. Instead, I'm to do a passive straight leg lift using a strap to lift the leg about 12-18 inches and then lower the leg slowly over a 5 count (15 times, every other day to start). He'll also do psoas muscle massage by pressing through the abdomen (ouch!). I've had a massage therapist massage the psoas in my upper thigh, but the PT points out that 75% of the muscle is above the groin in the torso, behind the abdominal muscles.

I've had some pinching pain and inflammation deep in my hip that is in a group of small muscles that include the inf/sup gemellus, the obturator internus, and the quadratus femoris. He found that I had absolutely no strength in these muscles and said that these were likely cut and subsequently repaired to allow access to the joint in my original posterior surgery. I had always thought the muscles were only separated, but not actually cut.

The PT said still too early to start strengthening of quads, hamstring, etc. He wants to wait at least a few more weeks for that.

I'm increasing the length of my walks. I'm now doing about 1.5 miles every other day at a pretty good pace of about 3.5 MPH. During and after these walks, I'm getting pain in my operated hip (R2B T and S) that I suspect is piriformis syndrome. I'm icing it after my walks, but probably need to do some stretching. I don't know if piriformis stretches are ok from a dislocation risk this soon after an anterior approach. I'll wait till I discuss it with the PT. @Josephine, do you see anything in the info that I got from the PT that looks odd to you? Your candid feedback and experienced guidance has been invaluable for getting me to this successful outcome.

Despite all thee minor challenges, I'm feeling very positive and doing much better than I was at this point after my original THR surgery. I hope this physical therapy will help me regain the strength and activity level I had prior to the onset of my arthritic hip, but I still have a way to go. I just want to take it slowly and avoid doing damage by being too aggressive. This physical therapist seems be well-aligned with that approach. @Hipster63, let me know if you'd like his name. He works closely with our surgeon.

@chalcedonian1, I read the latest post on your thread and couldn't be more happy for you! It is remarkable how we've moved from such despair, disappointment, and anxiety to our current successful outcomes.
 

Josephine

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@Josephine, do you see anything in the info that I got from the PT that looks odd to you?
Not many! Read on!
I likely have a real LLD of about 1/4 to 3/8 inch
You 'likely' have? And ¼" is nothing to worry about. It's certainly not going to impact on any muscles to any degree.
Instead, I'm to do a passive straight leg lift using a strap to lift the leg about 12-18 inches and then lower the leg slowly over a 5 count (15 times, every other day to start).
I suggest you don't do these. And never use a strap or any other 'assistive' device.
He'll also do psoas muscle massage by pressing through the abdomen (ouch!).
Yes, it is ouch! My chiropractor used to do that for me and at first it really hurt but after, the benefit was profound!
I've had a massage therapist massage the psoas in my upper thigh, but the PT points out that 75% of the muscle is above the groin in the torso, behind the abdominal muscles.
It is indeed

psoas group 3.JPG


said that these were likely cut and subsequently repaired. I had always thought the muscles were only separated, but not actually cut.
You are right and he was wrong. To the best of my knowledge nobody ever cuts a muscle during a hip replacement.
The PT said still too early to start strengthening of quads, hamstring, etc. He wants to wait at least a few more weeks for that.
Well he's right there!
I don't know if piriformis stretches are ok from a dislocation risk this soon after an anterior approach. I'll wait till I discuss it with the PT
Piriformis syndrome has no effect on the risk of dislocation.
 
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TerryB_TX

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@Josephine , “likely” is my characterization of LLD, not his. PT was unequivocal. When I wrote that I was in denial mode, hoping it might still be apparent and eventually disappear!:praying: I think I’ve moved to acceptance at this point, especially with your feedback that it shouldn’t impact muscles.:) :-) (:

This was the piriformis stretch I was referring to. Is this ok to do 11 or 12 weeks post anterior approach revision? Operated leg would be the one crossed over knee.

F742E282-4542-4504-A12D-D387CAD50529.jpeg
 

Hipster63

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@TerryB_TX Good to read you are progressing. I'm impressed you are walking that far. I can only dream of that! I'm pretty sure the PT you are seeing is the same one Dr K referred me to. Sam? If so, I admire him so much. His approach and manner are above any PT I've encountered. He is conservative and respects the patient. I had issues with my Psoas, which Dr K identified on my first visit with him. At that time I was trying very hard to regain glute and quad strength. Sam had me stop all exercises, rest and try gentle stretching. The stretches hurt, so he said stop. I too did the strap assisted lifts. Sam explained to me the theory behind the movement. Sam and Rich also massaged my Psoas. I was very hesitant about that because I had read some horror stories about it. But after I learned to relax, I think it helped. The Psoas tendinitis did improve but it took quite a few months. If my memory is correct, I thought in a posterior approach, some muscles were cut. Other muscles are just separated to reach the joint. I see Dr K and Kevin on Tuesday, maybe I should ask. I am 6 weeks post op - still no weight bearing on the operated leg. My understanding is if x-rays confirm bone and bone grafts meshing together well, I can progress to partial weight bearing. Hoping I can move on to a cane soon!!
 
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TerryB_TX

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@Hipster63 Yes, Sam is the PT I’m seeing. He is very good... knowledgeable, conservative, and explains everything clearly.

I am happy to be walking as much as I am, but I’m trying to be extra careful. I increase my distance only gradually and give myself a day of recovery in between walks. I get a few aches and pains in the deep interior butt muscles that I’m trying to relieve with massage and stretching (thank you @Josephine for the feedback on the pyriformis stretches).

I remember making a significant step change improvement at about week seven or eight. Hopefully you’ll start to see that kind of improvement soon too. Just remember, though, every surgery is different and everybody recovers at their own pace. It can be a slow, frustrating process, but it will all be worth it when you finally get your mobility back!
 

Hipster63

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@TerryB_TX I've been very accepting of my limited mobility until just recently. This walker is driving me nuts! My shoulders ache from their new job of holding me up with every step, haha. Lots of new aches and pains this past week. I have not left my house for 6 weeks. I am noticing atrophy in my operated leg calf and that scares me. I will have plenty of questions for Dr K on Tuesday.
 

Layla

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Encouraging news, Terry. I'm happy to read how well you're doing
It's been a long journey and things are slowly falling into place for you.
Wishing you the best of all!
@TerryB_TX
 
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TerryB_TX

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Thank you, @Layla . I feel like I’m progressing well. I’m walking regularly at about 1.5 miles every other day, doing some light physical and massage therapy targeting my psoas tendonitis.

I’m anxious to start working on rebuilding strength in my legs, but I’m told still too early for that.

@Hipster63 , I certainly feel your frustration with limited mobility, especially after 6 weeks of non-weight beating. I expect you’ll be feeling a lot better soon now that you’re partial weight bearing. And yes, I remember the aching shoulders from using the walker for so long, and I wasn’t even NWB!
 

Mojo333

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And yes, I remember the aching shoulders from using the walker for so long, and I wasn’t even NWB!
Me too!:sigh:
I'm sure all of this bei g patient is getting old...but you'll be proud for it.
Hope your weekend is a good weekend!
 

Mojo333

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I too am hoping this Thanksgiving find you happily healing and that you are feeling well!
All the best, Terry
 
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TerryB_TX

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Thank you @Layla, @Mojo333 ! Hope you also had a great Thanksgiving. I’m doing well. Now walking 2 miles every other day and doing slow, steady, progressive PT to increase muscle strength. I’m very impressed with the PT group I’m working with. I’ve always been one of those fools who believes “if a little is good, then a lot must be better.” These PT’s keep me in check and progressing at the proper pace to avoid chronic soft tissue problems.

Pain is minimal now and when i do get any, it’s usually is gone by next day. I’m getting some grinding/clicking/popping noise from my hip when I get into a hyper flexed position (like bending over to tie shoes while in a deep chair), but no pain. Just makes me nervous about dislocation. OS’s PA said shouldn’t be a problem. PT said to avoid that position till we strengthen the small muscles that stabilize the joint, that it might be a consequence of the joint capsule being compromised from both the posterior and anterior sides.

I still can’t believe things are progressing as well and as quickly as they are... so different from the first surgery. I consider myself one lucky, grateful guy.
 

Layla

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Hi Terry,
Thanks for the update. It's all great news. May it only get better.
I hope you have a wonderful holiday season and a great 2019.
Things are looking up!
@TerryB_TX
 

Mojo333

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You've come so far...don't get too impatient now:)

Happy to hear all is progressing...onward and upward!
:egypdance:
 

chalcedonian1

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@TerryB_TX I am delighted to hear how well you are doing and that you have a PT group that is helping you and making sure you do not overdo. Two miles every other day is really impressive--I am not up to those numbers but also doing well with walking, the elliptical, etc., some weight training, just taking it strong and steady. It is so wonderful to be able to walk and not feel constant pain, isn't it? Hope you had a wonderful Thanksgiving, this year was certainly different than last year's and I too feel very grateful! Hard to believe our luck!
 

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