Revision THR Continuing thigh pain from failed osteointegration?<

Thank you, @Mojo333 . I'm certainly feeling chilled out with all the icing I'm doing! I've got my 2 week follow-up on Tuesday, so will likely post an update then. You have a good weekend, too!
 
Second week of recovery was quite a bit rougher than the first week. Lot's of thigh pain, very reminiscent of the loose stem feeling prior to revision. I had stopped the narcotic pain meds completely for a few days but am back on them now, but only at night. The pain is constant along the outside and front of my thigh, from my knee up to about two thirds of the length of my thigh. Pain intensifies significantly the more I flex my knee. It's a burning pain at the knee, but changes to an aching, bruise type pain mid thigh. Hip actually feels quite good - very little pain, just a little achy at times.

Saw the surgeon's PA yesterday who said the pain I'm experiencing is nerve pain. Good news, as I had worse case scenarios running through my head for much of the week. He said pain was likely to get worse before it gets better, and that it could last several months. That's ok with me. I'm happy that it's not something more serious, or worse, something requiring another surgery to correct.

I'm taking 600 mg/day of Gabapentin. Can't tell if it's helping or not since I've been on it since the surgery and pain has continued to ramp up. Icing doesn't seem to help much. It just seems to stimulate the nerves even more. I've been applying Lidocaine patches (over the counter Salonpas brand), which seems to mitigate the pain a bit, but it's a small area at a time and max 8 hours a day. Hopefully, the pain level begins to plateau and decline soon.

Having constant weird dreams at night now, various scenarios of me in a helpless state, confronted with fight or flight situations, unable to fight or flee due to various lower extremity injuries or limitations. Ok, I get it. You'd think my subconscious could scrape together enough creativity to come up with something less obvious. Or maybe something pleasant for a change.

Despite all this. I'm seriously feeling very optimistic. Surgeon's PA said all looked to be progressing as expected, but agreed the true confirmation of stem integration would come at next appointment at 6 week post-op. I'm to continue with the walker for two more weeks, then move to cane. He says no PT other than some light stretching. We'd talk about possible PT at the 6 week mark.

Comparing the posterior and anterior approaches (I've now had both on the same hip within 15 months of each other), at this point I don't see a clear winner. Posterior had much more muscle trauma and swelling, but none of this nerve pain. If the nerve pain recedes in a month or so, I'd give the anterior approach the thumbs up. If this goes on at this intensity for 5 or 6 months, I may have to go with the posterior. Of course that's just me, and everyone's experience will be different. Also, remember my anterior was a revision so there was a lot more carpentry involved.

Any ideas on dealing with the nerve pain would be appreciated. Really looking forward to getting off the narcotics again. For me, it seems like they don't do much to reduce the pain, just put me in such a stupor that I don't care that it hurts.
 
Any ideas on dealing with the nerve pain would be appreciated. Really looking forward to getting off the narcotics again. For me, it seems like they don't do much to reduce the pain, just put me in such a stupor that I don't care that it hurts.
Same for me...I'd say I had some pretty significant thigh pain for first 6 weeks...and alot of numbness which in hindsight could've been a blessing.
About the time I decided to see if I could get meds for it, it began to dissipate...replaced with intermittent zings and zaps.
Ice, ice, ice was the main go to...tired of that too I suppose.:sigh:

Patience... and time hopefully will do the same for you.
All good now!:ok:
 
Hi @TerryB_TX
It's nice to hear from you. I'm sorry you're struggling with the nerve pain.
Your dreams sound more like nightmares. I hope that ends soon. I'm sure as you are feeling
better / stronger your subconscious will let go of the gloom and doom scenarios. :fingersx:

Let's have @Josephine weigh in on your question about dealing with nerve pain. See if she has any ideas
or just re-confirms it's all part of the process that you'll have to live with temporarily.
Wishing you relief, a great day and sweet dreams tonight. :yawn: :sleep:
 
@TerryB_TX Your post, and my driving for an hour in the car yesterday on my own, just triggered a memory after my anterior hip surgery. I started driving, I think, around 6 weeks from my first surgery. Unfortunately, after 20 mins I had insufferable burning pain down the outside of my right operated leg, knee and calf, that eventually migrated all the way down my leg. No driving position would make it go away, I was constantly adjusting my seat position etc., but I would have to stop, get out, walk around, rest for a couple of minutes and then proceed, only to have it happen 10 mins later or so again. I don't remember feeling that pain laying down while recuperating, but sitting in the car with my foot on the accelerator pedal MOST definitely triggered it. But it was also my body position in my car--my first surgeon had said it would be best if I drove an SUV, which my car is not. And having been told all was well otherwise despite all my other pains and discomfort, I decided, as is my usual approach, to tough it out. But this nerve pain was actually excruciating, I can't even really describe it except that it was sharp, burning and unrelenting, always starting I was in the car driving. It was so debilitating in the car, and why the anterior surgery triggered it, I do not know to this day. I could make it go away by standing, walking around and shaking my leg out, but it always returned when I got back in the car to resume driving. Very odd.

I am not saying my nerve pain was the same as yours, but I can also tell you that it dissipated completely after a number of months from the original surgery (I want to say 4-5 months or so, but am really not sure anymore), but it did take time and was slow. I noticed I could drive farther longer as time went on, until I no longer noticed it.

And I never felt that particular burning nerve pain again, once it dissipated completely. Surprisingly, driving yesterday for a solid hour, I didn't feel it at all either and in fact I had completely forgotten about it until I read your post! So, I am hoping I will not experience this at all with my lateral/posterior revision, so far so good.
I am also hoping that time will be healing to your nerve pain too. It definitely was my experience, and if the implant had taken, my healing was otherwise pretty seamless after anterior. But it also has been with the posterior, so each I suppose has its benefits and disadvantages. Keep us posted on your progress, and try not to worry too much, as pat as that may sound! Keep on doing your only job right now, which is to follow instructions and then rest plenty, let your body get on with the business of healing!
 
I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?
 
Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.
 
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
Outside of knee and up about 5-6 inches, 0-8, none when knee is extended, rises to 6-8 when flexed beyond 45 degrees
Outside of mid-thigh, 2-6, aching, tingling, pain increases over course of day, especially after sitting for long period

3. Pain Meds
Gabapentin 2x 300 mg per day (total 600 mg/day)
Hydrocodone/Tylenol (10 mg/325 mg), once at bedtime
Tylenol 2x 500 mg, every 6 hrs, I substitute the hydrocodone/Tylenol (above) for one of the 500 mg Tylenol at bedtime (total 3825 mg/day)
Tramadol 50 mg, twice per day, typically once 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, short strolls to relieve boredom and stiffness, always still with walker

7. Exercises at home

ankle pumps, 30 reps, 8-10 times a day
quad squeezes, 30 reps, twice a day
glut squeezes, 30 reps, once a day
First week I also did long and short arc quad extensions, but stopped these second week post-op due to knee pain when flexing knee
No additional PT at home or outside

Thank you @Josephine. I've been trying to follow the BoneSmart guidelines for exercise and PT. My wife is convinced my previous loose stem was caused, at least in part, by being too aggressive with exercising too much too soon after my original THR. She's keeping me on a short leash this time.
 
@chalcedonian1 , the pain you describe while driving seems almost identical to what I'm experiencing. Burning, aching, unrelenting when I'm in a sitting position with my hips at 90 degrees and knees flexed downward. I can only relieve it by getting up and standing, stretching, or laying down with my legs out straight or elevated. My knees are so limited in flexion range at this point that I can barely sit at a table or get in or out of a car.

I've read either here or elsewhere that nerve pain is a common side effect of the anterior approach. My understanding is that a sensory branch of the femoral nerve runs right near the area that is invaded to access the hip joint in this approach. I can't seem to manage the pain with medications or even icing. The only thing that seems to help is laying down and stretching out my legs. I feel like such a sloth because that's about all I do anymore.

As long as I get confirmation that this is indeed just nerve pain, that's fine, I'll get through it. The pain on the side of my mid-thigh is very similar to what I was feeling in the last weeks prior to my revision surgery, and that makes me nervous. Is it happening again? Perhaps the loose stem just prior to revision was beginning to irritate the femoral nerve. I have no clue. My surgeon's office says it's just nerve pain, but after my loose stem experience, I've become skeptical and I'd like to have independent confirmation.
 
Wishing you comfort and peace of mind, Terry.
It's sad your mind goes to the bad place but I certainly understand.
I know I'd do the same. Just try not to linger there.
Hopefully Jo's words will console you.
Wishing you a lovely weekend!
@TerryB_TX
 
2. Pain Levels
Front of Hip: 0-2, aches a bit with use, very tolerable
Outside of knee and up about 5-6 inches, 0-8, none when knee is extended, rises to 6-8 when flexed beyond 45 degrees
Outside of mid-thigh, 2-6, aching, tingling, pain increases over course of day, especially after sitting for long period
Interesting!
3. Pain Meds
Gabapentin 2x 300 mg per day (total 600 mg/day)
Hydrocodone/Tylenol (10 mg/325 mg), once at bedtime
Tylenol 2x 500 mg, every 6 hrs, I substitute the hydrocodone/Tylenol (above) for one of the 500 mg Tylenol at bedtime (total 3825 mg/day)
Tramadol 50 mg, twice per day, typically once during the night, once during the day
I suggest you switch to the Tramadol instead of the hydrocodone. I think it's a better pain med

I used this after my TKR
aa Tramadol routine 1.JPG


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)
Good.
5. Elevating toes above nose 10 hours a day
Good
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, short strolls to relieve boredom and stiffness, always still with walker
Good

ankle pumps, 30 reps, 8-10 times a day
quad squeezes, 30 reps, twice a day
glut squeezes, 30 reps, once a day
First week I also did long and short arc quad extensions, but stopped these second week post-op due to knee pain when flexing knee

No additional PT at home or outside
I suggest you stop all these.
The ankle pumps are only required for the first few days after surgery when you're not very mobile.
Squeezes, the same.
I've read either here or elsewhere that nerve pain is a common side effect of the anterior approach.
It can occur but it's not common. Mostly such pain is just after-surgery pain.
I feel like such a sloth because that's about all I do anymore.
Stop thinking of it like that! Right now your body (NOT 'you'!) is working hard healing. Be satisfied with that.
The pain on the side of my mid-thigh is very similar to what I was feeling in the last weeks prior to my revision surgery
But this is just after-surgery pain. Nothing more. You need to try the Tramadol/Tylenol routine I left you earlier.
 
@Josephine , thank you for your feedback. Glad to hear you believe it to be normal post surgery pain. I don’t think I’d seen many accounts of knee flexion pain on this forum, so this was concerning to me. I wonder if it could be referred pain. @chalcedonian1 mentioned she had lower limb pain, and everything appears to be turning out well for her.

I’ll call the surgeon about switching to Tramadol. It makes me much less dopey than the hydrocodone. I had been using leftover Tramadol from a previous injury, so will need to ask for a new prescription.

Thank you for your continuing encouragement, @Layla . It means a lot to me. I have much more peace of mind with Josephine’s feedback. You have a great weekend too!
 
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@TerryB_TX You've got to just love @Josephine!

I think the most important thing you can do for yourself is to really, truly accept and acquiesce that you will be lying around a lot more than maybe you originally anticipated, as annoying as that is! And remember Josephine's words that your body is hard at work healing inside, even though you can't see it obviously. The healing process for the body is at whatever pace nature allows after the assault of surgery--even for so-called "minor" surgery. There is nothing that can be done to accelerate that biological process until a certain amount of biological healing (and bone growth) has occurred. As you mentioned, anterior and posterior each has its advantages, but both are major surgeries of course and a revision most certainly a bit more so. No need to strive for an A+ here in terms of being active, let your body use all its energy towards healing internally, it is already plenty active inside that hip and thigh. It probably goes against personality type for you to think this way, as it did for me, but maybe your wife is on to a little something--let all your energy go to healing. Nevertheless, do also try to remember failed bone growth is not your fault, Josephine resoundingly said that to me, so please don't automatically blame yourself even though I know it is maddening to not know why it happened the first time.

When I had that intolerable nerve pain after my first surgery, it was only when my leg was in the seated position and knee was flexed (e.g., when driving), most of the rest of the time I was at home with my legs extended out flat, either sitting on a couch sideways or on my bed. I might have done that because sitting in a chair triggered that same pain, but I honestly don't remember, and I wasn't as smart as you to attribute it to knee flexion when clearly that's what was happening. I do remember thinking I would go insane if the pain did not calm down when I drove, it was the weirdest, sharpest, scariest burning sensation I had ever experienced (I could never understand on the pain scale what "burning" inside your body meant, until I had this kind of nerve pain). OMG. Anyhow, I had to stop driving for longer periods (the pain would start up after about 15 -20 minutes), and I didn't "sit up" in a chair for very long either during that time--quite a number of weeks, not just a few weeks, so strap in. As I said, the great news is that it did finally dissipate COMPLETELY. I even forgot about it totally until your post, but it was a force to be reckoned with.

It is so easy to jump to conclusions when your implant has failed already once. Yet this time around, there are many things going right with you which hopefully will lead to success. And you are using your friend the walker, icing a lot and feeling like a sloth! So be it, this too shall pass. Just fyi, I was in another all day meeting yesterday (had an earlier one this week, too), did not get home until 8:45PM, went straight onto the bed, iced, and then went to sleep early, and this morning I am OK. I sat for over 7 hours in this meeting, had to use my poor brain to think, I got up and stretched a few times, drove home for an hour afterwards. I was stiff by the time I got home--this is also a product of arthritis elsewhere, like in my lower back, but today I feel pretty good, no limp or sharp pain in my hip. Just a few short weeks ago I was muttering about having no brain, no stamina and I still had groin pain, but apparently I am getting some energy back and healing is still occurring, groin pain may be gone, not yet sure. My big test will be getting back to the gym, but I absolutely will do nothing to upset this "oh-so zen experience" (said sarcastically of course). My surgeon said no PT (not even heel slides or pumps or squeezes, etc.), and nothing weight bearing or athletic, including swimming, until at least 4 months after surgery. Just gentle walking. I will see him for an x-ray at the end of month 3 and get the all-clear from him for weight lifting etc. at that appt. for the end of month 4. It isn't quick, but it is happening even when I don't notice it. Right now I am 9 1/2 weeks out, and I think I am doing OK. So I remind myself that patience usually pays off, even if trying to be patient is in itself a chore! Have a nice weekend, rest easy, and check back in with us when you can.
 
I wanted to chime in regarding the nerve pain. I had posterior and had horrendous nerve pain for 6 months. It would strike out of the blue but mostly after sitting. But not always. The Gabapentin truly depressed me and I had odd dreams much like you reported. I think I discontinued it around 4 weeks. I had knee pain as well. So much that I ended up getting a cortisone injection. I am just now, after 18 mos getting my muscle strength back. And next week is my revision! Dr K promised my recovery this time around will not be as rough as the first. Best of luck to you in this journey. Thank you for sharing.
 
@chalcedonian1 , Yes, it's time for me to accept that this recovery is going to be every bit as long and fatiguing as the first. I guess I had visions of a much quicker recovery from all the hype I had heard about the anterior approach. Perhaps it will come to pass, but at this point in my recovery, I don't see it.

I'm now three weeks post-op. My upper thigh still feels like an overstuffed kielbasa. Rock hard and warm to the touch despite all the icing and elevation. This swelling is taking longer to subside than I had expected. Perhaps my expectations were unrealistic. I don't remember anymore how log it took for the swelling from my first surgery to subside. I'm a naturally impatient person, so this recovery is making me crazy. I just want to get up and out and start doing things again. But I know that patience is key. I need to reset my expectations. They were probably unrealistic to begin with.

I'm getting more of the occasional tightness and pulling and little jabs and pinches of pain in the hip and incision area, but these are quite tolerable. The unrelenting, burning thigh pains seem to have plateaued and appear now to be receding in intensity. The knee flexion pain is still there, but avoidable as long as I don't try to move my knee toward the 90 degree point. I recognize the challenges you've had with driving. I don't drive or even ride anywhere because I have to slide my butt all the way up onto the center console just to get my leg inside the car! I'm resigned to staying housebound till I get a little more flexion in my knee.

All-in-all, I'm still feeling very confident in a successful outcome. Just a little frustrated that it's taking longer than I had hoped. In the end, it won't matter if it takes a few more weeks or a few more months as long as it works. All indications so far point toward success.

I'm so happy to see your progress. It truly gives me hope. And your coaching me through this revision experience has been a life-saver. I can't imagine going through this alone, without the help and encouragement of all the kind, knowledgeable people on this forum. And yes, @Josephine, your reason and experience help keep my mind from flying off into the odd tangents of catastrophizing that is its natural tendency.
 
@Hipster63 , I really don't know anymore whether my pain is nerve pain, muscle trauma, or just pain from residual swelling. I don't have the knowledge to distinguish between them. The third week was better than the second, so it is definitely improving. I dislike being on any medication so the challenge for me is knowing when to discontinue them. At one week I tried getting off the narcotics completely, but found that was too early. I'm not having the side effects from the Gabapentin you describe, but I'd like to drop that med as well. I just don't know if it's doing anything. I'll probably wait another week or so and see how the knee flexion and thigh pain trend. If it continues to improve, I may begin to cut back.

Regarding my knee pain, I don't believe there is anything structurally wrong in the knee. I can move it without any pain at all to about 45 degrees. The only time I feel pain is when I flex it more than 45 degrees, then comes the burning sensation on the outside of, but not within the knee.

I don't know if my dreams are cased by the gabapentin. Despite their nature, I find them mildly amusing, not distressing at all. I had another one the other night in which I was fending off an attack of some sort by throwing frozen bottles of water, the ones I use in my ice machine! Just silly, obvious stuff like that.

Your surgery date is almost here! I know it is disheartening to think you're about to enter into another rehab so soon after the first. I felt the same way. But the sooner you get started with the final fix, the sooner you will get back your pain free, mobile life. That incentive is what made me move as quickly as possible once I had a confirmation of the problem and a clear path toward resolution.

Dr. K made no promises to me regarding recovery. In fact, he prepared me for a pretty conservative recovery schedule. While I don't think anybody can give guarantees when it comes to recovery times, I think you can take heart in his belief that yours will be easier for you this time. I wish you luck and a speedy recovery!
 
@TerryB_TX I attended the "hip class" yesterday that is mandatory for hip patients. I was impressed at emphasis the hospital puts on infection control. Wow! Overall, I'm ready but scared. The nurse educator stated most of us in the class would only stay 1 night in the hospital. Honestly, I'd like to stay 2-3! The spinal block will probably wear off just as I leave for my 1 hour drive home :)
 
I left the hospital the next day. I didn’t think it was possible — but it was, @Hipster63. Spinal block wore off for me about three hours after surgery (yes I know you were joking, but anyway....).

I appreciated that they didn’t want me to catch MRSA or Staph or anything...
 
@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.
 

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