THR DonnieP's Hip Recovery

[Mojo333]

There is merit in weight bearing...

Stress shielding refers to the reduction in bone density (osteopenia) as a result of removal of typical stress from the bone by an implant (for instance, the femoral component of a hip prosthesis). This also occurs underneath bone plates and intra medullary rods.

How does stress shielding happen?
The science of it is that bone growth is stimulated by loading or weight bearing. Consequently anything that relieves the bone of weight bearing is likely to incur osteopenia. Non-traumatic examples of this are

1. long term bed rest which is common in pre-twentieth century ailments when

patients could be confined to bed for months with conditions such as pulmonary tuberculosis, heart conditions such as heart attacks or heart failure. Conditions where nowadays, patients are encouraged to be up and ambulant within a day or two​

2. having a leg in a plaster cast or requiring non-weight bearing for prolonged periods

of time, implying a matter of 3-6 months​

3. the most well known case of this problem was when man started to explore space.

It’s well-known that in space, the human body is weightless and therefore osteopenia will be more than likely to occur. After the first trip around the moon, it was generally expected that when the astronauts took their first step out of the recovery helicopter onto the ship, in at least one of them a bone in their leg would just give way. Later journeys and in the Space Station, exercise was an important part of the daily routine for astronauts aboard the station to prevent bone and muscle loss. On average, astronauts exercise two hours per day.​

The equipment they use is different than what is used on Earth. Lifting 200lbs on Earth may be a lot of work. But lifting that same object in space would be much easier. Because of microgravity, it would weigh much less than 200 pounds there. That means exercise equipment needs to be specially designed for use in space so astronauts will receive the workout needed.

​

How does bone grow/heal
The pathology of bone growth is that stem cells, the bone equivalent to a foetus, are developed in quantity within the medullary cavity by small organisms call pre-osteoblasts. Just like it mammals, not all these cells go on to develop but most do and develop into immature bone cells, osteoblasts, which rest in the cancellous material in the centre surface of the hard bone. Over a few days, these grow and develop and gradually move into the hard bone.

One little known fact about bone is that it is continually growing from within out, just like skin. Over the next few weeks, the baby bone cells mature and migrate towards the outer surface of the bone where they die and are absorbed by other organisms called osteoclasts. This is how a bone grows or heals after injury.

Interesting note: did you know that bone is the only tissue in the body to NOT leave a scar when it sustains an injury? This obviously excludes very major fractures.

 

[Celle]

Here is a link to the article under discussion:
https://startingstrength.com/article/rehabilitation

When discussing sources of information, BoneSmart does require a link, please.

I don't want to rekindle an argument, but Mark Rippetoe is a strength training coach. Strength training is very different from rehabilitation therapy.
According to Wkipedia, he holds a Bachelor of Science degree in petroleum geology, but does not appear to have any medical qualifications.

 

[Mojo333]

According to Wkipedia, he holds a Bachelor of Science degree in petroleum geology,

Well there you go!
He has a degree..
Thanks for the added info Celle!

 

[Josephine]

I will do PT again because I am young

@Toddlermom 45 is not particularly young - not in the THR world!

I should probably go down to the local university to suss this out and see if there are any studies

@Bone-obo Don't waste your time! There aren't any! But I've persuaded a professor to consider this as a research topic so hopefully in the next year or two, we might actually get a study going!

In terms of PT, the profession is very hit and miss with its practice it seems.

It surely is and very little in the way of peer-reviewed material. If it's the last thing I do on this earth, it will be to see such a study published!

the author gives an example of a heart attack.

Let me tell you about the history of MIs (myocardial infarction). When I started nursing back in the dark days of the 1950s, a heart attack patient was confined to bed on TOTAL bed rest for at least 10 weeks, more often 12. This meant he wasn't allowed to wash himself, feed himself or even turn over in bed! We nurses had to do all that for him! Hardly surprising then that most of them died within weeks of another catastrophic MI. Nowadays, they are up and in therapy within 48hrs and discharged withing days. Then they have to go to the local gym where, under the care and supervision of a suitably qualified 'heart nurse' they spend at least 1½hrs on every machine, first at about 5 minutes but fairly quickly building up to about 20-30 minutes - on each machine! And the survival rate of MIs is extraordinary!

he just shook his head and asked how long is a piece of string?!

That/s my favourite phrase or saying!

Of course it's necessary to stress your muscles to make them stronger. I'm not sure the same applies to tendons, but let's assume it does.

The thing to bear in mind with tendons is that unlike muscles, they are not very blood rich. Which is why the more important ones (like the Achilles) can appear to heal but then fail again and very likely fail again!

It's the difference between "hurt," which can be good in the context of working out, and "injured," which is just going to be exacerbated by stress.

@JoeKnows I very much doubt the various tissues know the difference between hurt and injured! I also believe that these tissues have a memory for pain so if you stress or overload them and they become inflamed and painful, it's very easy for them to return to that pain response when faced with a similar activity. Meaning that if you have a period of pain from activity and it appears to resolve, it can flare up again very quickly without much of a stressor.

 

[Eman85]

The more you look around at healthy sahll we say "older" people the more you notice that they weren't "atheletes". Most walked a lot for enjoyment and did things like yoga. Most hard workers and athelets end up broken down having joint replacements.

 

[dlp]

athelets end up broken down having joint replacements.

Johnny Bench and I have the Stryker ADM X3 in common - just wish I had his income in common.

 

[DonnieP]

Thank you for all for such great responses. Wow, so much experience and insight truly helps me, and others, I hope, to figure out how to manage our own way through rehab.

Tomorrow will be day 14 post-op and I'm scheduled to have my staples removed (44 of them, lateral approach performed). If asked if I've started PT (and I bet I will, I can feel it coming) I'll explain that I've decided to postpone PT to give myself time to heal. Hopefully I won't be labeled 'non-compliant' but probably will be. I went into surgery almost immobile because I waited way too long to have the surgery. Now I need to strengthen and rebuild muscle but I'm so behind the curve that if I push it too fast I know I'll make myself miserable. Now that I have a new hip to use, I hope it'll bring my weak muscles along for the ride. If in a few months I don't seem to be making good progress I might consider PT, especially if my gait hasn't improved. Someone mentioned 'gait training' - have to look into that! Honestly though, I've been to PT half a dozen times with different therapists and what they offered me was the 'normal protocol' I assume - squeeze ball between legs 10 times, lift heels 20 times, leg slides, using bands, etc. I'll never use the bands again though, I think they are really bad and hard on new hips.

I'm anxious to find out if my leg lengths are more equal now, I really hope they are. I asked my OS if he could work on getting me even (prior to surgery) and his response was, absolutely, but giving you a stable, secure hip is my first priority (I have a great doctor that gave a great answer).

Since it's been 4 years since my first THR (right), and I don't recall, can anyone comment on how long it took to feel comfortable ditching the walker and walking unaided? I'm so excited to be able to walk and walk and walk and enjoy being out again. I tell my daughters that people take their mobility for granted and they shouldn't (but I did, when I had it..).

Now, if I can just get some sleep and actually sleep in my own bed instead of this recliner (which I've always loved but am now starting to dread being in) I'll be thrilled!

 

[Celle]

Tomorrow will be day 14 post-op and I'm scheduled to have my staples removed (44 of them, lateral approach performed). If asked if I've started PT (and I bet I will, I can feel it coming) I'll explain that I've decided to postpone PT to give myself time to heal. Hopefully I won't be labeled 'non-compliant' but probably will be. I went into surgery almost immobile because I waited way too long to have the surgery. Now I need to strengthen and rebuild muscle but I'm so behind the curve that if I push it too fast I know I'll make myself miserable. Now that I have a new hip to use, I hope it'll bring my weak muscles along for the ride. If in a few months I don't seem to be making good progress I might consider PT, especially if my gait hasn't improved.

That sounds like a very sensible approach, @DonnieP .
One of the things that I think a PT therapist can be most helpful about is gait.

My surgeon doesn't allow any PT at all for the first month after a knee or hip replacement. He says your joint needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good mobility, as I did.

 

[Eman85]

You might laugh until you try it. I found the best walking aid to be a shopping cart. It was winter when I had my THR so once I could drive, 2 weeks, I would drive to the local super store. I'd park near a cart corral that had a cart and I could leave my cane in the car. I'd use the cart to walk from there, through the store at least a full lap or so, and then back to the cart corral next to my car. The cart allows you to concentrate completely on your gait.

 

[Bone-obo]

Now that I have a new hip to use, I hope it'll bring my weak muscles along for the ride.

You will, but you might have to relearn how you move first. If you're like most of us, you developed a peculiar gait because of pain, and possibly bone spurs (my personal bête noir). Now you'll want to consciously start tweaking how you move to favor your new capabilities. To refine my gait, I "followed" people with a healthy walk, usually at the mall. (And at a distance!!) The idea is to flow when you walk. If you fall behind the people you're following, lengthen your stride instead of taking quicker steps. Notice the timing of their walk, and see if you can walk in lock-step. It might make you sore at first (there's those weak muscles starting to perk up), but you'll get the hang of it and be stomping along like a boss in no time!

 

[Jamie]

@DonnieP ... I notice that we don't have your surgery information in your signature. If you would please provide the dates of both your surgeries, one of the staff will create a signature for you. Having this information at hand helps us provide better information and advice for you.

 

[DonnieP]

Jamie, here are my previous surgery dates:
Total LKR: August 2013
Total RKR: December 2013
Total RHR: August 2014
Total LHR: September 2018

 

[DonnieP]

Thank you for the replies. I do need help with my gait. Unfortunately, I've been dealing with another issue now.

I developed an humongous hematoma at my incision.

Three days ago I went to have the staples from my surgery removed but they would only remove some of the staples (not all) because the hematoma was making my incision area swell. I was instructed to massage the incision vigorously to help the hematoma reduce/go away.

It's about the size of a extremely large grapefruit, very hard and makes my whole hip and leg hurt. It's been there for about a week and I'm not a happy camper. Ugh.

Anyone else had this problem?

Oh, and if anyone does, don't try a heating pad if you still have staples in!!! You can imagine what happened when I did this. Metal staples get hot and there's no way to get out of the situation, needless to say. Not one of my brighter moves...

 

[Layla]

Aww, I'm so sorry! Let's ask @Josephine to weigh in on the hematoma and any ideas she may have to help it resolve. The thought of hot staples embedded in flesh makes me cringe. Hopefully you placed ice to cool them off quickly. Wishing you comfort as you move through this set back.

I tell my daughters that people take their mobility for granted and they shouldn't (but I did, when I had it..).

Isn't that the truth I often express that this experience presents many opportunities to realize what we took for granted and to give thanks for second chances. We're blessed! In the not so recent past many had no other option but to use assistive devices for life so they could hobble around, or be pushed along in a wheelchair.

I hope you have a peaceful week.
@DonnieP

 

[Bionic]

@DonnieP
I can't offer any advice with the hematoma. It sounds horrible. Just hoping it doesn't hang around long and you can then have a good recovery

 

[Josephine]

I developed an humongous hematoma at my incision.

How about posting a photo for me? Preferably with a finger in shot or something to give me perspective.

don't try a heating pad if you still have staples in!!! Metal staples get hot and there's no way to get out of the situation

You could have put ice on it to cool them down!

 

[DonnieP]

Hello all! My apologies for not posting sooner but I just wasn't up to it. My surgeon saw my very large hematoma last Tuesday and asked if I'd like it removed. I agreed, and was thrilled that he thought removal was the best course of action because I certainly did. No way was that large of a hematoma going to go away anytime soon and was only getting larger. I was readmitted into the hospital and underwent surgery on Thursday. I told him I thought it was softball size and he agreed - it was softball sized! I spent one night in the hospital and came home this past Friday afternoon. It is now Monday evening that I write this. I think the size of the hematoma was of great importance in the decision to remove it. He said initially he made a 3 inch incision but couldn't get it out so he made a 6 inch incision and scooped it out (hope I'm not grossing anyone out).

Hopefully now I can begin my road to recovery. I'm on antibiotics every 6 hours and praying that there is no infection. My surgeon says he doesn't think there is.

Also, I didn't post a pic of the hematoma because I couldn't figure out how to take the pic without showing a lot of what shouldn't be shown on this forum or any forum!

Thank you all for your support and kind replies. I'll keep updating also.

 

[Alitm]

@DonnieP So sorry about the hematoma! Yikes! Great that your OS removed it and you are on antibiotics. Let the healing recommence! Really glad you got that sorted out, and that you are doing well with it now.

I had my two week check up last Tuesday, staples removed etc. OS said to continue to walk only until six weeks, but not to do any formal physio for the hips. This was his instruction from post op to the two week check up as well. I asked why no formal physio. He said that the new hip capsule is forming around the prosthesis (from scar tissue) and the other soft tissue trauma from the surgery needed to heal (I had posterior approach). This process takes about six weeks, and my next visit with him is at that time. He said I should walk as much as I am comfortable in doing, as this aids the body in laying down the scar tissue in a more uniform way. I know this to be to be true through my work with soft injuries in my competition horse and subsequent rehab. My equine vet was very thorough in the explanation of that rehab and I did a lot of research about it.

I went to see my physio anyway, only because I wanted to adapt previous upper body and core exercises to accommodate my healing hip, and not mess around with my hip in any way as per my OS's orders! I am heading into my second hip replacement surgery at week 8 post my first surgery, Nov 8, and want to be as fit as possible. One of the interesting points my physio mentioned was, that by exercising my upper body and core etc., I would be inadvertently being exercising my lower body to some extent. He explained that research with stroke victims have showed that by working their non affected side, it provided some strengthening on their affected side, before actually working the affected area. I don't understand the physiology/neurology behind that, but found it very interesting non-the-less. What physio found from my walking since surgery day, and also my fitness going into surgery, that despite not doing the formal exercises given by the hospital booklet and hospital physio (who seems to be disconnected from the surgeon's orders!), I was able to do a "heel slide" with excellent ROM for where I was post op, and able to lift my legs (both op and non op) onto the phsyio bed with no problem or assistance.

My OS doesn't seem very "global" in his dispensing of info, so I'll have to see what comes next at six weeks. I'll have two weeks from that point until my next surgery, so will only be able to fit in the next phase for that period of time..... as then I'll be back to the starting gate with the second surgery.

Wishing you the best in your healing!

 

[Bionic]

Hi @DonnieP
Wow that hematoma sounds nasty and I am glad they removed it for you. Give yourself a few days to get over this lot of surgery and then hopefully you will feel the benefit

 

[Mojo333]

Ouch! Softball size, that does sound painful!
no infection so we can get this show on the road.