THR Eight Weeks Post Op Still In Pain

[Mark Fitzgerald]

This forum is a Godsend--have so appreciated reading it. My story: I am 59, in good shape and a cyclist and I had left anterior THR June 3. One night in hospital then home. Three weeks of PT. Now eight weeks later still in pain. Have never been fully pain free. Using cane still for getting around. Without cane, weight bearing on operated hip causes shooting pain right down my leg, especially on the side, in my knee and shins. A 4 at its worst. If I rest it, it tends to get a bit better. Trouble sleeping at night as operated side gets sore and I have to turn over. Had a post op meeting at 5 weeks and XRays, according to surgeon, showed everything progressing well. Weird side story: at seven and a half weeks developed a staff infection in my elbow that necessitated surgery and bursa removal. Three days of heavy duty IV infusion followed by two weeks of oral antibiotics. Hand surgeon assured me infection could not have come from my hip. Visited hip surgeon again this week. He looked at wound and said it is "ok" and that he thought I was having IT band issues; his PA suggested bursitis as well. Both directed me to walk as little as possible, to ice and to do gentle stretching excercises.
I am pretty disheartened. Thought by now I'd be off cane and biking again. In terms of infection, I have no fever, nor night sweats, or undue swelling and no fatigue. I am a pack a day smoker and wonder if that habit has hurt my recovery. My hip surgeon, who is a very great guy, asked me to come back in two months if it was not better, or sooner, if the pain worsens.
Thoughts? Thank you.

 

[Layla]

Hello Mark, Welcome to BoneSmart! Thanks for joining us. I’m sorry you’re struggling and feeling disheartened at eight weeks post op. I’m going to address a few things you mentioned via quotes...you’ve shared a lot.

Three weeks of PT. Now eight weeks later still in pain. Have never been fully pain free.

While you can still have pain at eight weeks post op I’m wondering when did your PT start and end? Wondering if that’s part of your problem. PT really isn’t necessary and often cause people unnecessary pain.

Not sure if you’ve iced at all but it is a great pain reliever and helps with swelling. Ice any areas of discomfort for 45-60 mins, no less, each time you ice. Always place fabric between skin and the ice source.

Using cane still for getting around

Not unheard of at only eight weeks post op.

Trouble sleeping at night as operated side gets sore and I have to turn over.

Have you tried a pillow between your legs? It helps tremendously in my opinion.

Weird side story: at seven and a half weeks developed a staff infection in my elbow that necessitated surgery and bursa removal. Three days of heavy duty IV infusion followed by two weeks of oral antibiotics.

Thinking you have the timeline wrong here as it‘s not making sense according to when you had surgery. Can you please clarify?

I am a pack a day smoker and wonder if that habit has hurt my recovery.

This could be hindering your recovery, but I’m sure you’ve heard all the lectures and been cautioned on this already. My hope for you is that you gain the motivation and determination to lay them aside and walk away.

Even though you’re eight weeks post op, I’ll leave the BoneSmart Recovery Guidelines as some info may still be beneficial.

Please give yourself more time. It does some longer than others.
Wishing you comfort as you continue healing. Stop back often, we’ll be here for support and encouragement and would love to follow your healing journey awhile longer.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for THRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

Pain management and the pain chart
Healing: how long does it take
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask the at each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
@Mark Fitzgerald

 

[Layla]

An article on IT Band and another on Bursitis

ITB (ilio-tibial band) issues and treatments

The IT band is combination of muscle with a covering of tough fibrous bands called fascia. It starts on the outside top of the pelvis, passes over the greater trochanter of the hip, down the outside of the thigh and inserts into the side of the patella (knee cap) and the tibia, (shin bone). It...

bonesmart.org

Trochanteric Bursitis with THR

To explain about bursas - they are a natural little sac made by a) an extrusion of the joint lining (synovial membrane) in any joint or b) a natural pocket over a bony prominence. The little folds need to be there to allow for movement much like you need pleats in a blouse so it doesn't stop you...

bonesmart.org

 

[Mark Fitzgerald]

Thanks so much for quick reply! To answer your questions: started PT three weeks post op, ended two weeks ago and have not done any excercises since then save for gentle IT band stretches.
Elbow infection: this was diagnosed and treated with bursa excision surgery seven weeks after my THR. As I said that hand surgeon who treated me said infection probably developed through psiroasis in my elbow. He also said unrelated to THR surgery. Could infection have been present in hip and migrated to my elbow?
I use pillow between my legs and it helps somewhat.
My big fear is infection. As I wrote my wound is, according to hip surgeon, looking okay. Question: can implant loosen as quickly as 8 weeks post surgery? Is it reasonable for surgeon to ask me to give it two more months and then go back for consult?
One more note: while I was undergoing antibiotic infusion for elbow, pain seemed to lessen in my hip? Coincidence? Or perhaps it was elbow operation forced me to slow down and rest.
Thank you!

 

[Layla]

Any negative effects from PT can take several weeks to dissipate. For a couple weeks I’d try the icing and walk as your only form of exercise, but not to excess.

Have you talked to your surgeon about the elbow infection? I’d most likely do that, if you haven’t already.

As far as the pillow, I use what’s called a Body Pillow that I purchased inexpensively at Target ($10) they have them at many of those type of stores. I like it because of the dimensions. It’s longer and provides more balanced comfort in my opinion. Something to consider.

Most everyone fears infection, but I understand especially why you do for a couple reasons. Consider having a heart to heart with your surgeon, or a member of his care team expressing your concerns (infection, loosening) and a desire to meet again sooner than two months out for your peace of mind. I’m sure they’ll accommodate you and hopefully you’ll receive the reassurance you’re seeking.

A peaceful Sunday to you.
@Mark Fitzgerald

 

[Jaycey]

I am a pack a day smoker and wonder if that habit has hurt my recovery.

You have probably already heard this but smoking does inhibit bone growth. Sorry, but it's just not good when you are recovering from joint replacement.

Could infection have been present in hip and migrated to my elbow?

Probably not. But if you experience any unusual swelling, fever or heat around your hip incision I would get in touch with your surgeon.

Question: can implant loosen as quickly as 8 weeks post surgery?

Assuming you had an uncemented implant, the bone growth around the implant is very much work in progress right now. That's what your surgeon will be checking in x-rays. He probably compared the first post op x-ray to a more recent one. And he may do that again in 2 months.

Or perhaps it was elbow operation forced me to slow down and rest.

I think this is probably the case. Try backing off activities and more ice and elevation. Bursitis and ITB issues post THR are almost always cause by too much activity.

 

[Hip4life]

Wow. Talk about bad luck. I have my take. Having any major surgery stresses your immune system. So what might have been fought off in your elbow was able to take hold. Glad the docs feel they have that under control. I had pain continue in my groin post op. To be clear, the joint pain was gone but it’s hard not to worry about these other things. At about 10 weeks, my OS said to give it some more to allow things to settle and heal. A couple of months later we had to pursue treatment for tendinitis. There is no reason to worry at this point that will happen to you. You really need to give your hip that extra time to heal especially with the extra hurdles your body is navigating. I used my cane until about 12 weeks out until my limp was gone. It’s just another tool to help your recovery. Keep us posted.

 

[Mark Fitzgerald]

Thank you so much. I called surgeon, a friend who tells me to use his cellphone if I have any questions, and he said: 1)Does not think it is infection, as I have none of the symptoms save for pain 2)Cannot do blood test to rule it out this soon after surgery as numbers can still be high 3)Reassured me given my symptoms that it is more than likely IT band/bursitis and to rest, ice and do gentle stretching and keep using cane. If it is not better in a month, I am to get in touch with him. 4)Said elbow infection was serendipitous, a weird coincidence
Again--thanks for your quick and compassionate response.

 

[zauberflöte]

@Mark Fitzgerald I had to laugh! As I read your first post, I said to myself wow that sounds like IT band and bursitis if it were me. And your OS agreed!

We are all too prone to be concerned about this or that pain, but if your surgeon is happy with your progress, including your elbow (scary!), hopefully you can take a break from the worrying and just rest and ice. And try to go cold turkey on the cigarettes. I am sorry you are stuck with that.

 

[Layla]

Happy Two Month Anniversary, Mark!
With any luck some icing and rest over the weekend is helping with your discomfort.
Keep on resting and icing as time allows.
Here‘s to you feeling stronger and better everyday. Take good care!
@Mark Fitzgerald

 

[Layla]

Happy Three Month Anniversary!
I hope all is well and your concerns were relieved. Please leave us an update if you stop by. We’d love to hear how you’re doing. Fall is quickly approaching, I hope it’s a good one for you.
@Mark Fitzgerald