THR gwenc's recovery
- Thread starter gwenc
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gwenc
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@Josephine - I am wondering if you can answer a question for me. If a stem becomes slightly loosened at 3-6 months post op, will it definitely require surgery to correct, or can it heal and tighten up again with complete rest (basically starting recovery over)? Obviously if its VERY loose or causing extreme pain this would not be an option, but just curious if bony ingrowth can restart and rectify a loose stem if its not too severe? I find this whole subject of joint surgery and recovery fascinating, and want to learn as much from you as I can!
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Josephine
NURSE DIRECTOR EMERITA
Nope, never ever. It's to do with the nature of bone growth. To simplify it, let's talk about a fracture.
If a bone is broken and secured either with a cast or with screws and such, the object of it is to hold the fracture site absolutely secure and in contact, one side against the other. This allows and even encourages the new bone growth to be created between the broken surfaces. Over a period of time, new bone is grown and eventually joins the two surfaces together and the fracture is healed.
However, should this new growth be disturbed, usually by movement, then the healing process is arrested, the surfaces of the bone lose their freshly fractured state and seal, eventually becoming much like the cortical or surface bone. So healing has failed.
In an uncemented hip, the surfaces are now represented by the inside of the bone and the surface of the stem which is coated with a substance called hydroxyapatite which is attractive to new bone cells so the melding oof new bone between the real bone and the stem is allowed to take place.
However, just like fixing a fracture, the two surfaces have to be accurately placed and securely fixed to enable good bone growth. The contradictory issue here is that this bony growth is actually enhanced by longitudinal pumping pressure, such as in walking. The more of this pumping action that occurs, the healthier the ingrowth will be. Hence the contradictory advice about non-weight bearing that some surgeons believe is necessary. (Never could figure that one out myself! But it's a fact)
Now if somewhere in this process there is a problem - either the surgeon has not made sure there is a really tight and accurate fit of the stem in the bone, or there is some other reason this growth is arrested, then the bone will die back and seal over, making it impossible for any further new bone to develop.
Hence the answer to your question is a very definitive 'nope not ever'. Does that answer your question?
If a bone is broken and secured either with a cast or with screws and such, the object of it is to hold the fracture site absolutely secure and in contact, one side against the other. This allows and even encourages the new bone growth to be created between the broken surfaces. Over a period of time, new bone is grown and eventually joins the two surfaces together and the fracture is healed.
However, should this new growth be disturbed, usually by movement, then the healing process is arrested, the surfaces of the bone lose their freshly fractured state and seal, eventually becoming much like the cortical or surface bone. So healing has failed.
In an uncemented hip, the surfaces are now represented by the inside of the bone and the surface of the stem which is coated with a substance called hydroxyapatite which is attractive to new bone cells so the melding oof new bone between the real bone and the stem is allowed to take place.
However, just like fixing a fracture, the two surfaces have to be accurately placed and securely fixed to enable good bone growth. The contradictory issue here is that this bony growth is actually enhanced by longitudinal pumping pressure, such as in walking. The more of this pumping action that occurs, the healthier the ingrowth will be. Hence the contradictory advice about non-weight bearing that some surgeons believe is necessary. (Never could figure that one out myself! But it's a fact)
Now if somewhere in this process there is a problem - either the surgeon has not made sure there is a really tight and accurate fit of the stem in the bone, or there is some other reason this growth is arrested, then the bone will die back and seal over, making it impossible for any further new bone to develop.
Hence the answer to your question is a very definitive 'nope not ever'. Does that answer your question?
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gwenc
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@Josephine - yes, thank you for that VERY thorough and interesting answer. I am learning so much on this site!
@Layla - thank you and everything is fine here, just asking the question because I am curious. I spent another 10 minutes riding today. No pain whatsoever! So good to be back in the saddle again, however brief! Also went swimming today at a local beach. Wonderful feeling to walk in the water and swim doing the froggy-kick!
Walking has become a bit more painful again, though. I believe its because I have stopped taking the Advil altogether. Jo seems to think all NSAIDS are "rubbish" anyway LOL. They work well for me, but I have been on them for 3 months and I do know they have some bad side effects with long term use, so trying to do without. For some reason Tylenol doesn't work at all for me. Anyway after reading the above post I am going to make sure to keep up with the walking, but in moderation of course. I want to make absolutely sure everything is healed well before increasing my activity level. I have my next appointment with my OS in a couple of weeks.
Happy Monday, all!
@Layla - thank you and everything is fine here, just asking the question because I am curious. I spent another 10 minutes riding today. No pain whatsoever! So good to be back in the saddle again, however brief! Also went swimming today at a local beach. Wonderful feeling to walk in the water and swim doing the froggy-kick!
Walking has become a bit more painful again, though. I believe its because I have stopped taking the Advil altogether. Jo seems to think all NSAIDS are "rubbish" anyway LOL. They work well for me, but I have been on them for 3 months and I do know they have some bad side effects with long term use, so trying to do without. For some reason Tylenol doesn't work at all for me. Anyway after reading the above post I am going to make sure to keep up with the walking, but in moderation of course. I want to make absolutely sure everything is healed well before increasing my activity level. I have my next appointment with my OS in a couple of weeks.
Happy Monday, all!
Josephine
NURSE DIRECTOR EMERITA
That's not exactly what I said - I said they were 'rubbish pain meds'!
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gwenc
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@Josephine - can you explain your comment above? Do you mean they are not so good for killing pain, but good for other things? Do you think I should keep taking them? I am getting by with just ice but having some mild pain when walking (1 or 2)..
Mojo333
Former BoneSmart Staff Member
I have read many of Jo's posts and I'm sure she will answer this herself but I believe they are most effective for inflammation and not effective for pain per se.
Plus, not good for long term use as to the complications they can cause.
I never had faith in Tylenol as nothing got rid of the OA pain not even opioids.
But I have used the Tylenol in the doses Josephine suggests, and mostly it does help especially during day.
Plus, not good for long term use as to the complications they can cause.
I never had faith in Tylenol as nothing got rid of the OA pain not even opioids.
But I have used the Tylenol in the doses Josephine suggests, and mostly it does help especially during day.
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Josephine
NURSE DIRECTOR EMERITA
They, by definition, anti-inflammatories. Not pain killers. Though if the swelling is reduced, it will obviously also reduce the pain a little.
You can if you wish but do read what I said above.
Try Tylenol 1,000mg 3-4 times a day. Much more effective.
Waterlady
junior member
@gwenc, I've been reading some of your posts and curious about how you have been doing with riding a horse again because I enjoy horseback riding. I don't own a horse but, I was wondering if I would ever be able to ride again. It sounds as though it will be possible from what you have written. I hope to keep hearing how long you are able to ride and if there are any problems along the way to be aware of.
Keep safe and out of harms way from hurricane Irma.
Keep safe and out of harms way from hurricane Irma.
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gwenc
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Hi @Waterlady - being able to ride pain free is one of the main reasons I had the surgery. So far I have only ridden twice, and only for 10 minutes at the walk. No hip pain. However my thighs are still quite weak so I did have some quivering after I got off. I am going to take it very slowly, but expect to make a full recovery where I will be able to ride daily, and for several hours at a time. I see no reason why you should not be able to do the same. One thing I don't think I will be able to do is mount from the ground, but I have my horses trained to sidle up to me on the fence and pick me up, so that is not an issue. Good luck and I will keep you posted! Oh and my surgeon said 12 week minimum before even attempting to ride. I gave it 12 weeks and 2 days LOL
Gone again
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gwenc
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@Gone again Last projected forecast is 100 mph winds in our area. House and barn are built to withstand 120, so hopefully we will all be OK
@Layla I took my first ride in my new saddle today!!!! It fits me like a glove and is so comfortable. I think everything is going to be OK! I am going to go really slow for the next couple of months and hopefully by the time riding season really starts (and I am retired in November!!!!) I will be back to almost normal riding again. Always assuming Irma doesn't eat us for breakfast!
@Layla I took my first ride in my new saddle today!!!! It fits me like a glove and is so comfortable. I think everything is going to be OK! I am going to go really slow for the next couple of months and hopefully by the time riding season really starts (and I am retired in November!!!!) I will be back to almost normal riding again. Always assuming Irma doesn't eat us for breakfast!
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Oh Gwen @gwenc
What wonderful news! I'm so happy for you and sense your joy and excitement!
I think everything will be okay and with retirement around the corner.....the sky is the limit!
You can live life to the fullest now without the nasty pain we all suffered.
Praying Irma doesn't eat you for breakfast, lunch or dinner!!
Stay safe, Gwen
What wonderful news! I'm so happy for you and sense your joy and excitement!
I think everything will be okay and with retirement around the corner.....the sky is the limit!
You can live life to the fullest now without the nasty pain we all suffered.
Praying Irma doesn't eat you for breakfast, lunch or dinner!!
Stay safe, Gwen
