THR Had a bilateral CD, now have had a THR

[bonaventur]

Hi Everyone,

I had an outpatient core decompression done on both hips last week following a very interesting summer of back issues (3 bulging discs), limping and a bilateral AVN diagnosis.

Both surgeons seen stated that my bones were very healthy to go the THR route but while #1 recommended fosamax; #2 recommended CD without anything introduced.

Fortunately or otherwise, I found this forum one day after my surgery and so I couldn't avail myself of all the posted stories of THR longevity while making my choice of surgery decision. I was just too thankful not to be on Fosamax.

I am here for camaraderie and tips on how best to assist this surgery in being a success.

What I am doing:
--Resting/Sleeping
--Elevating both legs
--Icing both legs
--Doing a bit of pacing/walking with crutches(4 point gait) or walker following bathroom breaks
--Not a fan of pills so only taking ibuprofen when pain is unbearable. I had the blues/depression when I took the prescribed oxycodon and feel better without it. It might have been coincidental but I am too scared to try the oxycodon again. Besides, post surgery pain is no worse than my bad days with AVN.

What more do you recommend that I do?

Thanks in advance for your time.

 

[Layla]

Hi, Welcome to BoneSmart and Recovery Thanks for joining us.

The first thing I would recommend is reading member's threads who have had CD. Go to the hip recovery area and find the threads with the gray CORE DECOMPRESSION indicator at the beginning of the title. Click on that part of the title and you will get a list of member's threads who experienced Core Decompression.

Please find below the THR recovery reading list. I understand you had CD - but a great deal of this information applies to recovering from any hip procedure. The Activity Progression and Healing: how long does it take may give you some insight in regard to the process.

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​

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 that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.


Hope this helps. Stop by often, we'd love to follow your journey.
A great week to you!
@bonaventur

 

[bonaventur]

Hi Layla,

Thanks for the warm welcome.

I am indeed digging through all related threads that I can find on AVN and CD and immersing myself in them.

As part of the take away, I am resolved to be consistent with the pain management (1000mg Tylenol every 6 hours) rather than waiting until my body yells for it.

Pre-surgery, left hip was the one in pain that had to be supported with a cane while the right hip showed no indication of the idiopathic condition until the radiologist thought to check the right hip on discovering the AVN on my left hip's MRI.

Post surgery, the left hip seems to be okay...no pain save for tenderness around incision site and some infrequent sting (kind that begs to be scratched). The right hip on the other hand has the same tenderness, more frequent stinging and just within the hour a throbbing that reminded me of the pre-surgery AVN pain. I slapped the ice pack on it and the craziness disappeared.

I'm keeping my fingers crossed and praying that this madness (my body failing me despite my clean living, active but low impact lifestyle) be a thing of the past soon.

 

[Josephine]

I was just too thankful not to be on Fosamax.

I am thankful for you! Evil stuff.

Not a fan of pills so only taking ibuprofen when pain is unbearable.

That's a worry.

What more do you recommend that I do?

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?

 

[bonaventur]

Hi Josephine,

Top of the day to you!
Thanks for checking my post out. Your advice would be most appreciated, so ask away.

As to medication, I actually switched from Ibuprofen to 4000mg Tylenol per day after reading your recommendation on some threads.

Today is day 8 post op and all is looking good and I pray it stays that way. Any day without pain is a blessing!

 

[Jaycey]

@bonaventur Just adding a welcome to the forum while you wait for Jo's questions. Do try and keep ahead of the pain by taking your medication around the clock. This will help you regain your mobility. I look forward to following your journey.

 

[bonaventur]

Hi Jaycey and thanks for the warm welcome and advice.

I was put on oxycodon but it made me agitated and depressed. This wore off once I switched to Ibuprofen but I am now on Tylenol and sticking with it following the table posted by Josephine in one of the posts.

Just got back from my post op visit with stitches removed. So far so good and still keeping my fingers crossed.

Thanks much,
Bonaventur

 

[Josephine]

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 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).

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

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

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

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

6. 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.

 

[bonaventur]

1. average is 1
However, the surgery site feels very tender to the touch. Yesterday with the removal of the stitches, there was tremendous itching which subsided in about an hour. Last night, my sore back kept me awake and I rigged up something with some pillows to elevate the legs and still permit sleeping on my left side. I woke some hours later feeling a level 2 pain on that joint. I iced both legs and went back to laying on my back. My ankles get very sore (level 3 pain) from the legs elevation from time to time...constantly having to rotate/wriggle/crack them for relief.

2. Oxycodone 5mg tab rho (take 1 tablet by mouth every 6 hours as needed for pain)
However, after the first dose, I went from serene, thankful to be alive to anxious and fighting to keep myself from weeping. After some introspection, I laid the blame on the drug and switched to ibuprofen 800mg when in pain. Further reading of threads on this forum led me to switch to Tylenol 500mg every 6 hours.

3. Yes While awake I have an ice pack which gets rotated from one leg to the other at intervals of about 20 minutes or if I feel the need to pass it on to the other leg

4. Yes for virtually the entire day (using regular + wedge pillows on recliner or in bed) save for when I am sitting up in bed in preparation to move or sitting on bathroom counter to brush my teeth.

5. For the home, hubby (working from home for now) has been gracious and takes care of the chores. I have only had to help with mixing and blending baked food for our picky eater and for this task we took all precautions...seating on a cushioned chest next to the dining table. I did try once to straighten the living room when he went out for an errand and ended up so tired that I slept for most of that day (day 2 post op). I did do a huge amount of spring cleaning the days before surgery. Activity level may change somewhat next week but I will be cautious and defer anything that is non-critical until I have company.

For work (telecommute), it was agreed upon before my surgery and due to the abrupt transition that I would work on limited basis in the background with my backup being the face of the team. So my hours vary with breaks as needed. Yesterday, I put in 3 hours.

6. None. I just pace the halls with my crutches whenever I get up for bathroom breaks or when hubby is out on errands and I need something from the kitchen. I ascend or descend the stairs on my butt paying attention to how my hip joints or legs feel. Once at the top or bottom of the stairs, I use the banisters as a fulcrum to lift or gradually lower myself before switching to the crutches that I drag along the journey.

 

[Josephine]

Okay, don't see anything untoward in all that. You seem to have it all well in hand.

 

[bonaventur]

@Josephine,

It's thanks to this forum and all the tips shared on all the threads I have managed to and continue to digest.

Very minimal instructions were given to me after my surgery and I felt adrift at sea until I found bonesmart.


I will provide updates as I progress. My follow up vist with the OS is in November and the hips will be X-rayed then to gauge progress.

 

[bonaventur]

@Josephine or anyone else who can help!

I am in need of help. I am a side sleeper and have slept on my back since my surgery. However, I currently have 3 bulging disks (L3 through to S1) which was diagnosed a month before the AVN.

In a bid to ease discomfort from constantly laying on my back, I attempted alternating left side sleeping and right side sleeping last night. The result is groin pain (L2FV on the chart). I have iced it for most of the day with no change.

Though pain level is about a 4, I am more scared that I may have put my recovery in jeopardy.

 

[Josephine]

Worry not, there is nothing in your operation that you can put in jeopardy!

The result is groin pain (L2FV on the chart).

What you have here is simply post-op pain. I must have missed some significant things in your answers for which I apologise. So here they are now

2. oxycodone 5mg tab rho (take 1 tablet by mouth every 6 hours as needed for pain). However, after the first dose, I went from serene, thankful to be alive to anxious and fighting to keep myself from weeping. After some introspection, I laid the blame on the drug

I think your anxiety and weeping was probably more likely to be co-incidental and nothing to do with the oxycodone. You were taking too small a dose and for too short a time for that to be the case. So I suggest you either

a) try it again
b) ask your surgeon or GP if you can have some Tramadol instead​

This because you are only 1½ weeks out and need more than Tylenol!

Here is a good chart to follow for that

Further reading of threads on this forum led me to switch to Tylenol 500mg every 6 hours.

I'd be most surprised if this is working for you because 500mg Tylenol is not a working dose. To have any good effect, you need to take 1,000mg every six hours.

 

[bonaventur]

@Josephine,

I am so sorry for the confusion (re: dosage). Where's the face palm emot?

I messed up my initial response and should have written that I am on 1000mg of Tylenol (2 tablets of 500mg each) every 6 hours.

The groin pain has gone on hiatus and despite this being my first extended outing since my surgery and a protracted 4 hour long work day, I am only dealing with a stiff back.

Thanks everyone for the care and concern. Apologies once more for the confusion.

 

[Mojo333]

Very glad you are feeling better.
Hope today is a better day!

 

[Layla]

Hi
Great news the groin pain is gone
Hope the back stiffness eases soon.
A great rest of the week to you....stay in touch!
@bonaventur

 

[bonaventur]

Hi @Layla and everyone else,
Hope you all are doing great and making progress.

Most of last week, I was able to do 20 minutes daily drive per day and l successfully managed about an hour's drive to the OS office for my appointment today.

My x-rays look good and I was told to continue with the crutches for another week and to begin PT to help my weakened muscles. I will insist on some exercises for my shoulders which suffer quite a bit from all the upper body work involved in my non weight bearing movement on crutches.

Occasionally, I get the groin pain on the left leg (the one with the pre-surgery AVN pain) but all in all life is good.
Even though I have been back to full time work for about a week and a half, I am cognizant of the fact that I have to listen to my body. Thankfully, I work from home in bed with legs elevated and when the occasion permits, I take the break my body needs (my work day lengthens of course but the give and take is fine with me).

At home, I do help out with the chores and light activities until lethargy creeps in. Hubby, however, handles the bulk of the load.

It is ever so amazing as to how the AVN pain disappeared with just holes drilled into both legs. Pre-surgery, l had the pain 24/7 including when I laid still in bed.

I keep praying that the healing continues and the fear of setback reins me in when I contemplate getting aggressive with getting back into shape.

Thank you all for sharing your time, knowledge, experience, compassion and tips. It meant a lot at the beginning and even now.

Blessings to you all.

 

[Josephine]

It is ever so amazing as to how the AVN pain disappeared with just holes drilled into both legs.

Then your surgeon never explained how this works. It works this way: when the bone is drilled, it causes bleeding to occur. When this happens, it also stimulates the growth of new bone and also new blood vessels. At least, this is what we hope happens! Perhaps about 50% of cases it does.

 

[Mojo333]

I hope all continues to get better and better and Yes! Take it slow.
No overdoing at this critical stage
Plenty of time to get back anything you lose .

 

[Mojo333]

Just wondering how things were with you @bonaventur ?
Hope you are getting ready for the holidays and all is well!:tree lights: