THR DonnieP's Hip Recovery

DonnieP

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I had my 2nd THR 10 days ago.

My NP is really insisting that I begin PT ASAP but I'm not convinced. I did PT after both knee replacements and I do believe PT is very useful for knees. I tried PT after my first THR and since the therapist was constantly trying to rehab my hip while involving my non-operated hip (this was 4 years ago) I had to stop. At that time I was afraid it would injure my other hip (and I knew that hip was living on borrowed time).

Just wondering from those that have had THR what their opinion is on PT for hips - yes or no... useful or problematic? I'm walking with aid of a walker and trying to do some PT myself throughout the day - moving my leg out and back, raising my knee, and ankle pumps while really focusing on not breaking the hip rules. Thanks to all those that respond!
 
Hi, Welcome to BoneSmart. Thanks for joining us.
I can only speak for myself. I attended 3 PT sessions and quit. I don't believe it's necessary in most instances
and it's really not recomended here.

Check out the Recovery Guidelines below and pay special attention to the BIG TIP toward the bottom of the page.

Please provide the surgery dates for each of your THR's and which hip was replaced.
Stop back often, we'd love to offer you support on the journey!


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
5. At week 4 and after you should follow this

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. @DonnieP
 
Donnie P,
Welcome to BoneSmart, glad you joined us!

Hips do a pretty good job by themselves, PT not required beyond being sure you can get in and out of bed, walk household distances, and go up the number of stairs you need at home before D/C from the hospital.

Here is an article to help you choose what is best for you.
Saying no to therapy - am I allowed to?

Please post your all your surgery dates, a moderator will add them to your signature for you.
Having the exact dates will allow us to advise you properly,
Thanks!
 
I've had knees not hips but I've had a LOT of experience answering questions and complaints on here and the one irrefutable truth I have learned is that PT and hips do not go together! That's why we post this paragraph repeatedly

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.

I've worked with an awful lot of hips surgeons in my time (which is extensive) and almost none of them have their patients do exercises (or PT) after surgery. None at all. In fact, my sister had her hip done a few years ago by a surgeon with whom I was acquainted and I suggested she ask him if she didn't believe me. He went up like a rocket at the mere suggestion!
 
I've had both hips replaced and can honestly say any PT offered was a waste of time. Most of it was not applicable to hips and far too aggressive. All hips really need is walking.
 
I've had it hinder my recovery.:oyvey:
At two weeks out..I called it off...did my own walking, stretching, etc.
I did go back for some gait training guidance and light PT at about three months out with preconditions to therapist that would not be utilizing bands or weights as they caused me issues.:no-fin:
 
My PT told me the only exercise I was to do is walking, so other than the usual ankle pumps and buttock squeezes and climbing my stairs I haven't done anything else.
The hip,is feeling really good and no pain.

In a few months time I need to have a knee replacement and I know there will be more physio for that
 
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I need to have a knee replacement and I know there will be more physio for that
Not necessarily - but I won't hijack this thread to confirm. Check the knee recovery area for more info.
 
I had my 2nd THR 10 days ago.

.... I'm walking with aid of a walker and trying to do some PT myself throughout the day - moving my leg out and back, raising my knee, and ankle pumps while really focusing on not breaking the hip rules. Thanks to all those that respond!

That's just what I have been doing since the operation--no Exercise or outside PT, just lots of REST (and icing, etc) and only exercise with small "e"--gentle everyday living with gradually longer walks around home, and incrementally more time doing everyday activities. I've read through so many threads where people try to push the healing --as though you can hurry it along-- but end up delaying healing, and dealing with increased and even chronic pain. So far with my cautious approach I have been doing fine, no pain. We will see if I can get to the 12 week mark (now at 8.5) without overdoing it; the risky time is now because I feel so normal when simply strolling along, yet I know I'm not up to anything vigorous, so I have to watch out --and stop trying to move furniture around!

In short--no outside PT for this Hippie!
 
My OS didn't want any outside PT, his opinion was they will hurt you. What he wanted was the very basic stretches and contractions they showed us in the hospital the day after surgery. Almost all were done while lying down or sitting in a chair. I had no problems doing the basics and I do feel they helped my recovery in a couple of ways. They helped to pass time and made me get up and do something. I also feel they helped me burn a few calories and get the blood flowing and helped with my mobility.
 
Hi @DonnieP I had RTHR three days ago. Having LTHR in 8 weeks. I am icing, elevating, doing ankle circles for circulations and some foot pumps, I think they are called, for circulation. MY OS wants me to walk only at the moment. I see him in ten days. I really believe, from my work with horses, that building up the walking on my walker, and working towards getting my gait sorted out (have LTHR in 8 weeks), is the best thing for me to do at the moment. The soft tissue that was disturbed through access to the joint (dislocation etc.) as well as what was stretched when OS checked the range of movement and for dislocation etc before closing up needs time to heal, before I try and re-strengthen it. I don't have too much swelling and am waiting for the bruising to come out, but am icing like mad with legs elevated to try and off set.
 
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@DonnieP
My perspective is slightly different. I waited until 10 weeks to start PT. But my core strength was ALL out of whack! I had a c-sections in 2011, 2013, and a THR in 2015 ( but I should have had it much sooner). I will do PT again because I am young and my back /pelvis tilt is terrible and damaging long term. However, I will wait until the recovery exhaustion passes again for hip 2. It is hard enough to keep up with young children. They are my PT for the first 2 months-
 
I'm the resident PT agnostic. Does it help? Probably not - I should probably go down to the local university to suss this out and see if there are any studies, but I can't say it helped me all that much. If you're careful not to do anything that hurts and you keep your PT on a tight leash, it probably won't hurt - but I can see the clear potential for harm, especially in the hands of an insensitive therapist.

While I couldn't find any studies that showed PT helped after THR, I did find studies that showed, interestingly enough, that exercise programs helped recovery when done before surgery! However that could because people healthy enough to exercise beforehand are less sick, and so recover faster. Too bad there's not more science done surrounding this incredibly common procedure!
 
I didn't begin water therapy until week 6. It has been a bit painful at the incision site on the therapy days. I rest in between & only have therapy twice a week for 45 minutes each visit. I like going & think it's good for my mental health & overall well being. It is strengthening my muscles without too much effort (easy on joints) being in the water. I tried the land exercises & experienced pain so stopped them. At home I walk, go up & down stairs 6 times a day & some heel pumps while lying in bed. My recovery is on track at 8 weeks in just 2_days. I don't need a cane but take it with me when I leave the house to let others know not to crowd me. Listen to your body & decide what's best for you.
 
While I couldn't find any studies that showed PT helped after THR, I did find studies that showed, interestingly enough, that exercise programs helped recovery when done before surgery!

This has been my approach overall. I think of it in terms of baseline. If you are an Olympic athlete, for example, you have a much higher baseline before the insult on your body. It only stands to reason that your return to function for “normal” human movement would be sooner because your baseline was higher before. If your baseline before the insult of surgical intervention is extremely deconditioned then it seems reasonable that your return to “normal” human function would be longer.

In terms of PT, the profession is very hit and miss with its practice it seems. Many would prescribe activities that may aggravate and result in inflammation while not contributing to recovery. There are some in the profession that are better than others. Movement is necessary for recovery as is stress at some point (and perhaps sooner than some on this board would suggest) but it must be applied correctly.

“While caution is necessary to avoid further injury, the belief that rehabilitation can occur in the absence of overload represents a failure to comprehend the basic tenets of the physiology and mechanics of the living human body.” Rehabilitation, Mark Rippetoe
 
I'm the PT enthusiast around here, I guess :) Have had no setbacks related to any PT. But not just any PT - working with therapists who know hips, and THR, and how to handle things after surgery. I've found it to be immensely helpful after both surgeries to deal with not the hips, but the muscles that get impacted by the surgery.
I had some adductor and glute trouble after my first THR, and my therapist worked to get them back into A-OK shape. After this second THR, I've had no real issues other than the iliopsoas not wanting to cooperate fully. I attribute most of that to what others above have pointed out - doing PT after my first surgery helped me get things ready for the second one.
I've said it in other threads, and as MrDIY points out, there are good therapists, and there are not-so-good therapists. Many will try to fit the patient into a treatment plan rather than try to fit the plan to the patient. Just like choosing a surgeon, you need to audition all of your providers to find the right one.
 
@DonnieP I think you have to look at all the different aspects of your pre-op fitness and post-op healing. My OS wants me to just walk for two weeks until I see him. I am three days post op and am amazed by my progress already, by just medicating as needed to get to the bathroom from where my recliner is situated. I’m more fluid on the walker than I was the day before.....but what did I do all day other than walking back and forth from the bathroom? Elevated and iced and dozed. It is paying off already.

Allow for the healing to happen and it will. Everything falls into place. The human body is amazing, if we just allow it to be. I’m amazed at the last three days since surgery really. I was prepared to assess on a weekly basis, but am seeing changes daily already. Going home the day after surgery was amazing. I did see a physio on and off for three years prior to surgery. Saw him a lot to help with pain levels the year before surgery. Was also going to yoga and Pilates until early this summer, when I became so limited in what I could do, that I decided to stop going and do what I could do at home. I was mucking horse stalls, sailing and hanging hay nets etc. I will go back to him when the time is right.

I saw hospital physio yesterday before I came home and she kept referring to “the booklet” of exercises that is doled our to everyone. I’m just doing what I can for circulation by walking and wiggling my feet and doing foot circles every so often. I’ll build up the walking within my comfort until I see OS in ten days and re-assess then.

Have you seen the BoneSmart guidelines for what to expect in the first 8 weeks? It is helpful as a guide.
 
You need to move, you need to walk - you need to listen to your body.
Here's a great article that can explain some things to watch for
Muscle guarding
 
From many posts on here I don't think most OS understand the recovery of THR forget about PT's understanding it. I see so much of this soft sell of this surgery and unrealistic recovery times presented to people along with the "better" approach deals.
 

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