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[REVISION THR] hip replacement gone bad<

Discussion in 'Hip Replacement Recovery Area' started by zinnia, Jun 25, 2017.

  1. zinnia

    zinnia senior
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    I had hip replacement in 2015 with a revision in 48 hours because of dislocation and pelvic fracture. I have suffered a spontaneous femur fracture and trochanteric bursitis since and can still not walk normally without an aid.

    I see a personal trainer now as I have no more PT and they weren't helping anyway. They seem to be afraid I'll break and they will be blamed. I have mostly muscle pain from exercise and a bit of pain left from the bursitis.

    Has anyone any good word for my situation. Ever hear of this at all?
     
  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @zinnia Welcome to BoneSmart! Indeed Trochanteric bursitis with THR is very common - mostly caused by too much activity post op. You say you are working with a personal trainer. Does any of this pain ease if you are not training? Are you icing and elevating your op leg?

    Can you clarify what your current situation is? Will you be having a revision or does your thread title refer to the revision you had 48 hours after your THR?
     
  3. Delphi

    Delphi senior

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    Wow @zinnia , that sounds truly dreadful. Thinking of you and hoping you get some helpful advice on here,
    Take care,
    Diane
     
  4. Jamie

    Jamie ADMINISTRATOR Administrator

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    Hi, @zinnia....welcome to BoneSmart. I'm so sorry you have had such problems. I'm going to tag our forum's Nurse Director, @Josephine, to come talk with you. I'm sure she'll have some detailed questions to ask you that will help in providing advice for you.

    You know, hips don't really need a lot of therapy to heal, so maybe it would be best for you to stop the physical training for a while and see how you do with just walking. Have you considered getting a second opinion on your hip? It would need to be someone totally unconnected with your current surgeon, so it might involve a drive to a different city. But it sometimes helps to have another set of eyes on the problem. It would be critical to see a revision specialist for this second opinion as they are the ones who typically see problem cases and are in a better position to know what to do.
     
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  5. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Oh my goodness, zinnia, what an awful tale!

    I'd like to help but first I will need some detail in your history.

    1. what was the date of your original surgery?
    2. did your surgeon ever give you an explanation as to why you got a pelvic fracture?
    3. do you have any xrays of this secondary damage and how it was secured?
    4. when did you suffer the 'spontaneous fracture' and what was done about it? Did it require surgical fixation?
    5. who told you this fracture was spontaneous (which to me means that it just fell apart, no slip, trip or fall)
    6. have your doctors checked your bone density and/or osteoporosis?

    I'll be back when you've supplied this information but I can't promise there won't be more questions after that!
     
  6. zinnia

    zinnia senior
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    My hip replacement surgery was Oct. 29, 2015. The revision was the next night late as an emergency to make the correction or revision.

    I do have osteoporosis.

    The pelvic fracture happened because the edge of the pelvis where the cup was attached that receives the artificial joint broke off, which set the cup loose or disconnected and thus the dislocation.

    The femur fracture happened spontaneously as I was walking from one room to another in my home. My leg collapsed, I heard a loud crack and I went almost down. Xray showed a hairline fracture at the top of the greater trochanter. I was put on bed rest and little activity for 2 weeks and a gradual return to exercises in the pool. Let me add that after the revision surgery I was only allowed to put 50% weight bearing on my right leg, the leg that had the replacement/revision. This went on for about 8 weeks, then it was reduced to 25% for another month or so, I can't remember exactly. I walked on a walker the whole of that time.

    The femur fracture happened about 4 or 5 months after the second surgery when I was beginning to walk. The bursitis set in last February; was incredibly debilitating and painful but is subsiding slowly now.

    I now have muscle soreness with the work I do, ½hr 2xs a week with my trainer. It is helping me in that it is making me stronger but the muscle pain from the soreness doesn't always allow me to walk unaided which I only do at my home anyway. I always use the cane outside when I am out and about. I also get a massage once a week on the advice of my personal trainer. The massage is geared to work on certain muscle groups.

    The revision I refer to is the one I have already had. There is no need, nor do I want another surgery. X-rays show the hip to be properly placed with no apparent reason for alarm.

    My current situation is that I walk mostly with a cane; without the cane around the house and sometimes outside. I have good days and not so good days. That is to say, some days I can walk unaided and some days not.

    The pain I have is nominal and mostly from muscle response to exercise. There is some pain from the bursitis. But I don't think there is any pain associated with the replacement or the revision. What is associated with those surgeries is a defined limp that I still have when I walk which makes it very tiring very soon to walk unaided. I have a 3 wheel bike I ride around the neighborhood but my left knee is also a problem with bone on bone. Although that is not preventing me from walking. When I do walk, it is with a robotic movement. On good days I can dance better than I can walk.

    I so appreciate any interest in my dilemma. It is a painful one for me, emotionally as well as physically. I continue to also do exercises at home and I can't understand why I am not strong enough after all this time to walk on my own.

    I have always been a person who exercised, walked, ran, danced, hiked, yoga groups and classes, aerobic classes, strength training, etc. I went into these surgeries very strong for 80 years old.

    Thank you every one for your encouraging words. I look forward to reading your suggestions.
     
  7. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Thank you, that was very informative.

    I would now like to ask you some more detailed questions if you can bear it!

    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)

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

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

    4. 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.
     
  8. zinnia

    zinnia senior
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    1. hip #3 or #4; left knee #4 or #5
    2. Tramadol 50mg as needed. I probably take one a day. Over the counter Ibubrophen, 2 20mg tablets in the am
    3. Light housework, clothes washing and fold, light cooking, light gardening, driving, shopping for household and personal errands, lunch with friends, 2 o3 three clubs and/or volunteer work
    4.outer hip stretch, hamstring stretch, tip toe stretch, heel rock stretch, lateral leg raises, 2x daily, 15 x a set, 2 sets, hip abductor with resistant band, laying on back leg raises, leg circles, laying on stomach and raising leg, the bridge, the crab, half plank from knees, riding my 3 wheel bike again for 1 mile, 3 x weekly. In the middle of the bursitis episode I could do very little of this, the pain was so hard, easily a 10+. So I am out of strength at this time and working to build up endurance and strength so I am back doing most of these.
    P.T. exercises: these vary from session to session, bridges with large ball, 5x 2 sets; bridge with a hover, 5x hold for 30 secs, one set, half circle toe press, 5x one set each side, foot press with 30 lb load, 5x; air bike, aerobic training, pedal at regular speed 10 minutes, fast as you can pedal 30 secs; repeat 3 x. This is just an example of what my trainer has in store 2x a week, 30 mins each time.
    I hope this is helpful. Understand, I am not in bad shape but not walking unassisted, etc., etc., etc. Thank you for any suggestions, directions, help. I appreciate everything. Gait improvement is a big yearning.
     
  9. kayak59

    kayak59 senior

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    Hi! I am having the same problems you are - trochanteric bursitis and the limp/lurch. Have you heard of the "Trendelenburg gait"? That is what my PT called it and it is caused by weakness of the gluteus muscles. I have been doing targeted exercises for those muscles - and also for the bursitis. I had that before the surgery and at this point, thanks to those exercises and two sets of cortisone shots, it doesn't give me much trouble.

    The main exercise I do for the glute weakness is the clamshell and I believe it is helping. I also try to "keep my hip up" when I walk and use the proper heel-toe-heel walking method. I do have to think about walking properly and can't do it for long. Definitely gets harder as my muscles tire. I had this problem before my surgery and wore lifts. As my legs are equal length, I am trying to correct this with these exercises. I may end up needing a lift still, and I may need to do these the rest of my life, but that is okay.


    Sent from my iPhone using Tapatalk
     
  10. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Before I get to answer you, zinnia, can you redo answer question 4 and make it as a LIST and not an essay - as I requested.
     
  11. zinnia

    zinnia senior
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    4. outer hip stretch, both sides, 2x, hold 10 secs.
    hamstring stretch, both sides, 2x, hold 10 secs
    tip toe, heel rock, 5x
    lateral leg raises, rt leg, 15x 2 sets
    hip abductor with resistant band, 10x 1 set, both legs
    leg raises on back, 15x 2 sets
    leg, raises on stomach, 15x 2 sets, both legs
    bridge, 10x sets
    clamshell, 10x 2 sets
    plank from knees, 2x holding 30 sec, 2 sets
    3 wheel bike, i mile, 3x weekly
    Personal Training Exercises:
    from this selection, 2x weekly
    bridge w/ large ball, 5x
    bridge with hover, 5x holding 10 secs.
    forward lunge with weight straps, 2x each leg
    bicep pull with weight straps, 5x
    1/2 circle toe press, 5x each leg
    leg press, 30 lb load, 5x
    NuStep 15-20
    Thank you for bearing with me.
     
  12. zinnia

    zinnia senior
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    Thank you, Kayak. I do know about the "Trendelenburg gait" through research of my own. It has not been offered to me as my problem either by a physical therapist, my surgeon, or my personal trainer. I've asked one or two about it though and gotten a negative response. The clam is part of my exercise program but I am terrible at it. I keep trying though. Since I have had so much interruption of other physical events, the trochanteric fracture and the bursitis, not to mention the immediate revision to the replacement which put me on 50% weight bearing for so long, I have lost so much endurance as well as muscle strength. I'd like to know what other exercises you have in your program if you don't mind sharing. My legs are the same length, they've been tested so that's not the limp problem. Some of it is psychological I'm pretty sure of it. I have a fear that I will have another fracture or that I will fall. I can walk but, as you say, not for long before I get tired and resort back to the cane. Do you use a cane? Thank you for any other suggestions you might have. I am open to any and appreciate all.
     
  13. zinnia

    zinnia senior
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    Thank you, Jamie, for your help. At this point I badly need my personal trainer to build back my endurance and strength. I have gone for so long since surgery recovering from something that I have lost a great deal of what I had before; just when I get to the point when I begin to walk again, something else happens. I am now waiting for the next shoe to drop. It is encouraging to me to have you all who care to talk to. Thank you for being here.
     
  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Are those pain scores?
    Um... ibuprofen comes in 200mg tablets - what that what you meant? Assuming it was, I would strongly advise against using NSAIDs. Despite the enthusiastic advertising, it is not a good pain killer and has some rather unpleasant side effects as well. Read this Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers.

    You'd be much better off taking Tylenol with the Tramadol. They make a great companion pair and much more effective than NSAIDs
    Not exactly a slouch then!

    Thank you for this - I can understand it this way!
    My first response is to ask WHY you are doing all these? You are so far out from surgery, you cannot possibly believe that these are all for the benefit of your hip? I don't see one of them (except the cycling) that is of benefit. Quite the contrary, they are much more likely to be causing you harm! I suggest you stop them all until the muscle pain abates.

    Yes, I know you're trying to build up your strength but I'm not sure that, with your hip, this is appropriate. It's been traumatised and the effects of that are likely to hang around for a long, long time. It's not like a new hip replacement where you could have been singing and dancing a year later with a true 'forgotten hip'. This may not be giving you pain or discomfort but it's still weak and needs to be treated with care. And quite simply, right now you are just doing far too much!
     
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  15. PS46

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    Wow, @zinnia - I need a lie down after just reading your exercise regime!
     
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  16. Irish Joe

    Irish Joe FORUM ADVISOR Forum Advisor

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    Oh @zinnia. Please stop.
    Could you try this just to see what happens.
    Do no exercises at all for maybe 4/5 days or even a week and then assess how you feel.
    I'll bet you'll feel much better.
    Joe.....
     
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  17. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    :thud:
     
  18. zinnia

    zinnia senior
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    Yes, I did mean 200mg on the Ibuprofen. My mistake. Thank you for the article; I will read and then consider your suggestion. I didn't mean to suggest that I do all those exercises every day. A selection from them 3x a week is about what I do. I do try to ride the bike 3x a week as well. The PT work is just 2x weekly for 30 mins. My question is besides resting the hip, what would you have me do to build back stamina and endurance and to improve my walking and my gait? Are you suggesting that I proceed with resting and babying of this bad hip? And then time takes over the walking improvement? I have about 4 days ahead before any pt session and I will do what you and Irish Joe suggest. I am just confused as to where I go from there in your mind. At any rate, I thank you, Josephine, especially, and All for your concern. I look forward to you next reply/replies.
     
  19. Horseshoe

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    Rest and baby those sore muscles. Pushing through pain further inflames them. Any pain I had post op was muscular from the surgery itself (moving muscles around) and directly due to physical therapy eg., leg raises, clam shells and bridges being the worst offenders. Your leg muscles are not lazy or weak, they are injured. Once fully healed you can then *slowly* start to increase walking, use cane or crutches as long as you need them. I was in good shape prior to getting OA and quite surprised at how long it took for muscles to heal.
     
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  20. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Walking is the best exercise for a new hip and then not to excess. As Horseshoe says, your muscles are not weak they were traumatised. Start slow and build up gradually. Pushing only results in chronic pain.
     
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