THR Hubblebubble’s not in trouble

Hubblebubble

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Greetings from across the pond. I’m a new member of the forum so please forgive any early mistakes made or errors in protocol.

I’m here at 0200 hrs not sleeping (but quite accepting of this) and have discovered your community which I’ve found to be incredibly illuminating and supportive. In anticipation of the journey to come I've created this, my recovery thread, where I hope I’ll be reassured and educated as I move through the recovery process. I’m sure this will, in turn, allow me to reach out and offer my thoughts and experience to others with a similar story. The title ‘Hubblebubble’s not in trouble’ is intended to be reflective of a positive and optimistic view of my situation thus far and the time ahead.

A little background.

I’m a 59 year old male, 6’2” 215 lb frame with a lifelong history of sport since childhood. Professional level rugby, then golf and marathon running, Ironman Triathlon through my mid forties and early fifties, then long distance road cycling as the various arthroscopies on my right knee made running a thing of the past. About five years ago I moved into open water swimming and a couple of years ago swam The English Channel. I’m used to injury and have had well over a dozen mainly orthopaedic operations over the years on fractures, knee cartilage etc.

Six months ago my (left) hip pain appeared as a groin pain when I dismounted my bike at the end of a regular week’s training. Almost overnight the pain was agonising. No warning. Just ‘boom’. The usual MRI scans followed and moderate/severe osteoarthritis was identified with THR as the most viable alternative given the nonexistent joint spacing. A second opinion confirmed this.

I was due to have surgery in January but emergency surgery for a (thankfully) macula on detached retina (successful) meant it had to be delayed and I was the grateful recipient of a posterior ceramic THR on April 12th (four weeks ago as I write this).

I made a good early start and left hospital after 36 hours. Recovery has continued well. I took myself off opiate painkillers after two weeks and now manage with over the counter meds (paracetamol which I believe is equivalent to your Tylenol and Ibuprofen which is an NSAID). Broadly speaking I just take these at night in what is proving to be a vain attempt to mitigate against the constant thrash of sleepless and to help provide some relief from the gluteal, leg and lower back pain that seems to attack with horizontal immobility.

I religiously do my exercises and now, at four weeks, am off crutches and walking with a cane for longer distances and unaided around the house and garden, albeit with a world class limp which is my physiotherapist’s bete noire and number one on her hit list of issues I need to fix.

My surgeon is supportive and I have an appointment with him early June. My physiotherapist oversees the physical aspects of my recovery.

So all seems well. However, I do continue to have questions and want to ensure I have as much knowledge as possible in any decisions I make going forward. Hence the slightly tortuous ‘story so far’ above so that anyone so inclined to respond has a reasonable picture of events to date.

One thing I have noticed is the discrepancy in leg length. I have reached out to my surgeon today to ask his thoughts. I am comfortable with the likelihood of differing leg lengths post THR - it was made clear to me prior to surgery and I understand why and how it occurs. My concern in my own instance is that almost everywhere I read up on this issue, it is the operated leg that is longer yet in my case the operated leg is shorter. Does anyone have experience of this?

Also, I’m now confident enough to allow my operated leg to ‘dangle’… for the weight of the leg to hang freely as I gently move it back and forth. I find this alleviates stiffness and pain that has built up but the sound of clunking and twanging of what I assume to be tendons is alarming to my ear (but in no way painful). Again, can anyone put my mind at rest? My non medical brain tells me that all my muscles and tendons are perhaps allowing themselves to become looser after the tension they put themselves under following surgical attack? Could this be correct?

Finally, when I do my standing up exercises the (operated) leg is flexed but on relaxation (standing with my foot on the floor) the muscles appear to expand and reposition ever so slightly and the leg spontaneously ’shifts’ slightly into what feels like a more fulsome, if briefly attainable, position. I feel this ‘longer’ leg is what my leg will become once I have full musculature and strength back. Does this ring any bells?

Finally finally , I may well have overdone the exercise today as my leg has been very sore. Prior to discovering the forum I was about to dip into my oral morphine for the first time in two weeks to try and alleviate the pain and get some rest. It’s a little easier now and I may well just see how it goes. But can I ask what thoughts are on the return to opiates when used as a nighttime breakthrough pain solution. I have no fear of addiction but hadn’t quite realised when I hard stopped just how long I’d been on tramadol, meptid and oramorph. The result was a nasty bout of withdrawal for a week which I’m in absolutely no rush to have to go through again. (I do ice which I find helpful in the daytime but doesn’t cut through at night).

Many thanks to those of you who have journeyed with me this far. It feels great to have shared and all advice and thoughts are most welcome.

Many thanks

HB
 

Layla

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Hello and Welcome to BoneSmart. Thanks for joining us!
Wow, you’re quite the athlete! Impressive.
I religiously do my exercises and now, at four weeks, am off crutches and walking with a cane for longer distances and unaided around the house and garden, albeit with a world class limp which is my physiotherapist’s bete noire and number one on her hit list of issues I need to fix
Here’s a tip -
Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.
Here is a visual on heel-toe walking -
1639236580030.jpeg


As far as Leg Length Differential goes, you're not alone, many feel this post op. In most cases it eases with time. We advise giving it 3-4 months as it can take that amount of time for things to balance. If at that point, you are still concerned we suggest you visit a reputable podiatrist or PT for a measurement.
Here's an article from our Library Leg length differential - LLD.

Noises - The soft soft tissue and prosthetic are settling in and adjusting to work smoothly together. It will dissipate with time.

Consider stepping away from PT and exercises, aside from the activities of daily living until the pain subsides. All you really need for exercise is walking, but not to excess. I’m not sure how long your icing sessions last, but you can ice as often as you like for as long as you want. Ice is a great pain reliever. As far as meds, you may want to check with your surgeon‘s office. I will add that many are still taking meds at one month post op. This recovery can take a full year and at only one month post op, you’re still in the very early days.

I wish you all the best as you continue on your healing journey!
You will find the BoneSmart Recovery Guidelines in the post below.
 

Layla

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As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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
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. Here is a week-by-week guide

6. Access to these pages on the website

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.
 

Mar

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I’m almost 3 weeks out and I have the leg length discrepancy as well but it is on my operative leg so can’t help on the why the operative leg feels shorter. A bit frustrating because if it weren’t for that I feel I could walk without any issues. I have found the cane actually makes my limp worse and I can’t do my gait as well with it. So if I do a long walk I stay with the walker and try really hard to do the heal toe walking with very little arm pressure for stability. I still need pain meds but have been able to stop oxy and just do tramadol/acetaminophen every 6 hours. But the leg length discrepancy is frustrating isn’t it ¯\_(ツ)_/¯
 
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Welcome,
I'm a newbie only 3 months post op but I did think my operated hip/leg was shorter than non operated but it has now seemed to even out and doesn't appear to be shorter any longer.
I'm walking very well with cane and can get around my kitchen pretty much just tapping back of a chair or counter here and there for support.
I'm anxious to be free of cane and assistance but if there's one thing I need to learn it's patience.
I managed grocery store quite well yesterday, bringing in a few bags and putting stuff away. I can also now get clothes out of the washer and into the dryer and fold.
Baby steps.
We are all in this together so it's great to have a place to discuss our day to day recovery.
Best wishes
 

CricketHip

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@Hubblebubble Just checking in on your progress? Any changes to report? I wanted to remark on something and see if you are icing? It seems that medical professionals on your side of the pond don't recommend icing. I used it for several months post op and it helped so much.

Would love to know your thoughts on that.
 
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Hubblebubble

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Greetings everyone and thanks so much for your kind replies. I’m pleased to report that everything is going well. I’m now at six weeks and not only walking pretty well (I still limp and walk with cane for longer distances, not to mention good tables in restaurants) but also am driving and am able to work out in a targeted way at the gym and visit my local pool for water based exercises.

Around a week ago I had my first ‘good’ night’s sleep since the onset of my hip problem six months ago. This has been a game changer. I went back to allowing myself a couple of tramadol when I wake up in the early hours and that hasn’t seemed to be a problem. I still have broken sleep but the glute pain has hugely subsided and this is what has made a big difference I think. I’ve also gradually been strengthening the glute so the leg seems to be ‘tying’ in now and there are definitely days when this helps minimise the perception of leg length difference. I’ve decided not to worry about any differential… most likely it’s my retained tendency to favour my good side pre surgery. If it is it will gradually shake down. If it isn’t… well, Que sera sera and all that .

I do ice but I should ice more.

Onwards and hope you are all doing well!!

HB
 

Layla

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Thanks for stopping by with the update. You’re doing really well! You mentioned you’re using the cane when walking long distances. We do recommend you use an assistive device until you’re no longer limping…just a suggestion. I hope your sleep continues to improve. You’ve made great progress and it’s going to get even better!
@Hubblebubble
 

CricketHip

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:sleeep: Those first few good night's sleep are pretty wonderful, aren't they? Good for you for not fretting about the feeling of a LLD, usually it evens itself out, as you and your body adjusts and progresses with time.


I do ice but I should ice more.
:ice: yes, you should .. hoping the visual helps to motivate you.
 

newguy

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Just walk and walk some more. Concentrate on getting rid of that limp. That may still be from some pain you have from the surgery, you say you still need some medication at times. I am now 5+ months PO and walking upwards of 10+ miles a day. The walking is my key to improving leg strength. I have decided not to run again. My 100 mile weeks my racing is over. Biking now 30 mins daily on the trainer has also helped with range of motion improvement.
 
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Hubblebubble

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Just walk and walk some more. Concentrate on getting rid of that limp. That may still be from some pain you have from the surgery, you say you still need some medication at times. I am now 5+ months PO and walking upwards of 10+ miles a day. The walking is my key to improving leg strength. I have decided not to run again. My 100 mile weeks my racing is over. Biking now 30 mins daily on the trainer has also helped with range of motion improvement.
Thanks newguy... I've no real desire to run again and pretty much gave that up before the hip issue anyway. So it's no great loss. I'm going to focus more on walking thanks to your advice. I've already been on the static bike and it went well, though only for 10 minutes or so... but pleased to be doing it after six weeks.

My glute is still very tight - the muscle is like rock in places so, now the scar is healed I'm going to ask my PT to focus on loosening that up. I have a feeling that will ease the pain in my groin, let my leg 'drop' slightly and allow me to walk with a little more freedom (and therefore lessen the limp) all at the same time. The tightening of the glute at night is why I still take pain meds... no issues during the day.

Glad to hear your journey has been a successful one. I'm toying with the idea of swimming around Manhattan next summer as my next challenge! That will focus the mind in recovery!!!

Cheers
HB
 
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CricketHip

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In the past, when my hip is rotated or elevated it tends to be from my Quadratus Lumborum (QL) and psoas muscle.
If you look those muscles up and see their locations you will see that it can be a problem when too tight. They refer pain to other areas like the hip also.
Maybe you can ask your PT to check them for you?
That is my issue at times. So just another thought to ponder.
 
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Hubblebubble

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Greetings all

I hope everyone is well and making good recoveries. All is well here. Interestingly enough I had an 8 week appraisal with my surgeon who was both pleased and concerned that my progress was what he would expect by week 16.

He's pleased I'm easily putting on socks, have strong muscles etc but concerned that I am overdoing things and has ordered me to pull back on my daily steps (no more than 7,000 a day) and any unnecessary loading of the (uncemented) joint.

I have to say, I feel it's been good advice and that the joint is feeling less fatigued than it has been. This allows me to concentrate on my exercise quality which is both the prescribed PT exercises and also my swimming and cycling on my road bike (albeit on an indoor trainer) He won't let me out on the road on my bike as he's concerned that I'll put too much stress through the hip.

So... good news all in all but a reminder I think to us all that it's not about getting as strong as possible as soon as possible, it's about getting strong in an organic and sustainable manner that suits our own personal situations.

All best

HB
 

Layla

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I like your surgeon’s advice. I am happy you’ve taken it to heart and that you’ve scaled back. A couple phrases I like -

Go Slow Now To Go Fast Later

Look upon this surgery as an investment in your future.
Look after it now and it will serve you well for years to come.

You’re making great progress. Thanks for stopping by to update.
Stay in touch! :)
@Hubblebubble
 

Mojo333

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:wave: Great to see your update and thanks for taking the time to share some of your good advice to other nervous new hippys.

Healing First is so important, and any loss of strength or tone can be regained, right?

I also think its important for ambitious new hippys to remember that your body only has a finite amount of energy to expend and internal healing takes alot of energy.
That is why the Energy Drain is real after major surgery.
Insisting energy should go to too much physical activity just saps away our healing energy.

Sharing your recovery story...and lessons learned is so helpful...so thank you.
 

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