Revision THR I have 4 questions, I could sure use your feedback!

THR-dude

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In late August, 2015, I underwent hip refresh surgery at a major VA hospital. The lead surgeon is a senior figure at a world-renowned university medical center. What follows is my experience and I would like feedback on what happened.

This hip was originally installed in June, 1994 at a civilian hospital. It finally wore out. Although the records were destroyed after 10 years, one of the surgeons said they knew which make and model it was, I assume through careful examination of X-rays.

Once they had me opened up, they opted for a refresh rather than a total replacement. Later, they told me that they replaced the polyethelene cup and the metal ball that sits atop the part that goes into the femur bone. Then they closed me up, slapped an occlusive dressing over the wound and dispatched me to a hospital bed

I spent the next two days in recovery, enjoying curiously decent hospital food, then demonstrated to everyone concerned that I could use a walker and crutches satisfactorily. They sent me home. There's the story, and here's where it gets odd.

The picture shows the hard-shell brace they put me in.

dude.jpg


1. Why am I in a brace? No brace was required in 1994 when the original hip was installed. They sent me home on crutches and told me to be careful on the stairs. This brace is a royal pain in the butt to use.

2. They told me to use this brace for three months. That's 12 weeks, far longer than typical recovery times mentioned in these forums. Maybe my age is a factor -- 69 -- but I hit the gym five days a week and am in excellent condition. My recovery time is quicker than most in my age bracket.

3. They told me no driving for three months. Seriously? OK my car has a manual transmission, I need to depress the clutch. Even now, just a couple days out of the hospital, I can balance on my left leg, which means supporting some 194 pounds. The pressure required to depress the clutch is far less than that. I see in these forums that six weeks is the common point at which driving is allowed.

4. They told me to not lie down on my tummy, only on my back or my right side, with feet separated by a pillow or foam block. Being able to lay on my front would make this entire experience more tolerable

Those of you who have gone through a THR or refresh, and those of you in the medical profession, I would like to have your feedback. If my surgeons are being unjustifiably over cautious, I want to know about it. Ideally I would like to not have to use this brace and be cleared to drive after a reasonable amount of time.
 
THR-dude,
Welcome to Bonesmart, glad you decided to join us.
I don't have any answers for you, but I am going to tag @Josephine , our forum nurse to see if she can help.
Recommend you directly ask the surgeon why you need the brace, there must be a reason.
My best guess is your hip easily dislocated when they tested it in surgery. The extended healing time is for the soft tissue to be healed enough to help keep your hip where it needs to be.

Please add your surgery date to your signature, hover over your username top right, click on signature and add your information there, Thanks!

Here is the post op reading for you, the articles are short and will not take long to read,

First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

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
Activity progression for THRs
Home physio (PT)
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?
 
Actually, 12 weeks is not an atypical recovery time. There is a ton of soft tissue disturbed during surgery, and it really takes a good year of more for complete recovery. Some hippies are walking without any assistive devices a month or even less after surgery, but a good many take 3 to 6 months or even longer to get there. There are so many variables.....the degree of deterioration prior to surgery; other health issues that may impede healing times; the skill of the surgeon; the activity level of the individual; the individual's tolerance for pain; the actual conditions once the surgeon gets inside; and so on.

The driving restrictions vary from one surgeon to another. My OS told me I could drive when I no longer needed the walker, as long as I wasn't taking narcotics. I drove at 3 weeks after my first THR, and 2 weeks after my second. If 3 months is the standard protocol from your OS (or maybe from VA hospitals generally), it sounds like a covering-the-backside restriction. But if it was tailored specifically to you, then your OS should have a rationale based on your specific circumstances, just like Pumpkin's speculation about the brace.

So really, you need to know from your OS if there were specific reasons for your specific restrictions. Is he concerned about a higher risk of dislocation for you for some reason? If so...I would err on the side of caution. Or is he just on the far side of the conservative approach to recovery? We always recommend that people follow their OS's instructions. That said, many people educate themselves about current best practices, and make their own best decisions about restrictions. Keep in mind that you won't harm yourself if you follow his conservative guidelines. 12 weeks is still a tiny blip in time to ensure yourself a solid recovery for many years to come.

Either way though, do be cautious about jumping right back into your rigorous exercise routines....as you start to feel really good, it's terribly easy to overdo the activity level, and then you will set your recovery back considerably. You did have major surgery, and it does take time and patience to fully heal.

Sharon
 
I also think that you need some answer's from the OS. Is there a PA or nurse in the office?? you can leave a message with them and they are more likely to respond with answers.
 
My best guess is your hip easily dislocated when they tested it in surgery.
That would be my guess to - BUT it's irresponsible of the surgeon to a) not address this problem and ensure a more stable hip by simply using alternative neck length or totally revising the hip with a new device, and b) not tell you about it and the reason the brace is required not to mention the over the top precautions.

Either way, if all this is due to slack ligaments and or other similar issues, it's unlikely time is going to make anything better. It just won't.

Were I in your shoes, I'd either be demanding information and explanations or seeking another opinion pronto.
For you not the be fully informed about all this is beyond the pale.
 
This is an update.

The VA has what they call Secure Messaging, a marvelous means that allows the patient to communicate directly with his/her medical teams. After receiving guidance from you fine BoneSmart.org folks, this morning I composed a message directed at my orthopedic surgery team. At 4:45pm, I got a call from one of the surgeons.

For reasons related to the need for development of scar tissue around the cup and soft tissue repair, it's important to use the brace, for three months. However....

Seven days post-op, off comes the wound dressing and also remove the brace I can shower like normal folks. Then the brace goes back on.

I can drive as soon as I'm sure I can hit the brakes and clutch with full force. He said to give it two weeks. And he cautioned me that if I cause a car accident while wearing a brace I will probably get sued and lose in court.

I like to read in bed. I can continue to do that, while laying on my stomach. But don't roll over and cross my legs.

Crutches can go away as soon as I can walk safely. He says give it a couple of weeks before I try it. He suggested the use of a cane for a while.

I feel a whole lot better now. Up until that call, I was a bit depressed.

Now, to go find some basketball shorts so that I'm presentable in public. Big 5, here I come! Are Lakers logo shorts still presentable in public?

Thank you very much for your assistance.

(In case you are wondering why the pic above shows my right leg in the brace instead of my left, it's because the mod flipped the image in the process of, uhhh, making my pic more modest).
 
Hi @THR-dude -- I have submitted a request to have the image reflect the brace on the correct leg/hip :)

Pleased for you that you received such a prompt response from your medical team to rest your mind :)
 
Glad to hear Secure Messaging got you a prompt response. I've never needed it for anything that serious, but I've been glad to know the capability is there, because the VA bureaucracy can be overwhelming, even though everyone I've interacted with there has been basically very good.
 
For reasons related to the need for development of scar tissue around the cup and soft tissue repair, it's important to use the brace, for three months.
Stuff and nonsense! As I said before, if the hip was unstable when they'd finished, they owed you a duty of care to redo it all before they closed you up.
And he cautioned me that if I cause a car accident while wearing a brace I will probably get sued and lose in court.
You would indeed! In other words don't drive !
In case you are wondering why the pic above shows my right leg in the brace instead of my left
Sorry about that - not paying attention. corrected now.
 
Wow...you really are in great shape. It makes me kind of sad to realize that our replacement hips don't last forever. I've never seen a brace like yours. They have them at that hospital, so they must use them(?) I think sometimes the restrictions are overly cautious, especially with very fit, athletic people, who exercise intensely. (They seem to be the ones who have problems at my surgeons's office. Well, if they overdo too soon.) I wanted to go to the gym right away, and they told me to wait four weeks. (I thought I could work around the hips.) I'm taking it easy. I was told not to drive for four or five weeks, but my surgery was bilateral. As far as driving, I'd never thought about the whole lawsuit issue. That's very true. I use Dial a Ride. Soon I will take the bus, since it's less expensive.

I'm very interested in what was done to our hip and why. I've never heard of this. My gut instinct is to not stress my new hips. I don't want to have to do this surgery again, and I'm only 50. Was it very painful to have it done again?...ugh.
 
Hello Hip Hip Hooray!

As you know, the VA is a huge operation, with hospitals everywhere in the USA. They stock probably everything manufactured, no doubt including any kind of brace that's useful.

Treat your recovery time as a vacation. Sign up for Netflix or hit Amazon and order a couple hundred DVDs. I may go back to the gym at the six-week mark, or not. In any event, I will be taking it very easy for a while.

Just follow your doctor's advice. If he/she says don't do this or that yet, don't.

Was it very painful to have it done again? Less painful than the first time. Back in 1994 when the original hip was installed, they took me off liquid painkillers a day too early. I went nuts. I was throwing stuff and screaming at nurses. Worst. Pain. Ever. They put me back on the IV drip then removed it the following day. By then, all was cool.

On the other hand, this was a refresh, not a new install, so the wound may be smaller this time. Bear in mind, medications change, technology changes and procedures change over time. By the time you're due for a refresh, what they did to me may be regarded as old fashioned.

Good luck to you. :)
 
Hi THR-dude,

Thanks for the advice. I'm definitely doing everything my surgeon says. I'd rather err on the side of caution. That must have been awful, being taken off the liquid painkillers too early.

Your post also makes me want to keep my original xray. I'm still hoping mine will last the rest of my life. As you say, who knows what they will be doing in twenty years...
 
Dear HHH:

When I tell folks about that 1994 THR and all the pain, I usually add some crack that the procedure is not advisable for those who enjoy recreational surgery. LOL

I'm up and about on crutches, getting in some serious walking distance daily now, but not yet ready to toss the sticks or get a cane. One step at a time. Saturday I will finally be able to take a shower (will probably take two), drought crisis be damned. I seriously need it.

But today, my lady friend/caretaker and I went looking for some kind of knee separator, to be used while sleeping. Turns out the several local medical supply outfits in this area don't carry them. My plan was to try the stores first, and if that didn't pan out, to order something from Amazon or online elsewhere.

After we struck out at the last location, she said, "We're going to Building 304 at the VA Medical Center," which is located in West Los Angeles, about 10 miles from where we were parked. I checked. Didn't have my VA card with me. I expected we would show up, they would want to swipe the card, and we didn't even have an order from a doctor for this foam hip abduction thing she had in mind to get. Meaning the trip would be for nothing.

We finally got to the Prosthetics Department in 304, and she explained to a gentleman what I needed. I could orally prove my identity, the card wasn't even an issue. He looked up my info, said to wait and disappeared. Meanwhile, both of us were dying of thirst. Here comes a guy pushing a cart, offering cold water with lemon in a cup to anyone who wanted one. Both of us latched onto that deal.

A few minutes later the gentleman behind the counter showed up with exactly what we needed. He typed a note into the computer and handed the package to us. We thanked him profusely and departed.

In front of Building 304 we encountered a ticked-off heavyset man in a scooter chair. He stopped to talk and said some "patch-up doctor" almost killed him a few days previously with a morphine overdose. He waved some papers at me and said he was switching to Medicare and advised me to do the same.

I told him my experience with the VA was outstanding in every way. The medical care is prompt, professional, thorough, very patient-centric and there are lots of nice touches. Free beverages in the lobby of the hospital. A lady playing a harp. Sometimes violinists and cellists. And then there's that guy with the lemon-flavored cold water on a cart, roaming the halls.

I've not seen this kind of care and attention to detail anywhere else, and I have had my share of civilian hospital visits. Good luck with Medicare, bub. I'm delighted with the VA.
 
@THR-dude,

Why can't you take a shower until Saturday? That must be difficult. Getting home to shower was such a huge deal for me. It made me feel SO much better!!! I bought grab bars, a shower seat, and a rubber mat before my surgery. Fortunately, I already had one of the hand held shower heads.

Glad to hear your experience with the VA hospital was so good. You sound like you focus on the positive.

Hope you like the pillow. It's nice that you were able to get it without your VA card.
 
They told me no showers until the dressing comes off on Saturday. So, every night, it's been a wet wipe-down. Just two more of those until that changes. :)
 
My live-in healthcare provider removed the dressing today. She says the scar is bigger than the one for the original install 21 years ago, which I thought unusual.

It's not like I can look at this scar directly so I will have her take a photo later today. I would be happy to share that stapled-wound image with the fine folks on BoneSmart but I wouldn't want to create a major pic editing headache for your mod. :heehee:
 
It's nine days post-op and I just took my first shower. Walked to the shower. Left flip-flops and crutches in the bathroom. Slid open the shower door, stepped inside, then my caregiver had me stand there while she unbuckled the hip brace and removed it, and slid the shower door closed.

Then hot water (finally!), soap, more water, all the while avoiding turning too much from my abdomen. Got to keep the rotation to a minimum. Turned off the water and toweled off as much as I could. I didn't want to raise either leg high or bend over to dry off my feet; got to keep the angles under 90 degrees.

My caretaker patted dry the surgical area; I didn't want to wipe it with the towel due to staples, etc. Then she dried my lower legs and feet. Then I just stood there as she brought the hip brace up. Buckle, buckle, buckle and we're done. I stepped out.

I grabbed my camera and had her shoot some pics of the area where they had opened me up, simply because I can't view that directly. Ugly big scar! I'd upload a photo but I doubt it would survive the mod's first look. So...use your imagination.

From here on out, every day, a blessed shower instead of a wipe. And as soon as the docs tell me everything is healed, I'll go back to taking a bath instead of a shower, which is very much a preference.
 
Well post it and I'll edit it!

But isn't that first shower glorious?!
 
Yes, it certainly was glorious. And here's the pic. Have fun. LOL
Capture.JPG
 
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