THR I have a cold, my mother has her THR today<

[Josephine]

Yep, she has a fracture all right. If you look at where I have the red arrows pointing, I think that's where it might be but it's difficult to be exact as it might be hidden by the prosthesis. But there does appear to some some slight abnormality in the bone structure there.

A website says "A periprosthetic fracture is a broken bone that occurs around the components or implants of a total hip replacement. It is a serious complication that most often requires surgery." I'm also reading that you cannot weight bear on that leg or raise leg without support on calf and knee or you can displace the fracture. But the doc said she has to put weight on the leg. I'm so confused.

That's more likely referring to quite a serious fracture. You mother's is actually just a crack. What can happen is that while the surgeon is reaming the bone to make a place for the implant, if he hammers just a little bit too hard, he can make the tubular bone just crack down the length of it.

Mostly they are just minor cracks and it has been fixed 'with surgery' - or rather 'within surgery' - as it has a circle of wire around it (blue arrow). This would be quite sufficient. However, I think it would account for the extra and excessive pain your mother is experiencing. She should be allowed to rest and not required to weight bear and walk for a few weeks yet just because of the pain.

The OS wants her to go home now, he's like "cmon, you need to push yourself a little"

It is my opinion that her surgeon has been remiss, to the point of being unprofessional, not to have been up front about this incident, never mind taking into account the obvious consequences. To be honest, I think she would be far better off at home where she can recover in peace.

Are the screws placed because of that to align the fractured bones?

Not at all. Miles away from the site of the crack. Those screws a simply a requirement of that device's design. There are several such devices requiring screws like that.

 

[nevillek]

Hi @Josephine hun.. Thanks for your reply

How did your surgery go? I believe it went well as you're back here.

It's good to know the fracture was fixed during the surgery, I didn't know the wire was because of that, I thought it was part of the implant. Is the wire dissolvable or remains in there forever?

When you say she shouldn't weight bear or walk for a few weeks just because of the pain, do you mean she should be in the bed 24/7? Not even the 2 daily Physio sessions?

Also, does the weight bearing/walking pose a danger like dislocating/worsening the fracture or is it only to control the pain?

Asking because I see she's pretty comfortable while walking during Physio. It's only when she turns in bed or gets up that it pains her. And even that has gotten slightly better due to the fentanyl patch I believe. A particular exercise called Hip Knee flexion (bending hip/knee upwards) hurts the most. Can you figure out if that's putting stress on the fracture or what other muscle could that be?

Thank you so much, and wish you a speedy recovery.

 

[Josephine]

How did your surgery go? I believe it went well as you're back here.

It went splendidly, thank you! Home and pretty much pain free!

Is the wire dissolvable or remains in there forever?

Since it's standard, surgical grade stainless steel, yes it will be there forever and quite possible become incorporated into the bone after a few years!

When you say she shouldn't weight bear or walk for a few weeks just because of the pain, do you mean she should be in the bed 24/7? Not even the 2 daily Physio sessions?

No not at all! She can walk as tolerated and she should sit out in a chair during the day. It's my professional opinion (controversial one, I admit) that 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.

Also, does the weight bearing/walking pose a danger like dislocating/worsening the fracture or is it only to control the pain?

It's just about the pain.

A particular exercise called Hip Knee flexion (bending hip/knee upwards) hurts the most. Can you figure out if that's putting stress on the fracture or what other muscle could that be?

I can imagine! But following my previous comment, she doesn't need to do it!

That's why I say she would be better off at home where she can dictate her own progress and pain management and also get relief from all the badgering and talk! All she really needs is rest, peace and quiet and whatever pain meds she is prescribed (Lanol which is, in my language, paracetamol). Lanol should be quite sufficient provided she is taking it easy as I have said. I remember in days gone by (when I was a young lass!) that was all we gave hip patients routinely.

 

[nevillek]

Great thanks @Josephine congrats on the successful surgery.

The OS is removing her stitches tomorrow and discharging her day after tomorrow! I asked him if I should continue the fentanyl patch for a month or so just to be safe and he was like NO, the body will get dependent on it. Just one more patch that he will apply tomorrow after removing stitches and that should be okay for 5 days.

I'm worried about this.. If it were the patches that were helping reduce the pain so far, it's going to get worse again once this last patch wears off. What should I do about this??

 

[Josephine]

Well, he's wrong about dependency. Specially since she's only had it for a few days! But gee, such paranoia!

But don't worry about it - read my previous post - all of it!

 

[nevillek]

Well, he's wrong about dependency. Specially since she's only had it for a few days! But gee, such paranoia!

But don't worry about it - read my previous post - all of it!

Yeah, I know Lanol *might* be sufficient, but what if it's not? If the patch reduced the pain from 10/10 to 7/10, what reason have I to believe that the pain won't go back to 10/10 when the patch is removed? I don't want to see her so miserable again and that too at home, where I'll have no help.

Isn't this pain expected to last 1-2 months atleast?

 

[Josephine]

Maybe, maybe not but do remember, she'll be able to rest and not forever being forced to do things which is what she needs at the moment. I don't know how your medical system works in India? Is it something like the US where patients have to go to their surgeon for pain medication. Or do you have a primary care or GP you can go to. I hope the latter as they are often much more level headed and sympathetic than the surgeons!

And it's impossible to say how long this phase will last. It should certainly stop being this intense very much earlier than 2 months.

 

[nevillek]

I'm not sure. I can try going to my GP and ask him to give me a prescription for the patches, but I have no clue if it's allowed or he would do it.

I need to decide whether to put another patch before the new patch he puts today wears out. What do you suggest @Josephine?

 

[Josephine]

I can try going to my GP and ask him to give me a prescription for the patches, but I have no clue if it's allowed or he would do it.

I wasn't thinking about the patches. There are many other medications she could try which could be just as effective but that will be up to your doctor to suggest.

Certainly don't change patches before the due time otherwise you risk overdosing her.

 

[nevillek]

Oh okay. Well, he removed her stitches yesterday and didn't even put a new patch. Instead, he asked remove the existing patch on day 5 (at home).

He has prescribed her 1 Lanol ER at morning and afternoon, and the Ultracet at night, and either of the two for SOS pain. I'm guessing I can tweak those for extra relief, like giving Lanol thrice a day or something, without any problems? If necessary that is.

She's being discharged in two hours. Want to thank all of you for so much help and support in the last few days. Special thanks to you, @Josephine and @Jamie.

 

[nevillek]

@Josephine Just got these from her discharge file.. Any thoughts or something I should know?

 

[Josephine]

1 Lanol ER at morning and afternoon
Ultracet at night

Lanol ER is paracetamol 650mgs.
Ultracet is Tramadol 37.5mg with acetaminophen (paracetamol) 325mg

The maximum per 24hrs for paracetamol is4,000mg , Tramadol 400mg per 24hrs.

I'd say that 37.5mg of Tramadol is quite a mild dose. She could do with 50 or 100mgs of that. So I suggest you contact your GP and ask if you can have Tramadol and paracetamol on their own as they will be easier to manage.

And when/if you get them, try this routine

 

[Josephine]

Re the notes: it doesn't say anything about the crack or the circlarge wire. Very bad record keeping.

 

[nevillek]

Hi @Josephine

Mommy is a weakling, I'm afraid she won't be able to tolerate the max doses of para/trama all of a sudden. I'll just wait until after I remove the patch tomorrow to see how she feels. If she feels fine, that'd be great, or I'll approach my GP.

We got a new Physio at home today who made her do 4-5 new exercises and mom, who was fine all day, suddenly got miserable again all evening, and is still like that. The Physio should have gone easy.

I just had a time difference question if I'm continuing the current regimen: Is there a minimum time gap she must have between two Lanols? She had to wake up much earlier at the hospital and was taking Lanol at 8-1-8 after b/l/d and Ultracet at 10. I know you suggested that 8-2-8-2 but at home, if she wakes up around 10 and eats breakfast around that time, can I adjust the dose to 10-3-9 or 10-2-6-10 or if taking 4 times a day?

Also, should there be a minimum gap between Lanol and Ultracet?

I'm also wondering why he discontinued her Levofloxacin for the UTI? Would the UTI have cleared in 10 days? What if it comes back in the future? We'd never know.

 

[Jamie]

You want at least 4 hours between the doses.

 

[Josephine]

We got a new Physio at home today who made her do 4-5 new exercises and mom, who was fine all day, suddenly got miserable again all evening, and is still like that. The Physio should have gone easy.

More than that, she shouldn't be doing any exercises at all! Remember what I said earlier? 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. STOP the exercising!

Mommy is a weakling, I'm afraid she won't be able to tolerate the max doses of para/trama all of a sudden.

Then give her 50mgs instead of 100. But if you have Ultracet then your options don't include this.You are stuck using the Ultracet. But you can use it with the same timing - 6 hours apart.

Is there a minimum time gap she must have between two Lanols?

Yes, 4-6 hours aiming at a maximum per 24hrs of 4,000mgs. Remember to add in the acetaminophen which is in the Ultracet.

I know you suggested that 8-2-8-2 but at home

What time they are is immaterial. If you look, you will see the doses are 6 hours apart.

Also, should there be a minimum gap between Lanol and Ultracet?

Take them together as per the chart I posted.

I'm also wondering why he discontinued her Levofloxacin for the UTI? Would the UTI have cleared in 10 days?

Actually, 7 days antibiotics is usually sufficient for a UTI. She's had plenty.

 

[nevillek]

Tysm @Josephine

I've already got a month's supply of Lanol and Ultracet so I guess I'll tweak around with these for now.

She's fine again today morning so I can go slow with the meds. If I myself want to start with baby steps at a time to see how she reacts, does this regimen below look okay to you? I've just added one extra tablet between 12 am and 10 am because of the 10 hour gap, and will only add it if she complains of pain in between those hours.

~10-11 am: Pantocid bbf, Lanol abf
~2-3 pm: Lanol abf
~8-9 pm: Pantocid bfd, Lanol afd
~ 12-1 am: Ultracet
~ 5-6 am: Ultracet/Lanol (Which one is more effective? I was thinking Ultracet because Lanol apparently needs to be taken after eating or causes acidity? Maybe even with Ultracet, I should give her 2 biscuits first?)

Yes, 4-6 hours aiming at a maximum per 24hrs of 4,000mgs. Remember to add in the acetaminophen which is in the Ultracet.

Isn't acetaminophen the same thing as para?


P.S. Is it okay to keep the op leg elevated on 1 pillow ALL the time? My mom feels really comfortable sleeping that way.

 

[Pumpkin]

Paracetamol and acetaminophen are the same thing.

 

[Josephine]

~10-11 am: Pantocid bbf

Pantocid is not a pain killer, it's a PPI (read this Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers)

Which one is more effective? I was thinking Ultracet because Lanol apparently needs to be taken after eating or causes acidity? Maybe even with Ultracet, I should give her 2 biscuits first?

Lanol is for "mild to moderate" pain while Ultracet (a mix of paracetamol and Tramadol) is for "moderate to severe" pain. As for the acidity issue, what you have described is for NSAIDs (see article above) and unless it has an NSAID mixed in it, which I haven't been able to ascertain, Lanol is not in that drug group so it's not an issue. Neither is it so for Tramadol.

However, your planned schedule appears to be a bit all over the place! The gaps you have described are 4hrs, 6hrs, 4 hrs and 10hrs. Pain med schedules should be at regular intervals, based upon the fact that these drugs only stay effective in the system for about 5-6 hours. So I would suggest you have set times for them such as 12mn, 6am, 12md and 6pm. Or adjust the times to suit your schedules.

Isn't acetaminophen the same thing as para?

Yes it is and I have always been at pains to mention this.

Is it okay to keep the op leg elevated on 1 pillow ALL the time? My mom feels really comfortable sleeping that way.

That's fine - whatever suits her. Just keep the pillow lengthways so it's not causing pressure on her calf muscle.

 

[nevillek]

Thanks @Josephine

I'm aware the Pantocid is for acidity. If neither Lanol nor Ultracet can cause acidity if taken on an empty stomach (as you mentioned), I wonder why they've prescribed her Pantocid before breakfast and dinner? Not too important though I guess.

I've removed her Fentanyl patch today and her pain has been moderate so far. More than pain, she says she feels lot of discomfort/heaviness in the hip area. Also her calf muscles have been paining.

I'm attaching two pictures: one of her sitting on my computer chair with a pillow underneath (to secure a height of 20 inches); and the other of her sleeping sideways for 10-15 mins every few hours as advised. Can you tell me if these positions are okay/correct?

If you notice her ankle, will the pressure sore on it go away on its own?