THR Joint Replacement #3 -- Getting Discouraged<

[Josephine]

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 approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

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

7. 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.

 

[Figment826]

@Josephine -- Are we talking knee pain or hip pain? I believe the original post that prompted this exchange was the fact that Im having increased pain and stiffness and decreased mobility in the TKR knee on the same side as the current THR. I will answer for both.

1. Posterior approach for the LTHR Apr 4, 2018. TKR July 2017

2. No pain at rest for either most of the time.
Hip -- Muscle soreness and tightness all around the op area -- lateral thigh, upper butt -- (and edema) 6-7 at worst which would be upon rising, moving in and out of bed, while walking, after activity. Pinchy pain along the incision esp when sitting on hard surface or raised toilet set. Rare, short lived muscle spasms upper thigh. The old arthritis pain is of course completely gone.

Knee -- Discomfort, stiffness and some sense of "not quite going to hold" across top of knee. Restricted and "tight" flexion. I havent measured but would say I can still extend to -20 or so (which is where I had gotten to before the THR) but flexion seems less than it was-- maybe 120 at most with discomfort. I have not done any stairs yet so I dont know how that would feel. It was not completely pain free by any means before this recent THR but was better than now.

3. I took Norco 5 mg tid-qid with Xanax 0.25 mg Post op days 1 and 2 with good results but significant side effects.
Day 3 I switched to Tylenol 1g (it had not helped much in the past but you strongly encouraged a try so I did), again tid-qid -- I don't wake up just to take pills so sometimes it averages less depending on timing.
I had a MISERABLE episode related to over-shooting constipation remedies where I was largely incontinent of stool -- LOTS of getting up and down and sitting on the bedside commode -- pain everywhere got much worse during that and its not quite back to normal.
Currently (day 7) I am taking Tylenol 1 gm tid-qid and Xanax 0.25 mg HS. I think it is working pretty well overall.

4. I am experimenting with icing so can't give you an exact routine. I have a gel pack as well as an ice man machine with a hip pad. Sometimes ice makes it worse -- tighter, more achy and spasmy. Sometime it does seem to help. When I use it, I keep it on for 30-60 minutes. I have been using a heating pad for my SI area which is just uncomfortable from lack of movement and stretching a couple times a day -- it helps the SI tremendously and doesn't appear to have any effect on the hip. I am doing nothing to the knee.

5. I am spending most of the day sitting with my leg elevated within my hip restriction of 90. Twice a day for maybe 15 min I lie on my bed with a special hip cushion that has my hips slightly above my heart -- very comfortable and relaxing. I require assistance to get on and off it though. While I am lying down, I do the very few mostly anti-embolic exercises my surgeon gave me (like you he is a big believer in hips healing themselves and not doing too much too early)

6. I get up, shower, groom and dress myself. Up around a small "loop" in the house which includes a BR stop 5-6 times a day (only takes a few minutes). Sit in a different chair and do knee flexion and extension and heel pumps 2-3 times daily. A friend is currently doing all my cooking, cleaning etc through the end of the week

7. No PT
In bed lying down --15 quad sets bid
15 heel slides bid
15 ankle pumps and circles bid
15 butt squeezes bid

In a chair sitting straight --15 heel pumps bid-tid
15 knee flexions and extensions bid-tid
NO straight leg raises -- that kicked off a horrible psoas tendonitis last year 6 weeks after the RTHR that I still have after loads of PT, steroid injection and PRP injection.

That's all I was encouraged to do with increasing general activity until my 4 week follow up. I am required to use a walker at all times with 30 lb weight bearing max on op leg until then. Usual hip restrictions.

 

[Josephine]

I was responding to this comment

I had my knee replaced on the same side last summer and it is stiff and unconformable again. Not sure what to make of that

 

[Josephine]

2. No pain at rest for either most of the time.
Hip -- Muscle soreness and tightness all around the op area 6-7

Well, you're only one week out so that's pretty much to be expected.

3. Day 3 I switched to Tylenol 1g (it had not helped much in the past but you strongly encouraged a try so I did), again tid-qid -- I don't wake up just to take pills so sometimes it averages less depending on timing.

Jolly good!

day 7 I am taking Tylenol 1 gm tid-qid and Xanax 0.25 mg HS. I think it is working pretty well overall.

Good

4. iciing - When I use it, I keep it on for 30-60 minutes.

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day.

5. I am spending most of the day sitting with my leg elevated

Gosh - how do you accomplish that?

6. I get up, shower, groom and dress myself. Up around a small "loop" in the house which includes a BR stop 5-6 times a day

Okay

7. No PT
15 ankle pumps and circles bid
15 quad sets bid, 15 butt squeezes bid
15 heel slides bid
15 heel pumps bid-tid
15 knee flexions and extensions bid-tid.

I think you are misunderstanding when I say "No PT" because to me, PT IS exercising! All you have described here is exactly what I am referring to when I say NO PT!

Remember this?
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.

 

[waterman1]

Hi Figment, been there done that in 2014 so I feel for ya, believe me. My two cents would be tramadol, you can take it, right? Some say its non narcotic, some say differently. Ice, Ice, Ice all you can stand of course...

 

[Josephine]

Tramadol is a narcotic but it's a synthetic version so less of a problem.

 

[gillycat11]

@Figment826, quite a sobering tale for those suffering from post op constipation, but so funny!
Glad you got it sorted in the end though. Miserable time of it when you're sore, fragile and can't poo!
Hope you are now feeling much better all round from how you were a few days ago.

 

[BeBe]

@Figment826
Just checking in to see how you are doing. Hope all is positive and recovery is moving along for you.

 

[Mojo333]

Hope you eased off of some of that PT and that your discomfort is easing!
Wishing you a good day!

 

[Figment826]

@BeBe, @Mojo333 Thanks for checking in! I wasnt really doing any PT so my activity hasnt changed much -- Im in a chair most of the day -- walking with the walker and 30 lbs of pressure just around the house a bit. The hip is not terribly uncomfortable -- icing a few times a day helps although the edema remains of course. My knee (replaced July 2017 -- same side as current THR) is getting stiffer, more uncomfortable and less flexible by the day so will probably contact my doc about that and see if he has any thoughts. Overall I think Im doing well from the THR itself! GI tract finally mostly back to business Not bad for 2 weeks out I think!

 

[Mojo333]

I think you are doing splendidly. Sorry your knee wants to give you a bit of trouble.
Hope all continues to improve.

 

[BeBe]

@Figment826
Good for you! Seems right where you should be?
My knee on op side is also grumbly but has not had a replacement -
Knees take a lot with these hip surgeries.
Have a good weekend!

 

[gillycat11]

Doing just fine. Keep it up!

 

[BeBe]

@Figment826
Hi just checking and wondering how you are making out with the new hip?
These weeks drag by and they also fly by KWIM?
Hope you're doing well with hip and knee

 

[Figment826]

Hi @BeBe -- Thanks for checking in! I think Im doing fine. I think much of the knee issue is just due to the general edema from the THR. So Ive been icing both hip and knee and it seem to be helping some. I'm still sleeping in a chair -- I don't really like that but at least I get some sleep that way so how bad can it be Going to try going out for a fast lunch with a friend today!

 

[BeBe]

@Figment826
Good for you! The getting out does tire you out so much at first but does worlds of good mentally!
Hope you have fun!

 

[Figment826]

Hi Everyone! I need some advice. My grandson is being baptized in another state the middle of June. I will be 10 weeks post op. It is an 8 hour drive and I will be alone. I would probably do it over 2 days. Im just not sure it's prudent. If Im not there, my daughter will face-time in and everyone will be very understanding. Thoughts????

 

[jaydub63]

If you are able to take frequent breaks such that you are not driving for more than about an hour at a time and can stretch and walk along the way it might be doable.

 

[Layla]

Hi @Figment826 Its good to hear you're doing okay. I hope your lunch went well today.

I slept in a chair for three weeks so you're not alone, many do.
I'll bet you graduate to the big bed very soon. Then there are the night wanderers,
those who start in one place and wake up in another. It's all good! Whatever gets you through the night

As far as the baptism. It took me a few months before I was comfortable sitting in the car for 30-45 minutes.
With that said....we're all different. It may be okay for you. I'd hate to see you halfway in though and hating life. I'd definitely take a practice drive, for an hours time, to see how you feel after that amount of time. With frequent stops to stretch and walk it may be possible?

Wishing you the best as you continue your recovery!

 

[Figment826]

Thanks @Layla! I have a little over and hour's drive to my first follow up appointment next week (then another hour home!) so we will see how that goes. I leaning against the baptism right now but it's still several weeks away. Glad to hear the chair sleeping thing is not unusual