THR Leg/feet swelling

[Sonnie]

I'm about 12 weeks post op after a THR. My feet and legs still swell during the day. It goes down a bit after a night's sleep, but starts again as soon as I get up. I've used the compression socks that the doctor ordered, but they don't help much. I'm scheduled for the other hip to be replaced next month and I'm worried that the swelling will get worse. Is it related to the surgery after 12 weeks, or should I try to find another reason for the swelling?

 

[Layla]

Hello and Welcome to BoneSmart and recovery. Thanks for joining us. I will leave our Recovery Guidelines and type more in a post below -

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​

elevate​

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

BoneSmart philosophy for sensible post op therapy​

5. Here is a week-by-week guide

Activity progression for THRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications​

Wound Closure​

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.

 

[Sonnie]

Thank you! I'm a fairly active 71 year old and I'm ready to be done with recovery before I need to start all over again. I guess I just need to be patient.

 

[Layla]

Yes, patience is required for sure and it’s not easy!
Please share the date of your surgery and which hip was replaced and we’ll create a signature for you. Also the date of your upcoming surgery. Thanks in advance.

Swelling lasts for varying amounts of time. The first stage of healing is the inflammatory phase. During this time it is very common to notice swelling. After lower extremity surgery, or trauma involving bleeding and inflammation, there will be fluid in the leg causing the sensation of heaviness. Gravity pulls the fluid downward and since the patient is less mobile the fluid is not pumping back through the heart as quickly. The swelling gradually eases, but can persist for up to 3-6 months in some cases. Regular movement will assist in the reduction of swelling, as will elevation and ice. Your surgeon may prescribe compression stockings for a short period of time. My surgeon told me that in some cases it can even last up until a year. I’m sure this is more rare and slowly decreasing over time.

Read the articles on ICE and ELEVATE in the Recovery Guidelines above and dedicate some time to both.

Jamie from admin once explained that It is our lymph system that rids the body of fluid (swelling). So you want to get the fluid to the lymph nodes in your torso area so your body can more quickly process it. The lymph system works rather slowly on its own and much more efficiently with the assistance of gravity. The fluid isn’t draining into the hips, but contained with the lymph system and moving to the torso and lymph nodes located there.


BoneSmart FA, @CricketHip is involved in Therapeutic Massage and has shared this exercise to assist in manual lymph drainage. This gentle, yet effective therapy will help prime your lymphatic system to move fluid and inflammation away from your leg, which in turn will help your range of motion and pain - you may want to give it a try and tag her if you have any questions.

While lying supine, take deep breaths...deep, as in breathing in to a count of 5, 4, or 3 seconds, whatever is most comfortable for you. Hold that breath for another count of 5, 4, 3 then blow out completely, still using the count that's comfortable for you. A series of at least 6 reps may help get the excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up. Repeat this whenever you feel up to it during the day or night. Lying flat (supine) is best as the lymph nodes seated in your groin are less restricted, allowing for better lymph flow.

In addition, after the breathing exercise, place your hands lightly on your upper thigh, at the crease in your groin and lightly stroke upwards towards your naval.
Be patient because it can take the body time to respond.

Hope this helps! If you feel you need peace of mind, don’t hesitate to communicate with your OS’s for reassurance. Stay in touch and let us know how you’re doing.

 

[Mar]

I’ve had two TKR and now 9 days out from my RTHR. I had bad swelling with both knees. But hardly any swelling with this hip. Only thing different: I had a air compression wraps for both legs. Plus it had a cooling pad for my hip that ran continuous cold water so I didn’t have to keep adding ice to a machine or ever worry about it being too cold. Only time I didn’t have them on was when I was walking. In my case I’ve suspected for some time I may have some vascular issues where the valves in my legs are not in the best shape. I think the on and off compression helped me tremendously. But I’m not a doctor but it makes sense. Just had to take them back today I’m praying it won’t cause me to start swelling.

 

[Sohowarrior]

I’m just over 5 weeks out from THR, right posterior. My recovery has been almost seamless, but I do get some ankle swelling as the day goes by and I do my regular activities, PT and walking. I ice and elevate at least at night and once during the day. I’m not worried about it. It resolves overnight, there is no pain, I’m fully weight bearing and doing fairly aggressive PT and sailing through. Was very fit and strong pre surgery. My non expert advice: swelling is normal. If you are not in pain, just accept it as part of your healing process.

 

[evangelinaleon]

I had horrible lymphedema in my leg and feet for 6 weeks after my hip surgery, but I am 25 years old. I was told that those aged 50+ may experience lymphedema for up to six months. It went away for me immediately after I started being physically active.

Have you looked into cupping therapy? Physical therapists use it to treat lymphedema so maybe a PT can do it on you or you can buy a set on Amazon and do it yourself if you're comfortable of course.

 

[Sonnie]

Thanks, everyone. The above-mentioned surgery was on my right hip (posterior). I had another THR on my left hip four months later (June) and am now three months out. Interestingly, the swelling on my right leg/foot decreased considerably, but the swelling on the left increased considerably following the left THR and is still swollen. I'm not too worried about it. Otherwise, the recovery has gone well.

Unfortunately, shortly after the last THR, I began having pain in my knees, mostly my left.
The doc says it's bone on bone and the right is almost the same. So it looks like I will eventually have four new joints!

Here's my dilemma. l was given a cortisone shot in my left knee on August 4, two months after the hip surgery. It was somewhat effective, but didn't last long. My husband and I are planning a six hour trip by car for our 50th anniversary at the end of November. I will do most if not all of the driving. There's practically no chance of having TKR surgery and recovering sufficiently before the trip. I see the doctor on October 5 and plan to ask him for another cortisone shot in the hopes that it will see me through our trip. I've been told that there needs to be a three month period between shots and three months between the shot and surgery. Since there will only be two months since my last shot and when I see the doctor on Oct 5th, I plan to throw myself on his mercy and plead my case.

Has anyone else been successful in getting a cortisone shot before the 3 month wait period? Sorry for the long post. I do tend to overexplain!

 

[benne68]

@Sonnie While the three months between cortisone shots does seem to be general practice, I don't think it is an absolute rule.

According to the Mayo Clinic website: "you shouldn't get cortisone injections more often than every six weeks and usually not more than three or four times a year."

So, if you haven't had more than one injection this year, and promise your doctor that this one will be the last, perhaps he will agree. And if not, since you aren't traveling until the end of November, you could schedule the injection for Nov. 4 and be the full three months out!
Happy 50th Anniversary in advance!

 

[Sonnie]

@benne68
Thanks for the info! The problem with waiting until November for the shot is that would push my surgery out to February. I'm not sure I can wait that long! Well, I'll see what the doctor says in a couple of weeks. Thanks again!

 

[BBCH]

My OS advised that the three month wait following a cortisone shot was related to cortisone's effect on the immune system, and not to how often you can get a cortisone shot or to the time between injections. As he explained it, the decreased immunity following the cortisone shot increases the potential for infection, hence the 3 month wait between the shot and surgery.