Revision THR Now Facing Left Hip Revision

[Beckford]

I had a letter today from one of Prof H registrars. It’s quite technical but it reads as follows:
I have reviewed the imaging today with Jane. Her right hip replacement shows to be well fixed with nicely orientated components. Her recent MRI shows significant TFL hypertrophy. There is a pseudotumour exiting the hip posteriorly. The gluteal attachments appear to be intact. There is some atrophy of gluteus medius and minimums but not a florid fat infiltration to suggest a denervated muscle. She has wasting of the short external rotators consistent with previous posterior approaches. In the first instance I think she would benefit from specialist physio therapy to see if we can retrain the hip abductors in preference to TFL butbif pain is a barrier then I would consider a local anaesthetic and steroid injection to the trigger point between the ASIS and AIIS. We will discuss her case at the hip debris MDT meeting and see her back in four months.

Sorry this is long and boring but if anyone has had similar problems with their progress it would be good to know I am not on my own.

 

[CricketHip]

I am glad you posted the report. It sounds like there's a real chance of strengthening your lateral hip muscles? At least this is what I gleaned from it.
Which means it is hopeful.
So it sounds like you are going to be seeing a specialist PT., how do you feel about that? I think it could be very beneficial to you, contingent on the PT going slowly and gently.

You really do deserve some positive news!
Please take care and it will be very interesting to see your updates going forward with the treatment.

 

[Mojo333]

Hi @Beckford
Just wondering what course of action you were currently pursuing and wanted to send you well wishes.

 

[Beckford]

I too had my third revision in May , the previous revision failed, 6 dislocations and a permanent feeling of leg weakness. On top of all this I developed a large Pseudotumour.

My surgery was on May 15th and my consultant in Oxford worked with a plastic surgeon because after removal of the tumour they used a donor muscle flap taken from my rectus femoris. The whole implant was removed, cup, stem, all of it. My femur had to be broken to get the old stem out so it was a really huge surgery.

My Xray last week showed good healing of the bone , nicely healed wound and I was told the hip is now strong enough to fully weight bear. I have tried and tried to walk but I just don’t have enough strength in the leg and this results in walking with a very bad limp. Every morning I wake and hope that I will be strong enough to get around but no , it’s still not up to the job.

I know revision hips take longer to recover from but my previous two only involved changing the acetabulum and by 3 months I was walking a good 3 miles a day. This is really wearing me down, I am having to really focus on trying to be positive but this has gone on for so long now as pre op I wasn’t able to do much so add those two years to my current 3 months post op and it’s enough to send anyone round the bend.

I would like to hear how others have got on with revision hips where the bone is cut to remove the stem. I too am starting to worry I will never walk again. This is so tough physically but mentally it’s as bad if not worse and last week I reluctantly decided I needed to go on antidepressants so I now take 30 mg per day of Duloxetine, I am told it will take a couple of weeks to start working.

Please, if anyone can share their revision recovery stories I would love to hear. It’s a lonely place when you don’t really have anyone to talk to who has been through this and my poor partner must be sick to death of hearing me go on about it.

 

[Jaycey]

@Beckford You will see I moved your latest post to your own thread. It will get more visibility here.

Can you give me the date of your second revision. I'll update your signature for you.

How long were you non-weight bearing before and after your revision? Have you had the physio the consultant suggested?

It sounds like your latest revision was very complex. Please don't compare this recovery to any other. Healing takes time but it will happen.

 

[Beckford]

Hi Jaycee, my last revision was 15th May
Please can you kindly explain how I add to my own thread as it’s something I don’t understand how to do.

I was full weight bearing before my revision, after surgery I was 6 weeks touch toe weight bearing. I then was told I could put all my weight through the leg which I am doing ( only just) it’s quite painful but I grit my teeth and get on with it. I am nowhere near being able to stand and balance on the leg which I feel is probably what is holding me back. My consultant wants me to really work the leg but I must say that is easier said than done!!

 

[Jaycey]

@Beckford You add to your thread just as you posted (above). Just scoot down to the empty box and start typing.

You said you had 3 revisions. I see one was done June 5, 2019. Then one on May 15, 2020. What was the date of the other one?

after surgery I was 6 weeks touch toe weight bearing

This is the problem. Your leg was already weak pre-op. Then not weight bearing for 6 weeks put your recovery back by at least that length of time. You don't just start to use a limb that has been traumatised and then completely rested. You will need to build up strength gradually.

My consultant wants me to really work the leg

Well until you have a bit of muscle tone back I can't agree with your consultant.

Did you go to PT for this? Some good PT with a focus on gradually building strength might be something you should consider.

 

[Beckford]

Due to Covid there was no physio. I was sent a video showing some exercises but I actually already knew most of them from previous surgery.
I have been encouraged to put some miles on the hip as he put it. But the problem is I can’t even balance on the leg in the single leg stance test. I imagine that until I can do that walking is going to be very hard. Basically my leg doesn’t want all my weight yet and I feel I am forcing it. Surely that’s not the right way. I do try every day , just to test it to see if the strength is there but then I end up really sore. I already know my glutes are weak from my MRI scan. I am a little concerned that at 12 weeks the leg still hurts but I can’t find many post op recoveries on BoneSmart that specifically are for revisions. I just wish I knew how I was doing, it feels like I am not making much progress which is so disheartening

 

[Jaycey]

Click on this link to get a list of every Revision THR thread in the recovery area. There are several members going through this recovery but none of them have your history.

I would just focus on gaining confidence standing and putting weight on the leg. Only when you have that confidence can you begin walks to build strength. It is simply not possible to "put miles" on your hip if you can't weight bear.

Are you using a walker?

 

[CricketHip]

It's understandable that you are concerned about walking on that leg. Like Jaycey, I also wonder if you are using a walker to help stabilize you as you attempt your steps?
It sure seems like you would be a good candidate for some physical therapy to help guide you.

If that is not possible, is there someone who can stand beside you and help you, alongside the walker? Sometimes having someone there alongside is very comforting.

I hope the link from Jaycey helps you to find other revision advice.

 

[Hip4life]

Hello. My heart really goes out to you. I didn’t have revision surgery but I can identify with some of the pain and weak muscle issues. With my tendinitis, I was able to walk and gain muscle strength only to a point until I got the tendon release. Then I was able to walk and buil up exercise on my own. If not, I would have turned to PT. I agree with the above advice. It is going to take a very slow and methodical approach. It will be important to have a PT in this case that specializes in this type of weakness to coordinate this undoubtedly complex recovery. The old adage that I’ll add a twist to: you need to crawl before you can walk. Mostly because I never liked running and wouldn’t do it now, anyway. Lol. I certainly understand about Covid limitations but can any of these ortho specialist steer you to an appropriate physiotherapist, even if it is virtually? I hope you are using a walker or crutches or at least a cane. I used my walker for a few weeks and my cane for about 2 1/2 months after that in my THR recovery. There is no time restriction except as your body dictates. I can only imagine how discouraging this is for you. Please, please don’t give up and keep pursuing getting help for your recovery. There are a few here who have had a rough time of it but have persevered. Keep coming back here for support and advice. There is a right answer. You just haven’t gotten It yet.

 

[Beckford]

Thank you all for your help and advice. I do have a virtual physio programme . It consists of about 8 gentle stretches and exercises , I am to pick 3 or 4 each day and afterwards I submit a progress chart . It’s very difficult trying to get to actually see anybody due to Covid so everything takes place via email and internet.
I was a little disappointed on Friday as I wrote to head of physio with my concerns, got no reply all day and several times tried phoning, no luck.
Just to add to my difficulties now my back hurts , possibly through limping to try to walk. I have been forced to do very little over the weekend and am laying on a bag of frozen peas as I write. Did any of you get back pain during your recovery? It’s worse than the hip which actually doesn’t hurt much at all now , just isn’t strong enough to walk unaided. Apart from that the hip pain is very manageable.

 

[Jaycey]

I'll ask again - are you using a walker? If so, is it adjusted correctly?

Be sure your walker (frame) is properly adjusted for your height. Your back may hurt if it's too low because you tend to bend over. If you are bent forward when walking, try raising it up a bit and see if that is more comfortable.

Correct walker posture:

Incorrect walker posture:

 

[helenium]

I had a second revision of my left hip nearly 11 months ago, and my femur was cut (a lot) to remove my fractured femoral prosthesis. I wasn't toe-touch this time, but was told to keep activity to a bare minimum for the first 3 months. I was 20 weeks post-op before I was allowed to reduce from 2 crutches to just the one, and that was difficult to start. I know no two surgeries are ever the same, and I've had what has been referred to as an extensive femoral reconstruction, but we do seem to share some similarities.

just isn’t strong enough to walk unaided

My understanding is that you are now 12 weeks post-op, and that for the first 6 weeks you were toe-touch weight bearing only? Although your surgeon has encouraged you to "put some miles" on the hip, do you really think he expected you to be walking unaided at this stage? You've had 2 revisions on that hip, your leg has been fractured, you've had muscle removed from your thigh, and you've had damage from previous dislocations (been there too). Trying to do too much too soon is bound to give you all sorts of new aches and pains, I'm not at all surprised your back is hurting . (I've always found a heating pad more helpful than ice when that happens.) If you do try some very short walks, my advice would be to use whatever aid you need to do it without limping or hurting, and if you end up suffering a lot the next day it was too much too soon. This needs to be a slow and steady recovery.

I don't know what gentle stretches and exercises you've been given, but I was e-mailed a gentle stretch and strengthening program just a month ago following a telephone appointment. Prior to that (in February, pre-covid) I'd had just one hospital PT session where I was encouraged to continue walking as tolerated with just the 1 crutch, and to try balancing on the 'new' leg while holding on to a worktop (or similar) for some support (still not very good at that one!). My new program of just 8 exercises didn't appear very challenging at first glance, but I do the same for both sides (my other hip has had 2 revisions too) and it makes me very aware of how much catching up my new side has still to do.

I hope this post doesn't come across as too pessimistic. My surgeon warned me that my recovery would be a very long one and would take at least a year - I'll post an update at my 12-month hip-anniversary (SPOILER ALERT - even without my planned follow-ups and x-rays, I'm confident I'm doing really well!).

 

[Beckford]

Thank you both for your replies and encouragement. Firstly, to answer Jaycees question, I am not using a walker, just a walking stick. Sometimes no walking aids at all but that is hard work. I think yesterday it really hit me hard that indeed this is going to take a long time. I had tried so hard to ‘put miles on the hip’ I ended up staying in bed nearly all day . My body was just exhausted by all the effort I have been throwing at this. I am going to take another day off and mostly rest , I feel it’s what I need.
I had a long discussion with my physio yesterday and she explained that the surgeon is happy with his work and confident the hip is strong basically he was giving the green light to go from his perspective . I guess I took this as a signal to push on even if it hurt. My physio reined me in and explained more about getting the muscles strong and until they can support me I am going to find walking unaided very difficult. I can well imagine that this could take a year , it really was big surgery and I have to try to get a bit more realistic about my recovery. I do feel better now I have come to terms with the fact that I am going to need patience and I am resting more and feel less anxious. At the end of the day I just want the best possible outcome. My impatience comes from feeling like I have missed out on life for such a long time now and I just want to be able to do things and go to places and basically just have some fun and enjoyment in my life , it’s been such a long hard struggle.

 

[Jaycey]

I can well imagine that this could take a year , it really was big surgery and I have to try to get a bit more realistic about my recovery.

This can be the hardest part of recovery. Accepting that you are discharged from the hospital TO recover, not fully recovered. For some of us it's a long haul. My LTHR recovery too over one year.

It's all about finding the balance. Rest if you need to and try again another day if an activity seems difficult. I found that what seemed impossible one day was very easy a few days later.

 

[Beckford]

Hi Jaycey, you are so right, this really is a tester! I am only just coming to terms with the fact that this is no way a quick fix. I can well imagine it taking a year.
I have developed a bit of a routine which helps. I live in a small culdesac of bungalows and to try to break the day up I walk around the pavement which takes about ten minutes then i either lay on the bed or sit and watch tv , I repeat this usually every hour. It’s very dull but it’s just about all I can manage. I just keep thinking every day is a day closer to being recovered and I don’t regret this operation because there was no way I could have carried on how I was pre op! This site is such a life line and definitely helps to talk.

 

[Mojo333]

You have more than your share of hip woes and I can only imagine how you muat be weary of the recovery time but I think helenium is right...you can put miles on your hip while using your cane until you are stronger.
Perhaps you can get someone to give you a bit if a short drive so you can get a change of scenery...maybe a little park (obviously without alot of people)
Keep the faith, friend.
We are rooting for you.

 

[Beckford]

Thanks Mojo, I need all the encouragement I can get at the moment. As long as I come out the other side with a good hip I will be very happy

 

[Hip4life]

If you keep doing what you are doing, little by little, your body can’t help but do what it naturally does-heal. You are giving it the chance it needs. You and your hip have been through a lot. You need to give yourself and hip some credit for your resilience so far. It was a little over a year before I felt I had “arrived” to complete healing and yet, I’m still seeing and feeling improvements. You will see bigger improvements at the beginning and important but smaller improvements as you gradually heal and get stronger. They are all victories. Use your assistive devices and ice and elevation to help you get there. Trust me. You WILL get there as long as you take it slow and keep going. No one can promise perfection but function and the ability to enjoy life again are a very realistic expectation. I journaled to be able to see my progress especially when I would get frustrated thinking nothing was happening. Nothing fancy, just a simple notebook to put down your thoughts will do. I made sure I would include my gratitude for the day. There will always be at least one. Some days that is difficult to do but I truly believe it is what got me through the rough times to the better and then on to the great times. Now, looking back, that year seemed to go by in a blink. My sincerest hope is that it will for you, too, even if it seems daunting right now. Better days are not that far ahead. We’re right there with you.