THR LLD Due to Pelvic Tilt

[DEL2020Jul-11]

NOTE on PT:
I did not do any in-home PT. My OS recommended walking as tolerated and to be gentle and careful with my surgical leg as it healed and settled, especially in the first months after surgery. She directed me NOT to start outpatient PT until at least 6 weeks out from surgery. I started my current outpatient PT around 2 months out from my surgery, per instructions to have the healing in the first six weeks without stress from PT. I followed my OS' advice and avoided anything strenuous for a long time and chose a PT who worked with my OS.

 

[Diane60]

Love it! Thank you so much for your advice. I definitely take everything to heart.
I have an appointment tomorrow with the PT only because I couldn’t cancel without being charged. I plan on having a discussion with PT tomorrow to see if I can just push back until after my next six week visit with my OS which will be in August. Until then I am doing light stretches, mainly for my calf muscles. I don’t know if I have nerve damage or if it’s the muscle in my calf or lack there of but I can’t raise my foot with my ankle.I can push my foot down like pointing my toes but I can’t pull my foot back. Has anybody ever had that problem after hip replacement?

 

[Layla]

Hey Diane

I plan on having a discussion with PT tomorrow to see if I can just push back until after my next six week visit with my OS which will be in August

That is your call, not PT’s, and you may, or may not, get push back from them.

Saying no to therapy - am I allowed to?

It's a matter of consent. Consent is a legal contract between you and your health care professional. It means you give them permission to do certain things such as lay hands on you for therapy and surgeons to perform surgical procedures. For instance, if you signed a consent form that said you...

bonesmart.org

I don’t know if I have nerve damage or if it’s the muscle in my calf or lack there of but I can’t raise my foot with my ankle.I can push my foot down like pointing my toes but I can’t pull my foot back.

Are you meaning pointing toes upward when you describe not being able to lift your foot with your ankle? Do you have a lot of swelling? If so, I’d suggest you elevate and ice more often.

 

[Celle]

I don’t know if I have nerve damage or if it’s the muscle in my calf or lack there of but I can’t raise my foot with my ankle.I can push my foot down like pointing my toes but I can’t pull my foot back. Has anybody ever had that problem after hip replacement?

We do have an article about foot drop, which can be caused by nerve damage.
Foot Drop After Knee Replacement

 

[Diane60]

Hey Diane

I plan on having a discussion with PT tomorrow to see if I can just push back until after my next six week visit with my OS which will be in August

That is your call, not PT’s, and you may, or may not, get push back from them.

Saying no to therapy - am I allowed to?

It's a matter of consent. Consent is a legal contract between you and your health care professional. It means you give them permission to do certain things such as lay hands on you for therapy and surgeons to perform surgical procedures. For instance, if you signed a consent form that said you...

bonesmart.org

I don’t know if I have nerve damage or if it’s the muscle in my calf or lack there of but I can’t raise my foot with my ankle.I can push my foot down like pointing my toes but I can’t pull my foot back.

Are you meaning pointing toes upward when you describe not being able to lift your foot with your ankle? Do you have a lot of swelling? If so, I’d suggest you elevate and ice more often.

Yes. I have no muscle ability to point my toes upward.

 

[Jaycey]

@Diane60 This might just be that tight hamstring. It's very common after hip surgery. Very often the hamstrings atrophy while you are limping around pre-op. The best person to talk to about this is your PT. But be sure you start any hamstring work very gently.

 

[Diane60]

So, I woke up this morning like every morning and I’m so depressed. I am going absolutely nuts sitting around thinking and dwelling on my situation. I don’t have anyone to talk to about my hip replacement without feeling like I’m a pain in the butt, which is also something I’m dealing with but my main concern is the LLD. I now know that my hips balls are even but that I have encountered a pelvic tilt which is the reason for the LLD. Every exercise that I read about to help correct a pelvic tilt are ones that require some sort of leg crossing. This would be risky for me and I would be at risk of
having yet another dislocation which would be #8. Is there any exercises for a pelvic tilt that I can do safely without risk if dislocating? I am on week 8 since my RTHR operation. I understand that I need to heal but if I don’t do something about the pelvic tilt, I’m afraid I’ll get stuck and mend incorrectly and it will be to late and I’ll always have a LLD and will never be able to walk.

 

[Celle]

@Diane60 - Please don't worry about LLD due to a pelvic tilt. It is very common indeed and in almost every case it will self-correct as your recovery progresses.
You don't have to fear being stuck with it for ever.

We even have an article about LLD:
Leg length differential - LLD

You don't have to start doing any exercises for it right now - it's far too early in your recovery.
Later on, in a few months' time, a knowledgeable PT may be able to help you to correct your posture and gait, if apparent LLD is still causing you a problem.

 

[Layla]

I don’t have anyone to talk to about my hip replacement without feeling like I’m a pain in the butt, which is also something I’m dealing with

Well, you have a sense of humor, because this made me giggle. Thanks for the laugh!

Being concerned as you are is understandable given all you’ve been through, but it’s sad to think of you ruminating over all the “what if’s“ which is clearly bringing you down. My heart goes out to you. Are you able to distract yourself somehow throughout each day so this is not in the forefront of your mind and just allow your body to do its thing and heal?

You really don’t need to be doing any exercising right now. I don’t believe you’re missing a window of opportunity, but it feels like you may be thinking that. I understand you’re only 50% weight bearing which makes it more difficult to do things, but It would be nice if you could structure your days ahead of time, staying busy and occupying your mind in an effort to squeeze out some of the worry and just trust that with time things will work out. I’m sure better days are on the horizon. Sadly, it takes a lot of patience sometimes.
Wishing you peace of mind.

 

[DEL2020Jul-11]

Hi @Diane60,
I read your last post, I can certainly understand your feelings, especially since this has been such a difficult experience with all that you have been through with multiple dislocations and surgeries.

Your situation is unique. We all are individuals. So, my experience might not be useful to you, but I did find reading how others approached their recoveries helpful to me and still do. I struggle with uncertainty. When I was a couple of months out from surgery, while I was glad for those members who wrote about how over time (months) they definitely improved and recovered, I wondered and worried a lot if this would apply to me, would I get better?

To deal with frustration and uncertainty and pain, I lean on my faith and I sought professional advice from highly trained medical experts.

I am now at 7 months from my right hip replacement. My gratitude is immense. I still worry. My pelvis still sometimes tilts. I just saw my OS, for many many months my LLD was around 3/4 to one inch. It is now 3 mm.

 

[zauberflöte]

@Diane60 where but here can you talk about hip surgery and be welcomed!! Talk away, it does the soul good. I know what you mean about sitting and stewing. This staying-at-home-cos-I'm-very-high-risk stuff has gotten on my last nerve a long time ago, and I also tend to sit and stew. My heart is with you, and I'll even loan you some patience!

 

[Mojo333]

I still think you need to give yourself time but there are pelvic tilt exercises and other exercises that don't involve crossing your legs that you can work on sloooowly very soon.
Please check with your OS due to your history with dislocations....you don't want to do too much too soon.
Healing mojo coming your way!

 

[Diane60]

May I ask how long inflammation stays in your body? I am going on week 8 since I had a custom right hip replacement and my feet are still swollen. I received a new walker with 4 wheels which was helping move more and now my knee is swelling as well. Not only am I suffering from pain every single day in my lower glute which I now feel is most likely nerve damage but I also have LLD. I cannot drive due to my LLD and I haven’t been to my own house since my hip dislocation in Sept 2019. I’m sorry for complaining so much but I’m losing it. I just need some encouraging words. Please tell me this is going to get better. I am so tired of pill popping (Tylenol) trying to bare this pain in my butt. Which really doesn’t even help. As you can read In my earlier posts, I’ve had 7 dislocations and 4 operations. Am I really just worry to much?

 

[zauberflöte]

I had a pain in my right lower glute which felt like I was sitting on a golf ball. It turned out to be my piriformis. There is PT for that which doesn't include pretzel/figure-4 stretches.

I wish I could help with the swelling!

 

[helenium]

Oh @Diane60, bless you, you’ve had a really rough 9 months. I had surgery 9 months ago and I'm still recovering. It's a long time isn't it, my heart goes out to you .

I can assure you the swelling is completely normal. You'll have heard this many times - elevate whenever you can. It will get better.

You'll read on this site that many people get glute pain after hip replacement. But you haven't had just a hip replacement have you. You've had 4 operations on that hip, including revision surgery less than 8 weeks ago. Not only that, you've said it yourself, you've had 7 dislocations (I had many partial dislocations so have some idea of what you've been through).

All of this causes major trauma to those poor glute muscles, no wonder you have pain. Can you contact your OS or primary care practitioner to get more adequate pain relief? And don't underestimate the relief from sitting/lying on an ice pack, I found that to be really helpful. In my opinion it's still far too early to be doing any exercises for this. Your body is still healing and I suspect it will make an excellent job of it. Please try not to worry.

 

[Layla]

May I ask how long inflammation stays in your body? I am going on week 8 since I had a custom right hip replacement and my feet are still swollen.

It can take months for some, I’ve read even a year is some instances. Ice and elevate often and remember there is a balance. You may notice swelling with too little activity, just as you will from overactivity.

You’ve been through a lot, it’s going to take awhile and you will need to dig deep into your reserves of patience. Try to take one day at a time and don’t look for daily progress or you’ll continually feel let down.

Do you have any plans for the day? Is a lunch or coffee out with a friend too difficult for you at this point? If you’re not getting out much, a change of scenery and visit with a friend may brighten the day and give you a more positive out look. Don’t forget, we’re always here for you!

 

[Hip4life]

Oh, the frustration of a long, drawn out recovery. You’re sick of doctors, of hospitals, of pain, of where the heck is my life?! You’re just plain sick of it all! Worst is the worry because you’ve been through so much wondering what’s next? Then, it’s not feeling like there’s anywhere to turn because you figure if you’re that sick of all of it, then those around you are, too. Maybe I’m totally off base, but I was there not too long ago as I had so much carryover from the long pre-surgery wait. Luckily, I had this great forum to turn to. Yes, it took a while for the swelling to go away. Your body has had a lot to deal with. Yes, you can use something more than Tylenol to help with your pain. I worked with my PCP on that: a good dose of Tramadol along with the Tylenol helped me immensely. I say this to let you know there are options. I even did another round of Celebrex which helped. Couple that with the icing and elevation and I could function well enough to not have the pain take over my day. That helped me to sleep better, be more mobile, and cope better. Like me, it’s going to take some time for things to settle because until now, they haven’t had a chance to. There’s plenty of time to work on stretching and strengthening. Remember where you’ve been because you don’t want to go back there but look forward and start giving your body the TLC and patience now to get you to where you thought you’d be after your initial THR. You will get there, literally and figuratively, step by step. I’m finally there. It is still very much worth it. Hang in there and keep us updated. Pat.

 

[DEL2020Jul-11]

@Diane60, From my heart to your heart, I am very sorry for what you have endured (dislocations and other surgeries) and for your current pain and worries.

By sharing, I hope to be supportive. When I was at 2 months, I was really scared and physically unwell.
During the last 7 months, I have been overwhelmed many times. When extremely anxious, I would despair and not think objectively. My OS saw me at 5 weeks, 3 months and 7 months, called it a rough start.

What/Who helped me (including reading lots of accounts on BS to see how other people handled healing):
TIME & PATIENCE - To see that I was making progress, however slow.
RECOGNITION - There are setbacks, but I learned I bounced back & to hang on until I moved forward again.
REALIZATIONS - My initial recovery was not going well. That I had to work on managing the uncertainties.
SUPPORT - I needed support from my people. Well meaning, but they did not get it. I had to explain that I was not ok. Once they understood, some provided different degrees of validation, sympathy and support.
FAITH - For me, my faith has grown over several years, and I leaned into my beliefs more and more.

Per your Inflammation question:
For my 7 month course;
Swelling mostly down by 5 and one-half months
Sore/Stiff/Pain mostly down by 6 and one-half months
LLD - From one inch to minimal(3 mm)by 7 months

 

[Mojo333]

@CricketHip, my compadre may have some helpful tips on how to engage your lymphatic system that helps to rid our bodies of fluid.
Make sure when you elevate, it is toes above nose.
My trusty recliner helped me do this more comfortably...
As I had golf ball knot in the behind for several months
And, like a broken record, Ice, Ice, Ice.

Hang in there, friend.

 

[CricketHip]

@Diane60 there is a modality that could help with your swelling and discomfort from inflammation. It’s very a gentle treatment too, and it's called Manual Lymphatic Drainage. (MLD)
It encourages your body to help rid itself of excess swelling, inflammation and soreness.
Our bodies actually need some inflammation to assist in healing, but too much can be troublesome, for sure. Inflammation is similar to carrying a fever, which our body does to try and heal itself
MLD can ease the inflammatory process while helping to ease the swelling and just generally make you feel better all around.
There are some easy things that you can do for yourself and I would be happy to share them with you but I think you would benefit from seeing a therapist who is fully certified and specializes in Lymphatic Drainage, specifically the Vodder Method.
I mainly see clients post surgically (oncology) but have also worked with joint replacements and MLD not only gives them relief but also gets them back in touch with their body again.

So! Just in case you are interested in trying a few of the techniques, I shall leave them here for you:


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Take deep breaths.. deep, as in breathing in to a count of 3 or 4, whatever is best for you. hold it for another count of 3-4, then blow out completely, still using the count that's comfortable for you. A series of at least 6 of these could help get your 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.

Then, as you slowly breath out, to the same count of either 3, 4 or even 5, gently press down and slightly upwards with the palm of your hand.
Do this whenever you feel up to it during the day or night. The more supine that you can get in the recliner or bed, the more effective this can be.. you have lymph nodes located in your groin and sitting up too much can cause a restriction of the lymph flow.

You can, after the breathing, place your hands lightly on your upper thigh, right where the crease is in your groin and lightly stroke upwards towards your naval.
I did this quite a bit post op and while it takes a while for the body to wake up and respond, it will and it will help get things moving.

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Please feel free to tag me if you need help finding an MLD therapist-- in fact some Physical or Occupational practices have MLD therapists on their teams.