Lots of questions...THR

[Stanj]

Hello Forum Members
I am a new member considering a hip replacement due to OA in my right hip that has greatly limited my mobility and activities. I am 58 and was very active before the pain got to be too much for normal movement. Several years ago, when I was still living in the US I had one of my very few doctor visits to determine the source of the growing pain. X-Rays showed high wear and bone spurs but was told not to worry about it, come back in 10 years and in the meanwhile, just get over the pain. My general distaste for the impersonal medical system in the US was reinforced. I would still resist dealing with it even if the US system was not horribly expensive. Paying close to $1000 a month for insurance, and never really using it and getting very impersonal service and being limited to 5 minutes of time with a doctor all points to a very badly broken system.

Since that time I moved to St Petersburg Russia and tried to enjoy the city as much as possible but in recent months the pain from walking has caused me to stop walking more than a few hundred meters on good days and much less on bad days. I talked to two OS here in modern private clinics/hospitals and had my faltering faith in the medical profession boosted. I was very confident that the long unhurried discussions with the doctor was the way it is supposed to be. Can you believe that house calls are normal and at no extra charge? Someone less than 50 years old in the US has probably never heard of such a service. I have decided to have the replacement done soon, the low cost was a welcome surprise.
I have gotten lots of reasonable answers to my questions from the doctors but I wanted to ask some questions posed to patients.

I love to walk and this city is made for it. The winters can be icy however and now I have problems on uneven ground and feel pretty intimidated by walking on icy sidewalks post op. If you were walking with severe limp and limited range of movement in the effected leg, did you feel it easier to balance and handle uneven surfaces soon after the operation? How quickly did you venture outside for walking exercise?

My affected leg has withered in muscle mass and is quite a bit smaller than my good leg, and it has lost 2.5 cm in length which also adds to the unreliable balance. There are only two activities that do not cause tremendous pain; disco dancing and sex. Both might be pleasurable enough to overcome the pain while walking a hundred meters causes me to flinch in pain with every step, the gliding and careful movements in dancing in my own much modified-to-minimize-pain dance techniques allows me to stay on the dance floor for hours (most clubs here stay active until 6-7a.m.) for non-stop rigorous exercise yet almost not impact on my joints. The next day is guaranteed to be a "bad day" however. What limitations were place on you and for how long, before resuming these activities post operation?

Did you take long flights or train travel after your operation and if so, how long after? Did you do any special circulation exercises during the flights to lower clouting risk?

I have no pool available to me, is bicycling a suitable substitute? The doctor say yes but has never ridden a bike himself so may not know the details....such as stepping over the frame. I love to bike but have not gotten one yet in St Petersburg partly due to the fear of the crazy drivers. In the last 2 years recreational bicycling has become very popular here so the drivers must be getting better behaved.

A major concern for me is the possibility of dislocation. It is mentioned a number of times in posts and on each web site. How much of a threat is it? What types of movements have been the most likely to cause dislocation? If it happened to you, how did it effect your recovery?

What range of motion is not advised after longer periods of healing? Several sites mention flexing over 90 degree( I would be happy with half that now), what about movement to the side?

I do not have the luxury of taking time off work but I will be able to avoid going into the office for months if needed as long as I can work from my home and my Internet connection works.

Say, a year out, do you feel as if your range of movement was similar to before your hip started causing problems. If less, how much less? Even after a long recovery, are there any activities that you are restricted from pursuing?

How independent were you from needing help for the first month, 3 months or longer? I have a live-in partner but our relationship is fairly new and I would prefer to not require her to modify her lifestyle to tend to me. Although she would gladly help, I've always been the last person to ask for or accept help.

Sorry for the long post and too many questions but these are not generally what anyone but a patient could answer.
Thanks for this great resource.....
Stan
St Petersburg

 

[Josephine]

I love to walk and this city is made for it. The winters can be icy however and now I have problems on uneven ground and feel pretty intimidated by walking on icy sidewalks post op. If you were walking with severe limp and limited range of movement in the effected leg, did you feel it easier to balance and handle uneven surfaces soon after the operation? How quickly did you venture outside for walking exercise?

My affected leg has withered in muscle mass and is quite a bit smaller than my good leg, and it has lost 2.5 cm in length which also adds to the unreliable balance.

One of the main objectives of the operation will be to restore the leg length. All the surgeons I have worked with do one critical check immediately after the op and before the patient is moved from the table and that is to compare the leg lengths of both legs to double-check that they have corrected any disparity. They place the feet and ankles together and make sure they are equal in length. I explain this to assure you that your legs will again be as near their optimum comparative length as is possible! Therefore you should have restoration of your balance once you have readjusted to the change.

There are only two activities that do not cause tremendous pain; disco dancing and sex. Both might be pleasurable enough to overcome the pain while walking a hundred meters causes me to flinch in pain with every step, the gliding and careful movements in dancing in my own much modified-to-minimize-pain dance techniques allows me to stay on the dance floor for hours (most clubs here stay active until 6-7a.m.) for non-stop rigorous exercise yet almost not impact on my joints. The next day is guaranteed to be a "bad day" however. What limitations were place on you and for how long, before resuming these activities post operation?

There is a certain time period during which such activities are not desirable. Probably about 8-12 weeks. This is because of the danger of dislocation which I will speak more of later but you need to speak with your surgeon about this as each has his/her own preferences of post op regimen. As for sex, I would think you would find conventional positions uncomfortable so perhaps it would be time for a little experimentation where you would not be required to be so active.

Did you take long flights or train travel after your operation and if so, how long after? Did you do any special circulation exercises during the flights to lower clotting risk?

Again, it would be something you should speak with your surgeon about but I see no reason you cannot undertake such journeys after 6-8 weeks. This is the optimum period for post-operative thrombosis.

I have no pool available to me, is bicycling a suitable substitute? The doctor say yes but has never ridden a bike himself so may not know the details....such as stepping over the frame.

The only risk I would see with using a real bike is the hazard of falling off! That could be very serious for your new hip! And yes, lifting your leg to get over the frame would not be a sensible action within the prohibition period. However, why not an exercise bike? It is low impact and you can easily stop and rest if the need arises. Later, say 2-3 months later, outdoor cycling would be just the thing.

A major concern for me is the possibility of dislocation. It is mentioned a number of times in posts and on each web site. How much of a threat is it? What types of movements have been the most likely to cause dislocation? If it happened to you, how did it effect your recovery?

What range of motion is not advised after longer periods of healing? Several sites mention flexing over 90 degree( I would be happy with half that now), what about movement to the side?

Dislocation is a just a possibility, Stan, no more! And for the first few weeks - say 8-12 weeks - one does have to exercise caution with certain movements. It is therefore generally considered ill advised to do things that involve flexing your hip such as getting up and out of a bath but that is only for the early stages as I have said before.

What you need to remember is that for most hip ops, the joint is dislocated for the purposes of surgery by placing the operative leg over the good one, much like an extreme version of crossing ones legs whilst sitting. So anything that imitates that movement or anything similar is to be avoided. The physios should teach you special techniques for getting in and out of bed, for instance, and things to avoid like rolling on to your unoperated side as that would mean the operated leg/knee being dropped down and being dangerously near that 'crossed legs' position.

However, abducting your leg, i.e., moving it away from the other leg, is okay as that actually decreases the position of dislocation. This is why surgeons often have a large, hard, triangular pillow between the legs for the first 24-48hrs post-op. This is known as a Charnley wedge, designed by the (second) originator of the hip replacement!

Say, a year out, do you feel as if your range of movement was similar to before your hip started causing problems. If less, how much less? Even after a long recovery, are there any activities that you are restricted from pursuing?

I have not observed nor known of anyone whose lifestyle was in anyway restricted one their recovery and rehab was concluded. In fact, many have said they mostly forget they have had it done!

How independent were you from needing help for the first month, 3 months or longer? I have a live-in partner but our relationship is fairly new and I would prefer to not require her to modify her lifestyle to tend to me. Although she would gladly help, I've always been the last person to ask for or accept help.

I think now could be the time to ask her for her help, Stan! In the first month you will need a lot of help. From basic stuff like someone getting meals for you, helping you in and out of bed or the chair, into the shower, to just plain being around for reassurance and support. After the first 6 weeks, you should find yourself getting pretty independent and by 8-10 weeks you can find yourself being almost back to normal, all things being equal.

Read around this forum, especially the After Hip Replacement-Recovery Forum which has many good posts packed with advice and personal experience from people who have 'been there, done that, bought the teeshirt'!!

You have a lively and enquiring mind and a very positive outlook. I wish you well. Please feel free to come and ask more questions if you need to.

I'm sure others will chime in here with their experiences.

 

[Stanj]

Thank you very much Josephine, your words are very reassuring. I read posts from another forum and was getting worried due to the concensus regarding the type of movements that could never be made even after an extended rehab. Your comments also furthers my confidence in the OS I've been talking to. After less than inspiring treatment or concern by my HMO orthopedist I was starting to think there was a occupational requirement of a bad attitude:>)

As a patient and consumer of health services, having doctors and staff act as if I was their only patient by spending all the time needed to ask in-depth questions about all aspects of my life before rendering a diagnosis, and being anxious to answer questions is quite a new and welcome experience.

I notice that most posters on this and other related sites are women(as would be expected because women tend to be much more intune or aware of their bodies and health), and some of restrictions on movements and positions are more of a factor for them and not for men. For example crossing the legs while sitting is a cultural trait and in only a few societies is it done by men, but is common among women in many cultures. I can see that as putting a great deal of stress on the joint but I also doubt if I can't ever remember do that, being a man. The leg positions while participating in romantic play are more related to the movements and positions assumed by women rather than men. My girlfriend would feel much more restricted than I would if she was having the operation instead of me. As a past ballet dancer, even today, her flexibilty at 40 is far better than mine was when I was an active athlete in college. Since the relationship is relatively new and we are just now beginning to live togther, I did not want to start off as a burden for her. She says she would love to take care of me, but the novelity of that would wear off soon I am afraid.
Has there been a study that collects data for THR dislocations measured by sex, length of time removed from the operation and age? That would be interesting to see whether men and women are at different risk levels and whether the ratio is closer in cultures where men cross their legs when sitting.

Based on posts regarding at-home assistance, I found a shop close to my city center apartment that has all sorts of aids such as toilet risers, grippers and a frame that fits overhead of the bed that allows several ways of lefting from or moving with arms. The sales clerk is a doctor(sales clerks here often make more than doctors who work for the national health care system here) who is very familar with hip replacement patient needs.

Thank you so very much again for your detailed and knowledgible reply.
Stan
St Petersburg

 

[Josephine]

I am pleased you found my treatise helpful! That is my aim.

As for studies regarding intimacy, I am afraid I do not know too much that - never having looked into it. I know from some writings about men (years ago) who have had inguinal hernia repairs and when they can restore relations with their wives but have never seen anything about THRs. But maybe that is because generally the age of the THR patients is such that it isn't an issue! (Or is that just ageist!)

Also, regarding the crossed leg thing, I was more referring to any position of activity that would put the operative leg in that kind of position rather than actually sitting with legs crossed. Even the kind of position akin to ankles being crossed would be sufficient to put a new hip hip at risk (note I said new hip!).