THR Min's Super Slow Confusing "Recovery"

MinnieV

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I had Left Total Hip Replacement (Posterior) May 16, 2022. It was done Outpatient, I was home before noon, had 6 home visits from PT spread over 2 weeks, mostly for monitoring the incision and teaching exercises and heel-to-toe walking. I have done all this regularly, along with icing, and have no problems doing. I had more pain and weakness than I expected from the beginning, but made decent progress the first few weeks, transitioning from walker to cane and managing personal care by week 3. No "hard" meds since week 1. Sometimes I take a couple of plain tylenol but it doesn't help so not sure why I do that, just habit and hope I guess.

Week 4 I hit a wall. I don't feel I've progressed much since then. My OP thigh is totally numb since surgery. I have had a series of strange pain in the OP side - groin, thigh, knee, shin - some of which fade in a week and some that stay. I cannot walk without a cane. I have the most significant pain while walking with the OP leg as the weight-bearing leg, though not much when sitting or when weight-bearing mainly on the good leg. This pain runs from my thigh to below the inner aspect of my knee. The knee crackles and pops. The pain is lessened by using the cane to offload some weight. The OP leg feels very weak. The incision area hurts a good bit when I sit and feels like there's a wad of barbed wire sewed up inside it. The incision itself looks OK, healing, not red, slightly swollen. I had an interim check with the surgeon's NP last week, and she noted some fluid in the buttock but not enough to have to draw it out. She gave me a cortisone shot since I cannot take anti inflammatories. She said the x-ray looked good. She recommended a PT evaluation which is scheduled for tomorrow. Will see the surgeon in 2 weeks.

I'd like to know any suggestions for questions/comments I should make to a new PT who has never seen me. And any ideas about this debilitating thigh/knee pain. I don't know whether to push through or rest, since neither seems to help. It is my first surgery since childhood so I may have had unrealistic hopes. It appears that in trying to reclaim my life I have jumped out of the frying pan and into the fire. It is depressing that I still have not crossed the threshold to less pain than I had before the surgery, and no idea if I ever will. I do get from other's posts that everyone's post-surgery is different.
 

Jaycey

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@MinnieV Welcome to BoneSmart!

All your symptoms sound totally normal for so early out from surgery. Are you icing and elevating? That swelling is what is causing you pain. Ice will reduce this and allow you to regain mobility. Ice for 45-60 minutes per session, several times per day.

New hips don't really need PT. Walking is the best exercise and then not to excess.

Please don't try and "push through"any of this recovery. It will only set you back.

Here are our recovery guidelines"

Hip Recovery: The Guidelines
We are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for YOU.“ Your doctor(s), physiotherapist(s) and BoneSmart are here to help. But you have the final decision as to what approach you use.

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
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 this BoneSmart philosophy for sensible post op therapy
5. Here is a week-by-week guide for Activity progression for THRs
6. Access these pages on the website

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 that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Zoebichon

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Week 4 was also a stagnant time for my recovery. I felt I made no progress in walking speed or distance in a week and a half and couldn’t shake that pain in my left hip joint area.

I cut way back on walking and activity and really rested, elevated and iced for several days. Finally I woke up one morning and had zero pain!

Those damaged soft tissues just take time to heal. Just time, not pushing through any pain or hard work on our part.
 

Eman85

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I don't know whether to push through or rest, since neither seems to help.
I don't think pushing through is a good idea. 4 weeks is very early on in recovery from a THR. Rest and ice is where it's at. Very common to have stall outs in recovery also very common to have setbacks from pushing through with the thinking that we need to exercise. It seems more and more especially with the drive through THR's home by noon people think they will recover in a couple of weeks. If you read the timelines on this site they are realistic guides in recovery.
 
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MinnieV

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It is scary that I can’t walk without a cane 6 weeks out from surgery. It’s scary that I‘m so much worse off now than I was before the surgery- I had pain but I was able to do mostly what I wanted if I gritted it out. Now I have pain and a ton of restrictions. I’ve always been so tough and soldiered through anything, but soldiering through is not working with this.
 

subie2021

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It’s scary that I‘m so much worse off now than I was before the surgery- I had pain but I was able to do mostly what I wanted if I gritted it out. Now I have pain and a ton of restrictions. I’ve always been so tough and soldiered through anything, but soldiering through is not working with this.

I felt the exact same way at about the same time. I remember crying that at least before the surgery, I could do things even though it was painful, and that after I couldn't do anything at all, so what was the point of all the trouble and expense?
So after that meltdown, I decided to wave the white flag and surrender. Back to the recliner! More icing! Pain meds on schedule! To heck with housework, my flowerbeds, the horse barn, hitting Aldi, and all other normal activity! I'll just vegetate.
But surprise, surprise - giving in to my hip worked like a magic wand. After some days of rest I felt a lot better and stronger. It caused a mental shift also, to allow things to happen in their own times rather than by force of my will.
I don't know why, but sometimes we think of ourselves as a tsunami that overtakes everything that's in our way. Giving up that idea and allowing ourselves to be a little wave in an ocean sounds like despair but actually, it can be a relief to just go where the ocean takes us. A least for a little while, as we heal :yes:
Don't push so hard, let your body adjust and heal. Try not to stress. It seems like you'll never get better, but you will.
 

Layla

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:goodpost: @subie2021

It is scary that I can’t walk without a cane 6 weeks out from surgery
I am sorry and I do understand your frustration, bit please know you’re not the only one who’s depended upon an assistive device at six weeks.
I’ve always been so tough and soldiered through anything, but soldiering through is not working with this.
Soldiering through does not work in this recovery. Honestly, I’m happy you aren’t able to push through the pain because “Pain Is Your Body Asking For Change”. I agree with all subie2021 said above. You are healing from an assault, a controlled trauma to your leg and its taking a bit longer than you’re comfortable with. Possibly you should
consider moving up your appointment with the OS, if you feel it’s the reassurance you’ll need that all is well and “slow and easy” is okay.
I hope today feels brighter for you. Stay in touch.
 

Eman85

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Don't know how to explain it but pre-op I was reluctant to have the surgery, I did everything I wanted to do for 50 years with the pain. Once I accepted having the surgery I went all in for recovery. Unfortunately I wasn't as aware of the reality of how long it would take and that pushing through just pushed me backwards. I did figure it out and the end result was worth it. I liked it so much I went back for another one and used my previous experience to avoid setbacks.
 
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Welcome and so sorry you are having difficulties but don't worry, everything you are going through is quite normal in recovery.
There's no shame in using a cane at 6 weeks. I still use one outside on uneven surfaces.
I feel like after my 4 month anniversary I started to really begin to become much more independent as far as doing household chores, laundry, etc. Maybe that's not everyone's goal to do laundry but for me it was a milestone!!!
You and you alone know your body the best.
I did the same thing, judged my progress by others recovery.
Then I learned from all the wonderful "hippies" here we all are own recovery journey.
Keep checking here and reading others experiences and you will find you are not ahead or behind anyone else.
Stay well
 
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MinnieV

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Thanks for the encouragement. I was pretty patient till I got to 5-6 weeks post op then I started to panic a bit about my stalemate. My PT eval today went OK, and I Iiked the therapist, who made it clear she would respect my pain limits and work towards my personal goals. First session was fine. She did say my pain pattern, my gait, and my pattern of weak areas were all unusual.
 
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MinnieV

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Just got back from my 8 week followup with surgeon. He has no definitive answers as to why I have this deep pain running from upper thigh to below inner knee in my operative leg. He says it is unusual for his patients to be unable to walk without a cane at this point but told me to keep using it as I needed to. He said the X-rays look fine. He removed ALL restrictions which surprised me as I had a posterior approach and am not doing all that well in recovery. He renewed my PT prescription, prescribed medrol and mobic (I’m afraid to take the Mobic because I’m on eliquis).

I am glad he thought the hip X-rays looked ok but I’m still confused. My PT was hoping for more answers too as she does just hips and knees, and considers this an atypical pain pattern. The work she’s doing with me is successful in that I’m meeting goals for strength and flexibility but the pain is still the same. I’d appreciate any ideas from others.
 

Eman85

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I'd look at a diagram of the bodies muscles and try to see which one you think it is that hurts. Might help to figure out how to make it stop hurting. Not all muscles recover the same. I've had 2 THR's and each side is different and certain muscles didn't like having a THR and it was different on each side. Atypical pain pattern? I don't know what that could mean in the real world. If you read others threads about recovery there is no exact pattern, just generalizations. My right side has 1 muscle in the rear area that stayed sore for a long time. My left has 1 muscle that hurts in the frt. of my outer thigh that hurts occasionally still.
 
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MinnieV

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I'd look at a diagram of the bodies muscles and try to see which one you think it is that hurts. Might help to figure out how to make it stop hurting. Not all muscles recover the same. I've had 2 THR's and each side is different and certain muscles didn't like having a THR and it was different on each side. Atypical pain pattern? I don't know what that could mean in the real world. If you read others threads about recovery there is no exact pattern, just generalizations. My right side has 1 muscle in the rear area that stayed sore for a long time. My left has 1 muscle that hurts in the frt. of my outer thigh that hurts occasionally still.
Thank you for your thoughts! The pain track best matches the location of the sartorious muscle BUT the muscle itself is not sore, I can press deeply everywhere along the track and nothing is sore, the pain is just invoked by weight bearing when standing with more weight placed on the operative side or during normal stride when weight is shifted to that side. It feels mechanical, very deep and full of pops and crackles.

Having puzzled overnight (since I no longer sleep, I have plenty of time for that) I am even more confused. With no restrictions after 8 weeks and being told to do whatever I want now, I find I don’t know HOW to do so many things like tie my shoes, sit on the floor or a low stool (or get up from such a thing), climb complex stairs, pick up stuff I drop, etc etc. Does anyone know of a guidebook for such things? I don’t know how much to force the stiff new joint to do stuff it doesn’t seem to want me to do, or what the workarounds are.
 

Eman85

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Once my restrictions were past it was just a common sense try and see at how to resume life. I remember my 1st reaching down towards my foot in the shower. It was a little more each day kind of thing and I could feel the stretch and didn't force it. I slowly was able to reach and tie my shoes with my first. With my second it took a long time. For some reason with my second there was a muscle in the glutes that would not relax. I could bend over and touch the floor if I kept my knees straight. If I bent my knee slightly I could not bend at all. Sitting and tieing my shoes was impossible. I just kept stretching and eventually it relaxed. I could push and press on the muscle with no soreness but if I bent with my knee bent the pain was strong.
The only fear post-op is dislocation, that's the reason for the restrictions. The risk is still there after restrictions it just diminishes over time. You just have to move and stretch slowly and don't force anything that feels uncomfortable.
The greatest gift of my THR's is sleep. I couldn't sleep for the pain from my hips, now they are never a problem.
 
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Just finished cleaning my bathroom and I can finally clean the glass shower doors all the way down to the bottom.
I'm finding I can bend further and pick up more items, still have my tongs nearby, (just in case).
Still haven't attempted bending to do my shoes. That will be next. I think once you conquer one milestone it's only a matter of time before you can move onto the next.
 
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MinnieV

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PT Re-evaluation yesterday:
My PT re-evaluated as the surgeon last week removed all restrictions and saw nothing wrong with the X-rays. I have tried hobbling cane-less about the house, sort of like a cruising toddler, and can get about that way with only mild to moderate pain.
PT put me through various exercises, etc to see if I was ready to push forward with trying to walk unaided. In one I had to balance on my operated leg alone. I failed that test, miserably, the pain was pretty severe and I had to grab onto the bars to stay up. She says I am not ready for unsupported walking so is working on my gait WITH the cane (still limping even with it but not as bad as without), and the muscles that should strengthen the hip.
I am proceeding with plans for my scheduled trips but have no idea how this will work. I expected so much more recovery in 8 weeks but it did not turn out that way. (I remember feeling elated pre-op when the surgeon predicted I’d be fine to go on these trips as I’d feel pretty normal after 4 weeks). I’m discouraged but trying not to dwell on it but just work with what I have.
 

Layla

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I am glad he thought the hip X-rays looked ok but I’m still confused. My PT was hoping for more answers too as she does just hips and knees, and considers this an atypical pain pattern.
If I were you, I’d request hard copies of surgery notes and notes from office calls for your personal records as sometimes they are more revealing than we’d expect. I found it to be an easy process. I made the request at one of my office visits, signed a form and all arrived in the mail, within the week.

Limping: Here’s a tip - Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

Gait -
You might want to check out the One Step program.
I am proceeding with plans for my scheduled trips but have no idea how this will work. I expected so much more recovery in 8 weeks but it did not turn out that way. (I remember feeling elated pre-op when the surgeon predicted I’d be fine to go on these trips as I’d feel pretty normal after 4 weeks). I’m discouraged but trying not to dwell on it but just work with what I have.
You mentioned “trips” as in multiple. I guess I’m wondering what type of travel these trips involve….airports? Or are they road trips? Are they lengthy trips? I’m asking because given all that you’ve shared, I’m not sure how much you’ll enjoy travel at this point in your recovery, Will you be miserable and possibly wasting time and money without any enjoyment in your travel? May be worth considering to do this at a later date, if possible.
 
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MinnieV

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I am glad he thought the hip X-rays looked ok but I’m still confused. My PT was hoping for more answers too as she does just hips and knees, and considers this an atypical pain pattern.
If I were you, I’d request hard copies of surgery notes and notes from office calls for your personal records as sometimes they are more revealing than we’d expect. I found it to be an easy process. I made the request at one of my office visits, signed a form and all arrived in the mail, within the week.

Limping: Here’s a tip - Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

Gait -
You might want to check out the One Step program.
I am proceeding with plans for my scheduled trips but have no idea how this will work. I expected so much more recovery in 8 weeks but it did not turn out that way. (I remember feeling elated pre-op when the surgeon predicted I’d be fine to go on these trips as I’d feel pretty normal after 4 weeks). I’m discouraged but trying not to dwell on it but just work with what I have.
You mentioned “trips” as in multiple. I guess I’m wondering what type of travel these trips involve….airports? Or are they road trips? Are they lengthy trips? I’m asking because given all that you’ve shared, I’m not sure how much you’ll enjoy travel at this point in your recovery, Will you be miserable and possibly wasting time and money without any enjoyment in your travel? May be worth considering to do this at a later date, if possible.
The trips are sort of in concrete so I either go or forfeit. First is next week, 13 hr train trip (sleeper car), a week in the city going to ballgames, family get togethers, and Beach. Next is mainly a concert which I think may be controllable, third is out of country flight, car riding, with short walks but unknown terrain. I am worried about the city, the transport stations, the ball parks, the beach, the terrain though I can control how deep I get into each event, and could opt out of some activities. I have a home base each place I can retreat to once I get where I’m going.

Therapist insists on heel-to-toe walking and oddly it is less painful that way after the first few rugged steps.

It never dawned on me to ask for surgical notes but I will do that. I’ll take a look at the One Step, thanks!
 

Layla

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I worry about you on these trips. The activities that may take a lot of walking especially, like ballgames, walks from your parking spot, up stairs or ramps. Wondering if the concert venue includes the same. I think we all envision our self in these places, not always considering the time or the energy it takes to get to where we’ll sit / rest.

Out of country flight…while you’re able to get up and walk about the cabin, the seat itself is confining, even if business class. Wondering if you’ll be comfortable for hours in a confined space, after navigating an airport. Hopefully you can arrange for a courtesy transport cart to get you to your gate.

I also want to share something to be mindful of if you’re considering beach walking
(in the sand) Beach sand provides an unpredictable and uneven walking surface. This can place increased stress / strain and loading on your joints. Walking in the softer sand requires increased energy expenditure, forcing you to work harder, compared to walking on an even, firm surface. The foot will sink slightly into the sand. This will provide the least amount of stability, which forces you to use muscles throughout your legs more.

I don’t want to be a Debbie Downer, just hoping you’ll have an enjoyable time, avoiding discomfort / pain / fatigue as much as possible. It’s good to hear you’ll have a home base where you can rest or stay behind if you’re not feeling up to the activity of the day.
@MinnieV
It never dawned on me to ask for surgical notes
The office visit notes also. If interested, like I was.
 

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Bless your ❤..I feel your pain literally.
I am slowly figuring out that slow is better.

From the outside looking in I agree with Layla that's going to be alot of walking and you are still in recovery mode.
Would hate to see you strain more muscles and take double the time to get back to where you are now.

Would be nice to have some sort of device like a wheelchair ( rental?) to
save some walking in the city...not sure its doable. Maybe a chair to sit at the beach instead of much walking.
Hopefully the trips can get your mind off of it and raise your spirits.
I have seen on this forum some people taking 9 weeks to 4 months to walk finally without aids.
 

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