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My dad's hip

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allison4922

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Hello All....
I'm thankful to have found this GREAT website! I am a RN living in CA ( i work Pediatric ICU...am NOT an ortho/rehab nurse at all) My dad (61) had a left THR on 1/13 (in PA, which i went home for) Pre-op he was a very active person despite the pain in his hip, he would walk on the treadmill 30 mins about 5 days a week and also bike ride...he did have a limp and his gait had an obvious compensation for his bad hip.
He developed a fairly large hematoma post op, which wasn't drained, but of course caused a significant amount of additonal swelling. He recieved two transfusions and started his PT in the hosp. He was discharged three days after surgery, and was in a fair amount of pain. Over the next few days, the swelling decreased and he was moving along with his PT. At about two weeks out he started having alot of groin pain and pain down the outside of his leg, it would lessen while he was walking, and be at it's worse right when he would sit down after walking, or right after PT. The OS said to backoff on the PT (he was doing 14 different exercises, 30 reps, twice a day...just what he was told to do by the PT). He backed off and continued to use his ice...it only got a little better... It is now 3 weeks post surgery and he is still using the walker and cannot put more than about 50% of his weight on his operated leg...it feels like his leg will give out?? THe groin pain is there, as is the pain down his leg. His frustration level is through the roof, as is mine and my mothers...Has anyone else expierenced this?? My mother has worked for this OS for about 18yrs and there reputation is great.... I feel so bad for him... :(
 
Re: Post Recovery Hip Problems

does anyone recommend heat vs ice? How about pool therapy? I am thinking that maybe all of the pre-op activity and compensation may have his psoas muscle/ligament extra inflammed? He has his 4 wk appt. scheduled for Monday...
 
Hi Allison - I moved your post into a thread of its own as they tend to get better responses that way. Being tagged onto the end of an old thread often means they inadvertanly get passed over.

My first observation is that 3 weeks is very early on in his journey and almost everyone feel frustated at this point. They had such high expectations of 'getting their life back' and suddenly they seem to be on a plateux where nothing is moving.

Okay - what to do about it?

First thing, pain management. What is he taking in the way of pain meds? And how much, how often? He is at the peak period for post op pain and it must be controlled or he won't be able to get the most out of his PT.

Second, is he using ice and elevation to help? This is almost as important as pain meds. And elevation is not just putting his foot on a footstool, it's raising it up until his heel is above the level of his behind! It's the only way you get gravity to work in your favour and reduce the swelling>pain. How often does he use ice? 10 minutes 2-3 times a day is not worth the effort! He needs to use it lots and for long periods.

Finally, he's probably been going at his PT with too much enthusiasm, considering his previous exercise regime. He should realise that he has had a major, major op and healing needs a lot of rest even though, contradictorily, he needs the PT to help his hip get back into trim. But healing takes lots of energy. Pain soaks up lots of energy. PT expends lots of energy. But he only has so much energy to go around. So he has to shelve his frustration and prioritise the use of his reserves. So 1. manage pain 2. rest to enable healing 3. then he can do some PT.

Finally, he needs to chill out and stop setting himself such high goals. He has 2-3 weeks more of basic healing before he can start getting frustrated by lack of progress! He should also keep a daily journal because often we don't realise how far we've come unless we have a record of it.
 
I have proceeded to have a wonderful new hip, I am 51, had it replaced June 6th. At about 4 weeks my activity level increased and my pain skyrocketed. I was very worried. I did go to see my doc. No harm done,. My pain level was higher than anything immediatley after surgery.

It just took a little more time. By 3 months I was back to hiking my local mountains (I llive in socal) with only aches now and again.

Just make sure your dad relays all of this to his doc on monday. He should be in a good position with your mom being so close to the surgeon.,

Just tell him to rest!!! I kknow it is hard. I actually at that point started swimming a lot which was great for my hip. It is the best part I have in my know.

Judy
 
The original PT regimen sounds a bit intense so soon after surgery but I'm no expert, just going by what I was assigned which was about half the number of exercises and half the reps. Another thing to note is my PT would drop any exercise that proved to be too painful.

Good luck to Dad.
 
thank you all so much for your responses....well my dad went to the Doctor today (like i said my mom works there, so it was easy to get in)...and the hip was OUT!!! I knew that my father had a high pain tolerance, but this is crazy...
He was taken right to the OR for a closed reduction and apparently felt relief right away...I can remember when this may have happened, it was when he was taking his first step up with PT in the hosp...his hip "gave out", but the PT was there to help/catch him...the OS thinks it was a combination of that and the large hematoma pushing against his "new hip" (I myself as a nurse thought that it would have been beneficial to drain the hematoma, but i also get the whole increase risk of infection with placing a drain...and like i said i'm NOT an ortho nurse)... The OS said that it had to have been out for a little while, there was already calcification with it dislocated...
I guess i am relieved that it was figured out, I do agree that 3 weeks is early, but the extent of his regression was shocking, now we know why!!
Josephine thanks....he was taking Darvocet and we actiually added vicodin to the mix 4 days post op, he was also using tylenol depending on his pain level, he was icing alot, esp initailly beacuse of the hematoma, and elevating...
OK... my question now is, is it likely to cause bleeding with the manipulation from a closed reduction?? He had issues with bleeding after the THR, and of course has been on the coumadin....man it is hard being the nurse of the family and living 3,000 miles away...looks like it is time to move home. Thank you Everyone for your responses and encouragement...

Allison
 
Wow,it sounds like your dad went to"boot camp" right after surgery.It also sounds like your dad's luck is about the same as mine.Seems like everybody's story is kind of unique on here.After my last THR the OS said no PT for awhile.He said that healing was more important than PT.I had my last surgery on 11-07-08.I had my first PT session just today.It sounds to me like your dad was pushing way too hard and way too early to me.
 
Your dad is amazing. I thought I had a high tolerance for pain but to be working out with a hip out of place. I can only say wow and wish him all the luck in the world now for an uneventful recovery.

Judy
 
Hi, Allison. This must be so difficult on you to be so far away and trying to help. I'm thankful the problem was diagnosed and fixed and I'll pray that things only get better from now on. Hang in there!!! You can always get support from the folks here if you need it.
 
It is amazing how everyones post op managemnt is so different from OS to OS....my dad was just doing as he was told, which seems to have been way to much, esp. since his darn hip wasn't even in place!!! It's frustrating that the PT was coming out to the house and not reportng back to the OS that my dad wasn't in fact "meeting his goals"..oh well whats done is done, hopefully this will be the turning point in his recovery and things will progess as he had hoped....Thanks again to everyone :)
 
Oh my good grief!
[Bonesmart.org] My dad's hip
[Bonesmart.org] My dad's hip
My experience of dislocations has been that most people cannot even sit up in bed much less walk! I am truly staggered that your father even managed to cope at all! Please tell him he a) has my admiration and b) has my sympathies!
 
I will pass it on to him...everyone at the office and hosp. were amazed as well...he was only taking tylenol Q 4hr...getting himself out of bed and dressed in the morning, doing his PT, walking about every hr...insane!!! To add to this "Random" situation it was an anterior dislocation, so now all of his hip precautions have changed...THey really seem to think that the hematoma had alot to do with it...
 
Bad News!!!! My dad got up this morning and noticed his foot was facing outward and the pain was back....they called the OS and went to the ER for an xray...sure enough the hip is back out!!! So he is now on the way BACK to the OR...they are going to put in a longer "ball" part of the component. I spoke with the OS this AM and he thinks that the hematoma needs to be evacuated and that ist is the reason for the redislocation...he also said he thought there may be some collected blood in the socket itself?? Of course now my major concern is the bleeding...he had a ton of bleeding the first time without the 3 weeks of coumadin, i did ask about a drain being placed so if he did bleed, it wouldn't form another hematoma, the OS said he was possibly going to do that!!! Also INFECTION...Josephine, this is probably my biggest concern...any input? Obviously they will do preop Ancef and the OS told me post operatively he would be on Vancomycin, then dc'd home with oral antibiotics. This SUCKS!!!!!!!!!!!
 
I can understand your concern, Allison. Anytime you reopen a JR there is always that risk but it's not more or less than the first time. Addtional antibiotic cover is appropriate though and they may well put some straight into the wound. Some do that, not all.

I think you were right to raise the issue of the drain, though. Did he not have a drain first time?

I think his haematoma needED to be evacuated! I am amazed it was left.
 
Allison, my heart and prayers go out to you and your Dad. Please let us know how things go. I know you are worried, but he is in good hands.
 
Allison your poor dad. Prayers are being sent to him from me in socal . Please let us know how he is doing
Judy
 
once again...thank you!! He is feeling alright, using his Dilaudid PCA for the night. The hematoma was cleaned out and larged ball part of component successfully placed. Got my fingers crossed....
xo
 
I have my hands together ...
[Bonesmart.org] My dad's hip

 
We're praying for you and your Dad, Allison.
 
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