THR Need Advice RE: Broke 90 degree precaution & No PT

MJ's Hip

new member
Joined
Jan 6, 2019
Messages
2
Age
48
Country
United States United States
Gender
Female
Hello Everybody!!!
I'm so thankful to have found this Group/Resource so I can learn from the people who know what I'm going through!!!! I'm hoping to get some advice on 2 issues. I'm 43 & I just had my (Posterior) Right THR on December 18th. I think I have been doing really well despite NOT having any PT. I had Humana Medicaid & they denied my "In Home PT", then cancelled my policy as of 12/31/18, without any notification at all. I was Very Eager to begin Outpatient PT since I have developed "Bad Habits" from years of Pain & Compensating when my hips weren't functioning as they should. I have to Catch myself & Really Focus to make sure I pick my leg up at the knee so my hip can rotate properly. It doesn't hurt (post surgery), so that's WHY I call it "Bad Habits". I'm sure there are more that I'm just not aware of & that's why I'm upset about not getting PT. I would Greatly Appreciate any advice that may help!!

I was able to walk without my walker for about 2-3 days & then I did something really foolish. I broke the 90 degree precaution about 2.5 days ago. I definitely didn't dislocate, but I was unable to bare weight on my Right leg for the rest of the night. Since then I'm back to using the walker which is very disappointing. I have been having pain/discomfort in various places in the front & back of my hip. (Doesn't feel like anything I experienced after my surgery & it moves.)
I have tried to google what happens (after breaking the 90°, but w/o dislocating) so I would know:
1.) When to be Concerned & what would require a trip to the ER?
2.) What did I hurt/aggravate? (Implant, Muscles, Tendons, etc)
3.) What is the best treatment I can perform at home to soothe & heal my angry hip?

With loosing my Insurance & Not being evaluated by PT, I feel like "I'm on my own". It really isn't hurting enough to warrant a trip to the ER, but I would feel so much better if I understood this better.

Thank you to EVERYONE (whether your able to respond to these issues or not). I have found all the other posts so Helpful, Informative, & Reassuring!!! I already feel like I have Benefited GREATLY & It means so much that I'm not completely alone during this process. Thank You Bonesmart & Fellow Hippies!!!
 
Hi, Welcome to BoneSmart and Recovery. Thanks for joining us and Congrats on your new hip!

You will find the Recovery Guidelines below. Please read them thoroughly as they are very informative.
Please also notice the Big Tip toward the bottom which hopefully puts your mind at ease in regard to PT -

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.

I experienced RTHR posterior approach just as you did. I didn't have any restrictions, only instructions to move slowly, carefully and if anything hurt to STOP. If you suffered a dislocation, you'd know, you'd be in severe pain.
I'm sure you've aggravated some soft tissue and with your meds, rest and frequent icing the pain will hopefully ease. Give it a few days and if it doesn't check in with your OS or a member of his care team.

Please stop back often. We are here to offer support and encouragement as you're healing.
Wishing you comfort!

Hip Recovery: The Guidelines
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
elevate
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 these
5. Here is a week-by-week guide to

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. @MJ's Hip
 
Last edited:
Layla is right on target with her advice for you. No need for a trip to the ER. Please don't worry about your new hip joint. Dislocation or even subluxation (A joint subluxation is another way of describing what people often call a partial dislocation. In the case of the hip joint, it means the ball started to come out of the socket but did not come fully out or dislocate.) would have been very, very painful. In all likelihood you've just irritated tissues that are still healing from your surgery and they should settle down in a few days. Use ice and pain medications to control any pain or swelling and keep your activity to just walking about the house several times a day as needed to go to the bathroom or make meals and snacks. Once things are back to where they were you can increase your walking. That's really the best exercise for hips and you'll do fine without PT.

I'm really concerned about what happened with your health care insurance, though. How can your provider just cancel your policy with no warning? Were you supposed to let them know you wanted to continue the policy? Was it a policy you got for yourself or something through your work? What state are you in? You need to be covered by some type of health care insurance, so have you done any investigation into what you can do now?
 
@MJ's Hip What state are you in? I know medicaid is different in different states. Is this like a recert period?

Don't panic too much about the PT. I have met several people who had their THR while on NC medicaid. PT is not covered here unless you go to rehab. They all did well with just walking and the basic PT sheet that was sent home from the hospital.
 
PT is not necessary, and in truth, shouldn't be your biggest concern. Other than resting, icing, and letting your new hip settle down, I would think that your biggest issue right now is probably figuring out a new insurance plan. Do you still have your follow up appointments covered with your original surgeon? I know my follow up appointments were part of my "surgery package follow up". Be sure to make those appointments, and ask them your questions. Unless you took a bad fall or had an accident, it's unlikely breaking the 90 degree rule has resulted in a serious injury. But since there are so many variables related to recovery you'll want to look into a plan for future medical issues, in addition to the great advice offered here in this forum.
 
Hi @MJ's Hip
I'm sure that breaking the 90 degree rule resulted in a scarey moment for you but as others have said you would definitely know if you had dislocated it. It sounds to me as if you have joined the ODIC (over doing it club) and now need to take a bit of extra care for a few days to let it settle down again. Ice, elevate and rest.
As for the PT, I didn't do any. I came home from hospital with a booklet telling me about ankle pumps and leg slide s in bed, but other than that my PT said just walking round the house initially and then outside when you feel up,to it. Other than the stairs I have at home, which I climb a few times a day, that's all I did. I had my first THR in July 2018 and the second in Nov 2018. I think I am doing well and am sure you will too once yours has calmed down a bit. Just be patient
 
@MJ's Hip Many surgeons no longer impose the 90 degree restriction so I really would not worry about breaking it. Just move slowly and if it hurts, stop and rest.

The best treatment for an angry hip is icing and elevation. Read the articles Layla left for you on this.
 
As you'll have probably seen on this site and elsewhere in addition to all the sensible thoughts posted above- many surgeons and countries no longer recommend a 90 degree rule- and there is research about this. I haven't had it for either surgery- like you I had years of pain and misuse to work on- and for me, my physio was able to assist by suggesting things to help, exercises and massage- but overall, time and just walking are really the most important thing. And you are really early on post-surgery. If you have years of problems then you might find you need to use crutches/ sticks for longer to really work on your gait.

Good luck if you are able to sort out your insurance issue.
 
Ooops so keen to reassure it seems to have posted twice- my apologies- @Jamie or @Jaycey I don't know if you can delete one of the posts please?
 
If you look at bottom of your posts @LdnFizz you will see options
Includes Edit Delete Quote...you should be able to do it...we will if not.
 
Thanks @Mojo333 unfortunately I don't seem to have the delete option- and it isn't included with my edit options?

Sorry all!
 
No problem - duplicate deleted for you @LdnFizz .
 
Don't panic! Outside PT isn't necessary at all, all I did was the basic moves and stretches recommended by my OS. As far as breaking the 90* rule it's very good you're aware. You just made the muscles angry and telling you not to do that yet. Even at 6 weeks when my restrictions were lifted it didn't mean magically I could bend without consequences. You have to ease into tying shoes, washing feet and clipping toenails it doesn't just happen and if you force it it will hurt. Ice and more ice along with rest is the cure. We all over do and suffer the consequences. The worst part is sitting there trying to determine if you screwed up badly. It's very hard to determine if the pain is tissue or skeletal. Usually it's tissue and rest and ice is the fix.
As far as eliminating old or bad walking habits the absolute best method I found was pushing a shopping cart. I would park at the furthest cart corral that had a cart and use it instead of a cane or a crutch to walk in the store and all around the store. The bigger the store the better and I would walk laps around the perimeter. The cart is enough support and prevents anyone from bumping you. You can really concentrate on your gait and walking heel to toe and walking straight.
 
Thank EVERYONE for the Valuable information & advice!!! I Appreciate it IMMENSELY!!!!! I just can't thank everyone enough!!!
 
Stop back often....we'll be here. Lots of peeps, with lots of info and advice through experience.
A great Wednesday to you!
@MJ's Hip
 

BoneSmart #1 Best Blog

Staff online

  • Jaycey
    ADMINISTRATOR Staff member since February 2011

Members online

Forum statistics

Threads
65,181
Messages
1,597,070
BoneSmarties
39,365
Latest member
Dave4562
Recent bookmarks
0
Back
Top Bottom