THR Now THR #2 with DVT precautions


new member
Jan 12, 2023
United States United States
I had my first THR (right side, anterior approach) just before Thanksgiving 2022. That healed perfectly and I was pain-free in no time. That also resolved misc. knee pains on right side. I was bone-on-bone and unable to hobble more than 50 feet prior to surgery and in a lot of pain.

As noted in other posts, my limiting factor became my left hip, with similar pain, ITBS, and increasing discomfort and inability to move well in spite of PT.

My surgeon and I decided at my 6-months checkup on right side to move forward with left hip THR since I was increasingly hobbling and in pain. Though OA was not as advanced as in right hip, x-rays showed rapid degeneration over time.

Same surgeon, same prosthetic, same facility, and same (anterior) approach. I learned pre-op that my surgeon and his team had been involved in designing the hip. Prior to surgery we discussed my LLD (1/4 to 5/16 inch) and he already began working up a template to correct that and bring both legs into perfect alignment.

Surgery was easy since I knew exactly what to expect, and lasted about 60 minutes. Like last time, I was walking on the hip hours later. I was discharged by lunch the following day and can walk quite nicely now with a Walker at home.

I’m Day 4 post-op and have been on 1/2 doses of opioids for a day already. Feeling great, minor pain, and am doing light PT (quad sets, glute sets, heel slides, seated bent leg raises, toe curls). I’m taking things a bit easier than last time, focusing on rest and healing.

I checked my notes - I first noted right hip discomfort in late 2021 and started PT in early 2022. Was not properly diagnosed until September, then got THR in November 2022. Now 8 months later I’m a double hippie. Surgeon says hips look great and both my knees are great, so hopefully after a couple of years with pain and limited activity I will soon be back to new normal.
@Bhippie Welcome to the double hippie club! Both done and dusted. Sounds like you are well on your way with this recovery. But I'll leave your recovery guidelines here in case you need a fresher!

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:
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.
Thanks, always good advice. From previous THR I’ll underscore:
- Take your time and listen to your body.
- Don’t push the recovery process, it’s not a competition.
- Everyone is different.

For me, what’s been an advantage is a power recliner which I rent and helps me keep my legs up and iced, and delivers easy up/down lounging while catching up on FIFA World Cup games!
I should add a quick note after THR #2 regarding DVT. I had my first diagnosed DVT in 1989 (or so) but believe I had at least one undiagnosed DVT prior to that. On GP recommendations, I started taking baby aspirin (81mg) after finishing a course of Coumadin after the DVT. When on long trips or international travel I’d up the aspirin prior to travel.

In 2019 I decided to drop the use of aspirin after reading it was not recommended long term. After some lengthy travel, I developed life-threatening bilateral PEs with a saddle embolism. Testing in the ER revealed that I have Prothrombin Factor II gene mutation, which predisposes me to clotting. It’s the second most common clot factor mutation and explains my history. As a result, I’m on Eliquis for life as a prophylactic.

This was a concern for me with both THRs given my history, as I had to stop taking Eliquis prior to surgery. I discussed this in detail with my surgeon, who (as he should be) was quite familiar with the concerns and gave me confidence in managing the risks.

My hematologist, in concert with my surgeon and anesthesiologist, put me on Lovenox bridge therapy leading up to surgery, and I resumed Eliquis post-surgery.

For those with similar concerns, fear not. While never risk free, the risks are well-understood and can be mitigated. But do consult your hematologist and do ensure there is clear communication across your entire surgical and care team.
Thank you for taking the time to share a bit more of your history including precautions and reassurance in regard to DVT. I am sorry you had to experience this, but thankfully between you and your doctors you are proactive in your protection. Wishing you only the best as you continue your healing journey! I edited your thread title to reflect the DVT information shared above.

Please notice that we have merged your newest thread with your original recovery thread. Having your recovery information contained in one place will make it easier for you to reflect back on. It is also helpful for those stopping by to be able to review your history before advising or commenting. Please post any updates, questions or concerns about your recovery here.
Thanks for the post, it's important to note the risk of blood clots and how to manage and prevent. Your surgeon worked with you and kept you in the loop along with hematologist, and you are proactive in your own health care so that is how we all need to approach any surgery or testing. Educate ourselves.
Very timely and informative.
Today is Day 7 post-op. The outer bandage is off now, everything looks good. Stopped opioids yesterday after weaning down to half dose the day before. Pain is minimal, a couple of Tylenol is all I need. Sleep well and can sleep on non-op side. I typically hit the wall during the middle of the day which makes for great napping!

Started walking without the walker yesterday, today PT says I can start to lose the cane now too. Have expanded PT beyond the basics (heel slides, quad sets, glute sets) to begin very light strengthening/stretching.

So far super easy compared to first hip, even PT is surprised. But I know must keep things slow, steady, easy…
Lots of nice changes over the last few days. You‘re right about slow, steady, easy.
That’s how you’ll get to the finish line without setbacks.
Keep us posted, you’re doing great!
I too have a clotting disorder APS (Antiphospholipid syndrome which accompanies lupus) for which I usually take Xarelto. Bc I had bleeding w 1st hip in 2018, surgeon very concerned conferred w cardiology and they decided stop Xarelto 5 days prior w baby aspirin twice daily for a month. Even then I lost “a lot of blood” and surgery went longer than expected 3.5hrs and also had to get a unit of blood. Hgb did not bounce back (only 7.5) but he still dcd me. I am having significant drainage now at Day 11 post but it’s thin, pink, watery, no odor, no fever. I sent photos of bandages and incision (which looks great).
But I’m wondering since they restarted Elliquis have you had any drainage at incision ?

It’s an awfully tough balance for them to get correct balancing clotting vs bleeding. My antibiotic also ran out today so they sb calling me tomorrow. Since I’m person w walking I’m thinking my Hgb is still low and actually went to lab today w one of the “future appt” lab sheets since it had all the tests I needed for Hgb, inflammation and infection. (Decided it was better to ask for forgiveness later to get the answers I need now). Nurses really are the wurst patients . Good luck in your healing. The more you wiggle and shuffle the better for not getting a DVT
I restarted Eliquis the morning after surgery. I had stopped it 4 days prior, then went on Lovenox bridge up to surgery time.

There is no drainage at all, no bleeding, etc. I did not have a hematologist prior to first hip, and my surgeon insisted that I find one. He and my surgeon and anesthesiologist worked out my protocol for blood thinners for both hips. In Eliquis we trust! It’s been a life changer for me.
I am now a day away from 3 weeks post-op and doing very well, I think. I walk about a mile a day, focusing on gait. I do take my cane along in case I tire, but don’t really need it.

Tomorrow is my last visit with post-op PT. I’ve been slowly increasing that with PT guidance, and am now adding light weight (2.5 pounds) to knee raises and lifts. Also do step-ups. I can do a half/dozen or so straight leg raises on op hip, which seems to improve daily, this is very similar to first hip experience.

In general I’m super happy and this THR is much easier than the first. Sure… I get sore and stiff but overall this is very manageable and I listen closely to what my hip tells me.

I’m driving with no difficulty, rarely take Tylenol, and sleeping soundly on my non/op (previous THR) side.

Looking forward to increasing distance and strengthening op hip. I could not be more pleased with current progress.
Definitely sounds like you are doing amazing at 3 weeks out, but I really worry about some of the exercises.
Certainly there are those folks who can manage leg lifts with weights and situps in these critical early days but I must say, it would not be something we recommend while so much healing is still happening.
Under the "Healing how long does it take?' recovery article there is an important chart... particularly #10.
We can rush our activity level, but healing takes the time it takes.

Not to be a Debbie Downer, but sit ups are very hard on hip flexors and the SLRs are equally hard on healing tendons and ligaments that hold your new prosthetic in place.

Of course, you can manage your recovery as you wish and I'm glad you are confident you are not causing any issues... I followed more of a "Just because I can, doesn't mean I Should " mentality and felt confident that any tone or strength lost during the first months could be regained after that new joint was settled in.

By the way, 6 years out from bilateral ...and I work a very physical job, play hard on the weekends, and just turned 60, but feel 30!
I appreciate your comments. I don’t believe I’ve mentioned “sit ups” but rather “step ups.” I’m not sure they are the same or not.

Following how I feel (always most important) I would agree that my current program is perhaps a bit aggressive. I’ve downshifted a bit and reduced 5 lb weights to 2.5 lb which seems better. At this point I think it’s better for lighter weight and less stress exercises than pushing it.

I am almost always sore on my op area/incision which likely means I’m pushing more than I should, hence the downshift. I also know the surgeon did some extra “wrestling” to bring both legs into perfect alignment, which could explain the extra soreness.

With the previous hip replacement on the other side, I had a lack of feeling that lasted a couple of months. This time on the other side, I have none of that so perhaps that’s why I’m more aware of tenderness.

In any event, I totally understand the need to find the fine line between forward progress and doing too much. I know full well my tendency is “too much” so I know I need to dial a few things back to find the optimal recovery zone.
appreciate your comments. I don’t believe I’ve mentioned “sit ups” but rather “step ups.” I
:doh:- obviously I misread that....
well good, glad to know you aren't tackling situps.
Glad to know you are listening to your body and are willing to dial it back....
Keeping your patience muscle toned is the toughest part of this recovery business.
Hope you have a nice weekend.
I should also mention that my step-ups are using a step just a bit over 3.5 inches, so not quite a normal size step. I do 12 to 15 reps a day.
Happy One Month Anniversary, Bhippie!
Enjoy the weekend and stay in touch! :wave:
I just had my 6-week checkup visit with my surgeon. Everything looks great, and he explained how he aligned the new hip, removed some osteophytes, and corrected minor alignment issues.

He’s given me thumbs up to proceed (cautiously) with anything I might want to do, except yoga. I’ve avoided hypertension and external rotation, using a sock-puller and never crossing my legs. He said it’s now ok to do those movements with caution. I specifically asked about biking, and he said that’s fine as long as I’m careful.

I’ve been walking 2 out of every 3 mornings, doing between 1.5 to 2.5 miles on my walking days. I still get a little sore and definitely stiff if I sit for too long. He gave me a prescription for PT to improve strength and ROM.

I’m lucky that I have an excellent PT facility in town that really helped with my bad hip prior to surgery and I think that made this recovery much easier.

Next appointment will combine my 1-year checkup on my right hip with my 3-month checkup on my left.
Wonderful update! Thanks for taking the time to share the good news.
A great rest of the week to you!

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