THR Pain 4 months later?

[upset]

I had a THR in July. There was a "misunderstanding" with the OS, and I had a posterior rather than the anterior approach that I had requested, much to my surprise when I woke up. I was told my muscles were very tight and I had a large amount of swelling and bruising for weeks the entire length of my leg. No restrictions after surgery even though it was a posterior approach and I was told I could go back to all activities in 6 weeks. I went to PT 3 x weekly for a month and then an additional 2 days/week for 2 more months and although I was quite weak at first in the operated leg, things seemed to progress fairly well.
I am an avid rider, and was even able to start riding after 6 weeks, ( one of the reasons I had surgery was that my riding was becoming painful). At first, after the initial 6 weeks, I had no pain while riding , although there is still some pain over and around my incision, which still has a large firm knot in the muscle under the scar. I still had some pain while walking, but it was more muscle stiffness and would disappear after I moved around. All these felt more like muscle pain - like I had scar tissue being stretched
In the last 2-3 weeks, everything has become more painful - I feel like I have pain in my femur, deep in the leg and it also hurts to weight bear with each stride, My ROM has also decreased and I am getting a sharp pain ( just like my bone on bone pain that I had before surgery ) in certain movements. I also cannot sleep on the good side, as even with a pillow supporting the operated leg, it hurts - not like the muscle pain I had before
I am due to see my OS this week - this is the first recheck since I had my staples out 10 days after surgery and I am really worried that there is something really wrong

 

[sharonslp]

Hi Upset. Couple questions for you....

Rider of what? Bike, motorcycle, horse????

How much riding of whatever, plus other activities are you doing. Be specific...what, how often, how long? This may be a big part of the problem.

What pain meds are you currently taking? (What, how much, how often?) If you aren't taking any, when did you stop?

I'm thinking this is all normal for someone who is quite possibly doing too much too soon and maybe under-medicating. But let's tag Josephine for you. She will want to know this information.

Sharon

 

[upset]

Sharon,
Sorry - I horseback ride competitively and was quite sure my OS knew that and specifically asked him when I could go back to riding. He said 6 weeks. Right now I am riding 30 min 3-4 times a week, which is about half of what I was doing in September and October. I also am working full time - but have been doing that since August - if anything I am doing less now than in Sept/October
Currently on 600mg Ibuprofen BID as needed - actually had no pain meds at all for most of October and felt great., tramadol ddin't seem to do anything for me, and ibuprofen works better than acetominophen for me. Stopped the occasional Percocet back in early Sept, so no change there either
I guess I am worried that although I am doing less, I am hurting more and that has me worried....

 

[sharonslp]

Since we don't want there to anything actually wrong, the best case scenario is that Jo tells you are doing waaaayyy too much. I just realized that your surgery was just three days before mine. I had an easy recovery, and I am have been easing back into dancing for the last month. I danced quite a bit this past weekend with no setbacks, but I am picturing that riding a horse could be quite a bit more jolting to all the healing tissues.

It's good though that you'll be seeing your doctor this week. I imagine he'll take xrays, and assuming no issues there, you'll get some peace of mind. I would strongly advise that you take a few days to really rest and give any inflammation a chance to quiet down. Use your ibuprofen enough to give you solid pain relief. Once you've got it under control, then slowly and gradually increase the activity level....always staying ahead of the pain. Are you limping when you walk? That would definitely be an indicator that you have got to slow down.

If he does find some issues...well that's a whole different story, and you'll have to see where that takes you. I really hope to hear that everything is fine, and you've just done what many of us do....too much too soon.

While you're waiting to hear from Jo, have you checked out the library here on BoneSmart yet? There are many useful articles, and lots that pertain to what you are experiencing. Click on the Library tab at the top of the page, and then click on Library Index.

Sharon

 

[Josephine]

You recommenced riding at 6 weeks? My goodness no wonder you are getting pains! What is your job? What does it involve and how far do you travel to get to work.

Would you also tell me what kind of riding you have been doing? Walking, trotting, cantering, jumping? There's a big difference between a gentle walk around a paddock to taking even a short canter, not to mention the natural action of the horse which makes it not exactly like sitting in a chair!

I don't think there is anything wrong with your implants but there is a lot that can be going wrong with your soft tissues meaning muscles, ligaments and such. People often fail to realise that 'too much too soon' damages them far more than the implants and far quicker and more extensively.

My suggestion to you is to at least stop riding for at least two weeks and cut down on every other unnecessary activity as well. Your soft tissues were not yet healed when you started all this and they are rebelling. You need to give them time to settle down and complete their healing.

So I will list some questions

1. what kind of riding you have been doing - walking, trotting, cantering, jumping?
2. what about using a mounting block?
3. any mucking out, grooming and feeding?
4. how much house cleaning, laundry, meal prep, making beds?
5. what is your job, what does it involve and how far do you travel to get to work
6. are you still doing PT, if so, how much and how often?
7. are you still experiencing fatigue, disturbed sleep patterns?
8. finally, take a look at this chart and tell me where the pains are. Give the grid references and add 'front' or 'back' as appropriate - I'll watch this thread so I can see when you have replied.

 

[upset]

Josephine,
Thanks for replying . I have not been jumping, but have been doing all the rest.
Always use a mounting block - a big one, so I am literally just stepping over and not having to push up. Sometimes even stepping down into the stirrup.
Have not been mucking - horses live out, but am feeding and sorta grooming ( just knocking enough mud off to ride). Having someone else pick feet, so not holding or lifting legs
No housework at all ( see where my priorities lie?....)
Veterinarian, - large and small animals, but have help to do lifting and carrying. Some days I have a 15 minute drive, some days I am in the truck for hours, but get in and out multiple times, so am not in the same position for more than an hour usually. Self employed and main income producer for my family, so that is pretty much non negotiable and cant be reduced.
No PT ( figured 14 weeks was enough ), but trying to walk for 20 minutes a day - prob getting that done 3-4 times weekly
Never sleep well ( havent for years!) , but sleeping on my "good " side is painful in my operated leg and not just muscle - feels deeper somehow. I have had some pulling in the soft tissues before, but this feels sharper and deeper and is different . No real fatigue
Pain in L2 2 - groin ( like before surgery)
L1 1 front and back and then some radiating pain almost down the femur to L1 3 in front

Thank you

 

[Josephine]

Did I read that correctly? You are a veterinarian? How cool is that! I am in awe of vets! Human doctors only have to know about once species, you have to know about hundreds of them!

Anyway, to your problems....

Pain in L2 2 - groin ( like before surgery)

That sounds like an Iliospoas syndrome.

L1 1 front and back and then some radiating pain almost down the femur to L1 3 in front

While this one sounds like an Ilio-tibial band (ITB) issues.
Both would be in keeping with the activities you have been doing such as riding and frequently getting in and out of your truck. You need to go back and see you surgeon about them and get them treated.

 

[sissy46]

How are you doing now? What did your OS say when you went back? Don't leave us hanging, wondering about "the rest of the story...."