THR Pain 9 years after THR

[trav86]

Jaycey, I was prescribed oxycodone, which made me feel nauseated and gave me a headache and was then switched to tramadol. I don't need it though - I don't really have pain and when I feel a little achey, Aleve works well.

I take the subway to work which involves walking a little more than a quarter mile twice a day (morning/evening). I've been walking around the neighborhood, too, doing some grocery shopping, walking four blocks to the gym to ride the stationary bike most days.

When I'm home I mostly rest and ice. I prepare meals but not often - 2-3 times a week.

Because the anitbiotic label warns of interactions with NSAIDs, I stopped taking the Aleve, but I just spoke to the pharmacist who said its okay to take it as long as I'm not running and jumping, which I'm decidedly not. (Apparently Avelox can mess up your tendons and NSAIDs increase that risk.)

Thanks for your help!

 

[trav86]

Josephine - see answers below

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

Antero-lateral

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

) Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

Pain level - 2

Warmth, swelling, redness over 40% of incision. (I can send a picture if you want.) My son had periorbital cellulitis when he was a baby and as far as I remember, the bruising was the same color.
Today, pain extends all along ilio-tibial band from hip to ankle (though this hasn't been the case in the past). It's a slightly burning pain.

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

I take 2 extra strength Tylenol in the morning and 2 Aleve in the evening.
Oxycodone was prescribed but me nauseated and headachey. Switched to Tramadol, but I don't need it.

4. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.,

Work at a desk job, take subway to work (stairs + quarter mile walking 2x/day), walk four blocks to gym, ride stationary bike for 10-15 minutes, grocery shopping 1-2x/week (someone carries bags in and out of taxi for me). No housework except for meal prep (but that's only 2-3 times/week).

5. what kind of PT exercises and exercises at home are you doing? How much and how often?

All exercises 1x/day:
Calf raises, 2 sets of 10
Quad strengthening - lying down with bolster under knee, straightening one leg at a time - 2 sets of 10
Hip rocking (lying down with knee on operated leg bent and slowly moving knee side to side) - 1 minute
Clamshells - 2 set of 10

I really appreciate your advice/input!

 

[Josephine]

Pain level - 2. Warmth, swelling, redness over 40% of incision. Today, pain extends all along ilio-tibial band from hip to ankle. It's a slightly burning pain.

Okay - can you please give me the exact site of your pain using these charts? You will need to give me 'hip' and 'knee' headers to each selection.

I take 2 extra strength Tylenol in the morning and 2 Aleve in the evening.

And does that help? I would suggest you try taking the Tylenol 4 times a day. You see, both those drugs are only active in the system, for about 4-5 hours so you are spending a major part of your day and night with no pain killer cover at all.

Plus you might want to read this to see how Aleve and other NSAIDs (despite the advertising hyperbole!) are actually very mild pain killers and you'd do much better with the Tylenol. Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

Work at a desk job, take subway to work (stairs + quarter mile walking 2x/day), walk four blocks to gym, ride stationary bike for 10-15 minutes, grocery shopping 1-2x/week (someone carries bags in and out of taxi for me). No housework except for meal prep (but that's only 2-3 times/week).

All exercises 1x/day:
Calf raises, 2 sets of 10
Quad strengthening - lying down with bolster under knee, straightening one leg at a time - 2 sets of 10
Hip rocking (lying down with knee on operated leg bent and slowly moving knee side to side) - 1 minute
Clamshells - 2 set of 10

I would strongly suggest that with all you do in the doing of your work, you don't need any exercises at all now! Work on its own is quite sufficient!

You see, THR hips actually don't need much 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. And especially not those clamshells! Ugh! They are so hard on the IT band!

 

[trav86]

Hi Josephine -

Thanks so much for your help.

Hip
Main pain location D/E RF1 - if I had to choose between D and E, I'd say it's at the very top of E.
Today, the pain is running all the way down RF1 through E,F,G and H

Knee
Pain continues all down IT band RF1 A-H

I'm so worried about this being an infection - pretty much anything else would have me singing a happy song.

 

[Jamie]

Let me tag @Josephine to be sure she sees your responses.

 

[Michegon]

@trav86 Hi, Bilateral Jim here. I hope you don't have an infection. Rest and ice is your friend as you're only one month post op. Don't forget you were all beat up with major surgery and your body needs to heal. Good luck!

 

[Sullivand]

@trav86
Just reading your posts that described your day made me take in a deep breath and sigh for you! It seems to me you might be overdoing it! I think your walk to the subway, riding the subway, walking to work and back again is enough of a workout! Walking is the best exercise ~ take care of yourself and rest, elevate and ice your way to wellness. Patience is the Bonesmart way!

 

[trav86]

@Michegon @Sullivand
Bilateral and Sullivand,
Yes, you're right. I'm taking it very easy this weekend - resting and icing continuously.

@Josephine
Today, I have less redness and more swelling. The pressure of the swelling is causing some pain, more in hip E R6B - that is, it's moved a little toward the back, whereas yesterday it was more in the front (E R1F).

I'm continuing to take the antibiotic (Avelox) and Tylenol. What I don't understand is whether this is a situation where I should be insisting on blood tests, etc. RIGHT NOW or if the best course is to finish the antibiotics and wait and see.

Thanks for everyone's good wishes!

 

[copsham]

In my humble opinion, I would say best thing to do is finish the anti biotics. Mine did not clear right til the end of the 7/8 day course so hang in there! At the beginning of my infection I was panic struck but it did all clear up with out problem, so good luck and thinking of you. Like wise I have an allergy to penicillin

 

[trav86]

@copsham
Thanks - it's encouraging to hear of a good outcome! I'm continuing with the antibiotics and trying to be optimistic.
My philosophy has always been 'don't put off worrying till tomorrow when you can do it today!'
(Wish I could stop myself...)

 

[DesertHorses]

@trav86 - Lots of good advice already so I'll just send you a hug
Living in NYC is hard work - just hang in and you'll be Ms Holly Golightly again before you know it!

Patti in Vail AZ

 

[copsham]

An afterthought @trav86
Josephine did say to me, what was obvious, but in my panic i had not realised, that an infected incision is not directly related to the hip joint. I went from 1 to 10 on the worry scale until I was told this LOL.

 

[Suzette]

Need to keep an eye on my incision too. The ends of both are a little sore due to tight dissolvable stitch that the nurse wouldn't 'loosen' still hasn't dissolved and is feeling a bit sore and red, and a little wet.

Its good to know though that that has no impact on the hip joint

xx

 

[donor]

@trav86 @Suzette infection is the word we are most afraid of! My rubber dressing pulled so much on my skin I could not stand up straight. It hurt alot. When it was off the incision changed appearance almost daily. Red bumpy like a zipper, then purple etc. So odd. And it seems all normal.

 

[trav86]

@Suzette
My incision was never wet - I'm surprised to read that this is fairly common. Hope you're feeling wel!
@copsham
Infected incision doesn't equal infected hip - hmm, I hadn't thought of that. However, since I started the antibiotics three days ago, I've been having night sweats, which is something I'd not experienced previously. (@Josephine, this is adding to my worries.)
@donor
I'm so hoping for normal!

 

[Josephine]

@trav86 you have no need to worry about infection!

These patterns are typical of Trochanteric bursitis and ITB (ilio-tibial band) issues. and possibly also Piriformis syndrome which often goes in company with IT band issues.

You can see it here in this image how the IT band pain tracks down the side of the leg and the piriformis is also indicated (the piriformis is a small strong muscle at the back of your hip joint, almost at centre point of your cheek - see article).

This is because, as you will see in the article, the piriformis in spasm become very hard and squeezes the sciatic nerve between it and the bony pelvis. Hence the sciatica which is tracking all the way down to your foot.

What is even more significant is your description

Today, I have less redness and more swelling. The pressure of the swelling is causing some pain,

which is very typical of a trochanteric bursa

I've had all these issues but the most mysterious was the bursitis. It started with the piriformis which was excruciating and had me sleeping on my recliner for a few weeks. It wasn't until I went back to bed I discovered I had it. I favour my right side to sleep but when I lay down, I sprang up again, convinced I'd dropped a sewing needle or pin in the bed! The pain was that sharp! I explored the mattress carefully and finding nothing, tried to lay down again. HA! Ended up sleeping on the left side that night but in the morning, I decided to explore the area with my fingers and found a firm yet soft swelling, about the size of a duck egg, right on my trochanter! It was exquisitely painful to the touch as well. I was lucky enough to have a really excellent GP who not only accepted and confirmed my suspicions but gave me a cortisone shot there and then. I rose from her examination couch like a Lazarus! The pain not only gone from the bursa but the piriformis as well. My chiropractor got rid of the IT band spasm for me over the next few weeks.

I do hope you find a doctor who will treat your TB with as much alacrity and success.

 

[DesertHorses]

Ah - I should have read @Josephine 's post first - sounds like you may not need the antibiotic after all?

Patti in Vail AZ

 

[donor]

@Tweefishy see Josephine's reply above to @trav86 . I know your sciatica is acting wild.....perhaps this is why?

 

[Suzette]

Oh the bursa area is where my right hip throb is and where its quite warm and puffy. Will keep an eye on that too....only just in case of course

xx

 

[Josephine]

Get your doctor to give you a cortisone injection. It worked like a miracle for me!