Pain in femur

[North]

Had my first THR (anterior) December 3, and with all this time sitting around waiting to go back to work, my mind wanders and I'm curious about things. So here are a couple of questions:

1. In the anterior approach few muscles are cut, and so since that is the case, why can't a person just get up and walk after the surgery if the surgeon is basically replacing the bones in the joint with the prosthesis? Why the numbness in the quads and the weakness of the muscles? (And to give some background to my case in particular, which is a little unique, I was on track to have THR but no date set. I was able to keep the pain manageable with meds and was working out 3 times per week and even playing competitive singles tennis once per week. And I'm not overweight. Four days before my surgery, I went "off the cliff" so to speak, and was unable to walk even with crutches without excruciating pain and thus had to have it done on an emergency basis. So, I went into this surgery basically in very decent physical condition).

2. Is my surgeon giving me a CYA answer when he says I shouldn't ever play competitive singles tennis again? I hear very conflicting things from Internet research and from other tennis players whose surgeon basically gave them the green light to play tennis, and these are from players whose replacement materials and size are similar to mine, and not metal on metal or hip resurfacing.

3. Why is it painful to lay on the side of the THR? I have no pain from the incision or the outside of the hip. It's deep inside which seems strange because I've read there aren't any nerve endings in there. And does this eventually go away.

Well, those are my questions and thanks in advance to any insight anyone has to offer.

 

[bottomshollow]

North, so pleased that you have joined us here on the forum. Will certainly attempt to answer your questions for you.

First, although muscles were not cut, they were forcibly separated and some nerves were severed, the hip joint itself was forcibly dislocated, bone was sawed off and reamed out, implants were hammered in, and the incision was closed in about three layers. I suggest you watch a YouTube video of the surgery. Your hip has undergone major trauma. Physical condition before surgery will have impact on recovery--but actually the better shape you were in before usually causes you to have expectations that your body cannot meet immediately after surgery.

Second, high impact sports put more stress on the implant. Most OSs do not recommend returning to high impact sports. And yes to some degree it is CYA. If you go back to playing competitve singles tennis and the implant fails---it is on you, not him. In today's litigious society, you certainly can't blame your OS for this stance.

And, third, the surface incision heals pretty quickly, but the under layers take far longer. Also do not forget that bone is living tissue and it is also healing; thus the pain from deep inside.

You have undergone MAJOR surgery that has had a TRAUMATIC impact on your body. It is not like having keyhole surgery to remove your gall bladder. And complete recovery is going to take quite some time. I am going to give you links to some articles from our Library that may help you understand all this a bit more.


THR approaches or incisions
Pain management and the pain chart
How Long Does Healing Take ......
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy Drain for THRs
Elevating your leg to control swelling and pain
Activity progression for THR
Some suggestions for home physio (PT) and activity progress
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?

Hope this gives you the information you were after. Please take care and keep us posted. We care.

 

[sissy46]

did you have to say "reamed out?"

Hello, North, and welcome! Yes, you need to watch the video, then you'll understand. I also had the anterior approach, and was able to do many things (walk without cane, climb stairs) very quickly but my OS still did not want me to return to bike riding or kayaking for 4 weeks, and he doesn't want me to do anything high impact for at least 6 months, and I don't plan to, ever, really.

Being in good shape is beneficial, and the anterior approach leads to quicker recovery with few precautions, but you still need to chill for a few weeks. I was able to comfortably lie on my operative side within 3 weeks---it never hurt, but there was a sensation of pressure before that.

 

[North]

Great and helpful answers! Thank you!

Sissy46, how long before you were able to get into and out of your kayak? I do a lot of canoeing, so am hoping to be able to do that in the spring.

Anywhere I can find statistics on THR failure, especially as it relates to impact sports like tennis? I mean, if it's a 5% increase chance of a failure for me to play tennis, that might be a worthwhile gamble. But 50% increase might make me more cautious.

Impact sports have all kinds of risks associated with them, but those of us who enjoy sports understand and accept those risks. I could go out there in a year and play singles tennis, worry about my hip, and all kinds of other injuries could happen instead, just like they could happen to someone with no THR.

I want to do what is wise, but as a competitive player at a high level for over 40 years, that is a hard thing to envision giving up entirely.

 

[sissy46]

North, when I first discussed THR with my OS, I asked how long before I can ride my bike and paddle my kayak and solo canoe? What he said, "4-6 weeks." What I heard, "you will be back to normal in no longer than 4 weeks," which of course, he never said, and wasn't quite the case.

On the 28th post-op day, I had a friend bring her boat over so she could go with me, and I paddled one of my kayaks for 3 hours. Getting in it was easy; I had more anxiety about getting out after sitting for 3 hours, but I had no problem. I was able to do my usual exit in shallow water by putting my left foot out and standing up with weight almost equally divided between left and right foot, keeping control of the kayak. This is a small sit-inside-kayak with a large cockpit. I've also paddled my sit-on-top kayak, which is really easy to enter and exit (sit down, stand up,) and my solo canoe which I do the same as my small sit-inside.

The only thing about paddling, and this is still true at 11 weeks out, I get stiff if I sit too long, and here in Florida unless you want to balance on a gator's nose, there isn't always a good spot to get out all that often.

 

[bottomshollow]

Sorry, North, I meant to also tell you that return to high impact sports is an individual decision. We have many members who play singles tennis, snow ski, water ski, etc. And there are other risks in life that could impact the new hip---like an auto accident---but we don't stop driving. and I am not suggesting that implant failure is a given---just a bit more likely---if you go back to playing. The reason for THR was to improve quality of life---so if playing tennis is part of that quality of life, then go for it!

 

[Jaycey]

Hi North, my only restriction post op were not bungee jumping or parachuting. Otherwise I can do what I like. This is all OS dependent and yes it is a decision you need to make yourself. You need to keep in mind that until all the muscle seats back around the joint you should avoid twisting or that changing direction quickly like you do when playing tennis. But since you were in pretty good shape pre-op I'll bet regaining that muscle tone won't take long. Just wait until after your post op followup before starting anything.

PS - I personally would not recommend watching YouTube vids of the op. Why scare yourself silly!

 

[Dingbat7]

Hi
I was posterior x 2 as stated the muscles take time to heal as pulled apart, I asked my physio if I would be able to run, not marathons but to catch a bus or avoid getting soaked if started to rain and said yes but the more impactive things you do the more the hips could wear and could mean a shorter life before revision , now do I really want to go through that all again sooner than I have to.....Nope.
Re watching the vids I am trying to convince myself I just had torn muscles that still hurt I suppose im in denile and can't even look at my x-rays , the thought of replacement parts still freak me out, so watching the carpentry a no no.

 

[nerdgrrl]

From what my OS said, if you wait for complete healing (9 months to a year) the risk is less of failure and more of the ball or cup liner wearing out sooner and then requiring a revision sooner. Interestingly, he did not include snow skiing or snowboarding in his list of high impact activities. The ones he was worried about were, running, soccer, and anything with a lot of jumping or pounding. Bungee jumping was forbidden, but I never had a desire to throw myself off from a great height, so I was ok with that. I suspect your OS is cautious because you play at a competitive level, so you will be a lot harder on your joint than a rec player like me.

Also, some of your deep pain may be due to a snug fit of the prosthesis in the femur. I was having some deep pain in my thigh and mentioned it when I went in for my first post-op appointment. They said it was likely due to the aforementioned snug fit and that it would go away as more of the bone knitting takes place. Sure enough I am now about 5 weeks out and that particular deep pain/discomfort is gone.

Let us know if you find any stats. I would be interested to see what you find, if anything.

 

[nerdgrrl]

Hi North- as it happens, a friend of mine just sent me a link to an article about athletic participation after total joint arthroplasty. Have only skimmed it, but it looks intresting:http://www.nyuhjdbulletin.org/Mod/Bulletin/V68N2/Docs/V68N2_3.pdf

 

[Josephine]

Never seen any statistics such as you mention so cannot provide them. But it might help to know there are something like 0.8 million hip replacements done globally in recent years and I would guess that quite a number of them have never been given any "can't or mustn't" warnings at all. So there are most like thousands of people do what they fancy doing on their new hips, totally oblivious there is any concern!
You might like to check these out
Hips that have lasted 40 and 32 years
Stories of amazing hip recoveries

 

[Damn!]

Hey North, I have every intention of going back to my CrossFit workouts. I plan on waiting the suggested 6-12 months so the bone will fuse with the implant and then I going for it. I will probably start back with a modified CF workout a bit earlier, but will skip the running, box jumps and burpees. (I'm ok with skipping burpees....forever, if need be)

 

[cnydutch]

Hey North, I have every intention of going back to my CrossFit workouts. I plan on waiting the suggested 6-12 months so the bone will fuse with the implant and then I going for it. I will probably start back with a modified CF workout a bit earlier, but will skip the running, box jumps and burpees. (I'm ok with skipping burpees....forever, if need be)

What is a burpee????????

 

[cnydutch]

Hi North- as it happens, a friend of mine just sent me a link to an article about athletic participation after total joint arthroplasty. Have only skimmed it, but it looks intresting:http://www.nyuhjdbulletin.org/Mod/Bulletin/V68N2/Docs/V68N2_3.pdf

I had read that article last week,
glad my OS didn't!
Hockey is listed as a no no,
My OS didn't tell me I couldn't play again (not like i'm a pro or anything like that)
when asked about falling, he said "get back up and get going again"
he did say my bones were hard as a rock, and was confident in my recovery back
to doing what i did before. as far as running, he said if i was running away from
a burning building or emergency situation sure, go ahead, but didn't recommend taking
up running 5ks etc. (which i never did anyways)
i think a lot of docs will treat each individual as just that, an individual, and make
their recommendations on that person's health/ability/conditioning, within limits.

 

[MaxBuck]

North, in my case my doc said if I wanted to resume running, he'd go with a ceramic-on-ceramic prosthesis. I don't, so he went with ceramic-on-plastic. Not sure what design and materials you have, but if you'd mentioned a desire to continue singles tennis I'd expect the doc to have considered that.

As for the weakness in muscles (especially the quadriceps), that is definitely something I had at the outset, and to some degree I still do. I also still find my muscles "freeze up" a bit if I sit too long.

Pain lying on the side (or in my case, more discomfort) I had until very recently - possibly because my mattress is a very firm conventional spring mattress with a fairly thin pad on top. But the discomfort has abated gradually to the point I now feel comfortable sleeping on either side, or on my belly.

 

[oldyellr]

That's a good analysis, Dutch. It was said earlier that active sports could shorten the life of your prosthesis. So what? You might need a revision at 60 or 70. My OS asked me what my expectations were and I said wanted to continue cycling . He said that would work. I don't know if there's a health coverage plan that voids the "warranty" if you do what you're not supposed to. But it's your life and you ought to be able to get the most out of it that you can.

 

[oldyellr]

Just to add to this discussion, I followed the Floyd Landis saga (go ahead, Google it) where he got a Birmingham Hip Resurfacing to continue racing. Apparently that was the best option for him at the time. I actually asked my OS about this and he said there were issues with metal-on-metal with this and he didn't do it for that reason. So if your passion is a sport that may shorten the life of your prosthesis, it's up to you to decide what's more important to you.

 

[nerdgrrl]

cnydutch , a burpee is also called a squat thrust.

 

[Poppet]

Welcome north.. great that you are thinking about your future goals for your activities, but the first goal is to recover from the trauma of major surgery...

I am certainly not saying, keeping the dream alive is very important check out these success stories..

Stories of amazing hip recoveries

 

[bellaroma]

oldyellr, I love your message about doing something that could void the warranty on our hips