Lounge Doctor

THR Pain vs. Covid: when to do THR?

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
Hi everybody, this is my first post.

I was born with hip dysplasia and had THR on my right hip about 12 years ago. In 2016, I had TKR on my left knee. My left hip, which has always been fine, started bothering me about a year ago. I had X-rays last week and it looks like half the joint is trashed and the other half is still OK, but may not have long, depending on how fast my arthritis progresses. The doctor is having me try Celebrex to see if it helps. If not, and if my pain keeps getting worse, he says I need to go ahead and schedule the THR. He says it will be anterior, that I won't have the post-op restrictions I had with my right hip years ago, and that it will be my easiest joint replacement recovery yet (as long as it's not like the knee, I'll be happy).

I have good days and bad days with the hip. The Celebrex seemed promising at first--I've only been on it a week--but now doesn't seem to be helping. Today I am limping badly, and when the pain is like this and I'm walking too much (like grocery shopping), I feel like I'm going to lose control of my bladder, which is awful. The issue lately is standing up from a sitting position--I have to go slowly and remain bent over, straightening up very, very carefully so the hip doesn't "catch" and give me a sharp jolt of pain. I'm not sure why I'm in this much pain, because the X-ray made it look like half the joint was pretty decent.

I'm leaning toward doing the THR asap, but I'm worried about going into a hospital with Covid, which is very bad right now in my state. And I know this is stupid, but I also feel like a wimp, because it's not like the whole joint is bone-on-bone. I'm curious to know how recovery from THR differs now from when I had mine 12 years ago. Is it really that much easier? Anyone out there who has had a posterior THR and a more recent anterior THR?
 

Pumpkln

MODERATOR
Moderator
Joined
Oct 27, 2011
Messages
23,593
Location
United States, West
Gender
Female
Country
United States United States
@Fennel
Welcome to BoneSmart, glad you joined us!

Please post your surgery dates, a moderator will add it to your signature for you. Having the exact dates will help us properly advise you. Thanks!

Covid-19, you are not a wimp, you have serious concerns with high levels of transmission in your community.
Have you asked about same day surgery in a joint replacement surgery center?
if you will be in a hospital, ask how Covid-19 cases are separated from the rest of the hospital, and if staff is limited to working in only one area, no crossing over between Covid-19 wards and other parts of the hospital.
Ask about the protocols to prevent Covid-19 transmission in the hospital.
Your surgeon should be able to reassure you that you will be safe.
I'm not sure why I'm in this much pain, because the X-ray made it look like half the joint was pretty decent.
And half your hip is trashed and is going to hurt, overriding any other part of the joint. X-rays do not always reveal the full extent of the damage. Parts appearing undamaged, may in fact have mild arthritis which can be just as painful as bone on bone in some individuals.

Here is an article about THR vs TKR
TKR or THR: which is more difficult surgery for recovery?
 

leejaa

FORUM ADVISOR
Forum Advisor
Joined
Feb 3, 2013
Messages
3,397
Age
66
Location
NY State
Gender
Female
Country
United States United States
Your description of your hip limitations sounds very much like my last hip before replacement except for the bladder issue. I could barely get through grocery store and actually started dragging my leg instead of trying to lift it.

I had my last hip replacement in Nov 2019 and it was a posterior as was my first hip replacement. Except for the restrictions I do not see that much difference in recovery from reading here on bonesmart. It still takes time and patience. Your hip still has some major carpentry done and all those tissues have to heal.

I asked my OS regarding anterior. He had already done my other hip and both knees and this is his specialty. He said he did anterior for a while and found that the patients did not gain anything from anterior so he went back to doing posterior.

Your body and hip will decide more about how you recovery than the approach the surgeon does as long as you have a good surgeon who does a good number of procedures.

Even with Covid I would try to figure out how to have the surgery soon as safely as possible. Most larger hospitals keep the orthopaedic case separated from the other cases in the hospital. Check with your OS as to what he knows about the hospital and Covid and orthopaedic cases. Remember, he does not want you to get sick either.
 
OP
OP
Fennel

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
I asked my OS regarding anterior. He had already done my other hip and both knees and this is his specialty. He said he did anterior for a while and found that the patients did not gain anything from anterior so he went back to doing posterior.
Wow--so your doctor said anterior surgery didn't have a good outcome? My surgeon seemed to be saying some hips require a posterior approach, but for others you can do anterior (which if possible is preferable due to having none of the post-op restrictions you deal with after posterior). Now I guess I need to do some reading on the anterior surgery. :chinstroke:
 

Elf1

FORUM ADVISOR
Forum Advisor
Joined
Apr 2, 2019
Messages
2,081
Age
64
Gender
Female
Country
United States United States
@Fennel it's not that one approach is "better" than the other or doesn't have good outcomes. It's usually what the surgeon is most familiar with that he/she used and you definitely want your surgeon to be comfortable and most importantly, quite capable with the approach he uses. There may be a reason they use their particular approach but again, I think it's what they're used to and comfortable with.

Some surgeons aren't really imposing restrictions anymore and even when they do it's usually only for 3 months or so. And it's not really that hard to follow the restrictions, it's usually don't bend more than 90 degrees, don't cross your legs across center and possibly sleep on your back for some time.

Some surgeons advertise one approach is better than the other but usually in the long run they all take just as long to heal. What you want is a surgeon that specializes in and performs quite a few hip replacements (as in 100s) and that you feel comfortable with. The surgeon's skill and your comfort/confidence in him are two of the most important aspects of your surgery.
 
OP
OP
Fennel

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
@Fennel It's usually what the surgeon is most familiar with that he/she used and you definitely want your surgeon to be comfortable and most importantly, quite capable with the approach he uses. There may be a reason they use their particular approach but again, I think it's what they're used to and comfortable with.
My surgeon does lots and lots of hips, and he seemed to be saying some situations call for a posterior approach and some don't. He does both posterior and anterior surgeries regularly, using whichever approach each particular case calls for. Have you heard of that before?

When I had my posterior THR, the restrictions were pretty draconian. For example, I couldn't sit in a regular chair for many months (any chair had to be tall and it had to be flat, nothing soft/sinky, angled, reclined, etc.), and I had to get a special chair (because nothing I had was acceptable), and had to put a cushion on top of the cushion, to make it tall enough. I couldn't get in a car unless there was a special tall cushion on the seat. I couldn't put on shoes and socks without that long stick thing, couldn't bend over to pick something up off the floor, etc. With the surgeon saying I would avoid all that with the anterior surgery and that this would be a much easier recovery, I was pretty excited.
 

Elf1

FORUM ADVISOR
Forum Advisor
Joined
Apr 2, 2019
Messages
2,081
Age
64
Gender
Female
Country
United States United States
@Fennel makes sense that the surgeon might do different approaches depending on circumstances. That's fantastic if yours is adept at both and does them regularly.

I think that with the newer technology and such out there that things might now be so drastic now. There are specific ways to get in/out the car and it is recommended on here to use a cushion to help keep your hips higher than your knees, same type of thing with chairs/couches. As far as bending over there's a technique called the golfers reach that most can do.

There are a few folks on the recovery side that have had posterior fairly recently, if you go up to the search and type in posterior approach it will take you to these threads. That way you can actually talk to folks that have had this approach. Sorry I'm not more helpful but I had direct anterior or something like that, my scar is on the side of my leg so didn't really cause too much problem.
 

zauberflöte

alpha
Joined
Mar 8, 2013
Messages
5,501
Age
68
Location
Central Virginia
Gender
Female
Country
United States United States
@Fennel It's usually what the surgeon is most familiar with that he/she used and you definitely want your surgeon to be comfortable and most importantly, quite capable with the approach he uses. There may be a reason they use their particular approach but again, I think it's what they're used to and comfortable with.
My surgeon does lots and lots of hips, and he seemed to be saying some situations call for a posterior approach and some don't. He does both posterior and anterior surgeries regularly, using whichever approach each particular case calls for. Have you heard of that before?

When I had my posterior THR, the restrictions were pretty draconian. For example, I couldn't sit in a regular chair for many months (any chair had to be tall and it had to be flat, nothing soft/sinky, angled, reclined, etc.), and I had to get a special chair (because nothing I had was acceptable), and had to put a cushion on top of the cushion, to make it tall enough. I couldn't get in a car unless there was a special tall cushion on the seat. I couldn't put on shoes and socks without that long stick thing, couldn't bend over to pick something up off the floor, etc. With the surgeon saying I would avoid all that with the anterior surgery and that this would be a much easier recovery, I was pretty excited.
I would trust the hospital to keep the infectious patients separate from all else. I had a hernia repair in June and was terrified, but the hospital took very good precautions.

As to anterior vs posterior-- I have two anteriors, 7 and 3 years old. I can tell you that while you may not be restricted about putting on your shoes and socks, the swelling will cause you to be verrrrry careful! Same with bending over-- perfect your "golfer's reach" now lol! They probably do it so the audience never sees an unflattering view, but I did it so I didn't have to bend at my hip crease just yet. Or you may be one of the lucky anteriors I've seen here in the past few months, who haven't had much swelling.
I would go for it. Get it over before flu season hits hard, doubling your worries.
 

leejaa

FORUM ADVISOR
Forum Advisor
Joined
Feb 3, 2013
Messages
3,397
Age
66
Location
NY State
Gender
Female
Country
United States United States
Wow--so your doctor said anterior surgery didn't have a good outcome?
No, he did NOT say it did not have good outcome. He said anterior was not better than posterior. Basically he was saying recovery will take whatever your body needs and one approach or another does not change recovery. You can have good outcomes with any approach but it will take time to heal.

My restrictions from posterior were only 6wks and basically do not bend hip past 90 degrees, do not cross legs, do not cross ankles , do not cross midline of body with operated leg and use pillow between legs if laying on the side for sleeping. Even without precautions I do not think I would have been crossing my legs after surgery.
 

Schaargi

member
Joined
Jun 22, 2020
Messages
129
Gender
Female
Country
United States United States
I had my surgery in June (during COVID). The hospital had us separated, and I had to pass a COVID test beforehand and then quarantine. They had so many precautions in place, I felt completely safe (and I'm a bit of a germaphobe, so that's saying something).
 

Eman85

post-grad
Joined
Mar 4, 2018
Messages
1,867
Age
65
Location
E Tennesee
Gender
Male
Country
United States United States
I've had a few friends have joint replacement over the last couple of months. Hospitals are one of the safer places as far as Covid transmission goes as they follow guidelines to the letter. I've had 2 posterior replacements so I can't compare to anterior myself. I really didn't think the restrictions were a big deal. I looked at it like I want a good outcome so I'll follow them. MY OS does posterior, I asked him about that and he just felt it worked better for him and the patient. I trusted him so much so I did it twice.
 
OP
OP
Fennel

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
MY OS does posterior, I asked him about that and he just felt it worked better for him and the patient. I trusted him so much so I did it twice.
I lived in a different state when I had my posterior right hip replacement, so I can't go to the same surgeon this time. I wish I could! He did an amazing job and I've had ZERO problems with it in 12 years. What is concerning me from some of the comments is how many surgeons seems to prefer ("worked better for him and the patient") the posterior approach. I guess I'll talk to my doctor about my concerns and see what he says.
 
OP
OP
Fennel

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
Wow--so your doctor said anterior surgery didn't have a good outcome?
No, he did NOT say it did not have good outcome. He said anterior was not better than posterior.
OK, sorry. I thought when you said patients didn't gain anything that you meant they didn't gain an advantage from the THR itself, not that there was no advantage in anterior vs. posterior.
 
OP
OP
Fennel

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
From what I understand, the surgeon has to cut through muscle for posterior and doesn't have to do this for anterior. That doesn't have an impact on recovery? I've been trying to read up on anterior because I knew nothing about it until the surgeon mentioned it last week, and it looks like that is the main advantage. Maybe I should start a thread looking for people who've had one of each surgery!
 

Woodstockhip

junior member
Joined
Aug 23, 2020
Messages
98
Age
69
Location
Woodstock, NY
Gender
Female
Country
United States United States
I just had posterolateral — and I do mean just — still in the hospital. My surgeon does a minimally invasive, muscle sparing surgery. The muscles are separated along the muscle fiber and eventually grow back together.
 
OP
OP
Fennel

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
I just had posterolateral — and I do mean just — still in the hospital. My surgeon does a minimally invasive, muscle sparing surgery. The muscles are separated along the muscle fiber and eventually grow back together.
Good for you! I'm not quite clear on how this is different from a regular anterior approach, but from what I'm reading, it seems to be very good.
 

Woodstockhip

junior member
Joined
Aug 23, 2020
Messages
98
Age
69
Location
Woodstock, NY
Gender
Female
Country
United States United States
The difference is where they go in. Anterior is in the front, posterolateral is on the side. There are so many new approaches, lots to learn. Most importantly, be confident in your surgeon!
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
33,084
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
When I had my posterior THR, the restrictions were pretty draconian.
I think you will find the biggest difference between THR now and when you had yours 12 years ago is the area of restrictions. Most surgeons are no longer requiring any restrictions no matter what approach is used.

And I'll stress what has already been said - the recovery is not in any way approach dependent. It's all about how your body reacts to the procedure and the condition of the joint being replaced. Walking around with a bad hip can impact many areas of the body.

Here's an article from our Library on THR approaches or incisions.
 
OP
OP
Fennel

Fennel

new member
Joined
Sep 14, 2020
Messages
8
Gender
Female
Country
United States United States
I think you will find the biggest difference between THR now and when you had yours 12 years ago is the area of restrictions. Most surgeons are no longer requiring any restrictions no matter what approach is used.And I'll stress what has already been said - the recovery is not in any way approach dependent. It's all about how your body reacts to the procedure and the condition of the joint being replaced. Walking around with a bad hip can impact many areas of the body. Here's an article from our Library on THR approaches or incisions.
Thank you! That link shows a longer list of disadvantages to the posterior approach (more pain, more blood loss, more risk of dislocation) over the anterior approach, so I'm not feeling too bad about doing anterior. I'll talk to my doctor and get more info.
 

Jaycey

FORUM ADMINISTRATOR
Administrator
Joined
Jan 27, 2010
Messages
33,084
Location
Yorkshire
Gender
Female
Country
United Kingdom United Kingdom
Just to clarify - there could be more pain, bleeding or dislocation risk. As with every THR - all these things are possible. Do talk to your doctor. There are issues with numbness and nerves taking longer to heal with anterior. But you can not predict any of this until you have your op.

Perhaps don't over think all this and put your trust in your surgeon. They will alway use the approach, implant and techniques that are most appropriate for your own medical situation.
 

New

Active Antibacterial

BoneSmart #1 Best Blog

Members online

Forum statistics

Threads
52,880
Messages
1,404,108
BoneSmarties
32,954
Latest member
Femur_guy
Recent bookmarks
0

Top Bottom