THR Persistent limp after hip replacement

[Michael J]

I am 73, but in good physical shape, not overweight, and pretty active. I do a lot of work in the countryside. Eighteen weeks ago I had a total left hip replacement. I am still unable to take an even pace without limping badly, and am largely reliant on a walking stick. What has gone wrong? My physio puts it down to gluteal weakness (but this seems to be a trendy diagnosis these days and I'm not convinced). A chiropractor that I have considerable faith in believes there may also be nerve damage and that muscles are firing in the wrong order. I had a right hip replacement 5 years ago - no problem. The incision this time, by the way, was posterior-lateral. What is frustrating is that I can do 15 mins + working on a cross trainer in the fitness centre, and the walking movement seems to be unaffected . . . so long as I hold onto the bars. I can stand on the left leg . . . so long as I have one finger balancing me against the wall, Take the finger away and I fall over. Any hints gratefully received. Currently I feel as if I am going to be disabled for the rest of my earthly!

 

[sharonslp]

Hi Michael. To begin with, there's little use in comparing surgeries and recoveries. Each hip is different, and so many variables change. Like...to begin with....you are five years older.

So...what about this THR and recovery can you control? The first place we always start is with the mantra: rest, ice, and medicate. 18 weeks is still early in the full recovery game (takes between a year and two to get complete soft tissue healing), and it's also the point where many people have stopped pampering themselves with frequent rest periods, naps, and avoidance of more strenuous activities. But it is NOT at the point where soft tissue has healed enough to ignore any of these needs. So question one is: Are you overdoing? Answer: "I do a lot of work in the countryside." I am betting you are overdoing. You can't gauge recovery on where you THINK you SHOULD be. You have to let your body tell you where it really IS.

Ice? Ice is always your friend. You are past the point where your incision needs this. But soft tissue gets mighty inflamed with overuse. So 1: use ice. And 2: stop overdoing.

Meds? You are long past the point where you need the heavy-duty narcotic stuff, but if you have soft tissue inflammation, then meds can help you get past it, while you CONTINUE TO REST. Using meds to mask pain so you can continue to overdo just perpetuates the problem. But using them to help you feel good enough so you can walk without a limp is important. The limp is telling you something...and being pain-free enough to walk without a limp is important to your full recovery.

Whether it's tendonitis in one area or another, or bursitis, or SI band syndrome, or nerve damage or impingement or whatever....it's all going to need similar treatment.....sufficient rest, and staying away from the activities that exacerbate it. And when it's recovered, very gradual return to full activity level. I'm tagging @Josephine and she'll ask you some very specific questions about your pain (where exactly and what kind), about your activities (work, recreational, PT, etc) and meds (what kind, what dose, how often). And then she'll give you very specific recommendations. You won't like them, because they will mean decreasing what you currently feel you have to do. And NONE of us wants to do that. But it makes the difference between a great recovery and one that leaves you feeling hampered and in pain.

Hope this helps.
Sharon

PS....you are past needing some of this info, but it is what we give all new THR members:
First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

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
Activity progression for THRs
Home physio (PT)
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?

 

[Hip Hip Hooray!]

@Michael J, I've definitely noticed that my glutes were very weak. They used to be extremely strong, because I was a ballet dancer and teacher. The year before my surgery, I fell down seven times! I would just tip over, like a tree. It was a slow fall, and I didn't hurt myself. Once I rebuilt my muscles at the gym, (this was before the surgery,) the falls stopped.

Since my bilateral THR, my glutes and the backs of the thighs have really woken up, just from walking. They feel overworked from a short swim session. (20 mins.) I wasn't using them for a long time, because I was pitched forward and had a sway back. Now I am upright and my posture is corrected. The muscles need a lot of work, though. My bum is flat. I was amazed at what that limping did to my musculature. It really weakened certain areas. Plus, the trauma of the surgery does a lot of damage to the tissues.

So, I hope this is just a muscular weakness that you're describing.

 

[Jamie]

Have you been back to get your surgeon's advice about what you are experiencing?

 

[Grannyhippy]

@Michael J Your symptoms are so like mine. I am 13 1/2 weeks post op and am still using one crutch as I too cannot walk properly without it. I have also read articles about weak glutes, nerve damage etc. but really do not know the reason for my limp. Like you I don't need much to steady my gait but try to walk just a few steps without anything and I am limping badly. Even more so, if I gather up speed. Like you, I fall over if I try to stand on the operated leg alone and not hold onto anything, even with one finger. I have read some interesting articles on the Trendelburg Gait which seems to fit both of us. But of course it may well not be that.

Take heart. @Hoppy Nanny posted on my thread that she remained on a crutch for 6 month before she was able to walk without a limp. So there is light at the end of the tunnel. We just need patience. I am seeing my OS soon and will post his comments.

 

[Hoppy Nanny]

I sure did! If I tried walking without one crutch I limped very badly.....it was 6 months before I could walk unaided & even then I used a cane on longer walks. It just felt like I did not have the strength in the hip without an aid. Hydrotherapy helped plus all the reassurance from fellow BoneSmarties that it was ok to stay on the crutch if I needed to.
The physios said that it was due to bad gait prior to THR as I waited far too long to have the op done. Of course, I checked it out with the professionals.....but all is good now! Hope it helps x


Sent from my iPad using BoneSmart Forum

 

[Josephine]

I am still unable to take an even pace without limping badly, and am largely reliant on a walking stick. What has gone wrong?

In order to advise you appropriately, I need to ask you some questions but I am going to make ti complicated for you because I need you to answer them twice! First time around for the first 4 weeks after surgery and second time for now. If a questions doesn't apply, just say 'not applicable'.

It would also be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. 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

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

3. how often are you icing your knee and for how long?

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

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

Can you detail it like this

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Strait leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2

 

[lalo]

I can definitely relate to the comment that with just one finger to steady myself the limp goes away. I'm in the same boat. Right now I still have other issues and I hope that with time the limp either goes away or becomes barely noticeable.
Kudos to all that have posted; lots of good information. Sharon's response is so good I had to copy it to my notes so I can access it quickly and read it as often as I need to.