Question about technique

[Stanj]

I went back to the hospital today. It was my first attempt to leave my general neighborhood on foot. The hospital I used is located in a suburb of St Petersburg so I used a combination of metro(the ornate 300 ft deep subway), a bus and walked the rest of the way. I went back only to bring flowers to the nurses since I was not scheduled for an appointment. I ran into my PT in the hallway and she wanted me to talk to a woman who just has her left hip replaced a few days ago. The woman is 46 and did not have a BoneSmart type resource for information so she had lots of questions for me. What impressed me most was how she was doing fine, already walking with crutches 3 days post op. I asked if she was in pain or uncomfortable and she replied she was comfortable but could not sleep on her back, only on her side as she had been doing all her life. I started sleeping on the incision side about 13 days after the operation.
That was interesting, she is doing about the same as I was 2 weeks ago(my RTHR was May 29) and she had no pain medication either or excessive swelling.
Is there something about how the operation is done that might account for lack of pain, and lack of swelling? I've been reading post after post about how much pain medication everyone seems to be taking. It that a US thing or is it just that Lena, the new patient, and I are just strangely different. We both had the same approach: posterior, the only difference was she was heavier for her height than I am and she is female.

What percentage of patients have no pain and what percentage have great pain post op and how broad is the bell curve of pain distribution...are there any studies for this?
Or maybe the high use of pain killers is based on the posters being a self select group. If they did not have pain they would not have posted.

So the apparent difference caused by difference in surgical technique, personal threshold of pain(I never thought I was low sensitivity for pain but the last time I took pain medication was 40 years ago), or habit or what that made Lena's and my post op pain free?
Maybe there is something we are doing that would help others have a low pain post op period

Just curious.......
Stan

 

[JudyS]

Stan,
I hope somebody has some good info on your questions. I have a pretty high tolerance for pain and also had the posterior approach and use percocet. if I was just sitting I would probably be using a lot less. Getting in and out of bed,up and down sure hurts.
If I put full wieght on my operated leg ,muscles really hurt.
I stayed in shape by hiking up to the day of surgery and strength training as well and am not overweight.

It does all remind me of when I had my first child 22 years ago. I ran on mountain trails until I went into labor and went to prenatal exercise classes as well. I worked at a job where you are on your feet and thought all the women who came back and told how painful it was were wimps.
Well, it hurt like heck!!!!!

I was very miserable in the hospital.

What is going on special in Russia??????
Judy in So Cal

 

[Josephine]

Of course the surgical technique affects that, Stan - very much so. A surgeon who is swift and doesn't handle the tissues too much has much better outcomes in that area than one who takes twice as long for much the same procedure and is constantly having to use swabs to dry the surgical area so he can see what he is doing. Also having the wound open the minimum amount of time reduces the amount the tissue dries off by exposure to the air (internal tissues are not supposed to dry off) and the possibility of contamination from airborne particles. All of that contributes to post op swelling and stiffness.

Not exactly orthopaedics, I know, but when I had my hysterectomy, my surgeon was hand chosen by me simply because he took 20 minutes skin to skin whilst his colleague would take upwards of 1½ hrs! By way of validating my choice, I was able to take a walk around the hospital car park on my own 2 days after the op!

Short answer but one which has been cited since the heady days of Sir William Arbuthnot-Lane (father of orthopaedic surgery 1856-1943) who insisted on a total non-touch technique meaning that NO tissues, swabs, sutures or instruments that were going into the wound could be touched by the human hand (albeit gloved!). Most of his reasoning was based upon this very thing, that over handled tissue would get bruised and contused thereby making the area susceptible to scarring and/or infection. His was a somewhat stringent regime but had common sense behind it, some points of which seem to have been lost in this brave new world which is over medicated with antibiotics and the like. I make this comment after viewing many of the videos of operative technique - some make me shudder!

 

[JudyS]

Thanks Josephine,
That possibly explains a whole lot.

Also why I ended up with a uterine infection with the birth of my first with a week long hospital stay as they tried to figure out what was wrong and then how to kill it.

Judy

 

[Stanj]

Thank you so much Josephine, that makes so much sense I did not even think of that. Another contribution due to quicker in and out might be less anesthetic. I was reading the the epidermal often last 20 hours but 2 hours after I went into the operating theater, I was awoken in the sun room next to the OR. I do not distinctly remember feeling my legs when upstairs but only a short time later I was in my room and bed and testing wiggling my toes and flexing my upper leg muscles and felt no numbness. That was a real surprise to me, I assumed my legs would be dead for hours and then the pain would start. my second sensation was wondering where lunch was.
The PT came in shortly after lunch and suggested the schedule. She supported my leg a few inches off the bed and asked me to try to lift. It surprized us both that I was able to do a leg lift right out of her hands. I thought i might risk damaging something. My leg was weak but not painful so i did several of them.
This introduces the question of the influence of anesthetic on early response post op.
All this whole thread is very fascinating to me, generally and as a patient.

Thank you very much Joesphine.

 

[chaloo]

My op took over 4 hrs. There arose some complications during the op. The surgeons thought that they have damaged one of the major nerves during the op. The incision was made longer down the leg (it is about 15") to trace the nerve back to the hip area. I had no knowledge of all this until the next day when one of the surgeons came to see me and explain everything. He said that it would take longer for me to recover from the op. It is now 8 weeks post op. I still feel so much pain sometime around the incision, especially when I am seating down.

 

[Josephine]

Ohhh - chaloo - that's awful! I'm so sorry that happened to you.

 

[sunshine]

chaloo, I am soooo sorry to hear that. I hope from now on you might start recovering better and quicker now. ((Hugs to you))

 

[chaloo]

Thanks ever so much Josephine/Sunshine, It is ok. Its no ones fault. We all know THR is a major op and things can go wrong sometime. I am always very positive about everything. It is 9th week post op. I could feel that I am getting better slowly. I have started muscle strengthing exercises. Hopefully, within the next few weeks I would be able to start walking unaided.

This forum is really fantastic.

God bless you all.

Jaz