THR Question - One year after thr

[HelenaM]

Does anyone have an idea about why the length of the scar varies with the anterior approach? Does a longer scar equate to a longer recovery time?

 

[Eman85]

My THR was posterior but when I went to the OS I asked him to hold out his hands. He was puzzled, I wanted to know just how big of a hole he needed to get his hands in there. I think the scar has all to do with the OS and what they prefer and have the most success with.

 

[HelenaM]

@Eman85
Thank you. i compared notes with a friend who had an anterior, and my scar is much longer. We appear to be about the same height and weight. I wonder if the bigger incision gives the surgeon a better view. Hers is so small that I can’t see how her surgeon even got the implant in!

 

[Elf1]

@HelenaM not sure the length of your has much bearing on recovery other than your soft tissue.

I have to agree with others that those 6 week wonders may exist but I'm pretty sure they are few and very far between. I think one of our problems going into this surgery, unless you've been hanging out here prior, is that we really aren't given an accurate idea of exactly how long most recoveries will take. They really do take a year or more for "complete" recovery.

I'm coming up on my two year hipaversary and I still have some niggles, zips, zaps, etc. I've lived my life and in the process my body has some issues with the aging process. I think that's another thing that most of us forget, we're not 18 anymore, no matter how much we want to be. We may never be completely 100% but I sure will take the 99.5% I'm at now over where I was two years ago.

Everyone here always reminded me that the patience muscle is the hardest one you'll have to exercise. If you really feel that something isn't quite right and want additional tests or opinions then please do so to give yourself peace of mind. Not trying to minimize your experience, just sharing what I've experienced.

 

[Ric A]

Great Post thanks.

 

[Celle]

Does anyone have an idea about why the length of the scar varies with the anterior approach? Does a longer scar equate to a longer recovery time?

The length of the scar depends on how much room your surgeon needs to shape your bones and insert the replacement hardware accurately. It's related more to the size of the implant and the angles to which your surgeon has to move your leg than it is to the surgeon's hand size.

The length of the scar should not affect recovery time - which is going to be about a year for complete recovery, although you'll be able to do most things by about 3 months post-op.

 

[HelenaM]

@Elf1 @Ric A
Yes, great post Elf1. It is just so confusing when the advertising makes you believe in a swift recovery and easy recovery. I heard a surgeon on a zoom conference recently stating that he has done hundreds of these and the surgery and recovery are easy. Maybe it is easy for him...?

 

[HelenaM]

@Celle,
Thanks for the information. I am a little confused about what is a complete recovery. I have been able to do most things since three months or earlier, but still have some nagging discomfort later in the day.
I have trouble lifting and walking up full sized stairs in the normal way. II have walked 3-5 miles in a day on some occasions but could walk up to 10 before. if I sit in a restaurant, I need to stand and stretch about every 30 minutes, which is probably a good idea anyway. My surgeon says I need to be patient for a few more months, but I am not clear if that is true, or is this basically a full recovery (or less likely, is something not right). I am scheduled to talk to another skilled surgeon, but really want to know if my recovery is off, or is the advertising off. I think there is no easy answer.

 

[FCBayern]

I saw significant improvement in my recovery during my second year @HelenaM, particularly the 12-18 month range, so I would give it a few more months before judging it.

 

[Celle]

Thanks for the information. I am a little confused about what is a complete recovery. I have been able to do most things since three months or earlier, but still have some nagging discomfort later in the day.
I have trouble lifting and walking up full sized stairs in the normal way. II have walked 3-5 miles in a day on some occasions but could walk up to 10 before. if I sit in a restaurant, I need to stand and stretch about every 30 minutes, which is probably a good idea anyway. My surgeon says I need to be patient for a few more months, but I am not clear if that is true, or is this basically a full recovery (or less likely, is something not right). I am scheduled to talk to another skilled surgeon, but really want to know if my recovery is off, or is the advertising off. I think there is no easy answer.

First, you're right. There is no easy answer.
Even though your hip probably looks normal from the outside, muscles, tendons and other soft tissues are still healing and adjusting to the new way you're walking.

All the things you can't yet do, but you used to be able to do, indicate that your recovery isn't yet complete.

Your surgeon is correct in saying you need to be patient for a few more months. Most surgeons are reluctant to do any further investigating or surgery before a year post-op, simply because many things that seem to present a problem sort themselves out with time. That's all part of the normal healing process.

Your body needs to adjust to the different forces now acting when you walk - and you still need to be able to walk without a limp. Before your surgery, your body was trying to protect your painful hip and, unconsciously, you probably adjusted your gait to do that. Now, you have to learn how to readjust your gait, so you don't limp.

As for the advertising, yes, I think it's probably a bit over-optimistic. They're looking at the first 3 months of recovery, assuming that most healing has taken place - and it has. But after that there's the much longer period, where progress is slower and much less obvious improvement is made. I think of it as a two-stage process - 80% done and a slower 20% still to achieve.

Try to remember that where your hip is now is not where it's going to end up. It will continue to improve, but more slowly than before.

 

[Eman85]

@Elf1 @Ric A
Yes, great post Elf1. It is just so confusing when the advertising makes you believe in a swift recovery and easy recovery. I heard a surgeon on a zoom conference recently stating that he has done hundreds of these and the surgery and recovery are easy. Maybe it is easy for him...?

Advertising?? Just the fact that a major surgery would have any connection to the term advertising throws up red flags. It's very common for the approach being "sold" and hyped.
I'd want to ask him how his recovery was. It's a lot like the PT's that know all about THR recovery.
My left is 3 years, still plenty of reminders that I had a THR.

 

[HelenaM]

My arthritis really flared just before the pandemic, and the orthopedic surgeons were really busy at that time. I think that in my area the business has lessened temporarily, and there are many zoom courses offered. They are supposed to be educational, but probably this a new approach to finding patients. I think the competition may be fueling some claims and a focus on the best outcome as the expected for anyone. And I think that when in pain, I may have been more willing to listen to the most positive tales of recovery.
@Eman85

 

[HelenaM]

@Pumpkin

helps.

Since you are at the year mark and continue to have challenges, you may want to seek a second opinion for your THR. Find a surgeon specializing in Revisions, they have the education and background to determine what is happening with troubled hips. Look for a surgeon specializing in complex joint reconstruction or revisions. They should have no relationship with your present OS, not even golf buddies

I went for a second opinion today. Both my original surgeon and the second surgeon are highly qualified revision specialists. I cannot rule out that they have met, but I get the sense they are are being honest when they say that my X-rays look perfect. My os says that soft tissue is still healing and I should walk mainly and do ADLs and this should resolve. The second surgeon says I need to do pt to strengthen muscles for right IT band syndrome and trochanteric bursitis. About a month ago my internist said I had sartorius tendonitis. I am not paying so much attention to the different terms, but think my muscles are still sore and weak or a little unbalanced in simple terms. Today when the surgeon pressed the side of my hip I felt pain, but last week the pain may have been elsewhere but it is always around the scar.

Although they mostly agree (that the joint is great, and I saw the picture with some markings and measurements) the advice for next steps is different. Do you have any thoughts? I am thinking about giving pt a try in a week or two, but saying no to anything that seems too much.
Stretching and doing some motions in the pool helps.

 

[Pumpkin]

I am thinking about giving pt a try in a week or two, but saying no to anything that seems too much.

A good PT should be able, to help with an appropriate exercise program.
They should do thorough strength, core testing, and a gait analysis, prior to putting together a program for you. Often when you start out less is more for a strength and stretching program.
You might even want to cut the program in half if you feel it is too much too soon.

Keep us posted on how you are doing,

 

[Going4fun]

If you feel like you're struggling a year later and not as strong as you want to be, I say consider going to a PT.

As we we older, lots of muscles get weak from disuse and lots of sitting. There is also the compensation problem: when we have hip arthritis our body just naturally starts making adjustments to compensate for problems with the hip. Then we get a great new device and the body is not used to handling a strong, reliable device--lots of tissue have gone to sleep.

A frequent example is weakness in glute muscles. Our butt muscles are incredibly powerful, but they go to sleep from so much sitting in modern life. When the glutes go to sleep, the burden goes onto other weaker muscles that aren't really equipped for activity. Thus we get tons of soreness and sometimes pain.

A good PT can help you retrain your body and strengthen and activate the necessary muscles to get you feeling better. My Pt used to talk about two issues: weakness and atrophy from disuse ... and "inactive" muscles. Sometimes our muscles are fine, but they are simply asleep and we've grown used to moving around without "activating" those muscles. A good PT regimen (especially a year out) can safely help you build and activate muscles.

Just an idea. And if you look for a PT, go with someone really smart and likable ... someone you meet and really like. A good PT will listen to your goals ... and read your body language ... there is a lot of psychology involved. You'll feel comfortable speaking up with a PT you really connect with. You don't want someone who just rotely has has you doing certain exercises. Never be afraid to leave a PT you don't connect with to find another. My test for whether I like the PT: do I look forward to going and do I feel good at the end of a session? I always found PT incredibly boring in the past, but I struck gold this time when I went six months after my hip surgery. I basically just looked online for reviews.

Finally good PT's are great at helping you figure out reasonable expectations and helping you to pay attention to the precise conditions when your body feels good and when it doesn't.

You can get a PT script from your surgeon or from your family doctor. Just say you still feel weak and sore at times and you really think you might benefit from PT.

Good luck.

 

[HelenaM]

@Pumpkin @Going4fun
Many thanks for these important suggestions. I hope I will be able to find someone who is knowledgeable and pleasant to work with, and most importantly, who will help set reasonable goals, especially when we begin. I did have pt earlier in home and on line, but the surgeon stressed that some machines could help now that covid is less problematic.

 

[HelenaM]

This is not a reply but a new question. Has anyone had any luck with steroid phonophoresis for scar tissue and sore muscles lingering after Anterior Hip Replacement?

 

[HelenaM]

Also, can anyone explain more about what this is?

 

[Sashimu]

This is not a reply but a new question. Has anyone had any luck with steroid phonophoresis for scar tissue and sore muscles lingering after Anterior Hip Replacement?

I've never heard of it before, @HelenaM, but I did a quick search for phonophoresis in this forum. There is one person back in 2011 who got benefit from it, so you could try that same search and see what she had to say.

 

[HelenaM]

The os I consulted recently wrote that on my pt prescription. I checked with the pt company I want to use and they have someone who can do it after my evaluation, if they think it is right. I have never heard about it...but @Sashimu