THR Questions and concerns for Preparation for THR

James Fox

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I have enjoyed all the discussion on this pre-op forum and thought I would now throw my hat into the ring on the discussion. I found out this time last year that I need a THR on the left hip, I am “bone on bone” with symptoms spanning about 10-15 years. Yes, my activities have diminished considerably, gained weight, etc. I am well aware about the outcomes and results. The delays so far are from covid spikes taking up hospital space availability to have done and constant health insurance changes since I am years away from Medicare and retirement. Working for small companies, insurance carriers are always changing; to point of expecting being handed a 40-80k or more invoices for the procedure due to all the insurance flux which would definitely ruin retirement. I have just started a job with one of the largest employers with the best benefits so that is no longer an issue.

However, I do have some questions and concerns I would like to work through before having the THR procedure done to better “prepare me for the journey”. Like many others here, I am quite nervous as well. I had only one surgical procedure when I was very young and do not remember much of it. I had a traumatic injury incident at age 9 with a foot cut that was practically to the bone; with the local needle anesthesia insertion to numb the wound for stitching felt literally like a “battlefield wound” experience, with insurmountable pain I can distinctly remember to this very day!

In the meantime, I have researched the entire THR experience but only from a mechanical and procedural standpoint. I know all about the techniques, the procedure, preparations, recovery, the day of surgery, medications, timelines and equipment needed for the home. I have been to PT for preparation and anticipate re-engagement during recovery. But most of this information I have found has been provided by hospitals and orthopedic centers, from the practitioners point of view. Marketing materials to encourage having it done, or to calm the fears of newly scheduled patients and prevent cold feet.

The patient testimonials from these sources have focused on the long term results of THR which I have no doubt are nothing short of phenomenal. But I am seeking the short term, unpleasant “experience” that no doubt everyone, including myself has and will need to endure to get to that point.

I know everyone is different with different ages, physiologies, backgrounds,..etc and for the most part would have different overall experiences. However, this is a standard, popular and common procedure and thus there are probably common effects that would be experienced by most everyone going through this.

For example I almost fainted when described the spinal tap I will be initially administered. Would I have the option of being given nitrous gas before that to calm me before undergoing that similar to dental procedures?

It is given you would be completely out for the procedure and it would appear as instantaneous, but what would I feel internally when I am revived? What would the new artificial implant feel like to me vs. the natural hip? All information states that you would be induced to get out of bed and walk almost from when you are revived? What will that be like? What kind and how much pain will that be, initially? How difficult will that be? I have heard stories of “long leg”, your height being different..etc. Will my entire operated side feel like a solid block of cement and be immutable?

I have heard of side effects of the anesthesia, will they prevent me from sleeping or eating or being constipated? What is the expect extent of fatigue and drain from the procedure itself?

I am sure I will not be able to sleep the night before the surgery, but will anesthesia side effects or pain from the surgery prevent me sleeping the first night? Will I be able to sleep at all for the next few nights for the next 1-2 weeks of initial recovery?

Ever since I was diagnosed with THR, my hip has been feeling worse, with my weight shifting, walking with a limp and also the tops of my feet and ankles have been inflamed to the point of shoes no longer fitting. Will the re-learned walking in recovery induce a normal stance, with normal weighting and posture again to reverse these unpleasant effects?

About pain, what kind of pain will be induced by the surgery that I would potentially need opioids to treat? Right now I have throbbing pain in inner hip areas, tingling pain in the groin and sharp pains in the knee when I walk that come and go randomly, per the amount of walking I do, time of day..etc (along with tight skin in the other leg and feet from the inflammation from the limp re-weighting walk) After surgery, those pains will go away but I will have new ones from the “impact of the surgery itself” . Will these pains be similar in nature to OA pain I have had in the last year, worse like the childhood cut sharp trauma pain? Or will it be like the “sore workout pain” like your leg muscles after a day of hard extreme skiing, mountain climbing or steep mountain bike trail ride? What exactly is “healing” pain?

Are these pains related to the healing phases (Inflammatory, Proliferative, Remodeling) My research tells most of the pain aside from trauma of the operation itself stems from your leg muscles and nerves being moved around during the procedure itself.

How does the elevation and attitude of the new hip affect the pain and recovery from the THR? And lastly, what about the adjustment to the new implant and joint mechanism itself?

As you can tell, this in itself is STILL a lot to take in. Even after a year of researching this procedure. I would not mind speaking to someone who has gone this to discuss these experiences. I have tried in vain over a year to find someone, but I have been unsuccessful. Most likely because I am one of the few people who have not turned their entire lives over to Facebook, Twitter, Instagram or Tik-Tok and only interact with others only through social media.

The only responses I have gotten from anyone is just shut up and do it. I refuse to accept only that. I am not saying that I am undecided. I will do this. I just need to be total ready.



Respectfully,

-James Fox
 
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Mojo333

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Hi @James Fox and welcome to Bonesmart.

I hope you find, as I did, the forum to be a great resource for getting the scoop from those who have "limped the limp ", and gone on to "walk the walk" on the path back to healthy and happy.
The information and discussions on this forum were certainly helpful to me, and so keeping the conversation here, on the site, will not only be beneficial to you - but also be useful for others with the same questions and concerns.

You are correct that there are a wide array of recovery experiences...due to our own particular physiology, but I can tell you about mine.
It took me a few days. but the bone crunching hip pain was gone immediately.:happydance:
Even with the tightening and swelling (I did both at once) I was able to walk (gingerly) and yes, the discomfort was managed fairly well with pain meds, and the muscle pain (mostly quads with my anterior approach) I likened to running 100 miles or having my legs used for punching bags.
The first weeks were rough- ain't gonna lie - but doable and I never felt like I had an artificial hip implanted.
Some have expressed they can tell, but for me it feels like good natural hips.
My legs were somewhat uncooperative for some weeks and needed help when lifting onto bed and the like, but didn't prevent me from walking.

You have alot of other questions, which I'm sure you'll get feedback from the good folks here, but let me say that all of the temporary recovery struggles were nothing compared to the pain, disappearing range of motion, lack of sleep and all around feeling of being old before my time pre-op.
 

subie2021

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Hi James, welcome to the best hippie community on the internet.

My experience was that I went to the block room for an ultrasound guided nerve block to my hip, being wheeled to OR, and being asked to sit up on the OR table for the spinal, and that was it. Next thing I knew I was in PACU, getting ready to be transported back to my little outpatient surgery cubicle.
The nerve block was slightly uncomfortable, just a little transient pressure from injecting the meds.
The pain after surgery wasn't bad at all. For me it was a combo of a sense something had been done to my leg, and some stinging from the incision.

Upon being asked to get out of bed and use the restroom, I felt a bit woozy, I'm assuming from pain meds. But it wasn't difficult to make that trip on my own, nor to perform the necessary PT tasks required for release. It was amazing to not have that horrible grinding pre op pain any more.

My surgery was at 11:30 and I was home for dinner.

Pain management was good. The surgeon washed my hip with Exparel before he glued me back together. IV drugs were administered in PACU, and my OS prescribed tablets for home. He also prescribed meds for constipation, stomach upset, and a blood thinner. My original pain pills didn't agree with me, but a call to OS for a change fixed that.

I think I could have been fine without the pain meds, but they helped a lot with sleep. You'll need to sleep on your back for a while, possibly with an abduction wedge between your legs. It's fairly uncomfortable and annoying so any help with sleep is a godsend.

I've never had any sense of having an artificial hip. But after surgery I had log leg, which resolved in about a week or 10 days. My home PT guy helped with that.

Various aches occurred over time and hung on for days or weeks. For me it was nothing serious, basically soreness or stiffness in butt, thigh, or calf.

After about a month, it was all cleared. They were nothing compared ro the pre op OA pain.
You'll use walking aids post op, a walker at first, and then a cane. For how long, depends on your recovery. My OS ordered a prehab visit to PT, where I was instructed on proper use of both. After the surgery, I concentrated very hard on always walking heel toe in order to lose the habit of limping.

I'm an outlier here about PT in that I found it very beneficial to my recovery. My caveat going into it was that if it hurt or was even a little beyond my ability, I would refuse that exercise. However, my therapists never pushed or insisted, were very gentle and introduced new moves slowly. I had in home pt for two weeks, 2-3 times per week. That guy was also helpful with advising ADLs and sleeping with the dang wedge etc. Outpatient PT helped with balance and reawakening my log leg. I had also signed up for the OneStep program via this site which kept me moving and motivated.

At any rate, the best thing you can do post op is to walk. And walk some more. Just be careful and do not overdo it. For THR recovery, going slower seems to be faster.
Expect to have some restrictions post op. Some surgeons remove them after about six weeks, others like mine keep them in place longer. There are ways to work around them, but still, they can be a pain in the neck.

I hope you don't bog yourself down with worrying over every detail. Try to go with the flow and have faith in your surgeon and your healthcare facility.

So much is out of your control anyway, there isn't anything to be gained by trying to get ahead of it. To ease your mind, talk to your surgeon or someone on his staff about concerns like pain control, side effects, pre op procedures, and post op expectations. They know your surgeon's preferences and your case. But for your own sake, don't go borrowing trouble and worrying about what ifs.

Best of luck. You'll be amazed with your new hip.
 
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Eman85

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Anesthesia, the spinal with sedation was great! I've had GA many times before and I did not like it. The spinal is like a bee sting when they do it and it is an odd feeling when everything goes numb. When I awoke in recovery, I could have done crossword puzzles I was that alert immediately.
If you have bone on bone hip pain and the horrid deep bone pain that will be gone immediately post op. You won't have bone pain you'll have strained muscle pain. I won't lie it hurts but it's all soft tissue pain from a severe dislocation. Yes it can hurt enough to require pain killers if you want to be comfortable. Everyone's pain level is difference and so is their tolerance. I went most of my life with severe hip pains and can take a lot of pain. I took the pain pills and it made it much easier. I thought I'd go without the first day and then got up walking, that changed my mind after the fact.
Ignore anyone that tells you to shut up and do it. It is a major surgery no matter what many say. It is controlled trauma to your body. If you've researched it you understand. You're at the same age I was for my first. My GP didn't try to sell me on it but he did remind me I wasn't getting any younger and that I was in as good of shape as I would probably be so why not do it and enjoy the benefit of it. He also noted that since I was healthy that I would recover better than if I waited and possibly wasn't in as good physical shape. The decision is ultimately yours to make but the procedure can make your life better. Yes there are risks as with everything you just have to weigh them out.
 

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For example I almost fainted when described the spinal tap I will be initially administered.
If you tend to react this strongly to an explanation involving the procedure, I’m not understanding why you want to worry yourself with the details you’re seeking. You can’t prepare yourself mentally for every possible unpleasant sensation, degree of pain, or complication. This is coming from someone who was also extremely anxious pre-op. You need to trust the medical professionals and your surgeon to do what they’re trained to do and what they do best. They want a perfect outcome, just as you do and will work toward that end.

If you make your anxiety known as soon as you are in pre-op, they can give you something to tamp it down. Agree to it. As far as the spinal, it was no big deal. They had me sit up with legs hanging over the side of the bed while leaning my arms on a pillow on a bedside table. I felt a small painless prick and then basically a warmth that washed over my legs, they laid me down, mask was placed over my face and it was lights out.

I didn’t feel anything internally when I woke. I was shocked it was already over, but elated. After some time in recovery, I was assisted as I dressed in street clothes to go to the room I’d be spending the night in. Yes, they wanted us to dress to go to our room so I brought the softest, oversized comfy clothes I had and it was not an issue. I walked to the bathroom within a couple hours of surgery and also took two long walks down a hallway and back with a walker. I wasn’t in pain. I did experience Log Leg -
The first stage of healing is the inflammatory phase. During this time it is very common to notice swelling. After lower extremity surgery, or trauma involving bleeding and inflammation, there will be fluid in the leg causing the sensation of heaviness. Gravity pulls the fluid downward and since the patient is less mobile the fluid is not pumping back through the heart as quickly. The swelling gradually eases, but can persist for up to 3-6 months in some cases. Regular movement will assist in the reduction of swelling, as will elevation and ice. Your surgeon may prescribe compression stockings for a short period of time.

My surgeon injected Exparel, a non opioid pain reliever into the surgical site before closing. It provides pain control for up to 72 hrs after surgery when needed most. I did not experience increased pain once it wore off and Day Four and Five which are often mentioned as days of increased pain, were not for me. In fact I only ever took 4 Oxy, but did rely on Extra Strength Tylenol for several weeks.

“Long leg” as you referred to it, is Leg Length Differential -
Here's an article from our Library Leg length differential - LLD.
I have heard of side effects of the anesthesia, will they prevent me from sleeping or eating or being constipated? What is the expect extent of fatigue and drain from the procedure itself?
I didn’t experience sleeplessness, I had a normal appetite and wasn’t constipated as I took something for that, short term, and wasn’t on opioids after three days so that helped.

Sleep, I didn’t think I’d sleep the night before surgery, but after a quiet little cry, some prayer and making peace with losing my natural hip that served me well, I slept for probably five hours. I also slept the night after surgery and every night thereafter in two blocks of 3-4 hours sleep. I’d wake after 3-4 hrs, hobble to the bathroom, go back to sleep for 3-4 more. I got enough sleep overnight as I never found the need to nap during the day, but I’m not a napper anyway.
Will the re-learned walking in recovery induce a normal stance, with normal weighting and posture again to reverse these unpleasant effects?
Yes, all will gradually rebalance.

Pain - in my experience any pain was in the general area of my incision and relieved by almost non-stop icing.
http://bonesmart.org/forum/threads/ice-to-control-pain-and-swelling.5493/
How does the elevation and attitude of the new hip affect the pain and recovery from the THR?
https://bonesmart.org/forum/threads/elevation-doing-it-the-right-way.7602/#post-161609

Joint replacement surgery is one of the most prevalent surgeries performed worldwide. The outcomes of these surgeries have become excellent based on a number of techniques changing over the years. The implants are durable and long lasting, with longevity much greater than before offering an increase in the likelihood you’ll never have to experience this procedure again.

In an effort to divide this up a bit, I’ll leave some pre-op information below, then the BoneSmart Recovery Guidelines below that.
 

Layla

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HIP PRE-OP
If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:
Score Chart: How bad is my arthritic hip?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

And if you want to picture what your life might be like with a replaced hip, take a look at the posts and threads from other BoneSmarties provided in this link:
Stories of amazing hip recoveries
 

Layla

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Here are the BoneSmart Recovery Guidelines since you have a lot of questions about recovery -

As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these

5. Here is a week-by-week guide

6. Access to these pages on the website

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
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?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask the at each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Jamie

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I would not mind speaking to someone who has gone this to discuss these experiences.
James, I see you already have some detailed responses from our members and staff, so please continue to post here and I believe you will obtain the personal information you are looking for. That's what BoneSmart is all about and I'm glad you found us.

The only responses I have gotten from anyone is just shut up and do it. I refuse to accept only that. I am not saying that I am undecided. I will do this. I just need to be total ready.
It is good to be informed before any surgery or medical procedure. But it's also possible to flood yourself with so much information that it stresses you out even more. At some point all of us have had to take a bit of a big gulp and trust our medical team's expertise to get us back to living our lives again. Arthritic hips don't get better....only worse with time. A hip replacement will get you back to the life you want to live.

Not everyone experiences the process and recovery the same, so you might or might not experience what others will describe. I encourage you to read threads from other members. Ask about any specific questions or concerns you may have. But also know that literally hundreds of thousands of people in the USA have this life-changing surgery each year. This, along with knee replacements, are the two most successful surgeries you can have.
 

Hip4life

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I feel your pain, anxiety, etc. Lol. It is easy to overload on information. I had a healthcare career so l already knew a lot of the nitty-gritty details but I tried not to dwell on them. What I wasn’t familiar with, I only asked for generalizations to help keep my anxiety in check. I asked and explored for more details afterward when I was more ready and intrigued by the answers. I tried not to invite trouble.

I found this site was helpful in answering and supporting all the little (and sometimes big) issues that would present themselves. These were the things that weren’t covered in the literature and didn’t want to be calling the doctor’s office about every day. But they are important to you! In all the permutations that recovery can take, there is always an answer here or at least a willing ear to steer you in the right direction. The two biggest take-aways I got from here, aside from great support: ice and elevate often for 45-60 mins and that everyone’s recovery is different which includes how long your hip will require to heal completely. I recommend you take the longest amount of time you can off work and try to phase back in when you do go back. You’ll always have the option to go back sooner.

Spinal anesthesia: it was my first and I thought I wished all my surgeries had used it. I sat up on the edge of the bed with a nurse in front of me, they gave me something to relax me, I leaned into the nurse’s shoulder as the lights went out. I barely remember a flash of rolling into the OR and the next thing I was quietly waking up in recovery. Just let the professionals do their jobs and go with the flow.

The first week was rough for me. I had a lot of swelling. However, the joint pain was gone and I knew all the rest was temporary from soft tissue trauma. I never had to sleep in any particular position: whatever was the most comfortable as long as I didn’t violate my restrictions. A body pillow became my best friend much to my husband’s chagrin. Lol.

Try not to overthink this. You can prepare but can’t know all that might happen or even will happen. That is the hardest: preparing for the unknown. I certainly experienced way more anxiety than I needed to. I hope this helps some. Bottom line: the reward of a pain free hip was worth it all. Blessings.
 

Jamie

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Like many others here, I am quite nervous as well. I had only one surgical procedure when I was very young and do not remember much of it. I had a traumatic injury incident at age 9 with a foot cut that was practically to the bone; with the local needle anesthesia insertion to numb the wound for stitching felt literally like a “battlefield wound” experience, with insurmountable pain I can distinctly remember to this very day!
One other point I think it's important to address is your experience as a child described above. Contrary to what you're saying I believe you DO at least subconsciously remember that incident very well, especially the painful aspects of it. As you mentioned in your post, this was a traumatic injury that required intervention. By definition, it was a painful and scary incident for you.

A planned surgery like a hip replacement is not the same thing. Things are much calmer. Once you get to the hospital, you go through a lot of administrative tasks and things just click along one after another until you're prepped and ready to start talking to the various members of your medical team. They will explain everything that will happen and will be happy to answer questions if you have them. Should you be a bit anxious about the whole thing, you only need to let your admissions nurses know that and they will be happy to give you something to take the edge off. These nurses have a fantastic way of making patients comfortable. You should not experience any significant pain as you prepare for your surgery or while in the operating room. It will actually be just a short blip of time for you as you'll be that relaxed or asleep. Once in recovery and in the days or weeks following, should you have some pain, you just need to communicate that immediately to your surgeon or nurses. They have many options to keep your pain under control, which obviously is the goal.

I know this seems like a HUGE deal to you, and it is. But for your doctors and nurses, it's just another day at the office. They work with patients all the time and know their jobs well. You will be in great hands. Sometimes we just have to give up the idea that we might be in control and let the experts do their job. In the end, it will be worth it.

If you haven't done so, I recommend that you sign up and attend BoneSmart's annual Joint Replacement Awareness Day (JRAD) on May 14th. You'll not only learn a lot, but you will have the opportunity to type in questions to the participating surgeons. Good luck going forward. You've done great research. You've picked a good surgeon. You've got this!
 

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I was more afraid of the spinal than I was about my first THR. It was a non-event. They spray your back with an antiseptic spray that feels very cold. I didn't feel a thing and woke very alert post op. None of the groggy feeling or and nausea. I'll take a spinal over GA anytime!
 

djklaugh

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@James Fox Welcome to BoneSmart! You've gotten a lot of great information about what others have experienced with their hip replacements and I hope these reports have helped ease some of your concerns. What I'm going to address here is your 2nd paragraph above. You see I had a similar experience except I was much younger - age 4yo - when it happened. And this was way back in the "dark ages" when medical providers (except perhaps pediatricians) had little appreciation of the emotional impact of medical procedure on young children. What mine involved was having to have my head and jaw strapped down for a specific treatment - experimental at the time. My parents agreed to it because I was having recurrent ear infections. Mom was not allowed to be with me during the procedure and the (male) providers did not find it necessary to explain anything they were doing to a 4yo. Mom saw my tear stained face and shaking when it was over and - Bless her! - refused to allow any other treatments. But she said later I had night mares and could not cry aloud.

I forgot about this until my oldest son was about 18mo old and had to have a skull xray (he'd fallen and hit his head and his MD thought there was blood behind his ear drum) ... fortunately he was totally fine. When going for the xray I was told no I could not be with him and I had a full blown panic attack and worried Mom grizzly bear. No way was MY child having a head xray without me! Observing my reaction sort of outside my self I recognized it was over the top ... but persisted and was allowed to be with my son during the xray. And afterwards wondered why my reaction had been so extreme.

A few years later through my parents I got a notice from the hospital where the original traumatic procedure took place saying this "experimental" treatment was now being shown to cause thyroid problems in patients who had had it done. And it was then my Mom told me about what had happened. Again fortunately I did not have thyroid cancer but did have low thyroid functioning ... perhaps because of that treatment.

It wasn't until a few years after this (at age 45) that I really began to have problems ... I went to work in a hospital and my office backed up onto an xray suite. Every single time a child was crying in the xray room I had a panic attack. And also had panic attacks when a child was in the ER crying (office was next to that department too). With the help of a very good therapist I was able to put together my "as told to me by my parents" information and the written notice from the hospital with the panic attacks and see that YES this was ALL related. With the help of the therapist I got the panic attacks to stop. However, even now 70 years later, I still can not cry aloud. I know why and intellectually understand. But when ever a tears appropriate situation - even happy tears - comes up I feel like I am drowning. The same situation as when I was 4yo, strapped down unable to make a sound with tears running down my cheeks and down my throat.

For you approximately 53 years have past since your traumatic experience. And perhaps the emotions of that experience are still holding you back and amping up your anxiety about having needed surgery. You might want to consider finding a therapist who specializes in treating early childhood medical traumas - or one with lots of experience treating PTSD - this need not be lengthy therapy. Probably just a few sessions would help you put that experience behind you.

I wish you all the very best! Do keep us informed on how you are doing. And ask any other questions that come up for you.
 

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I haven’t been on this site since I had THR of my right hip in late 2016. I just hopped back on today, and already, posts by James Fox and JaeHelen, and replies to them by others, have helped me more than my confusing conversations with no fewer than four orthopedic surgeons as I try to reach a decision about whether and when to have THR on the opposite hip. The great thing about this site, which I’m not sure I fully appreciated when I was on it before, is the opportunity to discover similar concerns held by others and to get input from people who have actually had this surgery.

James, you referenced a “spinal tap” and your anxiety about same, but I’m reasonably sure what you meant was “spinal anesthesia,“ which others are referring to as nerve block. I had the spinal in 2016 and it was terrific, especially compared with general anesthesia, which tends to have more after effects. A spinal tap is something entirely different; it’s done for reasons such as diagnosis of certain cancers and hematological conditions, if I’m not mistaken—but in any case, not for THR. I remember the induction of my spinal anesthesia as being very smooth.

JaeHelen, I very much relate to your uncertainty about how bad the hip pain should be in order to justify the surgery to oneself. And I see myself in the descriptions of how one’s world imperceptibly begins to shrink as one shies away from activity that triggers the pain and discomfort.

I am tentatively scheduled for my second THR at the end of June, so I expect to post again in the interim. Meanwhile, I just wanted to express my gratitude for this great resource.
 

JoeKnows

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You have to be an engineer - am I right?

As to your specific questions:

I don't know what they'll do for your anesthesia. For me, a nice lady placed an IV, shaved my leg and made awkward small talk, then some guy came in and told me I was "going to feel really happy drunk for a few seconds, then go to sleep." That was accurate.

I woke up a moment / hours later, very thirsty. I don't remember any pain. After a while PT tried to get me to walk - I got very dizzy and aborted that plan. They came back and hour later, I took a lap around the floor with my walker, and they sent me home (I had the option to stay, but don't want to be in a hospital longer than I absolutely must).

I took my pain meds on schedule. They are constipating, but I was warned and had stool softeners. I don't recall that being a major issue (though I do remember they really need to make those raised toilet seats larger, and I'm not even a particularly large person).

As for recovery pain, it varied. I had one memorable episode of cramping in my glute. Other than that, the incision felt the way you'd expect - itchy, tender to palpation, generally annoying. I remember the muscles felt like I really wanted to stretch them. But the bone pain was GONE. I recall telling my wife I was so happy I did it after about two days. I also had complications with a cerclage wire, but that shouldn't apply to most people.

You can read through my old recovery thread for more detail (I should probably refresh my own recollection), but I can tell you I'm coming up on hip number two soon (5/25) and I am eager to get it done.
 

Autumn01

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I recall my denial that I had a problem…all I needed was a few days rest and all would be ok.

once disgnosed with dysplasia there could be no denial, but I was still in denial! The mind is a very strong master.

and in the heavy covid days stuck in backwater town looking after dementia mom, with decreasing mobility…..it was easier to be in denial.

i did some research, found a surgeon and it was his calm and detailed responses, that he gave up his weekend time to talk to me and answer all my questions plus a decreasing pain filled mobility reality, drove me forward. But I used every possible reason to try and delay.

this was my first op and fear is an insistent driver. and there is much to fear! Reading the posts here just made things much worse. I suddenly had a encyclopaedia of possible problems to deal with.

Somehow I kept ‘the faith’! I mean by that…positive thinking that nothing bad had ever happened so my life would continue after this blip, the same way.

i did consider whether i wanted a dual mobility because that was an option. other than that I put aside every other scenario and kept my end goal in sight like a demon possessed.

I did delay to upgrade myself to Mako because I am an engineer and it made sense, it felt right. And I think it was the best decision.

there is a point where you need to stop. Gather yourself. the world is filled with 50:50 positive negative results. everything we do has that potential. Stop focusing on your history. What happened prior is not what sill happen this time, unless you focus on it to the extent you recreated it. Start preparing for what you want this time. Focus on your op. Focus on your recovery. Focus in what you want the results to be, focus on what you want to happen. Stop accepting options on possible alternstives. Focus on what you want.

out body knows what it needs to do to heal and regenerate itself. We only need to get out of its way to give it time and nutrition and it does it all marvelously.

surgery is a trauma. It is felt like a bad intentional accident. You have shock and pain. You deal with it sensibly. Prepared.

you are dealing with fear. Its an emotion that cant get enough. every possible point turns into a mountain. Like a badly behaved child. It is not solution centered. Its chaos driven. Put it back in its box.

plan but keep it real.

Know you will have pain. But as everyone else said, and as I experienced, I only really needed 1000mg paracetamol every six hours for about two weeks. so the pain isnt that bad. I did insist on getting some strong pain killers for emergency in case I needed them. For insurance. They are still in my drawer unused.

i was given a pain killer post op that i had a bad reaction to…nausea, headache dizziness. I drank huge amounts of water to flush it out and refused any more.

you will need help. I could walk and did from first day but swelling and of course pain, post surgery body distress…all my energy went to healing and recovery. Accept and plan for help. My daughter was there for two weeks. I needed help for a week. Initially only to help with food, but more important was to help me get my one leg onto the bed! I didnt bother showering. I used baby wipes.

Chose a good doctor you are happy with.

the rest I intentionally blocked. There wasnt any point in considering. thats life. Every day we are faced with endless possibilities of disasters. Just crossing the road is a potential death event. There was too much that could go wrong at every second. We dont live like this. We live blocking negativity and keep confidence in knowing we can and do react sensibly to live second by second quite successfully.

There is only need to understand that whatever happened yesterday wont necessarily happen today. That anything can happen and we are well able to react to whatever happens ….with a good doctor at your side…or phone call away.…you have it as good as it gets.

each doctors pulls towards him or her the team they are happy with. Each doctor by their attitude also brings along results they also create by the sheer need for excellence. So chose a good doctor.

your need for results you want, should coincide with their need for results they want. Everything and everyone else comes along for free ride!

The only thing I do is plan for worst case. That I have a plan means I stop worrying and focus on the best outcome.

i dont need to know others experiences. For a variety of reasons, they cannot be my expriences. I decide what I want. Their lives are not my life. I have to chose what I want. For every given moment millions create disasters for themselves. I manage quite an ordinary life. I learnt that when I went hiking sith two friends that were insistent on having hair raising risk moments. Suddenly I couldnt cope. it was too much stress for me. So I cut lose and stopped hiking with them. I went alone. Best decision ever. i chose what was suitable for me and i was happy to enjoy my day. I dont make difficulties for myself. So I dont chose the scary hair raising way, so dont have those results.

chose your doctor. He is your partner. The rest falls into place.
 
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Lyla

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I have wondered the same questions but until now we’re afraid to know!
I am personally not a fan of the idea spinal blocks. I do have concerns of that as well but because of the osteoarthritis in my spine. ‍
I will discuss this on tues when they call me! Eeekkk. Thanks for the post reading the responses have been enlightening.
One thing I can say is do keep a positive mindset. No matter how scary this all is. Know whatever procedure it takes you are ok. You will heal before long. One thing I do know is no matter how painful recovery is it’s more tolerable knowing it’s very temporary unlike the pain before surgery. That pain lasts until you make up your mind and have the surgery done. For me it’s been the most depressing pain. Pain from procedure will be a cake walk knowing it’s not for long!

I do understand your childhood trauma. I also experienced it. It’s something that stays with you until you heal it. I will also point out that putting a needle into a wound with freezing is excruciatingly painful!! This is different. You will have painless meds to deal with the surgery pain. Once your incision is closed no one is poking it will injections and agitating it. I understand the pain you mean and I do hope you see this is not the same. They will ensure you have meds to keep you comfortable. The pain is a different kind of pain.
When I had spinal surgery it was very painful but it was not nearly as bad as I thought it would be. Our imagination can make it better or worse for us. Let yours make it better by focusing on living a normal life pain free.
 

Lyla

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I do wonder if you have had this surgery. I am on the other side now and would love to help address a few of these questions from my perspective.
I had chosen to be put under. I was given a choice and normally they don’t give choices but because of my age and health they allowed me to be put under.
I did not have nausea/ vomiting or sleeping issues.
I did wake up in a lot of pain but they were on it so quick I got relief in minutes. I also believe my perception of the pain was due to having an amazing dream then waking up pain. It made it feel worse then it was.
I argued with them to go home that night and they let me. My surgeon laughed at my 2 week check up that I was in a hurry. Was feeling well enough to go home.
Was not as bad as I thought. The pain from pre surgery is gone. It left that day and now just a little recovery pain and discomfort that is way better then what I felt before.
 

LaurieMarina

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James:
You may have had your surgery by now, it being June 10th now. But if not, I wanted to answer your questions, having gone through both total hip and total shoulder replacement and a total knee replacement coming up this July.

Regarding the anesthesia, you should definitely talk over your fears not only with your surgeon but with the anesthesiologist, who will talk with you just prior to surgery. I had issues with the "local" anesthesia (i.e., spinal) due to local making me very nauseous, so between myself, the surgeon and the anesthesiologist, it was decided to give me general anesthesia; if they go that route you will be given a tranquilizer pre surgery and then will be administered general anesthesia in the operating room, where you will be totally "out" during the surgery. In either case you are a little groggy when you wake up in the recover room, but should not feel anything internally. If you do feel nauseated the nurses can talk to your doctor about potentially giving you something for that.

In general, a new implant doesn't feel any different than the old natural hip. I did feel for a little while when I slept on that side that I was sleeping on a gun - however, the doctor chuckled at that and said that was the first time he had ever heard someone say that!

Generally nowadays, if your surgeon can get you up and walking that day, you are sent home the same day as surgery. They obviously wait to do this until you are no longer groggy from the anesthesia. I worked in an orthopedic clinic years ago, and surgery is SO much better now than it used to be!! I will not kid you in telling you that there will be no pain. The first day or two are the worst, and you may wonder what you have done to yourself, but you have to remember how bad the pain was from your bad hip and how much better it's going to be once it's healed. It also depends on whether they go in anteriorly or posteriorly. My right hip was a posterior incision, which was a little bad, as you are sitting on the wound, although I have heard from other surgeons that they do their incision a little more to the side of the hip, so that I think also depends on your surgeon. I would ignore the "long leg" stories - I have heard horror stories about my upcoming knee replacement, but I choose to believe that my surgeon who is doing that is the same one who did my hip and he did a beautiful job on that. I think if you have confidence in your surgeon, you should put your faith there and not listen to the horror stories, because surgery is scary enough for anyone without listening to those!

in answer to your questions about your entire operated side feeling like a solid block of cement and being immutable, the answer in "no". I the pain from the groin and the pain that referred down into my thigh was totally gone after the surgery and the worst of it for me was the pain from the wound and the muscles being moved around, and you have to remember, that orthopedic surgery involves a lot of drilling and hammering, so that causes some pain, too. The pain level as far as taking opioids really varies from one individual to the next. I took them for two days and they made me feel like I was going into a coma, because I'm on a lot of other meds, so I just stopped taking them, and switched to Tylenol.

The side effects of the anesthesia should not prevent you from sleeping or eating (although as noted above they can make some people nauseated, although the anesthetics they use today are SO much better at not causing nausea - even I don't have a problem with them like I did as a younger woman). They can make you constipated, so the doctor will probably suggest having a laxative or fiber supplement in the house after your surgery. The expect extent of fatigue and drain from the procedure itself is really unique and varies from person to person.

You mentioned sleep - I didn't get a lot of sleep the night before, just because I was anxious, but the night of surgery, I was so wiped out 1) from not sleeping the night before, and 2) just because surgery wipes your body out, that even in spite of the pain, I slept just fine. Going to sleep once I got home was a little hard, just because of where the incision was, but again, once I got to sleep it was fine. Plus you will probably find yourself wanting to nap a bit during the day during that initial recovery period.

Your hip should start to feel better and better, especially if you are good are doing your home PT and you shouldn't need to walk with a limp again. Have you discussed your feet and ankle swelling with your doctor? It might be a good idea to do that to make sure that is really related to the hip.

As I noted above you will have the pain from the incision itself, and as someone who climbed a 14er in Colorado and some others in Alaska (easy ones, not with ropes, but still good climbs), I will tell you that the pain in your hip/buttock/leg area will probably feel a little worse than a mountain climb or a hard day or skiing - probably more like you've been pummeled by a football player, but those pains will all be due to the surgery and will eventually subside.

The pain you will have are all related to the skin and muscles being cut during your surgery and are due to a complex process of chemical messengers that the body produces in the process of healing.
I hope this helps and I wish you the best for your procedure. You will not regret it!
Laurie
 

Layla

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@James Fox
Wondering how you’re doing and whether you‘ve scheduled a date? I noticed you received a lot of lengthy feedback since you posted. Hopefully with all that was shared here, it‘s helped ease some anxiety. Please let us know how you’re doing and if you feel any closer to scheduling a date for surgery. Wishing you all the best!
 

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