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THR Risk of moving femoral stem

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HolyGamon

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Hi All,

I am 18 days post posterior THR left leg. I had a ceramic on ceramic implant, cementless with a single screw in the cup. 36mm implant.

I have only just found this forum and it is fantastic.

I was released from hospital on day three with the advice that I could full load bear on the operated leg.

I have been taking it fairly easy, just doing the minimum physio until yesterday. The last two days I have been walking unaided around the house. My hip is now sore and swollen. I am hoping that I have just over worked the muscles but am concerned that I may have moved the femoral stem.

Is this something that can happen? Or are they generally jammed in too tight to be easily moved?

Thanks
 

Jaycey

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@HolyGamon Welcome to BoneSmart! At only 18 days out of major surgery you are still in major recovery mode. Are you icing and elevating regularly? Taking your pain meds as prescribed around the clock?

It may be too early for walking unaided at only 18 days out. Were you instructed to do this? Most people do not go off their walking aides until they start to leave them behind.

And what exercises are you doing. Hips don't really need lots of exercise - walking is the best therapy for them.

Believe me - it would take a whole lot more than walking and exercise to loosen the stem. It's in there well and truly. You have just done too much too soon.

I'll leave you with some reading to do. Slow and steady with this recovery is the best approach. Do let us know if you have any more questions.
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?
 

Chihuahuan

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@HolyGamon My instructions were two weeks with a walker then onto a cane then independently. Lots and lots of healing to do. Sounds as though you need to elevate (I use three stacked pillows angled like a ramp) and ice. Just because you can do something does not mean that you should.
 
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HolyGamon

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Hi Bone Smart Forum,

I have been reading the posts in here for sometime but had been getting an error when trying to create new posts. This is only the second time I have successfully been able to create a post.

The threads in this forum have provided me with invaluable information over the last 9 weeks. I can't thank you all enough.

At 9 weeks I am extremely happy with the outcome of my left total hip replacement. I feel well on the way to complete recovery. I have no pain and each week I am walking a little better than the week before. I now only have a small limp after much walking and recently reached the milestone of being able to lead with my operated leg when walking up stairs.

My prothesis is ceramic on ceramic, cement less with one screw in the acetabulum. I have been full weight bearing from day 1 and am basically feeling really good. I am still on the usual restrictions.

I am wondering, is it generally ok to lift and carry objects that weigh around 10 to 15 kilograms at 9 weeks?

Also is pushing a light wheel barrow with moderate loads ok?

Thanks,

HG
 

Jaycey

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Welcome to BoneSmart @HolyGamon ! Congratulations on that new hip!

At 9 weeks out your new hip may complain about carrying anything heavy. I know both of mine did. It's best to work up to a heavier object. Start small and if your hip doesn't complain add weight.

I was pushing a wheel barrow at that stage. Again, listen to your hip. You may find some twisting movements bother it. Just ease off and try again another day.
 

mopster

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I have CoC and full weight bearing allowed from first day too. I am now in week 6 post OP and can relate some very recent experience about lifting and carrying.

Saturday I had to do some unavoidable gardening and prepare a bit for fall/winter season. So I had to carry some stuff around (not far, not heavy - garden is small). I think that would have been OK.

But then I had to lift a 40lbs/20kgs bag o stuff (cement) and carry it for only 3 or 4 steps just to get it out of my way (I did hug the weight close to my body and took each step very carefully). Same day no real problem, but on the next day tigh muscles around incision felt very tight and a bit sore and first two or four steps when standing up hurt a bit (at least this was loosening up with pain receding when I kept moving). I took this as a strong recommendation to keep my legs up on the couch and applied iced gel pads for most of the day. By now, a day later, we are reconciliated and back to normal terms.

At 9 wks it might be that you can do better than that, but not too much, I presume.
 

Josephine

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I have been reading the posts in here for sometime but had been getting an error when trying to create new posts. This is only the second time I have successfully been able to create a post.
Yes, we had some issues during August and September but they've all been fixed, thank God!
I am wondering, is it generally ok to lift and carry objects that weigh around 10 to 15 kilograms at 9 weeks?
I agree with Jaycey - I'd be careful and cautious. 22lbs might be okay but 30lbs and upwards might cause problems. Maybe at 15 weeks or thereafter.
Also is pushing a light wheel barrow with moderate loads ok?
Same again. Jaycey has the right idea - test it out a bit and then add to the load a bit at a time.
My prosthesis is ceramic on ceramic, cementless with one screw in the acetabulum.
The screw is actually irrelevant as far as you are concerned. It's just part of the overall design of the device.
 

Hip Hip Hooray!

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I still have problems if I lift 25 to thirty lbs. I doesn't hurt at the time, but I pay for it a couple of days later. I brought a wheelbarrow full of manure to my yard from across the street last week...I had a lot of pain the next day. It feels like it's really bad for the new hips to me. I'm very cautious, though. I think I will do lighter loads in the future.
 
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HolyGamon

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Hi All,


I am 3 months post total hip replacement and everything is going great. I couldn't be happier about how things have progressed over the last few weeks with one exception.

For the years leading up to my referral for THR I was perhaps not taking care of myself all that well and had developed quite bad gingivitus. I had all dental work completed and was cleared of any gum inflammation and bleeding well before the operation.

However I slackened off with the flossing over the last couple of weeks believing that my gingivitus was cured. This morning upon flossing the gaps between my very back teeth I have discovered that the gingivitus and bleeding has returned.

Does this present a major risk of infection of my prothesis?

Should I be racing off to get antibiotics from my GP just in case?

Thanks

HG
 
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HolyGamon

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I was considering asking the GP for antibiotics just in case, but realize that there are risks with doing this also.

I have been carefully flossing today and think there is a reduction in bleeding already. I found some mouth wash with Hydrogen Peroxide, which I read is good.
 

newlybionic

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Some OS want their patients to have antibiotics with any type of dental work or dental problems. There have been recent studies though that have shown that they are not required. A call to your dentist or GP should ease your mind.
 

little red canoe

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With gingivitis, its lifelong diligence. Slack off and bleeding will start.. Knee or no knee that is the case. I use mouthwash more often when I find I am careless.

Don't worry about little cuts either

You are coming up on 12 weeks. When I had horrible gingivities my dentist wanted to see me every three months.
 

Josephine

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Most gingivitis is caused by strep, a normal mouth commensal, so shouldn't be any threat to your new hip.
 

SwimGirl

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So then why is everyone so careful to give antibiotics @Josephine when any dental work is done.? Do we need antibiotics before a cleaning or just something more invasive like a crown?
 

Josephine

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I don't know that 'everyone' is careful to give antibiotics. The august organisations of both the UK and the US in the form of the American Academy of Orthopaedic Surgeons (AAOS), and the American Dental Association (ADA), British Society for Antimicrobial Chemotherapy, British Orthopaedic Association (BOA) and the British Dental Association (BDA) collaboratively issued this statement back in 2012.

Evidence insufficient to recommend prophylactic antibiotics for dental procedures
 

SwimGirl

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@Josephine. Thank you so much. Very informative on no need for antibiotics prior to dental work. Hope many others read your information. News to me!
 

JMACCA

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I second @baclectic - I had bad gingivitis and it cleared SO quickly when I started using an electric toothbrush.
 

FraidyCat

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There is still a raging debate re: alleged "need" for antibiotics prior to so-called invasive dental procedures. The American Dental Assn has revised its guidelines to say that antibiotics are NOT needed for routine tooth cleanings, novicaine injections, etc., and not necessarily for other procedures either. The American Assn of Orthopedic Surgeons has dug in its heels, insisting that antibiotics must be given pre-just-about-ANY dental procedure for "lifetime" or at minimum two years postop. Infectious disease drs agree with dentists that antibiotics are not necessary prior to most dental procedures and that in fact more bacteria are released during daily brushing and flossing than during tooth-cleanings.

Unfortunately it is not a case of "better safe than sorry" re: taking an antibiotic in the hopes of preventing infection, as the risk:benefit ratio of antibiotics is no longer favorable. The incidence of C. difficile colitis is now so high in association with wide-spectrum antibiotics (the type that dentists prescribe) that the risk of contracting this major, dysenteric-type illness, which can even be fatal in elderly people, is now higher than the rare risk of a prosthetic infection. Overuse of wide-spectrum antibiotics has contributed to this situation.

It is a dilemma for dental patients, as naturally none of us want the spectre of a possible joint infection looming over us, yet accumulating evidence points to the risks of prophylactic antibiotics. Even more tellingly, there are no evidence-based studies showing that taking an antibiotic prior to dental work actually reduces the risk of prosthetic infection. There are many articles on this controversial topic; if interested, you can find by Googling.
 
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HolyGamon

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Due to avascular necrosis my femoral head was squashed flat causing my left leg to be 2.5 cm (1 inch) shorter than my right.

3 months ago I underwent THR on my left leg. The surgeon was able to lengthen the operated leg and my PT has confirmed that my legs are now the same length.

The only ongoing issue I have is tension in the muscles that were lengthened. I have finished with PT and never asked the names of the muscles that would have been stretched by the op. I can feel the tension through my inner thigh, lowers side of back, and groin. I have actually had spasms in the muscles that stretch from the groin to hip.

Has anyone had experience with this?
Would you know which muscles are likely to have been stretched?
Would you know the process muscles go through to return to a normal tension?

Thanks
 
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