Revision THR Slight pain - 2 years post revision surgery of TLHR

[tapan]

Hi folks. I had my hip revised 3 weeks ago. I would say that my recovery is going pretty good. I am pretty much pain free but my muscles around my hip still feel pretty tight when I walk or do my physio. I stopped taking my pain meds 2 weeks out. I used a walker for the first 2 weeks and have now graduated to a cane.

I still have a considerable amount of limp when I walk and it's impossible for me to walk aid free right now. I know it has only been 3 weeks but would love to get your opinion on how long it took you to walk aid/limp free after your primary/revision hip replacement.

Thanks and wish you all a speedy recovery!

 

[Layla]

Hi, Welcome to Recovery.
Following you will find the Recovery Guidelines. Please pay special attention to the Big Tip toward the bottom.
Many are still limping at only three weeks post op. It's recommended you use an assistive device until you are no longer limping.
A tip -
Try heel-toe walking when / if you're limping. Let your heel hit the ground first followed by toes.
It takes a concentrated effort but I believe you'll notice a difference. Give it a try.

Stop by often, we'd love to follow your progress and cheer you on along the way.
A great rest of the week to 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 discomfo

rest
elevate
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

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for THRs​

6. Access to these pages on the website

Oral And Intravenous Pain Medications
Wound Closure​

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 that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice. @tapan

 

[Jaycey]

@tapan Weeks or months - literally every THR is different even on the same person. Don't get too concerned about the time frame. When you start leaving your cane behind it's a sign you are weaning off assistive devices. But Layla is right - as long as you are limping use them. Early days for you!

 

[Josephine]

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[tapan]

@Layla @Jaycey Thanks! I am following all the precautions and not overdoing my exercises. Maybe it's just paranoia but considering the progress I have made in just 2 weeks, getting off a cane at the moment seems like a long journey ahead.

@Josephine Absolutely!

I am also hearing some minor clicking noises from the hip. I am not sure if this is normal but I don't think I experienced that during my first surgery almost 10 years ago.

 

[Jaycey]

I am also hearing some minor clicking noises from the hip.

Very normal. Once the soft tissues and muscles tighten around the joint again this will fade.

 

[Josephine]

Here y'go then!

It would 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 approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. 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 forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

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

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

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

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[tapan]

@Jaycey Thanks! Phew I am a bit relieved. I thought something wasn't right. I did experience clicking noises before the revision surgery due to metallosis. Clicking I believe is a common symptom of metallosis.

@Josephine Thanks so much for taking the time out and compiling these questions. I really appreciate it!

To answer your questions:

1. Approach: Not entirely sure but looking at the link you provided, seems like antero-lateral (my incision is right on the side of the hip in the middle)

2. Pain level: 3/10 (while sitting there is almost no pain. I only get pain while I do my physio and am walking. It's mostly tightness and soreness in my upper thigh muscles)

3. Pain meds: Oxycodone. I only took them for the first 2 weeks (325 mg each cap x 4 times a day. So 1.3 g/day). My pain now is manageable but maybe I will take no more than 1 tablet a day if absolutely needed.

4. Icing: Nope. I asked my doc and nurse and they didn't think it was necessary if I didn't have any pain.

5. Elevating leg: Yes, while sleeping. I put a pillow below my operated leg and in between both my legs. For most of the day I sit in a very comfy chair with no/minimal pain.

6. Activity: Mostly walking around the house and making a quick meal in the kitchen (approx 100-200 metres a day). I haven't left my house to go outside other than my doc follow ups.

7. Exercises (as prescribed by the hospital):

Weeks 1-6: Exercises at home with no PT
4 sessions of each of the below per day (every 4 hours)
Ankle pumps x15 reps
Gluteal sets x15 reps
Quad sets x10 reps
Heel slides x10 reps

Weeks 6+: Outpatient PT prescribed by the hospital

 

[Carriemay60]

@tapan Whoever said icing wasn't necessary certainly has never had a hip replacement. I didn't find this site until I was close to your stage with my original hip replacement and had not been advised to ice. Once I started, it made me SO much better!! You should be icing 3 or 4 times a day for about 45 minutes. Do use your cane and as suggested pay attention to heel to toe walking. That will improve your gait which will in turn help all those tight sore muscles.

 

[tapan]

@Carriemay60 Thanks for your feedback! I will start using ice packs today At times I feel like I am learning to walk all over again. For some reason (probably it's because it's a revision) I feel that recovery is taking a lot longer than what it took 10 years ago during my first surgery. I will just have to wait it out...

 

[Jaycey]

Every THR recovery is different - even on the same person. It may take you longer to recover this time depending on how complex the revision was.

Get that icing and elevation going. There is internal swelling even if you don't see anything externally. Still very early days for you.

 

[tapan]

@Jaycey You're absolutely right. I am going to start icing today and see if it makes my recovery and comfort any better. I guess I was expecting a much faster recovery - patience is not my virtue!

 

[tapan]

@Carriemay60 @Jaycey Happy to report back that icing made a HUGE difference! Walking felt so much easier and it was almost instant relief. Can't believe I hadn't been doing it this whole time. Thanks a lot folks!

 

[Josephine]

Weeks 6+: Outpatient PT prescribed by the hospital

Please tell me what exercises you did then

 

[tapan]

So for the first 6 weeks, I have been asked to do the following exercises:

4 sessions of each of the below per day (every 4 hours)
- Ankle pumps x15 reps
- Gluteal sets x15 reps
- Quad sets x10 reps
- Heel slides x10 reps

After 6 weeks, I have to seek physiotherapy from a clinic.

 

[Josephine]

2. Pain level: 3/10 (while sitting there is almost no pain. I only get pain while I do my physio and am walking. It's mostly tightness and soreness in my upper thigh muscles)

Okay

3. Pain meds: Oxycodone. I only took them for the first 2 weeks (325 mg each cap x 4 times a day. So 1.3 g/day). My pain now is manageable but maybe I will take no more than 1 tablet a day if absolutely needed.

Okay

4. Icing: Nope. I asked my doc and nurse and they didn't think it was necessary if I didn't have any pain.

Okay

5. Elevating leg: Yes, while sleeping. I put a pillow below my operated leg and in between both my legs. For most of the day I sit in a very comfy chair with no/minimal pain.

Okay

6. Activity: Mostly walking around the house and making a quick meal in the kitchen (approx 100-200 metres a day). I haven't left my house to go outside other than my doc follow ups.

Good

Exercises (as prescribed by the hospital):
Weeks 1-6: Exercises at home
4 sessions of each of the below per day (every 4 hours)
Ankle pumps x15 reps
Gluteal sets x15 reps
Quad sets x10 reps
Heel slides x10 reps

Weeks 6+: Outpatient PT prescribed by the hospital
4 sessions of each of the below per day (every 4 hours)
Ankle pumps x15 reps
Gluteal sets x15 reps
Quad sets x10 reps
Heel slides x10 reps
After 6 weeks, I have to seek physiotherapy from a clinic.

As you can see, I've crossed out ALL those exercises because none of them are required.
Apart from that, the ankle pumps are only require during the first few days when you're not very mobile. Since that is not the case now, then you don't need to do them!
Heel slides are also not suitable for a hip surgery!

But in with the Recovery Guidelines, you should have noticed this

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.

 

[tapan]

@Josephine Thanks Josephine! You were absolutely correct. I stopped doing those exercises and started increasing my walking distances. It has only been 2 days and it feels a lot stronger already! I will continue this and gradually increase my walking distances. I love this community...thanks for all of your advices!

 

[Mojo333]

Great news @tapan !
Lots of healing still happening...so add activity in increments to see how you feel and don't forget the ice

Onward and upward, friend!

 

[Going4fun]

@tapan, walking is so functional ... it's really what all those other exercises are allegedly helping us to do: walk better ... but lots of times, those exercises don't really "transfer" over to good walking. Walking is great exercise, great therapy ... and I have to say: it's so wonderful mentally. I relax in ways that I don't when I'm driving around all the time ... This was true even when I was using the cane.

BTW: I got off the cane at around Week 9 ... and occasionally I'll still have a limp ... or some tightness in my leg that makes me think I have a limp. Just keep walking with that cane. You're naturally building up stamina and strength and giving the muscles and soft tissue time and practice to figure out how to act with this new device.

 

[tapan]

Thanks @Mojo333 and @Going4fun! I know everyone is different but sometimes it feels that my recovery is taking a lot longer than a lot of folks who start walking aid free in 3-4 weeks. I guess my recovery is expected to be a bit longer as it was a revision? You're right, walking does help me build stamina. I feel more stable after a walk. I would love to go out for a stroll but the cold, snow, and black ice makes one bad winter cocktail. Can't wait for spring!