THR "Start up" pain 8 weeks post op

[wycombephil]

Hi all

Looking for some comparable experiences here...

I had a THR on my right hip just over 8 weeks ago. Op went fine and recovery in the 2 weeks post op was as expected (I had my left hip done 5 years ago so did have a rough idea what to expected). Since then recovery has been hampered by getting quite a lot of pain when I move from lying or sitting to standing. The pain is at the front of the hip and runs down towards my groin. It usually only lasts for a few seconds (say 20-30 steps) but it is uncomfortable and, because I know it's going to happen, it's making me really cautious in how I move.

The surgeon did make my leg about 3mm longer to level it up and I am wondering it the extra tension in the hip flexors is causing iliopsoas bursitis.

Has anyone else experienced this and if so how was it treated?

 

[Layla]

Hello and Welcome to BoneSmart and recovery. Thanks for joining us!
Please share the exact date of your recent surgery so we’re able to create a signature for you. Also, the date of your left hip replacement five years ago. Thanks!

It‘s so early post op and discomfort and pain is common in these early weeks and months. I am wondering if you’re engaging in any new activity, or if you’re involved in PT and it could be a result of something you’re doing there? Also, when is your first, or next, post op visit with your surgeon?
If it’s not soon, I’d advise stepping back from any activity or PT if you suspect it may be the cause. Rest, ice and use OTC temporarily if necessary. If it doesn’t resolve, consider checking in with your OS’s care team and see what they advise.
I will leave our Recovery Guidelines since you’re only 8 weeks post op. Many of the articles will still apply.
I hope your pain eases soon!

 

[Layla]

HIP RECOVERY GUIDELINES

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.

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​

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​

The recovery articles
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.

 

[Layla]

Here is an article on Iliopsoas Syndrome -

Iliopsoas syndrome

Experiencing pain in the groin could be iliospoas syndrome or more rarely an iliopsoas bursa. It would be a nagging pain or a "burning" feeling. It may not hurt as much when walking. It can be made worse when bringing the knee up to the body or it could ease it. It arises from a massive muscle...

bonesmart.org

 

[wycombephil]

Thanks @Layla

RHS 27/5/23
LHS 30/10/17 (roughly!)

 

[wycombephil]

Hello and Welcome to BoneSmart and recovery. Thanks for joining us!
Please share the exact date of your recent surgery so we’re able to create a signature for you. Also, the date of your left hip replacement five years ago. Thanks!

It‘s so early post op and discomfort and pain is common in these early weeks and months. I am wondering if you’re engaging in any new activity, or if you’re involved in PT and it could be a result of something you’re doing there? Also, when is your first, or next, post op visit with your surgeon?
If it’s not soon, I’d advise stepping back from any activity or PT if you suspect it may be the cause. Rest, ice and use OTC temporarily if necessary. If it doesn’t resolve, consider checking in with your OS’s care team and see what they advise.
I will leave our Recovery Guidelines since you’re only 8 weeks post op. Many of the articles will still apply.
I hope your pain eases soon!

Very little PT beyond the simple standing legs raises that I was doing straight out if hospital. Since then have been gradually increasing activity (walking up to 1/2 mile, exercise bike etc) which is progressing a little slower than I would like. Its just the pain on standing that us a problem.

Currently struggling to get hold of the consultant but if I get any info from him I will post it here.

 

[Layla]

Consider pulling back on everything, for a time, aside from some walking as exercise and see if it makes a difference. Hopefully it will.

It‘s really not necessary to exercise your injured hip to promote healing. The controlled trauma sustained through THR will heal on its own. Often though, we're impatient and want to move the process along. In doing so we run the risk of struggling with pain and setbacks stalling the healing process. The best therapy for recovery is walking, but not to excess. Start slowly increasing time and distance incrementally in an effort not to overdo it.

Stay in touch!

 

[Eman85]

One thing I can say is both of my hips were different from the other as far as the recovery. I had what I called stutter step when I got up and wanted to walk, took some time to go away but it did. I got a laugh out of your progressing a little slower than you would like comment. Didn't we all want to progress faster! Unfortunately it's not a fast progression recovery and 2 mos is not 1/2 the way there for most.

 

[wycombephil]

One thing I can say is both of my hips were different from the other as far as the recovery. I had what I called stutter step when I got up and wanted to walk, took some time to go away but it did. I got a laugh out of your progressing a little slower than you would like comment. Didn't we all want to progress faster! Unfortunately it's not a fast progression recovery and 2 mos is not 1/2 the way there for most.

"progressing a little slower than I would like" roughly translated means I am massively frustrated by the lack of progress but far too English to overtly complain about it

Thanks for your comments. Will keep working in being patient...

 

[wycombephil]

Quick update….

Saw the physio on Friday. She said that it is very unlikely that anything is wrong with the joint itself (no pain except when moving from sitting to standing) and the most likely cause was poor posture and very tight hip flexors caused by months of limping pre and post op. Which all makes sense in my head.

She advised gentle stretching after standing up and before trying to take a step which seems to reduce discomfort in the first few steps. She also recommended (and I love this) lying face down on the floor for 10mins 2 or 3 times a day. This gives a really gentle stretch to the hip flexors and allows them to relax in a lengthened position - adjusting to a new normal. I was really sceptical about this right up to the point when I stood up after my first10min session and walked away without any pain. The pain does come back after the next time I sit down - it’s not a miracle cure - but, having done this for a few days, I am definitely noticing an improvement.

Next appointment is on 25th Aug. Will post another update around then.

 

[Gloucestergal65]

@wycombephil - I guess lying face down in the bed would have the same effect and might be easier for those of us struggling to get up and down from the floor.

 

[SurreyGirl]

I was thinking the same thing

 

[lanstan]

I had that same kind of pain about the same time and did nothing different for it and it just went away as time went by. Maybe another 2-3 weeks. It will keep getting better and better.

 

[Elf1]

@wycombephil that's awesome if the stretch is helping. Have to agree with some of the others, might have to try it on the bed (actually think I did something similar) as getting off the floor isn't always the easiest.

Another thing you can try if you stand and get that discomfort is to do a few little marching steps in place before you start walking. I think it was @Mojo333 told me about this a bazillion years ago and it really worked. It helps work out those stutter steps.

 

[wycombephil]

@wycombephil - I guess lying face down in the bed would have the same effect and might be easier for those of us struggling to get up and down from the floor.

Both seem to work for me but I personally find it easier to stretch on the floor rather than the bed. Probably just down to individual preference though

 

[wycombephil]

@wycombephil that's awesome if the stretch is helping. Have to agree with some of the others, might have to try it on the bed (actually think I did something similar) as getting off the floor isn't always the easiest.

Another thing you can try if you stand and get that discomfort is to do a few little marching steps in place before you start walking. I think it was @Mojo333 told me about this a bazillion years ago and it really worked. It helps work out those stutter steps.

Good idea - will give it a go!

 

[Debru4]

There was a period of a few weeks when this was happening to me pretty often. Eventually it lessened and then disappeared. In addition to standing and taking a few seconds to stabilize and let my brain start talking to my leg, I also found that if I did a few stretches/flexes with my ankle and leg before I even stood up, that I was able to get moving more easily.

I also found that the floor gave me a better stretch because the bed had a bit too much give. With that said, I was really lucky and had a pretty easy time getting up and down off the floor, and I know that's not typical. So a bed, or even a harder sofa might be safer and more doable for most folks.

 

[Jaycey]

She advised gentle stretching after standing up and before trying to take a step which seems to reduce discomfort in the first few steps.

Many of our members experience this stutter step stiffness. What your PT suggested really does work. There is so much atrophy pre-op. It just take some time before things begin to work correctly again.

 

[Layla]

Happy Three Month Anniversary!
I hope you appointment went well on Friday.
A great week to you!
@wycombephil

 

[PugMomma]

I feel you. I had something similar at about two months and figured out the problem was referred pain mainly from the lower back muscle. (Quadratus Lumborum.). My core had gotten weak from not being able to do the plank exercises I usually do. A little self-applied trigger point massage to my back is doing the trick while I slowly build up my core muscles again. It's always something, I'm finding, but getting there. You will, too. Slow and steady!