THR Struggling with Recovery - THR

[jefro]

You do have a more complex situation than a typical hip replacement, but this is all the more reason to realize that making progress may be a slower process for you. I do hope you can talk with another surgeon as this would be the best way to find out if everything is okay.

Have you mentioned your concerns to your therapist? I would be curious to know how they felt your progress was going. I do know from personal experience with weak glute muscles, it took many months of therapy to see progress and I’m still working on it even though I’m no longer in therapy.

I've started the referral process, but it will take 6-8 weeks once the referral is received, according to the new Ortho office. I expect the healing process to be slow but its a red flag for me when I was doing much better at 6-7 weeks than at 12 weeks. I would expect things to generally gradually get better, with some setbacks to be expected. I'm going to see my orthopedic surgeon in a couple weeks, he wants to see how I am doing after a month of Meloxicam and PT. At that time, he is also willing to evaluate other options. That sounds reasonable to me.

 

[Jamie]

It sounds reasonable to me too. I hope he can give you a good explanation of what you can expect with your recovery. You know your body better than anyone and, if it feels as though something is not going as it should, you are wise to seek additional information and answers. I will be waiting to hear what he has to say.

 

[jefro]

It sounds reasonable to me too. I hope he can give you a good explanation of what you can expect with your recovery. You know your body better than anyone and, if it feels as though something is not going as it should, you are wise to seek additional information and answers. I will be waiting to hear what he has to say.

My problem is that when things stall or go backwards for many weeks, it's a red flag to me. At that point, it doesn't seem like a flare up but possibly a bigger issue. For some reason, its hard to get these Orthopedic doctors to listen to the patient.

 

[Jamie]

Here’s a look at your recovery status:

6 January - Total Hip Replacemnt, surgeon advises recovery will be more extended than normal.
20 January - 2 week check up is fine. Therapy prescribed.
27 January - Started light PT. Doing daily therapy. Therapy caused light soreness, but pain in glutes. Too intense and scaled back to every other day for exercises.
10 February - Pain continues in glute muscles.
17 February - 6 week check up is fine. Off oxycodone completely.
28 February - Tried home bicycle and pushed through pain for 3 minutes.
1 March - Woke up to severe pain requiring return to pain medication. Rested 4 days. No oxycodone and pain improved slightly. Stopped therapy.
6 March - Short walk in the park with walker. Some soreness afterwards.
7 March - Woke up to severe pain. Took oxycodone for immediate relief; Tylenol 1000mg/6 hours afterwards. Swelling in hip and leg. Decided to scale back to rest, icing, elevation.
10 March - Pain continues; glute pain is off and on. Muscle spasms; taking muscle relaxant. Trying to get meds on a schedule. Still taking oxycodone.
12 March - Pain getting worse. Can’t put weight on leg without pain. Pain worse in the morning.
13 March - Significant pain and spasms in glute muscles. Possible Piriformis Syndrome.
18 March - Surgeon reports joint is fine, no Piriformis, problem is tight and inflamed muscles from previous ORIF surgery. Prescribed therapy, stretching, recumbent bike. Meloxicam prescribed for pain and inflammation. Medical massage improves muscle tightness.
19 March - Looking for ways to help tight muscles. Restarted PT and employed a variety of other treatments to help.
26 March - Report that things were trending better after starting PT and other treatments. Pain and stiffness improved. Some reductions in pain medication.
1 April - Some improvements with tight muscles. Continued problems with stiffness. Still taking oxycodone in morning.
2 April - Questioning that more progress should be made by now.

If you look at this sequence of events, it appears to me that your hip may not have had a long enough consecutive period to adequately heal whatever soft tissue inflammation was going on as you began your recovery from the THR. As you’ve seen, when something like this is happening, even what seems to be a minor increase in exercise or activity has a major impact and restarts the pain cycle. That also resets your recovery clock.

Yes, March 1 was a severe pain flare. But on March 7, when you had what sounds like a worse pain problem after your walk in the park, you go back to square one with healing. There is nothing wrong with needing the heavy duty pain medications in this case. They are a tool to help reduce inflammation which should help reduce swelling. Please take them if you cannot otherwise consistently keep your pain under control. If you allow yourself to be in pain by trying to be off whatever level of meds is required, you slow your recovery.

Be sure you’re not being too impatient with yourself about progress. As you mentioned in a couple of your posts, you are frustrated and worried because it must seem like you’ve been in recovery mode forever. You recognize that things go better when you listen to your body’s signals and slow down when you do something that causes discomfort. These two things are going to be key in your ability to recover successfully. Your body has been through a serious disruption for almost a full year. You’re not going to pop back from something like that in a few weeks or months. When your surgeon told you 6 months, he wasn’t referring to complete recovery. Even a routine hip replacement can take a full year before a person is completely back to normal. It doesn’t mean you will be in horrible pain or unable to do things during the full recovery time. Things will gradually improve. But you may not see what you feel is “improvement” for months.

I sincerely hope you can get in to see another surgeon so that you can be evaluated and hopefully everything explained clearly for you. I’m sorry you are in this position and I do know it’s difficult. If your current surgeon is correct (and I believe he probably is) that you are dealing with soft tissue inflammation, that must be stopped before anything else will begin to get better.

So in this time between now and when you may see another doctor, focus on gentle daily movement to keep your hip mobile. If it helps, continue with any other treatments you’re doing that seem to make things better and allow your body to rest and heal for weeks, not days. If you are still on medication for inflammation, continue with it. If not, ask your surgeon or GP about the possibility of taking it again for a while. This is going to take some patience on your part. The very positive news is that your implant looked good in your recent x-rays. I’m thankful for that.

 

[Wheatsiebat]

but raises the possibility of creating soft tissue problems.

My problem is that when things stall or go backwards for many weeks, it's a red flag to me. At that point, it doesn't seem like a flare up but possibly a bigger issue. For some reason, it’s hard to get these Orthopedic doctors to listen to the patient.

I am so sorry you are going through this. I also had a hip replacement that failed. The stem was loose and it broke my femur. I didn’t find out until I reached out to another surgeon who did an X-ray. My surgeon wasn’t listening to me as I wasn’t progressing after 6 to 8 weeks. He would not do an X-ray. I could not walk. I reported sharp pains that made me gasp. He just didn’t listen. So I definitely think having someone else look at you is the right decision. I wish you luck in this.

 

[jefro]

but raises the possibility of creating soft tissue problems.

My problem is that when things stall or go backwards for many weeks, it's a red flag to me. At that point, it doesn't seem like a flare up but possibly a bigger issue. For some reason, it’s hard to get these Orthopedic doctors to listen to the patient.

I am so sorry you are going through this. I also had a hip replacement that failed. The stem was loose and it broke my femur. I didn’t find out until I reached out to another surgeon who did an X-ray. My surgeon wasn’t listening to me as I wasn’t progressing after 6 to 8 weeks. He would not do an X-ray. I could not walk. I reported sharp pains that made me gasp. He just didn’t listen. So I definitely think having someone else look at you is the right decision. I wish you luck in this.

I hope it's just inflammation that will get better but I'm not taking that chance. I've started the process of getting a referral going so I can get a 2nd opinion. The bottom line is I was doing much better at 6 or 7 weeks ago than I am at 12 weeks and that is a red flag to me. My last surgery(different surgeon), hip ORIF, the orthro kept telling me my fracture healed and she wouldn't listen to my pain levels & kept telling me PT would fix it. It was like talking to a brick wall. She would literally start to walk out of appointments while I was still talking to her. Then she said, oh, it's probably just the screw is bothering you and we need to pull it out. CT scan showed it was a non-union. These doctors don't listen and it's very hard to get a message through sometimes. They are too lazy or busy to investigate or think, wait, maybe I'm wrong?
My new surgeon called my wife after the surgery and told her he wasn't able to get my legs the same length, said they were way off (this kind of freaked her out). The next day he told me they were perfectly aligned and he was really happy with how the surgery went. I guess he confused me with someone else or he has a very sick sense of humor. The whole system is messed up, surgeons should go slow and be thorough, not be stressed and rushed, acting like patients are a burden on their precious time. They need to take on less patients and provide better quality care.

 

[jefro]

Here’s a look at your recovery status:

6 January - Total Hip Replacemnt, surgeon advises recovery will be more extended than normal.
20 January - 2 week check up is fine. Therapy prescribed.
27 January - Started light PT. Doing daily therapy. Therapy caused light soreness, but pain in glutes. Too intense and scaled back to every other day for exercises.
10 February - Pain continues in glute muscles.
17 February - 6 week check up is fine. Off oxycodone completely.
28 February - Tried home bicycle and pushed through pain for 3 minutes.
1 March - Woke up to severe pain requiring return to pain medication. Rested 4 days. No oxycodone and pain improved slightly. Stopped therapy.
6 March - Short walk in the park with walker. Some soreness afterwards.
7 March - Woke up to severe pain. Took oxycodone for immediate relief; Tylenol 1000mg/6 hours afterwards. Swelling in hip and leg. Decided to scale back to rest, icing, elevation.
10 March - Pain continues; glute pain is off and on. Muscle spasms; taking muscle relaxant. Trying to get meds on a schedule. Still taking oxycodone.
12 March - Pain getting worse. Can’t put weight on leg without pain. Pain worse in the morning.
13 March - Significant pain and spasms in glute muscles. Possible Piriformis Syndrome.
18 March - Surgeon reports joint is fine, no Piriformis, problem is tight and inflamed muscles from previous ORIF surgery. Prescribed therapy, stretching, recumbent bike. Meloxicam prescribed for pain and inflammation. Medical massage improves muscle tightness.
19 March - Looking for ways to help tight muscles. Restarted PT and employed a variety of other treatments to help.
26 March - Report that things were trending better after starting PT and other treatments. Pain and stiffness improved. Some reductions in pain medication.
1 April - Some improvements with tight muscles. Continued problems with stiffness. Still taking oxycodone in morning.
2 April - Questioning that more progress should be made by now.

If you look at this sequence of events, it appears to me that your hip may not have had a long enough consecutive period to adequately heal whatever soft tissue inflammation was going on as you began your recovery from the THR. As you’ve seen, when something like this is happening, even what seems to be a minor increase in exercise or activity has a major impact and restarts the pain cycle. That also resets your recovery clock.

Yes, March 1 was a severe pain flare. But on March 7, when you had what sounds like a worse pain problem after your walk in the park, you go back to square one with healing. There is nothing wrong with needing the heavy duty pain medications in this case. They are a tool to help reduce inflammation which should help reduce swelling. Please take them if you cannot otherwise consistently keep your pain under control. If you allow yourself to be in pain by trying to be off whatever level of meds is required, you slow your recovery.

Be sure you’re not being too impatient with yourself about progress. As you mentioned in a couple of your posts, you are frustrated and worried because it must seem like you’ve been in recovery mode forever. You recognize that things go better when you listen to your body’s signals and slow down when you do something that causes discomfort. These two things are going to be key in your ability to recover successfully. Your body has been through a serious disruption for almost a full year. You’re not going to pop back from something like that in a few weeks or months. When your surgeon told you 6 months, he wasn’t referring to complete recovery. Even a routine hip replacement can take a full year before a person is completely back to normal. It doesn’t mean you will be in horrible pain or unable to do things during the full recovery time. Things will gradually improve. But you may not see what you feel is “improvement” for months.

I sincerely hope you can get in to see another surgeon so that you can be evaluated and hopefully everything explained clearly for you. I’m sorry you are in this position and I do know it’s difficult. If your current surgeon is correct (and I believe he probably is) that you are dealing with soft tissue inflammation, that must be stopped before anything else will begin to get better.

So in this time between now and when you may see another doctor, focus on gentle daily movement to keep your hip mobile. If it helps, continue with any other treatments you’re doing that seem to make things better and allow your body to rest and heal for weeks, not days. If you are still on medication for inflammation, continue with it. If not, ask your surgeon or GP about the possibility of taking it again for a while. This is going to take some patience on your part. The very positive news is that your implant looked good in your recent x-rays. I’m thankful for that.

I'm doing the prescribed PT and taking Meloxicam for inflammation. These are the doctor's orders. Hopefully the Ortho is right and I just need some more time to bring down the inflammation. I'm worse off at 12 weeks than 6 weeks so that doesn't make sense to me. It feels like a red flag and not the path to recovery. It's going to take 6-8 weeks to get a 2nd opinion. The Ortho actually did tell me it would take 6 months for a full recovery. But then later on his assistants said it takes 6 months-year for the soft tissue pain to fully heal.

 

[Jamie]

Given what you’ve been through, I can certainly understand why you would not have full confidence in the surgeon who performed your THR. I wouldn’t either. Fortunately there are a lot of great surgeons out there and I hope you can connect with one soon.

 

[myglasshalffull]

Sorry to hear of all your pain & issues with OS just not listening.
I'll say I had decent recovery although much slower than I expected (seeing I was told in 30 days I'd be doing everything I was doing prior to falling & fracturing my hip).
At one year post op I had big setback cause figured I was superwoman & went back to working in a very busy restaurant. About 3 weeks in I could barely walk, back on cane & long icing & heating pad episodes. I was sure I had messed up my hip. I changed OS at this point not necessarily because of OS (he didn't do my surgery), but because of PA that just had very odd answers to my concerns.
I have a very good friend that is a doctor & he referred to me to Brigham in Boston.
It was so refreshing. He listened, had his PA plus some med students in room, I had brought my XRays & he took his own. He ordered MRI, said from XRays everything seemed to be in order but wanted MRI.
Turned out hip was fine I had spinal stenosis & he referred me to spine doctor.
Well by June all my issues with back/hip were resolved just by resting & taking some muscle relaxers & steroids. Spine doctor said I could get pain injections but I ended up canceling that appt cause I went back to normal & decided at 71 to hang up my apron for good! I love the hospitality business but I now dog sit. I get my walks in with the dogs & dog kisses, it's perfect therapy for me.
I wish you the best.

 

[jefro]

Given what you’ve been through, I can certainly understand why you would not have full confidence in the surgeon who performed your THR. I wouldn’t either. Fortunately there are a lot of great surgeons out there and I hope you can connect with one soon.

My doctor prescribed Meloxicam a couple weeks ago and I took it for a day but felt kindof crappy, so I stopped and just stuck with ibuprofen as needed for breakthrough pain. Now, I'm trying Meloxicam again - I'm on my 2nd day. Hopefully it helps with the inflammation/stiffness/muscle spasms.
Tomorrow I am going to try it in the morning with Tylenol. I'm hoping it could replace the 1/2-1 oxy I take for morning pain.

 

[Jamie]

I hope that works for the pain. But if not, please don’t worry about continuing the oxycodone if you need it. Or you might be able to ask your surgeon or GP to prescribe Tramadol, which is often used as a step-down medication from the oxy. You need a prescription for it but it’s not a controlled narcotic.

 

[jefro]

I hope that works for the pain. But if not, please don’t worry about continuing the oxycodone if you need it. Or you might be able to ask your surgeon or GP to prescribe Tramadol, which is often used as a step-down medication from the oxy. You need a prescription for it but it’s not a controlled narcotic.

The Meloxicam makes me feel nauseous, so I don't think its a good fit for me. I tried it a couple days, didn't help with pain, and not worth the side effects. I was able to get a 2nd opinion Appt in 2 weeks. No referral needed and only 90 day minimum since the surgery. https://jamesballardmd.com/ This Ortho has over 20 years experience and was named a Top Doctor in 2020.

 

[Jamie]

Great!!!! He looks like a good choice and I'll be looking for your feedback. We love having BoneSmartie recommendations for surgeons. The reason he looks good is not because of the Top Doctor award. Frankly, those are pretty meaningless because tons of them are given out. But he is a revision specialist and lists adult reconstruction in his biography. Both those things are what you want in a second opinion doctor. Good job!!

 

[jefro]

Well, my nightmare continues. My orthopedic Surgeon told me last month that he had no idea what was causing my on-going hip pain and glute spasms. He said to get a 2nd opinion. I got the opinion from a well respected Surgeon with 23 year's experience He said I don't think it's your hip that is the problem, I think it's the back, let's do a back x-ray. The back x-ray showed some compression in the L5-S1 area so he referred me to a Spine doctor and gave me a Medrol Pack to help take the edge off the pain. I went to a spine doctor and he did a couple of cortisone injections 2 weeks back. One directly into the SI joint and the other in the L5 epidural area. It's been 2 weeks and the injection did nothing. I was hopeful it would work because the lidocaine killed the pain for 6 hours so it seemed like we might be at the right spot. I'm going back tomorrow for a follow up. Not sure what he'll recommend. I also have an appt with a Pain Mangement specialist later this week so we'll see what he suggests.

 

[myglasshalffull]

Keep us updated. Sounds like you are at least getting attention to some of your issues.

 

[jefro]

On Monday my Spine Doctor recommended that I see a Spine Surgeon that he is going to refer me to. He thinks I need a Micro Surgery to get rid of a pinched nerve in my lower back that is causing my hip pain. On Tuesday, I went to the Chiropractor who also thinks I have a pinched nerve in my lower back. Then on Thursday, I saw a Spine Surgeon I know from high school. He doesn't think anything is wrong with my back. He thinks my hip pain is local. He ordered a bone scan to see where the inflammation is. So the investigation continues.

 

[myglasshalffull]

Have you had an MRI? I looked over your thread quickly & didn’t see one had been ordered but maybe I missed it. Sure would remove some of the questions regarding back vs hip discussion with your doctors.
Hope you get a resolution.

 

[jefro]

Have you had an MRI? I looked over your thread quickly & didn’t see one had been ordered but maybe I missed it. Sure would remove some of the questions regarding back vs hip discussion with your doctors.
Hope you get a resolution.

Yes, I had a Lumbar MRI done on 4/30. It showed some moderate compression in the L5-S1 area.

 

[Wheatsiebat]

Last year I had an L1 herniated disc that caused quite a bit of radiated pain down my leg and on my hip/glute. I was amazed at the range of pain, numbness, tingling. It was a mystery for a while.

One thing that really helped was putting the MRI results in Chat GPT. It explained everything including treatment options.

I fortunately healed without any surgery. At the time I was trying to figure out if I should do back or hip surgery first. I knew my hip would never get better, but I learned some back injuries heal on their own.