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THR Struggling with Same Pain as before THR

MsJunebug

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Hi! I have a connective tissue disorder called Ehlers-Danlos. I’ve had multiple joint and foot surgeries In the last five years. My left hip rapidly deteriorated from no pain in April to lots of pain but normal X-ray by July to severe space narrowing on X-ray and crippling pain by Sept. MRI in Sept. showed lots of inflammation, bone spurs, torn hamstring, torn labrum, tendon issues and ’inflammatory changes noted along the deep margin of the iliacus muscle belly and deep margin of the iliopsoas tendon extending to the level of the lesser trochanter’.

Posterior THR was January 15th. The surgery went well, I was discharged the next morning. OS reported most of the damage was in my acetabulum cup and there was an extreme amount of inflammation in the joint.

The only pain I really had post-op was aching around the incision until January 24th when the home health PT had me increase my activity (one 100 feet walk around the kitchen per day) and added several new exercises like marching in place and toe raises. Two days later I started experiencing the same exact pain I had pre-op. In the deep groin area with some pain radiating down to my TKR knee. The incision area feels fine but now it feels like muscles and/or tendons are inflamed in the groin. I stopped the exercises and the ‘laps’ around the kitchen but the pain is still there. By the time the pain re-appeared, I had already decreased my pain meds to 1-2 tramadols a day with 1000 mg tylenol 4 times a day.

Tried two days of the muscle relaxers they sent me home with and have limited my activity to just getting up for the bathroom, kitchen or to let the dogs out. This has helped some. I‘ve also upped the icing. They didn’t place much emphasis on icing at home. Nor elevating. When I ask the PTs I’ve seen, they tend to shrug and say it probably won’t help. I’ve had to up my pain meds again after weaning down.

It‘s clear to me that my swelling has increased over the last few days. I realize I’m very very early in the recovery process. 16 days! Though the PT did tell me most patients are walking limp-free with a cane by this point. He seemed surprised that I had gone backwards in terms of pain and mobility.

Since I’ve had so many orthopedic surgeries over the last five years, I know healing takes time. However, I am very concerned about how the pain is almost identical to my pre-op pain. I’m scared to death that this pain won’t go away. I’m a little paranoid because every six months I get hit with a new, painful orthopedic issue that requires surgery. It’s mostly likely caused by my Ehlers-Danlos but I’m so tired of living in chronic pain. My world has been reduced from being pretty active (I was still skiing 5 years ago) to just going to work and lying around the house in pain. Thanks for listening. Debbie
 
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Eman85

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Sorry to hear of your pain. I had no idea what EDS was so I googled and read. Are the PT's aware of your condition and previous surgeries? I don't know why a PT with experience would say that about patients walking limp free at 2 weeks? Not how it worked for me and many others.
Icing is the best thing for pain relief and swelling, I still ice if I do a lot during the day. In my case I had severe joint pain and all of that is gone but the post op pain is tissue pain. I didn't do any PT beyond ankle pumps and some muscle contractions while lying in bed.
 

Elf1

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:wave: @MsJunebug and welcome to Bone Smart, great group of folks here with lots of great recovery stories to share. Going to share some of our Recovery Guidelines with you for starters.

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
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 these pages on the website
Oral And Intravenous Pain Medications
Wound Care In Hospital

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.
 

Elf1

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Ok, don't know much about Ehlers-Danlos but I did a quick search of the forum and do see that there have been other folks dealing with EDS so maybe we'll be lucky and get someone to pop in.

Definitely think you need to take it easy and just do your normal day to day walking, in moderation as you're still pretty early. Point #2 in the above guidelines covers elevate, rest and ice, also take pain meds as prescribed. Basically I iced anytime I wasn't up moving around walking. It really helps with the pain and inflammation /swelling.

Have you reached out to your surgeon and his care team about your pain? You might to want to do a quick check with them.
 
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MsJunebug

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Thanks for the responses, they have eased my concerns. The PTs and my surgeon are aware of the EDS dx. I‘ve worked with the same PT for 10 years and he is great, knows my history inside and outside and got me through a catastrophic rupture of all the tendons and most of the ligaments in my left foot. Unfortunately, he doesn’t do home based PT but I will be seeing him as soon as I’m more mobile If I need more PT.

I spent yesterday icing and elevating and the pain was way down this morning. I decided to go back up on my pain meds also. Alternating or combining 1,000 mg Tylenol with 50 mg of Tramadol.

i have a post-op phone call with my Surgeon tomorrow. Fortunately, it is also my last home health PT visit. I’m going to take a wait and see approach about transitioning to outpatient PT. My OS doesn’t think extended PT is necessary for everyone and I have a standing order for PT due to my EDS, so I can always go later as needed.

So folks don’t need to look up Ehlers Danlos Syndrome it is a genetic defect in the collagen in the body. Collagen is literally everywhere in your body. EDS can cause numerous health issues and some forms are life-threatening. Some EDS patients end up very disabled at a young age but many people aren’t diagnosed until mid-life when early and rapid onset of OA starts to become an problem.

I have the Hypermobile form of EDS, which basically means I’m ‘double-Jointed’ along with a long list of unusual issues over the years. I was diagnosed by an geneticist In 2016 when I suffered a complete rupture of both my peroneal brevis and longus tendons in my foot..spontaneously, there was no known injury. The rupture of both those tendons is extremely rare, very few OS have ever seen a patient with that type of injury. Pretty much every other tendon and ligament in the foot also ruptured. My OS said it looked like a bomb exploded in my foot. He had never in 30 years of practice seen someone’s foot look like that. That foot is now about 85% functional after 12 weeks non-weight bearing, 6 months in an AFO brace and 6 months of PT. As you can see from my signature, it’s been downhill from there.

When I had my knee replacement 2 1/2 years ago, I found Bonesmart to be very helpful, though I didn‘t join at the time as my TKR was uneventful. I really appreciate the work put in by the moderators and other folks to make sure patients have a place to go for information and support.
 

Jaycey

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Though the PT did tell me most patients are walking limp-free with a cane by this point.
I have been on this forum for 10 years and also had both hips replaced. This PT is talking rubbish!

Your case is complex. I agree with the advice you received - ice, elevate and medication until this all settles. Then there is no need for all that PT. Getting on with normal activities is plenty of exercise for a new hip.

I hope this settles for you quickly.
 

Eman85

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You might try the search function, I remember there was someone that mentioned hypermobile in their posts.
 

Mojo333

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You can actually look up Ehlers Danlos Syndrome also.
 

leejaa

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I have had 2 knees and 2 hips replaced. I have had good recoveries and had home PT all 4 times. None of them ever said that I should be walking without a walker or cane or limp at 2 weeks. All of them encouraged me to continue with the walker and practice walking without a limp heel/toe so that I could recover safely and not hold unto the bad limping developed pre op due to pain. This was even though I have no other medical conditions. They would show me certain exercises but only said do it if it does not hurt and do not do too many reps at once. They pretty much echoed bonesmart and when they didn't I just did not follow but nodded agreement. Please do not do anything much on your last PT home visit - tell him you are hurting and cannot do this right now. They might huff and puff but you are the patient and have the right to refuse especially as you are hurting. You can always ask him to demonstrate what he wants you to do on himself and tell him you will try it when you are feeling better.

I have had really great recoveries from my surgeries following the bonesmart philosophy.
 
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MsJunebug

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Thanks! The Bonesmart philosophy makes so much sense to me. I actually think my OS follows the exact same philosophy. This particular PT hasn’t worked with my OS’s patients much. The PT is new to our healthcare system. He also mentioned that none of his patients from this orthopedic group seems to be recovering as fast as he expected. My OS only does total joint replacements and does about 500 a year. He has a 4 month wait for surgery. He’s considered a rock star among OSs in our area. So I trust him. He did my TKR. Will see what he says tomorrow My main concern is the groin pain.
 

Elf1

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Could you double check with your surgeon about the use of muscle relaxers with your Ehlers-Danlos? Have read here on the forum that they aren't recommended since you already have hyper mobility. Would rather you be safe than sorry. Happy the ice and elevation are working. And, since I was watching Vanilla Ice on DIY last night, :ice::ice: baby!
 

leejaa

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I also love my OS. His waiting list is like your OS - wait months for the surgical date but trusting his skill it was all worth it and kept me calm knowing this. Someone needs to have a talk with this PT person and spell out more as to how to help patients recover. Maybe your OS could be the one. I hope all goes well at your appointment.
 
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MsJunebug

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Elf1 - you’re correct. With EDS, your muscles naturally stay tight in order to keep your joints in place.

I rarely take muscle relaxers because it does cause my joints to temporarily loosen up. I can really feel it in my spine. I only use them out of desperation - usually when my cervical radiculopathy is acting up. I hate the way they make me feel and I can’t sleep while taking them. Interestingly, I took them for 2 straight days this week and didn’t notice an increase in my spine mobility. My muscles are probably pretty tight due to the lack of activity since the surgery. I do think it helped a little with the hip pain but I doubt I will take them again. I was a little surprised they prescribed them for a THR.
 

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Hi! It is still soon after your surgery. With the issues with your muscles and iliopsoas pre- op, it’s going to take them longer to recover. I had muscle and tendon issues pre op because I waited too long for surgery and I dealt with the same post op. The best thing I think you could do is not overdo, ice and elevate-a lot. That’s what I learned here and it helped. Don’t give up your assitive devices until that limp is gone and use the pain meds if you need them. This is from someone who learned all this the hard way. Lol. You’ll recover on your own timetable. Hope you start feeling better soon. Keep us posted.
 
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MsJunebug

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@Hip4life Thanks for the good advice. I spoke to my OS PA this morning. He said if the pain continues to contact them later in the week. After resting, icing and pain meds this weekend, I felt much better this am and was a little more active. The PT came for my last session and we walked up and down my front steps and to the mailbox (I was practicing with my cane). After he left, the pain went up and now when I try to shift from a lying position to sitting up or sitting to standing I get an impingement like pain. Almost feels like it’s dislocating. Needless to say, I spent the rest of the day resting, icing and elevating.

i noticed it was almost 11 months between your THR and your Psoas Tendon release. Did you try non-operative management between the two surgeries? Like cortisone shots, PT, etc? I’m just curious and want to be prepared for possible next steps if this doesn’t ease up. I had a bad feeling about going into surgery with my Iliopsoas muscle and tendon already swollen and ‘sprained’ per the MRI.
 

Mojo333

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I can imagine that it is hard to distinguish what might be complicating factors due to your other health issues, however...
Tightness is a normal occurrence after this kind of major surgery. Your surgeon did major carpentry work and disturbed every millimeter of soft tissue in this area. You aren't tight because your muscle is underused and needs to be stretched and rehabbed. You're tight because your tissue is healing... If a long full step right now is causing pain and limping, don't take long full steps. Take smaller steps. Take a short walk several times a day, instead of longer walks. Use your cane. Use ice. Rest a lot.

This isn't the time to do anything to excess. Baby steps now, and lots of patience, pays off big time later. Recovering from self-induced tendinitis can end up taking weeks or months. Consider yourself as still recovering from surgery and structure your return to your life as a slow, gradual process where you introduce very small increments in activity, and then give yourself time to see how you react to it.
Hope today is A Good Day!
 

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Forgive the long ramble ahead but let me try and give you some info and hopefully, some perspective from my experience. Yes, we did try different things but the best advice I got was from my OS. “It’s going to take some time, Pat. Let’s give you some time to heal and then we can go from there.” He had indicated post op that there was a lot of inflammation in the hip (“things were pretty angry in there. You were putting up with a lot” in his words) so anticipated it might take some time for things to calm down. We did an additional round of Celebrex to try and help. He recommended, like BoneSmart, the philosophy of walking, increasing activity as tolerated but no formal PT. I gave it 3 months after my pre back to work office visit. Things improved to a point and then just plateaued. Then my groin pain started to get worse and it was again a constant companion. My range of motion (ROM) with hip flexion was limited and painful. Previously, with every check, everything with the implant components was fine. The OS didn’t even have me come back in and referred me for ultrasound guided cortisone/anesthetic injection into the IP tendon. It seems all these different aspects of orthopedics have their own specialists these days. The pain relief was immediate which also meant it was diagnostic for it being tendinitis. But it only lasted 2 weeks. Then it was back to my OS. Tendon release (partial, or complete) or hip revision were placed on the table. 2 referrals/consults for tendon release (my OS was already the specialist in revision.) Partial release specialist did not think I was a proper candidate, complete release doc thought he could help. All offered suggestions of repeat injection and PT. They need to offer those options vs. surgery. Through my research on this forum and elsewhere and member stories, I elected to go with the complete release. Fewer potential complications, obviously. Also, the tendon would no longer be near the cup anymore to possibly be further irritated. It has all worked out great for me.
All that being said, everyone is different with different circumstances. You may recover without further incident or with no or minor treatment. It bears repeating, this all takes time-to recover enough to decide if anything else needs to be done and then more time to sort it out. Patience and persistence, if needed, are key. Especially patience which most of us are not good at when we want to get back to life. I recommend, unless you start to experience extreme symptoms, that you continue to allow yourself to heal and let your OS and his/her team to be your best source of what’s next in your recovery. Then you can cross any of those bridges when and if you come to them. Sometimes just knowing there are options and this is NOT as good as it gets helps in moving forward and lessening worry. There are plenty of people here, like me, who have been there and will be happy to help support you through this journey. Just let us know how. In the meantime, be patient and kind to yourself with blessings for continued healing. ❤ Pat.
 
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MsJunebug

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Thanks @Hip4life! That helps a lot. I was just curious about the process. I suspected that if one has an issue like that, it will entail going through the whole gambit of non-operative management again. Not fortune telling yet. I know it’s WAY too early to do that. On the other hand, I‘ve spent the last five years in chronic pain, dealing with one ortho issue after another. My life has gone from active to near bed-ridden outside of working part-time. The last 6 months with my hip was particularly disabling. So, I want to know what to expect should this issue with the inflammation of the psoas tendon/ muscle persists past a reasonable length of time. My next appointment is at nine weeks post-op. As you described, there is a ton of wait time and going back and forth between specialists to get things diagnosed and then treated. I vowed after this last experience to be much more assertive in the future.

On the plus side, I’ve taken your advice along with others and had made it a cardinal rule not to walk without my walker. I had gotten somewhat ‘lax’ about using it prior to the onset of groin pain. I took little short cuts like using the walker to get to the kitchen but then walking around the kitchen without it. I’ve also started taking smaller, more measured steps and being very cautious about getting in and out of bed and turning in bed.

It’s paid off! My pain is back down to a 3 or less. Yesterday, using my walker, I went to the mailbox and back, I immediately felt the swelling recur (while still at the mailbox! ), so promptly went to icing, Tylenol and rest. Happy to say within a few hours the swelling and pain had subsided.

Lesson learned: Need to be very deliberate about pacing myself and use the walker and/or cane consistently. Thanks for all the support and advice from everyone. Just taking it one day at a time for now!
 

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