Revision THR Surgery completed. I have crossed over.. :)

[Greg]

Hi friends!,
I wanted to check in and update you and I have a question. Overall, at day 18 I would say things are going really well with one exception and I am hoping some of you may have an idea of the problem. Reading my post OP report, it shows that the OS found bony defect in the Acetabulum and had to add bone graft. This is how its worded:
"There was significant bony destruction within the acetabulum as a cavity defect in the medial, posterior and posterior superior aspect of the acetabulum which were all contained defects and filled with necrotic-appearing yellowish-gray fibrinous tissue consistent with metallosis" "there was bony deficiency noted to the posterior rim as well as posterior superior rim of the acetabulum. He said that the medial wall was intact as he debrided the tissue from it. " He then said he power reamed the acetabulum and then added 30cc of cortico-cancellous bone graft to the contained acetabular defect then they reversed reamed the acetabular to shape it.

So, my issue is this. I am having pain in the groin/lower buttocks. The pain feels almost like it felt when I was a boy and I would fall on my Bike middle bar and bruise the bone near my "you know where" area. This has become very painful and it seems that its not getting better. weight hurts it and the pain refers into my right testicle area and its extremely uncomfortable.

I am wondering if I have had this all along and when the other areas healed this didn't go away so it now seems new. Just not sure. Could this possibly be because of the acetabulum and the bone graft? Any chance there is a tiny fracture somewhere. It sure does hurt and for now the OS prescribed Lyrica to go with te Norco. I assume he thinks the nerves may be causing this but not sure as he was in surgery.

Finally, I also have a tiny click in the hip when I move it and the PT says its just the unstable hip and the PT, ect will tighten that up and stop it. You guys agree?

Anway @Josephine or anyone else, any idea what might cause this pain after revision. This just doesn't seem like the typical surgical pain which I have had lots of in my life.

Thanks!

 

[Josephine]

The surgical notes indicate that you have developed the cavities in the acetabulum over a period of time and would certainly have contributed to any pain you experienced. However, during the surgery, the surgeon would have scraped out the cavities and packed them with the grafting material. This would contribute a portion of the post-op pain. He would then ream out the acetabulum as a normal part of the procedure to ensure a good seating for the new cup. I am assuming this was cemented in place?

The rest of your pain appears to me to be perfectly normal for your stage. So, I'm going to ask you some questions and 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 are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!

)

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

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

4. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

Note:
If you're not familiar with this, it goes like so: 3 sets of 5 x 3 daily
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.

Can you also tell me the exact site of your pain using this chart?
Please note the instructions in the smaller image

 

[Greg]

1. 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 compare this with the bone-on-bone pain you had before surgery!

) The pain lelel when I put the 50% weight on it or when I stand from the bed to use my walker is 6-7 most of the time. It throbs sometimes from joint area when I shift positions.

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
Had OXYCONTIN 10mg x 2 daily and then 5mg Norco ever 4-6 hrs twice first 10 days. Then they took me off OXY and I only had Norco 5mg every 4-6 hours 1-2 as needed. They then upped that to 7.5mgs. Then when this newer pain got worse I am referring to they added 50mg Lyrica twice a day. I also take Aspirin for clotting and 200mg of Celebrex twice a day.

3. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc.
I am really limiting what I do since Friday the 22nd when this pain got bad. My GF is back from France so she is doing the housework and cooking etc.. Before that, I was up and down stairs doing laundry, prepping food, etc.. Absolutely doing too much too early. Now and I doing very little and laying around a lot. I do PT but its minor like butt cheek squeezes, etc..

4. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)Note:
I am still only doing in house PT because of pain. When I get better I will move my personal PT at his office. The in home person has me doing the following or had me doing it until this pain got worse late last week:
1. 10 x butt squeezes 3 reps
2. 10 heel drags 3 reps
3. Same as above putting rolled towel under knee and pressing leg down
4. Two legged squats 10 times 3 reps
5. 10 x Abductor (lightly push my leg out against PTs body) 3 reps

I was getting a lot of exercise walking with my walker but have limited that now.


If you're not familiar with this, it goes like so: 3 sets of 5 x 3 daily
1 lift of a 500kg bell bar = 1 rep or repetition.
Doing 5 reps and then a brief rest = 1 set of 5.
And doing 5 sets and finishing = a session.


D- R3F -front
F/E- R48- back

Regarding the pain, it kind of came out of nowhere. Its possible that it was always hurting this bad and when other areas got better this became more noticeable but I don't think thats the case. I simply woke one morning (late last week)with pain in my right testical and realized it was referred from the new implant area. That's when they gave me Lyrica.

Thanks!
Greg

 

[Carriemay60]

@Greg I hope you can get this pain under control and your recovery goes smoothly. I had a lot of groin pain in the 1st two weeks so I know it hurts like heck and seems to be aggravated by every movement!

 

[Greg]

@Josephine In addition to the answers above, my in home PT just left and she wants to me have the Dr check the nerves. She feels I may have nerve damage causing this pain. Just one more piece of info for you
Thanks!

 

[Josephine]

So your pain is about here then?

Would I be correct in assuming you had a posterior approach! If so, Do you know if your surgeon divided (cut) the piriformis? If so, that would be the problem - under-medicated post-op pain
If not, the spot in red is Piriformis syndrome. A very common tendinitis after THR.
And the blue spot is most likely either referred pain from the piriformis or under-medicated pain from the hip itself.

The pain level when I put the 50% weight on it or when I stand from the bed to use my walker is 6-7 most of the time. It throbs sometimes from joint area when I shift position.

Yes, that figures ....

Had OXYCONTIN 10mg x 2 daily and then 5mg Norco every 4-6hrs twice first 10 days. Then they took me off OXY and I only had Norco 5mg every 4-6 hours 1-2 as needed.They then upped that to 7.5mgs. Then when this newer pain got worse I am referring to they added 50mg Lyrica twice a day. I also take Aspirin for clotting and 200mg of Celebrex twice a day.

Regarding the pain, it kind of came out of nowhere. I'ts possible that it was always hurting this bad and when other areas got better this became more noticeable but I don't think that's the case. I simply woke one morning (late last week) with pain in my right testical and realized it was referred from the new implant area. That's when they gave me Lyrica.

You need better pain meds than this. Your issue is not nerve damage, just under-medicated post-op pain. I suggest you tell your doctor what you have just told me. You are only 2 weeks out and had a majorly invasive procedure.

I also note you say " Norco 5mg every 4-6 hours 1-2 as needed". So how often are you taking them and are you taking 1 or 2? My recommendation is that you need to take 2 every 4 hours regardless.

I am really limiting what I do since Friday the 22nd when this pain got bad. My GF is back from France so she is doing the housework and cooking etc.. Before that, I was up and down stairs doing laundry, prepping food, etc.. Absolutely doing too much too early. Now and I doing very little and laying around a lot. I do PT but its minor like butt cheek squeezes, etc..

Well, that was unwise! If you are 50% NWB, that means your shouldn't be doing anything more than walking to the bathroom!

I am still only doing in house PT because of pain. When I get better I will move my personal PT at his office. The in home person has me doing the following or had me doing it until this pain got worse late last week: I was getting a lot of exercise walking with my walker but have limited that now.

I'm very pleased to hear it! I suggest you stop all these exercises as they are too much and too stressing for your hip as only 2 weeks, especially 4 & 5. 1, 2 and 3 are more for knees so are pointless for hips.

1. 10 x butt squeezes 3 reps
2. 10 heel drags 3 reps
3. Same as above putting rolled towel under knee and pressing leg down
4. Two legged squats 10 times 3 reps
5. 10 x Abductor (lightly push my leg out against PTs body) 3 reps

I'd also emphasise that hips actually don't need much 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. But for now, you don't need any except walking to the bathroom!

So basically my advise is, increase the pain meds and stop the exercises. I'd ask your PT to quit coming for the next 3-4 weeks at least until you get your pain under control.

btw, are you icing your butt? It's the best pain management tool. A nice big ice pack on the settee and sit on it! Ice as much, as often and as long as you want to.

 

[Greg]

Thanks for the response!!!!! See responses embedded in red

So your pain is about here then?

Would I be correct in assuming you had a posterior approach! If so, Do you know if your surgeon divided (cut) the piriformis? If so, that would be the problem - under-medicated post-op painIf not, the spot in red is Piriformis syndrome. A very common tendinitis after THR. And the blue spot is most likely either referred pain from the piriformis or under-medicated pain from the hip itself. Those are the central pain areas and it spreads of couse. Red goes acoss to the right and blue goes left and down a little. unfortunately, I am well aware of Piriformis Syndrome:( I do not know if he cut the muscle any but I was led to believe he would not cut any muscles severely. It was a posterior approach, ftr.. I will ask about the muscle because the pain is absolutely in that area.
↑
The pain level when I put the 50% weight on it or when I stand from the bed to use my walker is 6-7 most of the time. It throbs sometimes from joint area when I shift position.
Click to expand...
Yes, that figures ....
↑
Had OXYCONTIN 10mg x 2 daily and then 5mg Norco every 4-6hrs twice first 10 days. Then they took me off OXY and I only had Norco 5mg every 4-6 hours 1-2 as needed.They then upped that to 7.5mgs. Then when this newer pain got worse I am referring to they added 50mg Lyrica twice a day. I also take Aspirin for clotting and 200mg of Celebrex twice a day.

Regarding the pain, it kind of came out of nowhere. I'ts possible that it was always hurting this bad and when other areas got better this became more noticeable but I don't think that's the case. I simply woke one morning (late last week) with pain in my right testical and realized it was referred from the new implant area. That's when they gave me Lyrica.
Click to expand...
You need better pain meds than this. Your issue is not nerve damage, just under-medicated post-op pain. I suggest you tell your doctor what you have just told me. You are only 2 weeks out and had a majorly invasive procedure.

I also note you say " Norco 5mg every 4-6 hours 1-2 as needed". So how often are you taking them and are you taking 1 or 2? My recommendation is that you need to take 2 every 4 hours regardless.

I spoke to his surgical PA this evening and we discussed the pain for a while. She also agrees its not nerve and they would have known early on. We discussed me either taking the 7.5mg Norco every 4 hrs (2 pills) or going to 10mg Norco and doing the 1-2 every 4-6 hours. We settled on increasing to 10mg Norco 1-2 pills every 4-6 hours and I am going to take it twice every 4 hours (2 pills) for now and see how it goes. I also told her I am going to take a few weeks from PT and rest. She had no disagreement with any of that and said the same about the hip healing on its on. She said she thought I should do some PT once I feel better though. She did say the hip doesn't need the same PT the knee does or some thing like that. She also checked to make sure I am icing a lot which I am. I actually bought another ice pack today that is better and has a tie on it. So, if this doesn't control the pain I am to call back and we will consider another option which I assume will be switching to percocet which has worked well for me in the past. I hope I don't need it but we will see. One thing is for sure, once we removed the 10mg OXYCONTIN 2 x daily things went downhill fast.
↑

I am really limiting what I do since Friday the 22nd when this pain got bad. My GF is back from France so she is doing the housework and cooking etc.. Before that, I was up and down stairs doing laundry, prepping food, etc.. Absolutely doing too much too early. Now and I doing very little and laying around a lot. I do PT but its minor like butt cheek squeezes, etc..
Click to expand...
Well, that was unwise! If you are 50% NWB, that means your shouldn't be doing anything more than walking to the bathroom!

Not going to lie, I am an extremely restless person and I have major issue sitting still :(
↑

I am still only doing in house PT because of pain. When I get better I will move my personal PT at his office. The in home person has me doing the following or had me doing it until this pain got worse late last week: I was getting a lot of exercise walking with my walker but have limited that now.
Click to expand...
I'm very pleased to hear it! I suggest you stop all these exercises as they are too much and too stressing for your hip as only 2 weeks, especially 4 & 5. 1, 2 and 3 are more for knees so are pointless for hips.

1. 10 x butt squeezes 3 reps
2. 10 heel drags 3 reps
3. Same as above putting rolled towel under knee and pressing leg down
4. Two legged squats 10 times 3 reps
5. 10 x Abductor (lightly push my leg out against PTs body) 3 reps

I'd also emphasise that hips actually don't need much 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. But for now, you don't need any except walking to the bathroom!

So basically my advise is, increase the pain meds and stop the exercises. I'd ask your PT to quit coming for the next 3-4 weeks at least until you get your pain under control.

btw, are you icing your butt? It's the best pain management tool. A nice big ice pack on the settee and sit on it! Ice as much, as often and as long as you want to. I am icing a lot!!!

Thanks a bunch! I cant wait to see how the increase goes. Do you think 10mg Norco 2x every 4 hrs will work? Also, Celebrex twice a day at 200mg and Lyrica. ​

 

[Jaycey]

Do you think 10mg Norco 2x every 4 hrs will work? Also, Celebrex twice a day at 200mg and Lyrica.

I don't think anyone can predict if this will work Greg. But it certainly sounds like you have a plan. Do let us know how you get on with your new routine.

 

[Greg]

Today marks 3 weeks since my Hip revision. Overall I am happy with the surgery and I am finding the hardest thing to deal with is the 50% weight-bearing and, unlike last time, I can't take off around the block walking. Hopefully the next three week go very well and I will be 100% WB. Also, regarding the pain I have had, upping the meds has helped the buttocks but I still have groin pain that so far has decided not to surrender I am hoping its not anything more serious than just post op pain but we will see. I hope all of you are doing well!! Thanks so much for all your help so far. God Bless! Greg

 

[Carriemay60]

@Greg It sounds like you are making some progress with the pain which is wonderful. I suspect you may see some improvement in the groin pain in the next week. Unfortunately the pain/discomfort seems too move around as we heal; my worst moved from groin to the buttock to the thigh and is still there now. I have assumed it just a cycle we have to go through and accept it as part of the healing process. Because of my leg break, my healing and rehab is going slower than the average hip here but I can assure you will still see progress even when taking it a little slower.

 

[Josephine]

Nice to know his PA agrees with us on BoneSmart!

 

[Greg]

Hi everyone! Going to see OS Tuesday about the groin. Very possibly Psoas tendonitis which would explain this horrible groin pain I have had. The rest of the hip is progressing wonderfully but the tendon over the joint is like a golfball and on fire. 20mg Norco doesnt touch this pain but is plenty for all other surgical pain. I am hoping a steroid injection can handle it but preparing for bad news. Its been that kind of year ..

 

[Poppet]

Do keep us updated Greg, I hope that your surgeon delivers good news.

 

[Greg]

Hi!
I went to see the OS yesterday and he and I had a good disucssion. I explained to him that most things were progressing very nicely but the groin was still hurting anywhere from a 3-10 depending on the moment. I wanted to take xrays and examine the area but he was so certain that it was just part of the process at 4 weeks post surgery that he said let's meet back in two weeks when it's already scheduled to do a bunch of xrays. He was saying we needed more bone to grow in the new socket (I may have heard this wrong) and he feels it will feel much better with time.

I was pleased to hear this but asked him "Well, that's good but what in the hell do I do about this pain until it happens?"... Taking more narcs isn't the answer because the break through pain is just too much for them and I am already on 80mg of Norco a day, Lyrica and Celebrex. So, he added Flexeril (muscle relaxer) to see if that would calm down the groin and I took it last night at bed time. WOW! That pill knocked me on my behind if you know what I mean. I can't imagine people taking that during the day. I will take this a few days and see how it goes. So, I am back to the waiting game of revision hip recovery and I know God is in control and I need to give it to him to run the show.

So glad I have this site to communicate with people in the same situation. Overall, my surgery has been a success its just hard to handle this when I recall the first surgery I was walking on day 2 like it was normal and with this revision I am on crutches for 6 weeks

 

[Josephine]

Greg, I think much of your problem is that you are not taking your pills on a schedule.

Would you mind giving me a time table of what you take when? Perhaps I can advise you.

 

[Greg]

@Josephine I have been talking my meds on schedule. I take NORCO 10mg x 2 every 4-6 hours which ends up being about 4 times a day. I take 100mg of Celebrex twice a day (morning and night), I take Lyrica 100mg at bed time and they have now added Flexeril. I was told to slowly start on the Flexeril because it knocks some people out and I have found that I am one of those people so I just take 5mg at bed time. Also, my groin pain has settled down a bit since starting that med. Not sure why but it has but that med pretty much makes me a vegtable all day and I have no reason to do anything so I am just going to let it happen. It seems if I do anything but lie down my pain is bad so I am just going to do nothing until I start out of home PT on Sept 12. I take other meds for other health issues and the OS is fully aware of them and not concerned.
Thanks!

 

[Josephine]

That's fine, Greg. I'm pleased the Flexeril is working for you. It's about time something did!

Not sure why but it has but that med pretty much makes me a vegtable all day

I can imagine!

 

[Greg]

So, here is my 5 week update:
I am now doing MUCH better with pain, espcially that pain in my groin. I am no longer convinced it is Psoas tendon issues or some kind of impingement. Now, I actually feel like its going to recover just fine but we will see. I am now only taking three 10mg Norco per day because my pain is so much better (actually took 4 yesterday because I was aching with the all day rain).

I am not sure if the Flexeril made me better or the 12 hours of sleep I was getting every night because that med wiped me out. Prior to Flexeril, I wasn't sleeping well at all. It was not long ago that I was still taking 8 10mg norco per day. I am still taking the 100mg of Lyrica but that will probably end soon.

I spoke to my OS' office and since he is off next week on vacation, I still have to stay on 50% weight bearing with crutches until 2 weeks from today. Its a bummer but I have done 5 weeks so a few more will be fine and I am used to them. I start outpatient PT this Friday and I look forward to it. Boy, there was a time there where I was really getting worried that I was never going to feel good ever again but now I know I am. I know I need to be very careful because confidence is the enemy right? I know PT may be painful but I am going to take it slow and easy. I just want to walk

So, I will keep you guys updated. If you have revision and you are at week 3 feeling like your life is over, it isn't. It's scary but be patient...ha... easy for me to say Thanks so much for all the support and info. I am not done yet and not going anywhere but I am feeling better and mentally better.

Greg

 

[Jaycey]

Great news that you have turned the corner on this recovery @Greg !

I know PT may be painful; but I am going ot take it slow and easy.

PT should not be painful. Muscles and tissues may complain since you have not used them for awhile. But it's more like the discomfort after a good workout - not pain. Slow and steady and don't let anyone push you. You are doing great!

 

[Josephine]

I have but one kernel of advice to offer now which is this: hips actually don't need much 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.

Other than that, very well done. I'm delighted to hear of your progress.