THR There and back!

[nasruddin]

In at 545, surgery at 730, awake at 1000, home by 5 pm. Definite pain on wake-up, got some of the scheduled pain meds then, still good. Presumably it’s the drugs doing the talking right now & the Kaiser team warned me the next few days peaking maybe Fri will be more painful. More on all this later, this is sort of a pro forma diary entry to make me record the basics. I have a longer “week before surgery” diary I’ll add to this later as it might be useful to others & didn’t see anything like it.

A home health visit is scheduled for tomorrow (Wed) from a PT but it sounds like she is doing some basic post-op (wound checking) and helping organise the house. More on this & some exercises they gave me later.

Hip and leg is really different. It’s definitely a big physical reset even if it’s modulated by the drugs.

 

[djklaugh]

@nasruddin Congratulations on your new hip! Yes the reality of having a brand new hip is quite different from what one anticipates! The leg is swollen - called "log leg" here. The pain is real - do take medications prescribed for you on the schedule that goes with them. That will keep medication level in your blood stream at the optimum level. And do apply ice to the hip and elevate your leg! All of that will help with pain and with the swelling too.

Here are our post op articles and helpful suggestions:

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

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]

to recovery! So far, so good.
Thanks for recording your journey with us. Best advice….ice, ice, then ice some more.
I look forward to following your progress and wish you only the best!
@nasruddin

 

[nasruddin]

Day 2. Yesterday was a busy day of doing mostly nothing. I had a visit from the Home Health service about noon. At first during the day I was pretty pain free, but by the time Kathleen the PT/aid arrived I was feeling it. Burning sensation around where the incision is (covered right now of course), some pain when i moved around - I do a little practice walking with the walker and each time it was more painful. It reminds me of when I had a bike accident years ago & dumped on the concrete. The hip pain, tho, is gone.

The visit was supposed to be a short one but we wound up doing a number of things. Vitals check - I haven’t had blood pressure this low since Neil Armstrong walked on the moon. I was using the cane wrong - using like hiking poles, with which very familiar - she taught me a different method that is better, the cane hinges at the opposite hip. I practiced that a bit (kind of too difficult yesterday) and this morning (much more able). I’m going to stick to the walker for now but I’m in a pretty confined location and not doing the stairs to the rest of the house - maybe tomorrow. We also looked at the before and after X-Rays (I can get these from Kaiser, but it takes some work, & they’re not shown in the patient dashboard). The before-after pictures look QUITE different - I have some questions now for the surgeon for later. I have an impressive looking screw in the acetabular insert to hold it in - i saw that item in the surgery report but it’s something to really see it. I need gait retraining, I had developed a ridiculous and probably dangerous walking style as the left hip deteriorated, and brain/muscle are still thinking they need to work that way. PT/aid said she’d work on that with me as my recovery progresses & it’s appropriate.

Best sleep in probably months - no more all - niter hip thrashing. Probably thanks to Percocet too.
I have what is for me a very complicated meds schedule to work out & planning on taking the Percocet on schedule for the next few days & then start tapering it off on Saturday if pain level remains low.

Kaiser at least here at their San Leandro center seems very well organised and efficient in this area. They have a program they call ERAS - early release after surgery. THey have intake, anaesthesia, & recovery very well organised and get you up and moving, and out, very quickly. The good side of this (aside from being at home) is that you are so pain-free from the meds at the end of Day 0 you can do anything - the next days, tho, look out. The team was very up front about warning us about this. You really need help Day 1 (we’ll see about Day 2, but I’m getting back to functional so far). There is some unavoidable repetition and redundancy in the process (I felt like making up random birthdates I was asked this so much) but they streamline what is typically a very tedious paperwork process. There was a patient across the hall from me in Recovery, a knee replacement, he was up a bit more than me & they had him cruising the hallway on his crutches - we both left at the same time. On the other hand, there was another patient across the hall who had to have general anaesthesia, another hip replacement patient, he was in a lot of pain on wake up & didn’t look like he was leaving - they don’t throw you out if you’re not ready.

I think getting a successful spinal block is one of the keys to getting early release. General is much harder on you. I remember curling up & getting a lite jab at the base of my spine, somebody slipping a mask over my mouth … and then finding myself flat face up with blurry faces over my head and someone saying “He’s coming around”. Perfect. I was in recovery. No memory of whatever it was they did.

I also learned they use the Hana table for anterior - I had forgotten to ask about that; maybe that’s standard for anterior surgery.

Ok, back to icing for a while.

 

[benne68]

I haven’t had blood pressure this low since Neil Armstrong walked on the moon.

Love your sense of humor, @nasruddin! I think you'll find it will really help you on this recovery journey.

Sounds like you are off to a good start. If the pain level goes up over the next day or so, increase your icing and be sure to stay on schedule with the pain meds. Don't be surprised if you see a lot of swelling over the coming week -- bruising too -- it's all part of the healing process.

Wishing you an easy weekend.

 

[nasruddin]

I am getting more swelling - leg looks like puffy. Do patients benefit from drinking a lot of water, or drinking less, or no known difference? I’ve been drinking a lot of water (thinking it’s good with all the ibuprofen & other meds) but maybe I’m just filling a literally hollow leg….

 

[benne68]

I’ve been drinking a lot of water (thinking it’s good with all the ibuprofen & other meds)

Yes, it is recommended that you stay well hydrated. (It also help prevent/reduce the likelihood of constipation from the pain meds.)

 

[nasruddin]

Day 3. Attaching my before/after X=Ray. Not sure it’s going to work, looks like the upload might be clipped.
2nd visit from the Home Health aid today. Vitals are good (not quite as good BP as Day 1, but I’ll take it). I didn’t sleep quite as well last nite. Did I tell you about the bee sting? Mon nite, 6 pm, everything set and just had a last minute call with the surgeon for any questions, and then a bee stings me on the instep on my left (operated side) foot. I didn’t react to it much but it’s one of those things … fortunately the surgical team was ok with it & things proceeded. However it’s itchy, & it woke me up last nite. I think I have to keep it covered.

The swelling seems to be down a little (assuming it will ebb and flow), no sign of bruising yet. Almost no pain. I’m going to start tapering the schedule II drugs, maybe keep the one at bedtime. The HH aid said I looked like I was balanced and moving ok with the cane so I can use that. Definitely was not on Day 1 but I’ve practiced a bit. I escaped up the stairs to the rest of the house. I find I can use the cane ok but I get tired so back to the walker when that happens.

I have a couple exercises from the PT in recovery: clench / release glutes; clench/release quads; and while lying on back extend leg and draw back to hip - that one is really hard right now. HH aid added two more today - an extended leg raise, and a leg left (like the beginning of a march). I don’t have a lot of ability or ROM in those directions right now & she said not to stress about it, just try them a few days a week. I think I’ve had enough exercise and walking for today, watch says about 900 steps, time to ease up.

 

[trailrunner]

Interesting to hear about your experience with Kaiser. I'm on the east coast but it looks like you're on the west coast.

Most of my scheduling is set, but whenever I talk to someone or ask a question, I get a different answer or I'm told to ask someone else. I'm confident the important parts will work out, but sometimes I feel like I'm dealing with the cable company. I still don't have the home visits set up yet and always get vague answers when I ask about that. I was under the impression they will only come out once or twice for the first two weeks, and then I start going to a Kaiser facility for PT and other follow ups.

I have my first pre-op appointment next Monday. I figure this is just to make sure I'm healthy enough for the procedure so I'm not planning on asking any questions.

When my surgeon told me that it was outpatient and that I would be given a spinal, I got very apprehensive. I don't mind it being an outpatient procedure, but I don't like needles, and I don't like needles being inserted into my spine. She explained the benefits of a spinal, and since then I've read other accounts that it's not a big deal, so now I feel a little better about that.

Hope your recovery continues to go well.

 

[nasruddin]

Interesting to hear about your experience with Kaiser. I'm on the east coast but it looks like you're on the west coast.

SF Bay Area - Could be different Kaiser regions have different "cultures"

Most of my scheduling is set, but whenever I talk to someone or ask a question, I get a different answer or I'm told to ask someone else. I'm confident the important parts will work out, but sometimes I feel like I'm dealing with the cable company. I still don't have the home visits set up yet and always get vague answers when I ask about that. I was under the impression they will only come out once or twice for the first two weeks, and then I start going to a Kaiser facility for PT and other follow ups.

The home visits were sort of a surprise to me - I know another patient whose schedule seemed to be more extended than mine, her HH/PT visit was at about 2 weeks. Maybe here it's a discussion item with you and the surgeon. The surgeon seems to be in charge (as it should be).

I have my first pre-op appointment next Monday. I figure this is just to make sure I'm healthy enough for the procedure so I'm not planning on asking any questions.

Mine was a general visit (we had already done some of the prelims on the phone), evaluation of walk, what the range of motion looked like, a discussion of how the procedure would work and the general timing. We didn't talk about the anesthesia & I don't know if that was an opportunity I missed. I learned in the hospital the surgeon uses the Hana table - maybe that's standard for anterior. I forgot to ask. I would bring and ask your questions. You may get referred to the team but I think the surgeon is in charge of this. Mine was on the phone to me the night before checking to see if I had any further questions.

When my surgeon told me that it was outpatient and that I would be given a spinal, I got very apprehensive. I don't mind it being an outpatient procedure, but I don't like needles, and I don't like needles being inserted into my spine. She explained the benefits of a spinal, and since then I've read other accounts that it's not a big deal, so now I feel a little better about that.

You're right to be concerned about the anesthesia, it's maybe the most critical thing happening. They have to keep you under enough for the surgeon to work with you (I really didn't want to participate in what they had to do) but they need to keep your systems running. As I said I didn't really notice much. There was a poke in the back with me hunched over a pillow (& that might just have been the pre-injection numbing), a mask, & then wake up in recovery.

If the spinal doesn't work - I think that's the most likely problem - either your back geometry doesn't permit it to work, or it just doesn't , or it starts wearing off early - then you may get general anesthesia anyway so the procedure can be finished; that's how it was explained to me. There was a person across the hall from me in recovery whose spinal didn't work & he had to have general ; he had a much worse time going thru recovery and more pain. I am told the risks of general are a bit higher than local for us older patients, but don't know if that's significant. I was pretty ready and able to go home at the end of the day but I doubt my neighbor was. In fact I don't think I would have been nearly as able the next day, had they kept me like they used to. Day 1 was a lot more painful.

I think you should bring this up and perhaps you can get an interview with one of the anesthesiology team.

 

[myglasshalffull]

I've had a few surgeries and usually just prior to your surgery anesthesiologist comes in, introduces himself/herself and explains whatever anesthesia you will be receiving. When I had ankle surgery 4 years ago it was outpatient and anesthesiologist came to bedside and asked if I'd like a nerve block from my knee down to my ankle before surgery cause he said the some patients have a lot of pain. I said sure I'll take it. Then I had general, I like general, off to sleep and you wake up in recovery. Some coffee and crackers and away you go.
I had general for my hip as well and I was up and using walker within 24 hours, BP was a little low but you lose a lot of blood during this surgery so I guess that's why BP drops so much.
I had 2 C-Sections and had spinal for those, I was awake for son #2 and I liked that I couldn't feel anything but saw my son born.
Good luck with your upcoming surgery dw152, I'm East Coast as well.

 

[trailrunner]

I've had a few orthopedic type surgeries, so I'm pretty used to general anesthesia and didn't have any concerns over that. I had just assumed for something like a hip replacement I'd be getting general again, so I was very surprised when my doctor told me I'd be getting a spinal. She saw the shock on my face and explained the benefits to me. I told her "your logic is messing up my emotions" in a humorous way. Well, at least I hope she understood my humor.

SF Bay Area - Could be different Kaiser regions have different "cultures"

I was born in Oakland (a long time ago) but grew up in southern CA. Both my daughters were born in Kaiser. I've generally been happy with them. I grew up with the military health system, and Kaiser reminds me of that - big, bureaucratic, and sometimes you have to advocate, but when it counts, you usually get good care.

 

[nasruddin]

I've had a few orthopedic type surgeries, so I'm pretty used to general anesthesia and didn't have any concerns over that. I had just assumed for something like a hip replacement I'd be getting general again,

As I mentioned, you may wind up with general under circumstances. I think I read another 18 Jul patient had to switch to general because the spinal didn't take. Hopefully not but it will go well for you in any case.

I was born in Oakland (a long time ago) but grew up in southern CA. Both my daughters were born in Kaiser. I've generally been happy with them. I grew up with the military health system, and Kaiser reminds me of that - big, bureaucratic, and sometimes you have to advocate, but when it counts, you usually get good care.

San Leandro is a relatively new facility to me. It opened at the same time (year) that the new Oakland hospital opened - the OS all have their offices in Oakland but the hip/knee specialty surgery site is San Leandro a few miles down the road. The hospitals are similar. The old Oakland hospital you may remember is a hole in the ground.

 

[nasruddin]

Day 4. Plateau day I think. A few less steps, a little outside time finally, a little too much computer work (some video editing I wanted to play with). Leg doesn't like long term sitting, wants to be propped up/iced a little.
I was to remove the surgical bandage today so I just did - it looks buttoned up tite, no blood, no strips, a little
purple line. It's supposed to mostly air-dry / cure.

 

[Jaycey]

@nasruddin That stiffness when you sit for too long will ease with time. It's great you are icing regularly. Ice for 45-60 minutes several times per day. It's a slow and steady journey.

 

[nasruddin]

Day 6 (Monday). Sort of a plateau (let's think alpine meadow). I can move around pretty comfortably and don't use the walker much in the house - outdoors yes. Just the cane in house.
I circumnavigated the entire block yesterday (gotta make it sound like a big deal), while supervision including poodle kept an eye on me. Might have been a bit much but I was up for an epic voyage.

Operated leg feels a bit loggy and I think it takes on more swelling as the day goes on. I am also feeling some sensations like little currents of electricity sometimes - maybe that's some nerves repairing. I don't think I have any numb zones like some people report from anterior. I'm going to log less steps and spend more time on the bed with ice packs today. Also had my first lower sleep score and some restlessness recorded last nite - body was tired of sleeping only on back, hip needed some movement. Going to stop tapering the pain meds too.

I have been trying to practice heel-to-toe and straight-ish toes walking gait. I don't think I fully engage the operated leg with 100% body weight (I can, but I don't like it yet) but still think I can practice this and try to get ride of the pre-op twisted gait and limp to some extent.

As a piece of advice for future patients - set up a schedule for EVERYTHING not just your meds (but one that you can edit and re-adjust). The work I did day #1 getting a med schedule has paid off. I should have done the same for walking and icing just to keep things more sane. It helps a lot with the caretaker too they know when they need to be around, when to nag/audit and when they can do something else.

 

[Mojo333]

A plateau indicative of an alpine meadow may not be the highest aspiration, but invokes thoughts of easy does it (bird tweet, inserted here) and surely right where you need to be.
Yes, around ye old block similary may seem benign but I remember a trip to the mailbox at 2 wks out being a TRIP to the mailbox.

All temporary.... you will get there.
You are doing Right by your body which is working hard to overcome the assauIt necessary to fix that bad hip.
Happy Monday!

 

[tanvat]

Nasruddin,

Sounds like you are doing quite well. Keep it up, be patient, and ease back into the long recovery glide path.

 

[Layla]

I am also feeling some sensations like little currents of electricity sometimes - maybe that's some nerves repairing.

Small sensory nerve fibers are cut with the incision. These nerve fibers run from the inside to the outside of the hip and cutting them causes the hip to feel numb after surgery. It is a temporary sensation that normally resolves over a period of six months to one year post op.

While healing you may experience sensations of tingling, pins and needles, itching, burning and even the feeling of a minor electrical shock. These are usually good signs that the nerves are spontaneously firing through the regeneration process.

I circumnavigated the entire block yesterday (gotta make it sound like a big deal),

But....it is a big deal. You're doing well at only 6 days post op. It is your one week anniversary tomorrow.
Hope its a good day!

 

[nasruddin]

Day 8 -
Yesterday - Day 7 - was a busy and exhausting day. I slept much better - no restlessness - after returning to the original bedtime percocet dose. Not quite enough length and it did what it does to REM & deep sleep, but restfulness is a plus. PT/aid came in the morning, BP remains amazingly low. We went thru more exercises.
I have been able to raise my left leg high enough to safely clear the bathtub edge (it's just a foot off the floor,
not one of those old tubs). I continue to do that exercise figuring if I can do that I'm then fairly functional.
I also started trying stepping normally on stairs rather than the step one, drag one pattern. The operated leg
can now take full weight in small doses. Heel slides were easier, and I could do a few one leg raises. We checked walking gait, which looks good as long as some else is watching I guess. I have to practice standing up straight (something contracted during the hip decline) and surveying the ground in advance as I walk. Then we added a few new exercises - heel lifts while standing, lateral raises (abductor), and a couple different leg lifts - one straight leg to the back, and one bend the leg at the knee in the back (you might know this as the beginning of the
runner's quad stretch, the lift foot part). And then the bridge. No can do this one yet.

After PT left we went to one of the zoom art classes we signed up for this summer. Once that was done
it was time for ice and hard nap - 1 hr. Yep, it appears I'm still in recovery. Enough recovery from the nap to get in a roll around the block before dinner.

I was feeling it a little that night. Some soreness in the leg itself and a little in the back - starting to work on some other parts of the body that are having to adjust to new hip. Sleep wasn't quite as good as the night before, but the cause of that might be why the swelling seems a little less today. However I am feeling a little aching in the
leg, in the groin. I'm doing the new exercises lightly today, they seem ok but will monitor and see if any pain increase occurs. Another hard nap was needed after exercise and today's zoom class - it's a rigorous ordeal and a spa vacation all in one.