THR There and back!

[Hipopapotamus]

I like your writing style. Sounds like you are making great progress I’m inspired to take a walk out this afternoon. I too take art classes online. I mostly paint watercolours. Im going to write a schedule for my husband who is looking after me.

 

[nasruddin]

Day 9 - PT/Aid came for check again today. We checked walking gait - I need to relearn to stand up straighter, during the hip decline I declined with it I think. I need to get back to some upper body work, maybe seated weights. Done with the walker (probably not helping anyway since it encourages a lean). I'll use hiking poles outside for next while. I can do single leg lifts but bridge - still no-go. PT is pretty good I think - we need to find the sweet spot where we can do a little work, but not so we do something that sets us back. I do feel some odd pains here and there - the groin area feels "full" or blocked, pain in the outer knee, and some in the shin of the operated leg. I'm probably getting a lot more stress on areas of the leg doing new movements since I'm trying to retrain my walking gait.

I think I've plateaued, but then I just put on my left sock without any problem - ROM is returning, cm by cm.

I put some marks on my thigh & I've been measuring swelling. I think the peak (at least so far) over the weekend, but the past few days it's lowest in the morning, around 53 cm, and highest later in the evening, about 56 cm. Still may not be spending enough elevation time.

 

[nasruddin]

I like your writing style. Sounds like you are making great progress I’m inspired to take a walk out this afternoon. I too take art classes online. I mostly paint watercolours. Im going to write a schedule for my husband who is looking after me.

I hate having had to lose the summer to this, but it had to be. But I'm recovered enough to get out a little. I don't have any restrictions on how far I can walk - what I can tolerate I guess - so planning on gradually longer strolls. I won't be able to scale the hills for a while, that's what I'm feeling. I think that will rapidly irritate the hip right at the moment.

We do watercolors (I guess I should call mine dabbling) and we've been trying to learn to use watercolor pencils. We do a lot of plein air/ nature journaling - the pencils would be really useful - you can get the general colors down without all of the watercolor kit. And you can mix with regular watercolors (shh) but in fact they are a
different medium and a little cranky - colors shift when drying, that's the one everyone notices.

 

[benne68]

I put some marks on my thigh & I've been measuring swelling. I think the peak (at least so far) over the weekend, but the past few days it's lowest in the morning, around 53 cm, and highest later in the evening, about 56 cm. Still may not be spending enough elevation time.

You are still very early days and it does take a long time for all the swelling and bruising to dissipate. But they do eventually go away. It just take time.

 

[Eman85]

If your PT is even in any way for you to do bridges I'd question their approach to THR PT. This recovery is a very slow and long one. At a week and 1/2 our bodies just need rest and nutrition not weights and exercises.

 

[nasruddin]

Day 10. More walking today - we'll see if that was wise or not. Iced up after. It's the end of the day and I am really
tired. I have two areas of discomfort that appeared (not just today) - one is on the outside of the left knee, or just below it on the shin - I am thinking the change in walking style from the pre-op twisted leg to toes point straight
ahead is what is driving that. The other discomfort area is in the middle of the groin, and it feels like some attachments or tendons are nearby - maybe the surgical trauma. It's not that near the incision tho.

As far as the exercises go, they seem minimal, most of them, & I do the ones that I can do w/o obvious problems.
A lot of those are exercises I was doing right up to surgery day in the pool (that's a ways off) so maybe still have
the muscle/nerve control to do them.

Straight leg lift and bridge are just not going to happen right now. I had failed at them in yoga class well before
surgery. The single leg lift (eg step over a block) seems ok, and the heel drag while lying flat - I think that's helped me get just a little more ROM, & I need that leg to be a little better to have minimal functionality. If it doesn't work, so it goes, but a little more functionality will make me safer walking around the house & outside. As long as I'm not harming that chemical process bonding the insert....

One thing that's good is doing these under some kind of supervision - I'm the kind of person that's going to test
limits anyway. I'll do it unconsciously.

 

[Jaycey]

Straight leg lift and bridge are just not going to happen right now.

Why are you even attempting these at only 10 days out? They are strength building exercises. You are not in training, you are healing. Give that new hip a chance to recover from all the trauma of surgery. Training can come later.

 

[Eman85]

As long as I'm not harming that chemical process bonding the insert....

For the majority of us that is not even a concern and the implants are very tough. The whole recovery aspect of this operation is the healing of the traumatized muscles. We all focus on the implant and never realize what was actually physically done to us to perform this procedure. Our hip is dislocated and our leg completely rotated 90*, our bodies did not like this. You don't ever hear of people dislocating their hips, even bungee jumping or accidents, that's how well our hips are designed to stay together. Despite their design we have been disassembled and reassembled.

 

[nasruddin]

As long as I'm not harming that chemical process bonding the insert....

For the majority of us that is not even a concern and the implants are very tough.

The implants are tough, but the bond isn't tough until it happens. My surgeon wanted me to be cautious around this time as swelling / pain subsides (even tho "no restrictions") because that's when we want to do things (& I am there) but his view is that there is little integrity to the bonding between bone and implants yet. This is consistent with what I have read from others (eg Jonathan Hull - he says we need 6 weeks for the start of good integration & there's simply no way to speed that up).

I definitely have some muscle/soft tissue trauma as well as some leftover strength. I think it's working its way out - definitely walking better - but there are some limits I can't cross yet.

Anyway - day 13 - I have a little swelling in the foot and ankle, and some soreness in the ankle and the outside of the knee - all on the left side. Some of this is probably from walking with a restored normal gait, and some of this is probably from surgical trauma (the knee stuff?). I hope the swelling isn't something worse - have to keep an eye on this. The Health Aid will be in later in the week. I read that some knee pain can be caused by the anterior approach's trauma to some nerve tissue. I have noticed that I have a partly numb surface area at the base of the thigh near the knee - it's not completely numb, & originally I thought I had no numbness, but it's not quite right yet.

Kept the walk a little shorter today - didn't make it to the delicious mulberry tree whose fruit is going to waste (I guess the birds have had their fill). Maybe tomorrow. Elevating and icing after this walk - hope that's the right thing to do. Alternated between a long walk and nothing over the weekend, saved by some family visitors. I'm thinking the extra walking on Saturday was a bit too much and has led to knee/ankle unhappiness - just have to see how persistent it is. My sister recommended I try some racquet ball rolling for my feet - they came today. They are a lot softer and smaller than tennis balls or many other therapy balls - you can kind of grip them, roll them around, maybe they will help relieve the ankle too.

Woke up to 51 cm swelling in the thigh - this is much lower and pretty close to the right leg - but the thigh is lumpy, like it's not draining identically in all regions. Another thing to keep an eye on? Change leg elevation pillow?

 

[nasruddin]

Day 15 - Yesterday my ankle & the top of left foot were hurting, & noticed the outside of the left ankle was really red. Foot, ankle, calf are bit swollen & tender. I thought that was disturbing - reported that to the surgeon, & that won me a trip to radiology for thigh - vein ultrasound (no problems found).

I think I figured out the problem. I'm still icing & elevating regularly but I've gotten careless about elevation & I'm letting my feet dangle - perhaps they're filling up with fluid like a boot left out in the rain. Trying to fix that (definitely more comfortable my old way, but so it goes).

There's a little bit of soreness on the operated thigh but far away from the incision / joint. It's a feeling like a sunburn on the front surface - I think this must be some damaged nerve tissue working itself out. There's also a knot of tightness / uncomfortableness near the top of the incision at the groin. The PT/Home Health aid suggested that was typical for anterior patients and related to why single leg raise and bridge are nearly impossible right now - too much trauma to the quad attachment, needs to heal? Anyway, no strength exercise for a bit. Walking gait is better and I can walk some without cane, but it's not consistent yet & don't want to practice limping habits. Movement & ROM are definitely improving daily.

 

[Mojo333]

Hi @nasruddin
This first month post-op is a time of furious healing for your body... and we can help it the best by giving it what it needs to do its job... namely, good nutrition, lots of resting, icing and elevating along with short walks for circulation.
BOORING

Yes, gravity causes the excess fluid to fill up your lower extremities like a boot in the rain...
Your lymphatic vessels and veins have to pump up against gravity during the day, which can be challenging. Elevating the legs above your heart for 30 minutes can help the fluid move out of the legs.

I remember I also had the burning sensation (more intense than a sunburn) but was reassured that it was nerves coming back to life and normal.
Bridges and leg lifts and other strengthening exercises are really unhelpful at this point, so I'm happy to hear you are going to give it a break.
All Temporary....

 

[nasruddin]

Do you think it's worthwhile at this stage trying a compression sock? Somebody just suggested that to me this morning (didn't think of it before).

 

[Jaycey]

Do you think it's worthwhile at this stage trying a compression sock?

Many surgeons prescribe TEDs for the first 6 weeks. The problem is they are very hard to take on and off. If you have someone who can help you with these, they do help. But please don't try and wrestle with them on your own.

 

[Layla]

single leg raise and bridge are nearly impossible right now - too much trauma to the quad attachment, needs to heal? Anyway, no strength exercise for a bit.

Please keep in mind that it is 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. Give yourself the TLC you deserve and reap the benefits of a successful recovery.

A great weekend to you, nasruddin!
@nasruddin

 

[nasruddin]

Day 19 (Sun) - I feel somewhat better again today - something shifted overnite. The watch & the Oura ring say I didn't sleep all that well but sleep also felt a little better than the past few nites. I really really don't like having my leg / foot elevated that high, & my back is also getting tired of it. But -
That elevation & the compression sock are helping with the swelling in the ankle/foot, & the pain there is way down. There's a tender spot on the left side just above the ankle, but the pain all around and on top of the foot are gone, & it doesn't look like a balloon art leg. I also notice it a bit walking - I would think this might be consequence of gait retraining.

The compressed / inflated spot at the top of the incision feels (internally & externally) gone.
Now I feel something is sensitive on the backside, but towards where I think the joint is. I guess I'm entering the period where random (minor) pains come and go.

Right now I have a balloon of extra fluid in the thigh above the edema, & some numbness. The electric shock - sunburn feeling has lessened (but not gone) & comes & goes w/ movement. Not much to do about that? Hope it just continues to subside.

Sticking to lite exercise - planning on extending the walk past a block today (but not much). Doing the non-strength PT. I feel like I could do with a good bit of stretching but not going to try that just yet.

One word to the wise: Advise your caretaker NOT to get their calendar-mandated vaccination boosters during the period they're caring for you (I'm talking about you, Shingrix #2) or you will wind up having to take care of them. A week or 2 delay is unlikely to hurt.

 

[CricketHip]

Lol, I know of someone else who's supposed caretaker did the exact same thing. What bad timing for the second shot! She ended up caring for him instead of getting the help she needed.

I came here to respond to your questions about MLD from another thread.. as @Mojo333 stated earlier to you, elevation has a lot to do with getting things moving, fluid wise. But you can also stimulate your lymph nodes that are located in your abdominal around and in your groin area.

Here's the sequence:

****
Take deep breaths.. deep, as in breathing in to a count of 3 or 4, whatever is best for you. hold it for another count of 3-4, then blow out completely, still using the count that's comfortable for you. A series of at least 6 of these could help get your excess swelling to move. To ensure you are taking proper deep breaths, place your hand on your naval and watch while taking in your breath, if doing this properly you should see your hand move up.

Then, as you slowly breath out, to the same count of either 3, 4 or 5 gently press down and slightly upwards with the palm of your hand.
Do this whenever you feel up to it during the day or night. The more supine that you can get in the recliner or bed, the more effective this can be.. you have lymph nodes located in your groin and sitting up too much can cause a restriction of the lymph flow.

You can, after the breathing, place your hands lightly on your upper thigh, right where the crease is in your groin and lightly stroke upwards towards your naval.
I did this quite a bit post op and while it takes a while for the body to wake up and respond, it will and it will help get the swelling moving.
The reason this can help is because many of our lymph nodes are located in our abdomen. Our breathing combined with moderate pressure over our naval can help to "prime" our lymph system.

***********

Additional notes: you can reach down to your knee and lightly stroke upwards your groin after doing the steps above. Then lastly, gently pump the back of your knee in a rolling, upward motion towards the trunk of your body, using all 4 fingers of your hand and NO fingertips pressing in..

This can be effective if done daily.. use light pressure, no deep pushing. This isn't a no pain no gain thing.

I hope this helps!!

****

 

[nasruddin]

Day 21 - Week 3!
Thanks CricketHip for the lymph mobilization. Doing that a couple times a day.

Mostly good. I'm trying to be relatively conservative this week and next, as this was the time period my surgeon said was the most dangerous in his opinion. As he predicted this is when the swelling goes away (mostly) - at least on the surface - and there's enough improvement in ability you feel like you can do a lot more (check). I'm sticking with the modest exercises Home Health/PT aid has given me, but not pushing them, & not doing most of the
strength ones (bridge, supine leg lift). I can do the exercises ONCE a day without feeling like I've overdone it (more than that & I start to pick up some feedback from hip). I am trying to extend my walking range a little - one block is fine, I notice the tiredness after 2 - and make sure I elevate / ice right after that.

The balloon calf/ankle + pain problem seems to have subsided. I've been wearing a compression sock for the
past week & elevating my feet all nite (it feels like I have them planted on the ceiling). Awful, but it probably
worked. Today, leaving off the compression sock to see if ankle behaves. If it seems stable I will literally ramp
down the all-niter foot elevation.

The semi-numb area has shrunk & the sunburny-tingly feeling has subsided some. A sore area above the
left knee remains & some soreness along the IT band (I think that's what it is).

Sleep has become a complete disaster. Gone are the great sleep sessions of week #1, & the really good Oura and Garmin scores. I don't know why. There are pains, but they seem to come and go. Some of it is because of the way the body gets rid of all the edema fluids (you know what I mean) - that's been a lot of work. Maybe when I get rid of the discomfort of so much elevation sleep will improve.

Pretty pleased with the way this is going. I have a lot more mobility than I had before surgery. I am going to have to practice standing better, I adopted a right-leg-only standing policy for a while. How do you all feel about full weight bearing on the operated leg at this stage? Mine seems happy with it; the doctor & PT are ok with it; wondering about other experience. No hip pain. I think gait training is coming along, but going to shop for some coaching after the Home Health visits stop (tomorrow) and the surgeon in-office exam (next week).

Just about done with the so-called Durable Medical Equipment; some of it is being farmed out to another patient for use later this week. Not ready to dispense with the cane just yet. I still need it as the leg tires, and my gait is still in need of perfection so I have to be careful to get cane back in service when limping creeps in.

 

[bay_streety]

You are progressing nicely, it seems I think you just need patience, week 3 is very early in recovery. For me (I know, I know no two hips are the same), some milestones happened week 5 (full weight bearing on the operated leg, no need for walking aids, felt stability). Until then I kept exercising at minimum (just 5 bed exercises I got at hospital) and walked around apartment. Iced afterwards. After week 5, the progress was almost on a daily basis. You're doing great!

 

[nasruddin]

Day 28 - Week 4!
Mostly going well. I'll do a longer recap after the in person visit with the surgeon on Thu morning (2 days).

 

[nasruddin]

Day 30 - Surgeon in-house visit
The last week has had its ups and downs, but I think the reality is very, very good.
Last Wed (09 Aug) I had my last visit from Home Health & was "discharged" from that. Feeling pretty good,
walking every day about 1-1.5 mi in several slow sets, doing a PT set daily (1 strength exercise); in the
surgeon's red zone (where the tendency is to do too much) so trying to keep activity modest.
You may remember (maybe preop thread) I have a sort of job this time of year, monitoring a migrating bird,
& so I decided to go check. This is very early in the monitoring season; usually nothing seen, but it turned
into quite an exciting night with the result I did some extra walking & about an hour of standing - that was
a bit too much. About 7500 steps according to watch. The next day I took it easy.

By Fri felt fine & started phasing out acetaminophen (finished by Sunday). No discernible effect on pain
level (which is minimal anyway).

Minor pain continues to ebb & flow, especially around the thigh front & side, far from the incision. I think it's best to do a short ice & elevation after walking or PT workout. And PT workouts are actually feeling good - I suppose that must mean I'm either not doing them right (unlikely) or they're now too easy. First in-house PT appointment next week - we'll see what they have to offer.

Surgeon visit - X-Ray looks great. Right hip doesn't look that bad, he says, so ... maybe won't need to see
him in the OR for quite some time. I can stop the baby aspirin & just take ibuprofen as needed. It's probably good to get these pain meds out of my system ... i'm going to ramp down ibuprofen & see how it goes. Incision looks great, ok to swim, ok to drive. Most activities should be fine, I should be out of the weakest period post-surgery.

Running, jumping, things like that, avoid for a while - at least another 2 months.

Probably most of the pain in the front of the thigh & around / above knee is from nerve trauma, he says. He also says that the muscles around the replaced hip, while not cut, have their own problems - during the deterioration of the joint they grab & hold the joint together, and don't move as much (or get used) like they would normally, so they will take time to recover. I do notice some tiredness and a little soreness near the actual joint when I've hit my 5000-6000 step limit. I'd like to walk more but ... there's no hurry. Will see what PT suggests and what works, & start adding some pool work. It seems like I might need some asymmetric
and slow strength building on the left hip side, if it's ready for that.

The surgeon even fixed my sandals so they grip my feet properly!

Really good surgeon, team, and support all around - I have been so lucky.