THR THR Complications x4

InTheOnePercent

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Hoping for some advice / guidance after my surgery and a few complications.

I had THR on February 2nd, 2022 on my left hip. I was born with double dislocation due to under-developed sockets and at age 11 I was hit by a car that resulted in my left leg tibia and fibula bone loss of 1”. I made sure my OS knew this but every time I mentioned it he said the shorter leg was irrelevant with his this surgery. At the end of my 49th year, I scheduled a THR for my left hip which was giving me the worst pain.

In recovery while walking with support, I kept feeling a popping sensation in the hip but it didn’t hurt and it couldn’t be heard. I commented on it, but I was already grateful to walk without pain in that moment and was probably still loopy from the anesthesia.

By that evening, the popping became very painful and continued with any small movement. I felt this at my hip joint, and oddly I would also feel popping lower along my femur. I stayed off the leg and called my OS the next day. He advised to give it the weekend and come in if not better. The pain with the pops and clunks was only for a split second, but off the pain scale.

His PA first evaluated me and felt one of the clunks. She said she was pretty confident that it felt like the liner was slipping in my joint. After my OS checked me out for about 20 minutes of extreme pain trying to make it clunk more, (it popped only but he wanted to feel the clunk for himself) he ordered a CT.

The CT was ran the next day and came back with a femoral fracture at the lesser trochanter and two acetabular fractures. He ordered non-weight bearing 6 weeks, to hold off on PT until after that period, remain on baby aspirin x2 a day and advised to move my foot for circulation.

At about 2 weeks post-op, I discovered my left leg was very cold in comparison to my right. I assumed because I wasn’t using it.

At 4 weeks post-op, my chest developed a pain on my right side which felt like pleurisy. I went to the ER and they confirmed two clots in my lungs (pulmonary embolism) and said I am very lucky with where they had lodged. Later, they found one remaining in my calf (DVT). Prescribed blood thinners for 6 months. I asked my OS if compression could have prevented the clots and if I should start using socks or a cuff going forward, but he dismissed this and said no, and it wouldn’t have made any difference.

Last week I went back to my OS for my 6 week check up and he approved starting to walk on it again, despite not running a CT to check on the healing of the fractures.

I have been researching more about cup alignment during my downtime and am concerned about how my X-rays look in comparison with others. It looks to me the cup is rotated clockwise causing it to not be flush with my pelvis and it appears that my femoral head is partially out of the cup and in contact with my acetabulum. Also, the end of the femoral stem has a shadow which looks like the stem may have moved to me. This is the exact area I felt popping before, and now pain when I try to walk.

Note: Unfortunately this OS has not been apologetic, companionate, or even honest with me along the way. I could note many things he has said which contradict himself or are outright ridiculous. One example is when asked why my socket fractured he said it was caused by my bone spurs when placing the cup. I am a female, 5’6” with small / medium bone structure, yet he used a 52mm cup (most common size for men) and 36mm head, the X-rays show he had to ream my socket quite a bit to make them fit.

When I asked him about the cup position, he said that the bone I am looking at is in the background and that the head is not in contact with my own socket.

Today: I have been trying to walk on my leg, but am developing sharp pain in my groin and in my knee. It doesn’t feel stable. My whole leg is still very cold, and only warms up a couple hours after going to bed. After I get up, it becomes cold again. The ER ran an arterial ultrasound and said I had good blood flow though. (I was laying down when they did this, though)

I saw my primary again today, and despite multiple requests for a second opinion I am told that no surgeon will see me while after surgery by another OS. He said he thinks my cold leg is from Complex Regional Pain Syndrome (after looking it up I can’t agree the symptoms match up) and he told me to get with PT to try to work through the popping, clunking, and now the sharp pains in my hip and knee.

I am very concerned of dislocation, especially if my alignment is actually off.

Whew… sorry there is so much to cover here, but what I’m hoping for is anyone who might have gone through any of this which might help me shine some light.

Thank you!
 

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djklaugh

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@InTheOnePercent Yikes you really have been through a horrid experience!

"despite multiple requests for a second opinion I am told that no surgeon will see me while after surgery by another OS."
Who was it that told you this? The surgeon who did the hip replacement? Your insurance? As far as I know this is not true and there are quite a few orthopedic surgeons who specialize in evaluating and treating complex problems arising from previous surgery. Let us know what part of the country you are in and perhaps we can help you find such a specialist. If it was the surgeon who told you this you might also check with your insurance to see if a referral to a different surgeon is possible (and do they have a list of specific surgeons they refer to ) .
 
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InTheOnePercent

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I was told by my primary, his assistant, and arrogantly by my surgeon. Just today I requested again through my primary who has been great, but he said it’s too soon and they will reject m until I’ve tried physical therapy. I have my first appointment tomorrow morning, so we’ll see how that goes and I’ll ask again. That’s good advice, I’ll call my insurance directly to see if something can be arranged. Thanks for the feedback ❤️… I’m in the Sacramento, CA area.
 

Layla

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Hello and Welcome to BoneSmart. Thanks for joining us. I’m sorry for all you’ve endured. It certainly is a lot.

I’m assuming as far as the leg length differential, your surgeon thought it was something he could correct during surgery. Possibly that’s why he was dismissive when you raised the subject? I’m certainly not making an excuse for his lack of communication, only wondering if that was his reasoning.

I‘m sorry you ended up with multiple fractures after your surgery and also for the PE’s that developed. Thankfully you went to the ER and were successfully treated. I’m sure that was frightening.

I’m surprised at your surgeons response when questioned on blood clot prevention. I really can’t speak to his lack of transparency, compassion and seemingly unapologetic nature. I imagine you lost any trust you had in him as well as confidence in his abilities as a surgeon. If so…understandable.

The ER ran an arterial ultrasound and said I had good blood flow though. (I was laying down when they did this, though)
Thankfully this sounds encouraging.
I saw my primary again today, and despite multiple requests for a second opinion I am told that no surgeon will see me while after surgery by another OS
Sadly I’ve read this many times since I’ve been involved here, most often that another surgeon will not see you until you’re one year post.

Personally, If I was in your position, I’d be hesitant to begin engaging in PT after all you’ve been through. I’m not really sure how to advise you and would like to speak with Admin to see if they can make some recommendations. Until then, I’ll leave our Recovery Guidelines and a link to the BoneSmart Library - https://bonesmart.org/forum/view/library-index.78/

Please check back, hopefully others will offer you some feedback, support and encouragement. I wish you comfort and answers that lead to perfect healing.
 

Layla

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As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

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
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

5. Here is a week-by-week guide

6. Access to these pages on the website

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 the at each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Eman85

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I can't read x rays and have no medical experience. It sounds like you have a problem and you are not happy with your OS. If not satisfied I would start looking for an OS that you would feel comfortable with. I would have no problem paying out of pocket for a consultation with an OS. I've had insurance and didn't use it to get opinions from Dr.s as I wanted them treating me and not my policy.
I know there is a list of surgeons on this site. Maybe someone can link it or give you some recommendations.
 
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InTheOnePercent

InTheOnePercent

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Thank you for your feedback. Unfortunately, this OS who had great reviews in my limited research told me that he would not correct my LLD during surgery and that it was not a factor for consideration during the surgery. I hadn’t researched this prior, so I trusted his opinion. I joked with him that if in a position to lengthen or shorten my leg during the procedure, I’d prefer for him to “leave the line” for a limb the same or longer. I know now that LLD changes all the angles for alignment. I have just bought a lift, and hoping it will give me some stability as I start my PT. Thank you for your thoughts on holding off on PT until I have answers. That’s what my gut says, and your post gives me strength. I’ll go tomorrow, but I’ll be an uncharacteristically underachiever until I have more answers. ❤️
 

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I agree with your decision to go ahead and attend therapy tomorrow, especially since it may be a factor in how insurance might deal with whatever you have going on. Ask lots of questions of the therapist and be sure you're not asked to do anything that is beyond mildly uncomfortable. You have the right to say "no" if it's a movement or exercise you feel you're not ready to do.

I must say your surgeon really sounds like he doesn't want to deal with your concerns. He's wrong that revision surgeons won't see you. But it is fairly common for surgeons to decline to see a patient until they are at least 9 months out from surgery. I still think you need to try and find a good revision surgeon anyway.

I see that your pelvis is quite tilted. With the one inch leg discrepancy, have you ever used a life before? If not, I hope you went to see a professional to see about a lift. That's quite a discrepancy and suddenly adding that height to your leg could make you feel worse. You need some professional guidance with that process. Talk to your therapist about that as well. With all you have going on, this is rather minor, but it can be a factor.....you need to replace whatever shoes you're wearing. Your old shoes have wear patterns that may not be appropriate for your new hip. If you can, purchase a pair of good walking shoes that offer lots of support. At some point you may need to consider having shoes made with a lift incorporated in them, but that's up to the professionals to say.

If you cannot find a revision surgeon in the Sacramento area who would at least talk with you for a consultation, would you be willing to see someone in the Palm Desert area?
 
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InTheOnePercent

InTheOnePercent

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That’s a good plan. I’ll go this morning and hopefully get a therapist who can help and I’ll get started calling the insurance directly to ask for a referral. At one point I asked my primary to transfer my referral placed with this same OS for my right hip (which I haven’t been seen for, yet) to another OS who may take an interest in what’s going on with my left.
I knew this surgeon had a huge ego and no personality, but I kept telling myself skill was what mattered. You would think by his behaviors that I’ve done something to cause this treatment and attitude, but I haven’t. I feel violated and vulnerable, but every visit I meet him with a smile and have never argued or challenged him. I haven’t because they have convinced me that he’s all I’ve got!
If I am unable to find a specialist OS locally and soon, I most certainly would be willing to travel to find someone or maybe send my records in advance for review?
Do you have any opinion on my X-rays regarding cup and stem placement? I’d like to know if it’s a reasonable concern or if I’m way off base.
I tried a lift for a few weeks while I hiked and backpacked often, but it hurt my knees and I was advised to get rid of it since my body has been this way for so long. The lift I just bought is about 1/2 inch, and my thought was to see if it helped the hip and knee pain by getting my hip better aligned. So far, only 10 or so baby steps trying it out, but the sharp hip pain returned. I’ll leave it out and talk to the therapist today.
Thank you for your help… I can’t tell you how much posting my story and receiving feedback has already helped my heart.
 
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Jockette

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Hi and Welcome to Bonesmart!

I‘m so sorry for all you’ve been through. :console2:

If you don’t feel the PT you see today has enough experience with your issue, call around and try to find another who might be a better fit. PT’s are not all created equal and we don’t have to stay with the first one we go to.

Remember the Big Tip in the recovery guidelines about hips not needing a lot of PT. Going today is a good thing to do to, to check it off the list, as far as your insurance goes, but please be careful.
 

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@InTheOnePercent ,,,,I sent your x-rays to our retired Nurse Director, Josephine, to see if she had time to review them, as that is truly her specialty. I had a brief response from her and hope that maybe I'll get a chance to talk with her on the phone so we can discuss them in more detail. She did indicate that you were very unlikely to have dislocation issues and she didn't mention anything negative about the implant placement and size. She recognized that your right hip needed replacement, but I think you're wise to wait a bit until you get this hip settled. I hope you will be able to use a different surgeon for the second hip.
 
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InTheOnePercent

InTheOnePercent

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Gosh, that is great news so far! The joint pops and clunks so much it really had me nervous, so I thank you for giving me some reassurance. My PT is most concerned right now about my cold leg, so I will be requesting a CT Angiogram from my OS right away. Also, my insurance said that my PT is able to place referral requests, and she mentioned a particular OS she recommends who accepts my insurance…. SO…. Things are finally looking up, up, up! I sincerely appreciate your help and any other feedback she may have.
 

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Your case is a little more involved, but some members do complain about clicking, clunking and popping sounds. It is natural to be concerned and wonder if something is wrong. It seems more often than not that noises aren’t indication of a problem. It takes time for the soft tissue surrounding the implant to heal and settle in with the implant and begin working smoothly. If it continues occurring it’s worth discussion with your surgeon, especially if accompanied with swelling or pain, but if not over time it will most likely stop. Hope you have a nice weekend!
@InTheOnePercent
 
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Ok, good to know.
My popping can’t be heard, just felt with pain. My husband was able to feel the clunk while next to me on the mattress once. My next step is finally to see a second opinion. When I spoke with the insurance they seemed to support it, but need a physician referral. The only ones against it are my surgeon and now my primary as well. They advised I file a grievance if they don’t cooperate soon. My PT should help next week, though.
Thanks for your reply. I’ll respond again if I get to the bottom of it. ❤️
 

Eman85

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I had clunks or pops with both hips the left I felt while walking the right I could make it do it while lying in bed and sliding my heel towards my butt. Neither hurt but you could place your hand on my hip and feel it. It seems to be common and just tendons moving. But your situation sounds uncommon if it gives you pain.
 

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@InTheOnePercent
I am feeling your pain right now as far as dealing with dismissive drs! Grrr! I am cringing just reading about what you are going through! Layla and Jamie have been extremely helpful to me as well. As a matter of fact, I am looking for a different surgeon because I believe I am being played like a fiddle after I put my total respect with these drs. This morning I had just gotten off the phone with a dr's office a woman had recommended to me a couple of months ago. I no sooner got off the phone and saw that Jamie sent me this same dr's contact info! I hope that's a good sign that he will accept me!

After my first revision surgery in January failed I called my original surgeon to get a second opinion. I even offered to pay out of my own pocket because he is out of my network but he told me he couldn't touch me till 3 months after my previous surgery. I changed my mind though when I saw how much gas prices skyrocketed....it's a 300 mile round trip. Paying out of pocket and paying for all that fuel in my 8 cylinder pickup was more than I was willing to spend, lol.

So how are you now??
 

Layla

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Happy Three Month Anniversary to you…a couple days late.
Wondering how you’re doing since we last heard from you? Leave an update next time you stop by if time allows. All the best as you move forward in the healing process.
@InTheOnePercent
 
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Thanks, Layla!

I’m finally on the mend. I was able to take a few steps without crutches beginning my 12th week post-op and today am walking with just a cane for backup support. My doctors felt that I was suffering with Complex Regional Pain Syndrome, but the symptoms didn’t seem to match up in my opinion. They refused / delayed to schedule an EMG for me even though I believed I have femoral nerve damage. Finally a second opinion from UCSF documented his opinion of femoral nerve damage and showed me the fractures which were worse than my OS reported to me. After his diagnosis my PCP and OS both scheduled an EMG and it came back confirming the second opinion, but the neurologist refused to give me the actual results of the test and sent them to the PCP instead. (The neurologist also said that he didn’t agree about the CRPS.) Now, there’s only a summary listed in my chart that shows 3 femoral nerve branches are abnormal and I am lacking a future prognosis from anyone.
I’m glad to have somewhat of an explanation, and I am working with a fantastic PT and also electro-acupuncture with infrared sauna treatments. I hope to be able to backpack again one day, and I’m optimistic.
My right hip is definitely ready for replacement and I have been referred to a new OS who I hope to see soon. I know what happened to me is very rare, so I’ll tackle my next with courage I gain from this forum. I’m grateful for all of you as a resource and will keep you posted with the positive results for my next round!
 

Layla

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I’ll tackle my next with courage I gain from this forum.
Thanks for the grateful sentiment. As members, we’re all here to support and cheer you on. I hope you continue to notice progress. It’s encouraging to read you have confidence in your PT.
Wishing you the best, stay in touch!
 

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