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THR Total hip replacement activity level and dislocation

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bonnied999

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I am 5 months post THR on my right hip. I am 56 and was very active prior.

Second I just dislocated the affected hip simply bending down with the leg up on a ledge. Which Was well after the precautions. The leg jerked inward and there it was. ER. I was told that there was a 1% chance of dislocation after the surgery. I am in a brace for 6 weeks and I was told to be careful and it is almost starting all over again. Was told that my chances of it occurring again just shot from 1% to 33% and I will have to do the initial precautions for the rest of my life. No bending down to tie my shoes knee no more than 90 degrees. This has been devastating as I was stretching touching my toes doing a boot camp. If it happens again which would be agonizing they would probably to surgery to make it stable. Nothing is wrong with the hip replacement parts.

Are there others who have experienced a dislocation after THR? and are there more positive stories about post dislocation or advice About activities? Or techniques to help not always having to use the other leg as the weight bearing leg to bend down to pick things up? I feel too young and active to be so limited and want to be as physically active as possible. What have others been able to do if you have experienced this or precautions others really recommend? Positive stories? Thank you.



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Postalgal

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Welcome to BoneSmart @bonnied999 ! Here you will certainly gain a wealth of information . I am so sorry to hear of this. I'm sure the moderators have heard of stories as yours . I am only 3 weeks out. Hang tough, we never give up! Chin up!


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Bonnie, I'm so sorry this happened to you. Dislocations after a THR are not common and there is likely a specific reason why this occurred. I'm going to tag our forum nurse, @Josephine, to come and discuss this with you. I agree that you are too young to have to endure a lifetime of these restrictions. My suggestion is for you to locate one or two good revision surgeons (not connected with your current doctor in any way) and get other opinions. Even though the implant is fine it could mean that it is not the proper implant for you or it was not properly placed.
 

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@bonnied999 I am so sorry you've suffered this shock and setback, and hope you get the answers, feedback and guidance you seek. Will keep following your thread, take care :)
 

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@bonnied999 I agree with Jamie - I would seek out a good revision specialist and see if this is an issue with the implant.

Having said that I don't think I would have attempted that stretch you attempted at only 5 months out. As Jamie says the chances of dislocation are small but that is a pretty aggressive stretch for a new hippie. Was that the first time you did this post THR?
 

Josephine

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Second I just dislocated the affected hip simply bending down with the leg up on a ledge. Which was well after the precautions.
This is a difficult one to explain because though your period of restrictions was ended, you would still be at risk for some months. I made this chart to show what I mean

dislocation risk small.jpg


I was told that there was a 1% chance of dislocation after the surgery. Was told that my chances of it occurring again just shot from 1% to 33% and I will have to do the initial precautions for the rest of my life.
Not sure I totally agree with that opinion!
I just dislocated the affected hip simply bending down with the leg up on a ledge.
It would seem to me from your description that you did grossly overflex you hip which was am unwise thing to do. We had another member who dislocated her hip at one year out by making herself comfortable in this position.

dislocation risk.JPG




it is almost starting all over again.
Can you explain to me what "it" is? I'm a little confused but your statement.
 

FraidyCat

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@Josephine, if I am reading the chart right, the risk of dislocation goes to low only after nearly two years; is that correct?
 
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bonnied999

bonnied999

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@Josephine. Thank you. I am not sure how to post as you did separating out the issues and my content. Can you help with that.?

I really appreciate all of information and advice, perspectives you provided. So helpful. Thank you for taking the time.

In response to your post.

First. Do you mean get a second opinion about a revision surgery? Jamie said the same thing. X-rays were taken pre and post dislocation and no issues were found with the implant according to the ortho. I would hate to have a second surgery but if it means lowering the risk of future dislocations and more flexibility in movement after taking precautions I would support that. My ortho says he would consider putting in a liner if it dislocates again. but should I get a second opinion. I know the original doc might not like that or insurance may not pay. What do you think? But from Jamie's post there may be more methods to understand if it is the best implant for me (size of the ball going in the socket?)

Second No it wasn't the first time doing the flexion. I had being doing this after 3 months. It was just a small shower ledge but bent over was to reach the end of my leg for shaving on my toes a bit Up. Then that leg the affected leg lurched inward. The consequence severe major dislocation. 911 and all day in the ER and two attempts to get it back in. I had been doing forward bends. And dog with the head down for stretching the PT supported these movements.
So do you still think it was aggressive? I gather you are saying I might have moved too fast perhaps in hindsight on the rule of movements or it is a sign that the implant may not be the best fit?

This whole shaving technique has been hard to figure out. After the dislocation I got a long handled tool where you place the razor at the end but it doesn't do a good job. Perhaps sitting. Aren't people able to do regular bending to shave after hip surgery 5 months out?

Third thank you so much for the chart. Now that it has happened it sounds like It is more likely to happen but perhaps being conservative it may be less likely over time?

Fourth, Thanks for the reality check on the 1%. I did hear anterior hip replacements had less likelihood of dislocation? He only did posterior.

Fifth I am not sure what the picture shows. Did that position cause a hip dislocation or is this an activity to strengthen something? What is it demonstrating and is this something to look at doing in the future to help with something. Let me know.

Sixth? I am hoping to go back to a low impact fitness group of women over fifty but not getting much information about what not to do. I am assuming no burpees and no squats lower than 90% I would like to do planks and push ups but have to figure out how to get down and up carefully. I guess I wanted an opinion if it is wise to stick with the very restrictive precautions but have people been able to ease into doing some of thing above and how long after the dislocation even though I was told these are for life? I am in the brace For 6 weeks after which the ortho said I could start PT "light" after the 6 weeks which I assume Means i shouldn't go back to that fitness group until I can do more things in PT? The fitness trainer said they are used to providing adaptations. There is a woman who had two knee replacements and a hip replacement.


"Seventh "It " means the hip dislocation and results feels Like I am right back to where I was post op. Except Worse with the brace and recovery time with no PT for 6 weeks and precautions. It actually is more depressing because they don't want me to do anything like I did after surgery? PT and the restrictions and the brace vs working on movement and strength.

Sorry for long response in one reply. I just didn't know how to reply addressing each of the segments.

Any more clarity, insights, advice, additional information you have or others in the forum has and others experiences and More advice would be so helpful. AS you or others have time. Do you strongly suggest seeking a revision surgeon? I asked Jamie if this type of surgeon is any different from an ortho surgeon who does hip replacements?
Thank you!


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bonnied999

bonnied999

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Jamie. Thank you. That clarifies a question I had. Are revision surgeons different than orthopedic surgeons? Or are you saying to look for another orthopedic surgeon. Can they assess without "going" in if the implant is the right one. I am going to see my doc
Again perhaps it would be good or bad to tell him at that time I want to do this? Or go ahead and find someone not connected. The hard part is insurance and certain doctors who are in network that are not associated with him. Also I will clarify with Josephine. Thank you. Bonnie
I was trying to respond under your post Jamie but it didn't go there. Is this how the thread works a running thread?


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Josephine

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X-rays were taken pre and post dislocation and no issues were found with the implant according to the ortho. I would hate to have a second surgery but if it means lowering the risk of future dislocations and more flexibility in movement after taking precautions I would support that. Do you strongly suggest seeking a revision surgeon?
We've seen this scores of times on here (not necessarily with a dislocation) where people have pain months post-op and their surgeon just keeps saying there are "no issues with the implant". But a surgeon with lots of experience in doing revisions has noticed an malalignment, usually in the cup which the operating surgeon has either not noticed or declined to accept responsibility for.
My ortho says he would consider putting in a liner if it dislocates again. but should I get a second opinion.
I think what he may be referring to is a locking ring which will provide another layer of security. But generally this concedes some degree of malalignment.

locking ring thr.jpg


it wasn't the first time doing the flexion. I had being doing this after 3 months. It was just a small shower ledge but bent over was to reach the end of my leg for shaving on my toes a bit up. Then that leg the affected leg lurched inward. The consequence severe major dislocation.I had been doing forward bends. And dog with the head down for stretching the PT supported these movements.So do you still think it was aggressive?
Dislocations are always 'severe' and 'major'! But Yes, I think you have been doing far too much and at 5 months, this manoeuvre was ill advised. I think it would have been more sensible to have waited until at least 8 months and probably a year before doing things like that.
This whole shaving technique has been hard to figure out. After the dislocation I got a long handled tool where you place the razor at the end but it doesn't do a good job. Perhaps sitting. Aren't people able to do regular bending to shave after hip surgery 5 months out?
Well, you know what? Do you really think shaving your legs was so crucial as to risk a dislocation? I would have thought it was something that could have been left for a while. What's the harm in going au naturale for a while? It's not as crucial as cleaning your teeth, now is it? :wink:
I gather you are saying I might have moved too fast perhaps in hindsight on the rule of movements or it is a sign that the implant may not be the best fit?
Progressed too fast I think is the term. And it's probably a sign, not that it's not the best fit but that it hasn't been aligned correctly. In my experience, quite a number of dislocations in the early days are often due to malalignment - and 5 months out is early.
Third thank you so much for the chart. Now that it has happened it sounds like It is more likely to happen but perhaps being conservative it may be less likely over time?
Correct.
Fifth I am not sure what the picture shows. Did that position cause a hip dislocation or is this an activity to strengthen something? What is it demonstrating and is this something to look at doing in the future to help with something.
Them picture just demonstrates a position similar to the one you assumed when you dislocated. The flexion of the hip is the point I was making.
I am hoping to go back to a low impact fitness group of women over fifty but not getting much information about what not to do. I am assuming no burpees and no squats lower than 90% I would like to do planks and push ups but have to figure out how to get down and up carefully. I am in the brace For 6 weeks after which the ortho said I could start PT "light" after the 6 weeks which I assume Means i shouldn't go back to that fitness group until I can do more things in PT? It actually is more depressing because they don't want me to do anything like I did after surgery? PT and the restrictions and the brace vs working on movement and strength.
One thing I've always advised is that hips don't need any exercise at all. Maybe you want to do it because that's your custom but for the first six months I would strongly recommend none whatsoever.
There is a woman who had two knee replacements and a hip replacement.
So what? There's no value in comparing yourself to other people. She didn't have your condition or surgery and you didn't have hers.
"It " means the hip dislocation and results feels Like I am right back to where I was post op.
Ah - I see. Thank you explaining that.

Sorry for long response in one reply.
Please, please don't ever apologise for the length of your post. We don't have a cap on how long a post can be and sometimes it needs a lot of words to explain these things.
 
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bonnied999

bonnied999

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Thank you Josephine. Very helpful on every question. And I will find the how to use the forum section. I really appreciate the responses and they clarify and help me to think about moving forward. I'll keep people posted.


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FraidyCat

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@Josephine, I'd asked you a question, earlier in this thread (on Wednesday), about the dislocation-rate chart. Still interested in the answer :)
 

Josephine

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if I am reading the chart right, the risk of dislocation goes to low only after nearly two years; is that correct?
Postgal is correct! If you look in the top left hand corner of the chart, it clearly says "WEEKS".
 

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Are revision surgeons different than orthopedic surgeons? Or are you saying to look for another orthopedic surgeon. Can they assess without "going" in if the implant is the right one.
Revision surgeons are different. While they will often do primary knee and hip replacements, they also have a higher level of expertise that is needed when there are problems after surgery. They've seen a bunch of these cases (you want to check how many revision surgeries they do each year) and they can often see things that your original surgeon misses. They can do an evaluation of your situation with no invasive procedures.

I am going to see my doc again perhaps it would be good or bad to tell him at that time I want to do this?
I wouldn't tell him. There is no need to and you really want a totally independent opinion. The option for additional opinions is yours and you should never feel guilty about seeking as many opinions as you need to feel comfortable about these decisions. I have never known of insurance not to cover additional opinions, but if you're concerned contact your insurance provider and ask.

The hard part is insurance and certain doctors who are in network that are not associated with him.
It depends on the type of insurance you have. Are you in an HMO? That does make things a bit more difficult and you may need to travel to a different city to find someone not connected to your current surgeon. But this is important and it is worth a little extra effort, if necessary, to get to a good revision surgeon.

Is this how the thread works a running thread?
Posts in your thread run sequentially by the date and time they are posted. This is why we have the "quote" functions available. If you're responding to a post that is at the end of a string, you may not need to quote the portion of the post you are addressing. But using the "quote" feature really helps when you are responding to a post that's way up the line. Don't hesitate to ask if you have any questions. But do take a look at our "How To" forum that Jo linked for you. You'll find lots of things there to make your participation here easier and more fun.
 

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But it varies you see. From person to person it varies. In my chart I've quite clearly said that it is just "to give you a general idea" how the risk factor works.
 
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