THR Double THR Recovery

[Horseshoe]

Hi everyone, I haven't posted here in awhile and wanted to write an update as I remember how helpful it was during pre-op. I'm about five weeks from my last RTHR and seven mos from my first LTHR. Both THRs were spinal with sedation, anterior approach and uncemented ceramic on polyethylene, performed at the same hospital. Staples for the first, dermabond (glue) for the second. Aspirin twice daily for blood clot prevention.

Good news is that THR surgery wasn't bad at all! Pre-op pain and nerves were much worse than surgery and any post-op pain can be managed -unlike pre-op pain :(

There's also a magical moment to look forward to after surgery when you first stand up and realize there's no more grinding bone on bone OA pain! It's gone, it's history.. it's been cut out -yahoo!!

I def had a case of pre-op "THR terrors" along with horrid unrelenting pain from severe end stage OA in both hip joints. By comparison, the aftermath is very do-able, it's more of a nuisance. I had no problems coping either, was not bed ridden at all. I was very mobile, almost too mobile and found patience I never knew I had.

As on bonesmart, OS said each recovery and speed of recovery is different and not to compare scars. I found the super quick recovery stories very positive and inspiring and was glad to read them. I am having two satisfying typical recoveries and wanted to put it out there too. First hip is responding well to this second new hip.

Thought I'd have super fast recoveries as I recover quickly but my hips had other plans. First hip was worse than my very bad second hip. Pre and post-op, I had severe muscular contracture and tendinitis in both upper legs.. top, side and groin muscles were angry. Recovery from first THR was good at the beginning and then somewhat slow, second has been great. OS seems very pleased and assured me this is all very normal. In the beginning I'd see positive changes daily, then weekly then none at all and then it would advance again, kind of ricocheting around.

For me, post-op is like going through life in slow motion and becomes rather boring. My main challenge is to not overdo *anything* despite wanting to get back in the game. Bonesmart moderators and advisors correctly advise to do half of what you think you can. As for PT, I didn't do any the first few weeks except ankle pumps as they wake up my legs before standing. Just did gentle stretches that OS prescribed, may use PT for future gait training. I resigned myself to a long recovery if needed for the second THR, having learned a few lessons from the first.

I can write more details and tips learned in a later post, just wanted to spread some cheer. Looked around here and noticed there are a few people in between surgeries from two bad hips. I remember the frustration of waiting in limbo and recall the day when recovery from the new hip was getting hijacked from pain in the bad hip, no respite to be had! New hip was doing great, bad hip had slowed its progress.

Lastly, I'm solidly in the "don't wait, do it now" camp. It took time to wrap my head around it but the benefits have been great, both mentally and physically. I found the mental drain of chronic pain is not to be underestimated, it affected many aspects of my life even things I was unaware of and thought I'd covered up with a happy face. It didn't do any good either to have sick hip joints physically wearing down my body as it tried to heal from a progressive disease that would never get better on its own. Thankfully, surgical intervention offers a permanent solution.

*edited for clarity/typos

 

[Pumpkin]

Horseshoe,
Happy to hear you are doing well with your new hips, and have your life back. Thanks for sharing the ups and downs of your recovery, we all think ours should be a straight upward slope, when it reality it is more of a zig zag.
Wishing you continuing healing.

 

[chuckster]

Hi Horseshoe

First of all congrats !!! Secondly, your post couldn't have come at a better time for me.
I've read it many times over already and printed it out as a reminder of many things.

I'm Chuck and I am age 57 I was a vibrant happy part time accountant part time tennis coach. I've played for 40 years and I'm about 40 lbs overweight. That combo and other things had resulted in severe end stage OA in both hips. After a slow painful 2 year deterioration I was diagnosed last summer and had a LTHR on Dec 15 ( 8 weeks ago ). I was scared I've never had any surgery it was much easier than I thought and I had a great surgery. The OS showed me a pic of the hip he took out in the hospital saying it was one of the worst he's ever seen. I had a speedy and excellent recovery. It's getting stronger every day.


Unfortunately my right hip is now getting worse every day and I lay in bed as we speak almost in tears the pain is brutal and debilitating like you said. Discussed getting the second hip done in fall originally but no way I could wait till then I called the other day and scheduled it for April 27. I literally wish they would do it tonight. After making fast progress originally I have regressed I'm still in the cane ( for my old hip) and it's brutal.

Thank you for your words this evening please read this and give me hope and encouragement because after initially feeling like I made great progress I hope I can just make it to #2. Your story gives me hope and again my congrats to you!! This is the hardest thing I've ever faced bar none and I need and appreciate the support here. God bless.

Chuckster


Sent from my iPhone using BoneSmart mobile app

 

[Horseshoe]

Pumpkln, thanks for the nice welcome!

Chuckster, I remember waiting with that pain for months until the next surgery. Argh. April will be here soon, ask to get on a cancellation list and check in regularly. Knowing there was a date made the waiting part easier to bear. Also, ask OS about pain meds while you're waiting.

In the meantime.. I found that using crutches, even just one, opposite of the bad hip, helped keep the weight off that hip and reduced the pain. I used a walker at home and iced constantly. Slept with a large slushy homemade ice pack on top of hips and a sturdy one underneath, an ice pack sandwich . Extra strength Tylenol took the edge off and only used XS Advil when it was hitting a ten on the Richter scale of hip pain along with pillows between and under the knees. And oh, calcium citrate from Trader Joe's -no less- helped dreaden bone pain and calm the nerves. These are all small things when done collectively helped ease the pain spikes.

Pre-op pain is tough, hang in there. I hope you find this encouraging, you're already half way done and will soon enter the home stretch for hip #2. Keep your eye on the prize

 

[Jaycey]

@Horseshoe Welcome to the other side again! You are so right - no 2 THRs are the same even on the same person. Your slow and steady pace will go a long way during this recovery.

I am sure you have already read these but I will leave your recovery articles here in case you need any reminders. Happy healing!
First are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

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
Activity progression for THRs
Home physio (PT)
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?

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.

 

[Miss Muffet]

Great news @Horseshoe - I'm referred to by the kids/grandkids as a "double amputee" and couldn't be more grateful for the gift I've been given. Very happy to hear how well you're doing, and it has shaken me into thinking I too must update my thread. Wishing you continued enjoyment and freedom!

 

[kaliella]

I found the mental drain of chronic pain is not to be underestimated, it affected many aspects of my life even things I was unaware of and thought I'd masked.

That is so true! After healing from surgery I feel like a huge weight has been lifted off my shoulders, just knowing that my hip is taken care of and I won't have to worry about worsening pain and mobility anytime soon.

 

[Horseshoe]

Thanks @Jaycey The articles are worth reading again and again, full of useful tips. You're right about the surgeries being different, I remembered your posts when my second hip was recovering differently albeit better than the first. Love your donkeys btw, they look sweetly mischievious.

Nice to see you @Miss Muffet Glad to have joined the double hippy club. I enjoyed your recovery thread and also adhere to taking it easy during recovery, my second hip is loving it! I'm able to do more than I allow myself but am happy to wait. Noticed those who took it slow and easy have fared very well. Just because you can, doesn't mean you should is the mantra I sticking to.

Hi @kaliella , glad your recovery is going well and that you feel relieved and happy again . Thought I was covering it up by acting happy during pre-op. Admit I wasn't as social, declined invites and stayed home a lot, just didn't have the energy or patience. Watching silly comedies helped, nothing like a good laugh to reduce stress. After surgery some friends said the pain on my face had been quite evident (they felt bad for me) and I now seem lighter, more like my old self. Works for me

 

[chatterz]

After surgery some friends said the pain on my face had been quite evident (they felt bad for me) and I now seem lighter, more like my old self. Works for me

That's something that we don't often think about. That pain did show in our faces and in the way we carried our bodies. After my first hip surgery, I didn't recover as quickly as anyone (myself included!) would have liked. The other hip was holding me back. I had a few setbacks on my way to getting the other hip done, now that it is accomplished, I must say that it's amazing how many people talk to me when I'm out and about. I must have had a crochety unpleasant look about me while I was in pain, and who would want to converse with that person?!

 

[chuckster]

Thank you horseshoe !! I'm in a bit better frame of mind today albeit still feeling the dramatic bone on bone pain in hip #2 ... thanks for the encouragement and tips I appreciate it. I can't wait to have the old Chuckster back.

All I keep thinking king about is walking into my sons HS graduation on June 9 and giving some kids tennis lessons and the beach this summer. I got my eye on the prize I got this !!!!

Keep us updated on your progress and I'll keep on hanging in there until I'm a double hip man!!

Chuckster


Sent from my iPhone using BoneSmart mobile app

 

[Miss Muffet]

So many familiar words here. The remarks by others that we "look better, walk better" - things which had become parts of our lives which we simply lived with and we now recognise as so much improved. I was stunned when I was told I needed a second THR, but having had Hip #1 done I welcomed the opportunity to get levelled up as soon as possible! So @chuckster your time will come, and in the meantime keep the weight off that sore hip and, as recommended, ice and use walking aids to help take the strain. I would also recommend that you don't push, pull, lift or carry anything vaguely heavy - I found this really did aggravate things so are best avoided, because I would pay the price for a couple of days afterwards. Best wishes.

 

[Jaycey]

Love your donkeys btw, they look sweetly mischievious.

They are indeed. Anyone who says donkeys are dumb doesn't know donkeys!

After surgery some friends said the pain on my face had been quite evident (they felt bad for me) and I now seem lighter, more like my old self.

I remember this. After both THRs it was like a weight was lifted. No more planning life around hip pain!

 

[Horseshoe]

Hi, I'd like to get some advice. Recently had two THRs, OS said he would use the same implants for my second RTHR that were used on my first. Well, I received my hospital medical records today for the new hip that states a different femoral head implant was used. I'm shocked this has happened.

Records state a metal head (oh no!!) was used, not ceramic as was discussed at my appts. I have the same poly liner, stem and cup that was used before.

Why would OS have changed the type of femoral head implant without informing me beforehand? He *never* mentioned a metal head as a possibility, had no idea these were still being used.

If it was an insurance co or hospital expense I would have paid the difference. I'd actually be willing to take it out to get this rectified.. trying hard not to panic but this has come out of left field and feel betrayed, I trusted this dr completely.

I'll call his office tomorrow morning, hopefully this is just a paperwork error. I made it a point to research implant types and be informed, it's a big deal to me and like everyone else, implant safety was crucial.

 

[Jaycey]

@Horseshoe So sorry about this "surprise"! I am sure there is a good reason for the change and I would definitely discuss this with your surgeon.

Why would OS have changed the type of implant without informing me beforehand?

This decision will have been made during your surgery.

Please let us know what your surgeon says.

 

[Clipper]

I can understand the betrayed feeling. My OS said pre-op he would use the same implant in my 2nd hip and make both legs exactly the same length. After surgery he said he used the same kind and brand of implant, but there was some problem with the bones that caused him to use a smaller size. Hence my 1st operated hip leg (left) is now still longer by 2 cm and I'm using shoe lifts to make up the difference. I would ask your OS why he changed things at your next appointment. My OS made the decision based on what he found during the surgery since he couldn't very well wake me up and ask for my approval. I'm OK with it and trust he acted in my best interest.

My implants are all titanium with ultra-high density polyethylene liners. These new liners will last a long long time. I can't see how a metal ball would wear the liner out any faster than ceramic. Instead of getting the ball changed to ceramic now, maybe it would be better to wait 20, 30, or more years. Maybe better materials will be available by then. Just thinking out loud.

 

[Horseshoe]

Thanks for your reply @Jaycey. Called the office and the assistant called back after she spoke to OS and said a ceramic head *was* used for this recent RTHR, same as the first one. Whew.. what a relief. Hospital implant records are incorrect though, does this happen a lot?

I've been taking this recovery nice and easy and this was a jolt, glad to relax again.

 

[Horseshoe]

Hi @Clipper , thanks for your reply. I updated Jaycey above that OS said a ceramic head was indeed used so I'm relieved but think it's odd that records show otherwise. Similar sizes, not same, were used because he adjusted for LLD.

Does your OS say whether your body will adjust in time or does he think it's permanent? Lifts in shoes are do-able but going barefoot would hurt.

My LLD was obvious between THRs where my op leg was def longer and I tried some lifts too, had a really clunky walk. The severe hip OA made my knees bow inward and strike each other, legs used to be straight. OS said this may affect LLD. I'll give it a few mos to see if it will right itself. Apparently my hip OA had been coming on for a few years but I didn't know.

Your last THR was fairly recent, I hope your LLD gets better.

 

[Jaycey]

Hospital implant records are incorrect though, does this happen a lot?

Unfortunately yes this does happen. Although your surgeon is ultimately responsible for ensuring the correct information is in your record. Ask him about it at your next appointment.

So glad you can relax and get back to focusing on your recovery.

 

[Clipper]

@Horseshoe - Glad you straightened out the implant material question. What a relief!

Unfortunately, if LLD is real, it will not get better or 'even out' over time. For that to happen, bones in the shorter leg would have to grow longer and that simply can't happen. The lifts in my shoes were done by a shoe repair guy who did an excellent job. They are no problem at all and that extra 3/4 inch really helps level my gait.

 

[Horseshoe]

Seven week update for second THR and also some detailed comparison notes to follow on two sequential thrs for those interested. Each surgery was different yet similar on the same person, OS and hospital.

Pain- mostly some stiffness now, much less than first thr, use occasional XS tylenol. Stopped the aspirin for blood clotting last week and noticed my pain increased just a little, probably the anti inflammatory properties so I went back to half dose at present.

Walking- able to move around well, can do stairs normally using rails, get in/out of car ok but still have a choppy uneven gait. Op leg still feels big, hoping this will even out in time so I still use one crutch or a cane but would like to drop these.

PT- OS prescribed it and therapists report back to OS and will focusing on gait training. PT is overly enthusiastic, keeps mentioning cases where people are back to life in no time whereas I'm still stiff lol. I walk daily, do gentle stretches and so far, no pain. Would have preferred a massage therapist for my legs but it's not covered. Noticed some people's PT's knead and massage leg muscles though mine does not, unfortunately.
-----------------------------
For those interested, below are some surgery details from my two thr's. It is long. During the pre op phase, I was itching for such details, no matter how graphic, as it helped calm my fears. This is my pov, not a medical one, and note, some of this may be tmi.

Sequential thr's- I wanted a bilateral as both hips were bone on bone and very painful, was on crutches/cane. OSs I consulted said I was a great candidate for a bilateral but would not do it citing extra stress on body, blood loss, etc. Mine were done six mos apart which felt like a very long time. Was ready to get the second thr at three mos but then had to wait for a surgery date. Tip: schedule second hip asap, you can always reschedule.

Pro's- the extra time allowed my body to heal from first thr and get strong before second surgery, it was helpful recovering on a non op leg.
Con's- so much time spent recovering and waiting. Recovering on a bad leg hindered progress.

Implant type- I was interested in this aspect, preferred CoC as I'm on the younger side aiming to resume my sporty activities and had concerns about plastic wear particles down the line. OS agreed on a ceramic head but cited possible shattering/squeaking with ceramic liners so he went with poly liners.

Spinal w/sedation- wonderful both times and also had a pain killer, Exparel, injected into the thr wound before closure that lasted about 48 hrs -great stuff! Blood loss was average for first and minimal for second thr, little bruising, if any, for both. Had slight anemia with the first. Low BP during post op recoveries though I bounced back faster from the second. Three day hospital stay for the first, four for second thr. Didn't mind the extra days, OS stopped by every day and I was happy to be monitored by medical staff during the aftermath of two major surgeries.

I experienced hair loss from the first thr though not from the second. Not sure if it was from the powerful meds, anesthesia? Took extra biotin, msm, iron, protein after first thr and so far, have not experienced hair loss from the second.

Pain: mostly muscular in nature, never felt the the implant itself and had no clunky feeling, it was very do-able. Had a behind the ear anti nausea patch in the hospital but still vomited three times after the first thr and seven after the second. Guess my body doesn't like narcotics! Btw, vomiting wasn't bad and in fact, I felt better afterwards. Sent home with percocet, then narco, and anti nausea meds. Only used these for a few days before switching to XS tylenol. Narcotics made me groggy and stopped me up even with stool softeners, prunes, etc -but they were essential the first few days. The long awaited bm promptly came after I quit the oxy meds, within a week. Also did a tummy massage I found on youtube to help get things going which worked a charm.

First thr had staples, second was dermabond/glue. Loved the glue, scar looks great; first thr scar has widened considerably, may look into a scar gel. Both were anterior approach, about 5 inches long, had Aquacel dressings, no leakage and took a shower the day after I got home.. bliss!

Sleep was good for both thrs, no insomnia. In fact I made myself take daytime naps until they interfered with night time sleep. Percocet dreams were amusing and in color, it was like a tv series, each sleep featured a new episode.

Mood: had no real mood issues, just one frustrating afternoon when cabin fever hit me, it was pouring rain outside and I couldn't yet drive and felt stuck. I could drive within ten days for both thr's.. had been off all oxy meds for days, leg swelling had subsided. I practiced in the driveway beforehand and took very short trips using side streets.

Hospital experience: first thr was good, second was disjointed. Had better pain relief with the first thr, also had my own room. Hospital seemed calmer than the second visit where I had a roommate who moaned all four days from nausea, I felt sorry for her but it got tiring and I'd escape on my walker into the hallway for a break.

During discharge on second thr I could not flex my op leg knee -at all- and as a result could not get into the car to go home. This had been a known issue during my stay.. I had experienced difficulty getting on/off my bed, leg was very swollen (a nurse had tried to lift and force my leg one time -ouch!).

I didn't have a Hemovac drain for the second and noticed a significant difference (increase) in swelling. Nevertheless, an OT had apparently signed off on my discharge but never actually saw me perform getting in/out of a car as I could not do it. Had to arrange a ride home in a medic van and ended up waiting in reception for two hours; had no meds, money, argh.. I was under-medicated and discharged before I was actually mobile.

OS notes: he said my second thr went much better than the first. For both thrs, the femur heads were wedged/fused into the acetabulum, he had to use an instrument to scoop out the heads, said it took some doing too. When he opened the hip capsule during the first thr, synovial fluid spewed out indicating much inflammation (it was strangely gratifying to know that my horrid pain had actual proof). Bone stock and quality looked strong and healthy -great news.

Had a Hemovac drain and catheter for the first but not the second thr. Had much less leg swelling with a drain and liked the convenience of a catheter. OS said I didn't need either for the second though I would have preferred them.

I had very light sedation (no versed) for the second thr and was awake when wheeled into the OR. The room was brightly lit with big overhead lights and smaller than what I'd anticipated. Leaned over, got the spinal and was still awake and saw some of the OR prep.

Lower half of body went numb, it was weird watching my very stiff and arthritic legs getting strapped onto the Hana table. Fascinating to see the team all doing their busywork. Pleased to say they don't take much notice of you during the prep part, cleaning, draping, catheter, etc (felt shy about this part). At this point, the anesthesiologist put me out and I'd seen enough

I woke up before the end of surgery and saw the assistant surgeon sewing me up.. he smiled, I looked up and thanked him and was immediately put back to sleep lol. It didn't upset me, it was all very calm and quite interesting. There was a small tent between my upper and lower half so even if I had awakened during the main part I wouldn't have seen anything. Didn't hear anything but quiet chatter, the medical team were focused on their jobs, it was all very professional.

Both thr's followed the usual path post op. I remember being in PACU and eating ice chips while watching the monitors. I was then wheeled to my room and recollection gets a bit hazy due to meds and sleeping. I did get a spike of burning torch pain in my quads for both thrs and believe I was given Toradol which worked well. Found I could tolerate iv meds much better than pill form which I promptly threw up.

So far I'm thrilled to be done and hope recovery continues normally albeit speedier, my hip saga from correct diagnosis to thrs has taken up the better part of two+ years. I'm looking forward to getting back on my bike, horse etc., and to the forgotten hip stage