Revision THR Warm backside

[elliemom]

@Jamie ...today was long and no way to shorten...unless I told my client "no"...I have no intention of doing that. The next three days will be physically gruesome, but mentally creative, so we'll see hoe that goes. One day at a time and keep on putting one foot down in front of the other!

 

[elliemom]

It's been weeks since I've felt a need to ask for help...at least an opinion or two.
I just had my 3 month follow up visit with OS and all seems to be status quo, good healing of tissue and bone.
An interesting note though, was healing time just expanded from one year to two. I know there is no precise answer to the question of healing time, but I do have a few concerns that I'd like to hear back from the experts and revision fellows. Involved in my revision, was a trochanteric and subtrochanteric lateral osteotomy.
I'd be interested in knowing if this makes for a longer recovery from pain, as I still have a fair amount of pain, sometimes shooting and sometimes just a plain dull ache. Of course, OS indicates that some pain can be expected....as noted above. If there is something I can do to strengthen muscles, I'd like to know the proper exercise. Also...trying to get off Tramadol and occasional hydro, but I read awful articles about Tylenol and Aleve.
Is plain old aspirin a good idea?....coated?

 

[elliemom]

Do some people with hip replacement never recover fully? By that I mean, always have pain and never regain full range of motion. It seems bleak at 6 months post revision .

 

[Jamie]

Elliemom.....I'm so sorry that for some reason your post back in March was overlooked!!! We try really hard not to let that happen!!

Aspirin or any other NSAID is an anti-inflammant and not usually as good for pain as Tylenol. As long as you stay withing the guidelines for Tylenol dosage (1000mg per dose and no more than 4000mg in a 24 hour period), you should be fine with it. More than that can be a problem for your liver. And, of course, if you have any other liver issues, you should not take any of these meds without talking to your doctor first. With Tylenol (acetaminophen), you also need to count any other sources you might be taking like sinus or cold medication. It's important to read the labels and know what's in anything you take.

Certainly there are people who have ongoing problems with a joint replacement, but they are an extremely small minority of patients. In your case, I do think the additional work that had to be done could cause a longer recovery.

I'll tag @Josephine to respond to your pain questions. In the meantime, can you indicate on this chart exactly where the pain is and what causes it? Also, what makes it better?

Can you tell me the exact site of your pain using this chart?

 

[UHOHHO]

@elliemom...I hear you. It's been six months for me as well and the only thing that is just starting to be better is walking. It's been a very very long tiring process. I don't have pain from my hip anymore and the stabbing stopped but my nerves are slow to heal and my back prevents any real excersing. I guess this is it. I'm sorry it's been bleak for you.

 

[elliemom]

@Jamie... Thank you for the chart. Most of the pain is DL1B and seems to go right through to DL5F. At rest it is just an achy pain, but walking or squatting, is sharp and occurs when brining that leg forward during the stride.
I've been using 1 50mg Tramadol with 1 500 mg Tylenol twice a day and it helps a bit.
I've started PT and hope this helps, though there seems to be a great deal of effort correcting the LLD (with deep muscle massage on right piriformis) which turns out to be almost an inch and breaking up scar tissue along the scar and down to the knee with some interesting rod tools and electronic acupuncture on the scar. I am working on overall strength training and stretching, especially abductors and hamstring. Pain at A4B I'm sure is from my gait issues due to the LLD.
I'd post a picture, but not sure how to do that.
Good luck @UHOHHO...I guess we just need more time.

 

[Josephine]

Involved in my revision, was a trochanteric and subtrochanteric lateral osteotomy. I'd be interested in knowing if this makes for a longer recovery from pain

Yes, of course it does which is why we stopped using it back in the 70s when it was a routine part of a THR. But then it was shown that it added weeks to the recovery period!

I've been using 1 50mg Tramadol with 1 500 mg Tylenol twice a day and it helps a bit.

Considering that Tramdol and Tylenol are only active in your body for about 4-5 hours, taking them twice a day is not helpful. You need to take them 4 times a day for good effect.

I've started PT and hope this helps, though there seems to be a great deal of effort correcting the LLD (with deep muscle massage on right piriformis) which turns out to be almost an inch and breaking up scar tissue along the scar and down to the knee with some interesting rod tools and electronic acupuncture on the scar.

Sounds like a lot of hyperbole in there!

I looked at your pain site - these are it, yes?

Well the blue is nothing more than Trochanteric bursitis with THR and ITB (ilio-tibial band) issues. I suggest you get your surgeon to inject the TB with cortisone and you follow the stretches in the ITB article.

As for the green spot, that's most likely Iliopsoas syndrome which is also very common after THR. Again, check the article for appropriate stretches.

Pain at A4B I'm sure is from my gait issues due to the LLD.

There should be 4 characters there, Ellie. What's the other one?

 

[elliemom]

@Josephine I'm not sure what you mean by hyperbole. Not that I don't know what that means, but I was explaining what a typical PT session consists of. Can you explain? The deep massage on the right piriformis muscle and light stretching is an effort to correct the pelvic tilt and release tension in the shorter leg.
Also, the response to : "Involved in my revision, was a trochanteric and subtrochanteric lateral osteotomy"... This was apparently something necessary to remove the stem. What is used now when the stem doesn't "tap" out?
Pardon me for omitting a letter. That should have been AR4B.
I'll check out the stretches and ask PT about the bursitis, then proceed to cortisone shot if necessary, as well as increase Tramadol and Tylenol. Thank you, Josephine.

 

[Josephine]

I'm not sure what you mean by hyperbole. The deep massage on the right pisiform muscle and light stretching is an effort to correct the pelvic tilt and release tension in the shorter leg.

Do pardon me - just me being a little cynical! I l do love the way PTs embellish what they are doing with all this talk! Fact is that almost none of that is going to help reverse your pelvic tilt! Only time will do that.

Also, the response to : "Involved in my revision, was a trochanteric and subtrochanteric lateral osteotomy"... This was apparently something necessary to remove the stem. What is used now when the stem doesn't "tap" out?

Oh I understand that and it is still used on occasions though there are special tools now that will clamp on the top end of the stem and withdraw it but if they don't work then bone has to be cut!

That should have been AR4B.

That's okay - thank you. That site is the SI joint, most likely pulled out of alignment by your pelvic tilt. I suggest chiropractic treatment!

 

[elliemom]

@Josephine...so it sounds to me that I should stop PT, see a chiropractor, and then ask OS for cortisone? My how much $$ we spend hoping to fix our bodies that isn't. I did get a ball and weights for core training, which feels pretty good and riding recumbent stationary bike. Now if only the afternoon thunder showers would ease up in FL so I can begin water walking and swimming! Thanks for your common sense approach. Your experience means a lot. I even told my PT to check out this forum. I'm sure she will recognize me.

 

[elliemom]

 

[Vetgirl]

Hi @elliemom sorry to see your still in pain. I hope some of Jo's suggestions help you.

I love that comic. A friend sent it to me...very funny!!!

Hang in there....