Revision THR What all does this involve?

[Josephine]

Oh, a cautious chap, then! Well, though I do bear in mind that you've had a revision, I am happy to tell you that I've heard many hip surgeons quite confidently referring to a 'forever' hip though this does juts refer to the implants, of course. I do know there are many reports coming in of people who are still going strong on hips that were done back in the 70s! Read these
Hips that have lasted 41, 40 and 32 years
Longevity of implants and revisions: how long will my new joint last

You know, of course, that this is dependent upon lots of other factors.

 

[Angie68]

Ugh! I am 16 weeks out today. I know every hip & surgery is different. But it is very hard not to compare your other surgeries. This left hip is my 4th hip surgery. I have never had any other recovery move so slowly! I am usually walking without a cane by 12 weeks. I am still using my cane at 16 weeks. I did have to do 6 weeks of nwb due to bone grafting. At 6 weeks out my xrays looked good & I was given the go ahead to walk. Dr did say that he wanted to have another look after 8 weeks of walking on it. I had to reschedule the morning of that appt & I couldnt get back in til Nov 1st. So I have not had an xray since 6 weeks out. I dont have much pain. I have a slight ache or soreness. Its just that the leg is so darn weak! If I try to walk without the cane I have a terrible limp. There is no way I am ready to get rid of it yet. I am just so frustrated. I am only 44 yrs old & I have 3 kids still at home. I have basically been limited on what I can so since April with both revisions! I need to be moving better than this. Does bone grafting make a big difference? Could that be the hold up? Dr did say that I wore him out in surgery. He had to do a lot with me.

Josephine

 

[Josephine]

Does bone grafting make a big difference? Could that be the hold up? Dr did say that I wore him out in surgery. He had to do a lot with me.

Well I think his comment about says it all! There are a lot of different things can come under the term 'bone graft' so it rather depends upon what he did. And if he was 'worn out' by the operation, then I think you can fairly safely presume that for you, it is making a bit difference! But you do seem to be having a long old haul of it. 16 weeks - sheeww! You poor wee lassie!

 

[alexthecat]

Angie, are you working with a physical therapist now? I know most people do fine on their own but, for those of us with more complicated surgical histories, I think the right PT can make a big difference. That was my experience anyway.

 

[Angie68]

Angie, are you working with a physical therapist now? I know most people do fine on their own but, for those of us with more complicated surgical histories, I think the right PT can make a big difference. That was my experience anyway.

No I am not working with PT. My DR wanted me to have home PT as soon as I got home. I only have one agency in my ins network that will come to my home. I had a terrible experience with their one PT in 2009 with my 1st hip. I called to see if he was still there & he is. I refuse to let this man into my home. I have worked with several PT's as outpatient & got along wonderfully with all of them. This particular PT insisted that at like 9 days post op I should be able to do a straight leg raise off of my bed. He said it was simply mind over matter. Im telling you if someone told me the house was on fire & I wasnt getting out unless I raised that leg I would have been burnt to a crisp. There was no way it could be done. There's a lot more to the story. He was very rude. I told my Dr I would not do home pt & he was fine with it. But I do wonder if we should have done outpatient when I was given the go ahead to walk. I have a call in to my Ortho right now. I should get a call back tomorrow. Going to see if he thinks I should start some pt. I am way over this. Been crying most of the day. So tired of looking around & seeing a hundred things that need done..

 

[alexthecat]

I'm sorry. I can see how frustrated you are and I completely understand. It sounds like you have a plan though and that's good.

I had a bad experience with home PT too. I felt like the guy was very cookie cutter, treating everyone exactly the same. I had a great experience with outpatient PT though. I had two PTs in the same clinic. One was a specialist in joint replacement and the other specialized in athletic rehabilitation. It sounds like you already know where you want to go for PT, so just push your doc for a referral. I do think a good PT can get you moving forward again.

 

[sandybeach]

Angie68 I just got caught up with your posting. I feel for you and all that you have been through. You are stronger than you give yourself credit for and a day or two of a pity party is probably just what you need. You have been through much more than most of us on here and all your surgeries you have had close together. I know if I ever have problems with my replacements you are the person I will remember and know you went through it and did fine. Most of your posts are matter of fact with lots of time between them, either have a lot of family and friend support, which I hope you have or you're braving it alone. I did PT in the beginning after my surgeries and decided I could do better by myself. The PT I had was not unique to me and that was not good. If you do as alexthecat has suggested and find someone who specializes with joint replacements that might do you a world of good. All the things you see that need to be done will be done in time. Just take care of you for now and I am speaking from experience.

 

[alexthecat]

Angie68 If you do as alexthecat has suggested and find someone who specializes with joint replacements that might do you a world of good.

To be clear, that is not what I am suggesting. I got much more benefit from working with the sports rehab PT than the joint replacement specialist. The joint replacement specialist was mainly focused on activities of daily living and mundane things like housework. The sports rehab PT was more in step with who I was as an individual and seemed to have a better understanding of my goals in recovery.

So, my suggestion would be to find a PT you like and can communicate with. I don't see any advantage to seeking out a joint replacement specialist. If anything, they seem to be the ones with the cookie-cutter approach.

 

[sandybeach]

alexthecat sorry to have misquoted you but this is what I was referring to:

I had a great experience with outpatient PT though. I had two PTs in the same clinic. One was a specialist in joint replacement and the other specialized in athletic rehabilitation.

In my experience, a PT that doesn't know what they're doing can hurt you.

 

[alexthecat]

Both my PTs knew what they were doing and neither of them hurt me. However, I did find that I "outgrew" the joint specialist very quickly. I was a more complex case than he was used to and his repertoire didn't seem to extend beyond leg lifts. That wasn't really what I needed. He was fine immediately after my THR but, as I said, I benefited much more from working with the other PT, who seemed to have more experience with younger, more active patients and who was more well-rounded in his experience and expertise.

 

[sandybeach]

I was going to PT between surgeries and continued to see no progress, many times I hurt more after than before. I went once and had really bad pain for about a week afterward and I canceled a few appointments after that. I told my PT I had canceled because of the pain I was in. She then told me she had never worked with someone who just had surgery and was scheduled to have another. I should have be told that up front and had someone else who had that experience. Lucky for me there was no lasting damage done.

 

[Angie68]

Sandybeach you made me cry. Thank you. I do have a lot of support. My husband works a lot of hours but when he is here he is great. My Mother is a young, healthy 62 yrs old & lives 3 min away. I also have a couple of Sisters who have been a huge help. My oldest daughter is 20 & has been great til lately. She has really let up. I really think she thinks I am "milking it". Nothing could be further from the truth. I want to do stuff so badly.

I called my Dr yesterday & his nurse called back today. I asked her if maybe I should start some pt. She said absolutely not til my next xrays on Nov 1st. I told her I was so frustrated that I was 16 weeks out & still on a cane. I have always been cane free by 12 weeks. She said she wasnt surprised at all. She said you had a huge surgery Angie! Lot's of bone grafting and a reconstructive cage? I have never heard of that. Going to have to do some research on that one. She said this one is going to be a lot diff & move a lot slower than the others. We will take a look on the 1st & maybe talk about some pt then. So that has made me feel better. At least it isnt unusual & Im not "milking it"!

Josephine

 

[alexthecat]

Angie, do you have an X-ray or can you get one to post here? I bet Jo would like to see that, if you don't mind sharing.

 

[Angie68]

No I don't have a copy of X-rays.

 

[Josephine]

Lot's of bone grafting and a reconstructive cage?

Ah, so that's what he did! So let me explain.

It would appear that what you had is a form of joint damage called a protrusio which means the floor of the acetabulum (socket) had given away and the head of the femur was extruding into the pelvic cavity. This is not all that uncommon, actually, though in most cases, the bone has just broken through a bit and in other, less usual cases, up to half the head has pushed through.

But it all means that the floor of the acetabulum has to be reinforced and this is usually done with a choice from a variety of devices that are available. Most devices look something like this, the Mueller ring, but it could also just be a sheet of wire mesh which is cut to shape and molded at the table.

So the socket it prepared in much the same way as normal and then the ring is set in place. Some types are secured with screws though not all of them. Then bone is used - usually that obtained from the Bone Bank in the form of frozen femoral heads donated by patients when they have a hip replacement! This femoral head is milled at the table and the bone meal used to pack around the shell, behind it and within it, where ever he deems it appropriate. Sometimes bone struts may be needed and for this the surgeon might take some hard bone from your pelvis to use to shore up the whole construct. These also may or may not be secured with bone screws. The more work he did, the longer you have to go lightly on it so as not to undo all the reconstructive work he did.

You may also be assured that generally hips don't need a huge amount of PT. They have a neat way of working things out for themselves if given half the chance. The only exercise you will really need is walking - but not yet!

 

[Angie68]

Thank you for taking the time to explain it to me Jo.

 

[Angie68]

Josephine Your last sentence concerns me. My Dr told me to start walking at 6 weeks. Do you think that was a bad idea? Or are you just saying not to do a ton of walking?

 

[Josephine]

I told her I was so frustrated that I was 16 weeks out & still on a cane

Sorry, I meant 'normal' walking and not a ton of it!

 

[Angie68]

Sorry, I meant 'normal' walking and not a ton of it!

Shew, thanks!

 

[sandybeach]

Angie68 Did your surgeon talk to your husband after surgery to let you know what all he had do during surgery? Or on your follow-up visits, hasn't the doctor explained to you what had to be done? It seems odd to me that the nurse on the phone just told you a huge piece of information that you weren't aware of. Did they have to do that intense of surgery on both sides? No wonder you're not walking without a cane or aids yet. I know how frustrating it is to want to get on with your life but as you heal you will be up and moving around. For now you don't want to jeopardize the healing that is so much needed.