Revision THR What all does this involve?

[Angie68]

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.

Yes Sandy he did. I remember the day after surgery him telling me all of this. I just totally forgot the term "reconstructive cage" until the nurse said something yesterday. I have tried to think of it ever since to share with Jo. My Ortho has been very thorough.

 

[sandybeach]

Angie, I am sure you compare these surgeries to your first ones. How do you feel they compare as far as healing and pain levels? You may have said but how long were you in the hospital each time?

 

[Angie68]

Angie, I am sure you compare these surgeries to your first ones. How do you feel they compare as far as healing and pain levels? You may have said but how long were you in the hospital each time?

My left hip has always been the worst. I told my Ortho before my original thr's in 2009 that my left was much worse than the right. He (not my current Ortho) said there was no diff on xray.

My rthr in June 2009 was a breeze as far as the hip was concerned. I was in the hosp for 5 days but that was only because I had a spinal & ended up with a terrible spinal headache. Every time I stood up I would get dizzy, vomit, bp would take a nose dive and I felt like my heart was in my head. They kept me til they got that under control.
My right revision was April 2013. It was pretty close to the same as the original. I did not have a spinal and was in the hosp for 2 days.
My lthr was in Sept 2009. IT was sooooo much worse than the right. The pain was off the charts. Ortho guessed that he hit a nerve during surgery.
And of course that same hips revision has been very, very tough too. Honestly dont think the pain has been any worse than original. But the recovery has been much, much slower. This leg just doesnt seem to want to gain the strength the others did. Ugh! I was in hosp 3 days with that one.

 

[sandybeach]

Angie68 your first revision was 3 days after my second hip surgery. I just realized that when I went to see how long since you had surgery. My legs are still somewhat weak and ROM is coming back but not what it should be. You said the doctor really had to do a lot of work on it so there's probably a lot of healing going on in there. The strength will come back as time goes by and you're up doing things. The more things I do the stronger I'm getting. Every few weeks I realize how much easier it is do certain things. This time next year you will have forgotten about this time you're going through and be living life to fullest again.

 

[Angie68]

I saw my OS today. He did his usual maneuvering of my legs. Had me lay flat & lift my leg while he pushed down. You all know the drill. Said the left one was very weak but not terrible. Pretty much what he would expect with what all was done. He sent me for xray. Promised me if he saw anything wrong he would call me today. No news was good news. Wrote me a script for pt 3x a week for 6 wks. I didnt get a call so I am assuming I am in the clear. What a relief!

 

[sandybeach]

No news is good news. How are you doing? Even going to PT, if they try to push you into things that you can't do let them know. You don't want to get hurt. Sometimes they try to make your PT session like the next persons and that's not always what you need.

 

[Angie68]

Josephine
I went for my 1st session today. I think I got a good one. He took it very slow. It actually felt good to stretch some muscles. I feel great. I liked him a lot!
I am having a pain that I want to run by everyone. I have actually been having it since surgery but didnt think much of it. Didnt figure it was connected & thought it would go away. Kind of hard to describe.
Its on the top of my big toe & side of my ankle on the leg I had the latest revision. If I rub the area it has a numb sensation & is very tender to the touch. Doesnt really bother me unless I rub it. If I flex the leg then it kind of burns & hurts pretty bad. I told Pt about it. He said it could be related. So much is pulled & stretched with this surgery. So if a few weeks of pt doesnt resolve it I guess Im going to have to have it looked at. Thoughts?

 

[Josephine]

So if a few weeks of pt doesnt resolve it I guess Im going to have to have it looked at.

Yup!

But seriously, the nerve that serves that area is the peroneal nerve which runs across the front of the tibia just below the knee. It's the one that, if you knock your leg just below the knee, is excruciatingly painful! Well, this can come in for some pretty rough handling during successive surgeries and so little wonder you can get some disturbing symptoms further down. Will it resolve? Well, it might and it might not. If I had my crystal ball I might be able to tell you!

 

[Angie68]

Josephine
I feel like this is the thread that will never end! I also feel that this is the leg that will never mend! Pt was going great until the night of the 6th session. My pt increased my exercises some. I knew I was doing more & I also felt it. IT was the first time I broke out in a sweat. The evening I was in a pretty fair amount of pain. I didnt do my exercises at home the next day (Sat). When I attempted to do them on Sun I could not do a straight leg raise to save my soul. This upset me because after 3 sessions I was finally able to do these. Hated that I was regressing! I went back to therapy on Mom & told pt what was going on. He said I had prob made some muscles angry & we would scale back some. When we started doing exercises I was able to do my straight leg raises again thank god. That evening I did hurt again but not quite as bad as I did after the 6th session. I went back today & pt said we would keep it where we left off.I explained to him that the pain does not feel like a muscle soreness or strain. It is in the groin but feels like a very strong ache. Like an arthritic ache. He still feels that it can be a muscle. Tonight after therapy I am hurting pretty good once again. Another symptom I did not tell him about (mostly because I dont know how to describe it) is a strange popping feeling in the groin. Bare with me, this sound nuts but this is what it feels like. IT feels like there is a rubber band running from the top of my leg where the leg bends, down towards the knee. Only it stops a good 6 inches above the knee. It really isnt close to the knee at all. When I twist the leg & especially when I roll over in bed it feels like this rubber band is going boing, boing. It's kind of a snapping sensation, but not really a clicking. In doing some research on groin pain after thr I came across something about a snapping hip. It sounds like it might be what Im experiencing. Anyone else have this?

 

[Josephine]

He said I had prob made some muscles angry & we would scale back some

RIGHT!

Another symptom I did not tell him about (mostly because I dont know how to describe it) is a strange popping feeling in the groin. Bare with me, this sound nuts but this is what it feels like.

You've actually described it perfectly and the idea if it being like a rubber band is accurate too. When you have a muscle/ligament/tendon that is inflamed, it's very much like a rubber band - inflamed, angry and malfunctioning! It doesn't stretch and retract like it should, it goes in fits and starts just like when you limp!

So do remember that when you have significant tendinitis, the answer is NEVER more exercise. All 'more' will get you is 'more' inflammation, 'more' pain and discomfort and 'more' malfunctioning. Get it?

Or to put it another way, if you sprain or break your ankle, you don't increase activity, you rest it! Think of these structures as sprained or injured and treat them gently.

Anyone else have this?

And it's funny how people always ask this like they think that what they are experiencing is unique when it's actually almost as common as the common cold!

 

[Angie68]

RIGHT!


You've actually described it perfectly and the idea if it being like a rubber band is accurate too. When you have a muscle/ligament/tendon that is inflamed, it's very much like a rubber band - inflamed, angry and malfunctioning! It doesn't stretch and retract like it should, it goes in fits and starts just like when you limp!

So do remember that when you have significant tendinitis, the answer is NEVER more exercise. All 'more' will get you is 'more' inflammation, 'more' pain and discomfort and 'more' malfunctioning. Get it?

Or to put it another way, if you sprain or break your ankle, you don't increase activity, you rest it! Think of these structures as sprained or injured and treat them gently.

And it's funny how people always ask this like they think that what they are experiencing is unique when it's actually almost as common as the common cold!

This is why I ask. I want to hear that it is common...

 

[Angie68]

Josephine
Well it's Sunday evening. I havent had any pt since last Thursday. At that session we only did a couple of light exercises. My pt spent most of the time giving me a deep tissue massage. She said exactly where my groin pain is, is text book common. Told me to only do the light exercises at home & to not do the straight leg raises or step up on steps with that leg. She feels that those exercises are whats aggravating my muscles.

I am slightly better, but I do mean slightly. I am no where near where I thought I would be after 3 days of rest. In fact, Fri & Sat I did no exercises. Today I did the 2 exercises they told me to do. I do not think they hurt anything. I dont feel any worse than I did yesterday. I am still in quite a bit of pain when I step on this leg & when I turn over in bed. Would it take this long for muscle pain to get better?

I am sick to my stomach dreading pt tomorrow. It shouldnt be this way! I don't know what to do. Should I just quit pt? What would my Dr think? What would insurance think? If I decide I need it on down the road will they refuse because I didnt follow Drs orders this time? I am starting to think that this leg may just need to "work itself out" like Jo has always said hips can do. It was such a major intense surgery maybe therapy is too much at this point? I am so torn. Do I push thru the pain? I am regressing right now. I dont want to continue to regress...

 

[sharonslp]

Hi Angie. What a difficult time you are having. All these soft tissue issues can be every bit as debilitating and demoralizing as the original problems that sent us to surgery. Ugh. I just had a few thoughts reading over your last few posts.

1. Have you been icing? If so, does it help with the pain? If not, give it a try.
2. Are you taking any anti-inflammatories short-term while you are resting?
3. I had a bad cough throughout the month of October. Toward the end, I pulled/strained/somethinged a muscle in my rib cage. It is now almost a month later. The cough is quite gone. But every time I sneeze, that muscle still stabs like the dickens. I think that injured muscle can take quite a while to repair itself. It depends on how bad the original injury was, and whether you keep re-injuring it....something that PT can fool us into doing all too easily.
4. Your insurance company won't think a thing if you stop PT. They won't even notice. Your insurance company is a lot of people who open envelopes and take out claim forms and process them. (Or computer files....same idea.) I am pretty sure no clerk or processor is going to suddenly stop in the middle of the day and think.....oh my goodness! I haven't seen a claim from Angie lately! I do hope she didn't quit PT!! And no, they won't refuse more PT later just because you stop now. When your doctor writes a legitimate order for PT, as long as you are within the guidelines of your policy, it's covered. (That Angie....she stops and starts PT whenever she wants! The nerve of her!)
5. Your doctor....how adamant was he that you do PT? Was it his idea, or did you ask him about it and he agreed to it? What goals did he give the therapist to work on, do you know? Or was it left very vague? Did your OS have any plan if the PT didn't help? What's the next step? MRI? Something else?
6. You have been through a whole bunch of surgeries over the past few years. That's a whole lot of shaking going on in there! There's a whole lot of healing that still has to happen. Wait and see is not a bad plan.
7. If it hurts, don't do it. What about spending the winter following the mantra....lots of rest; icing; controlling pain. Just walking to get some exercise. Give all your inflammation time to settle down.
8. What does "push through the pain" actually mean? Just keep doing painful things while hoping the pain will magically disappear on its own? Isn't that what football players and Olympic contenders do? And then they live on steroids for a long time? And get brain damage and knee replacements when they're older? Oh wait a minute....push through the pain....that's what we women do when we have babies. We learn to breathe effectively through the pain...which is very short-term although at the moment it feels like forever....and then we get a baby as a reward.

Okay, I'm done with my thoughts. Don't know if they are helpful or not....ignore anything that doesn't help. There are no simple answers to much of this, but time does have a way of healing a whole lot of things.

Sharon

 

[Angie68]

1. Have you been icing? If so, does it help with the pain? If not, give it a try.

PT told me to alternate heat & ice the evening of therapy. I did, but haven't done it since because I haven't done any exercises. Maybe I should?

2. Are you taking any anti-inflammatories short-term while you are resting?

Today I started taking 1000 mgs of tylenol. Thought I would try taking that consistently every 6 hrs to get it built up in my system.

3. I think that injured muscle can take quite a while to repair itself. It depends on how bad the original injury was, and whether you keep re-injuring it....something that PT can fool us into doing all too easily.

I had very little pain til I started pt. The first two weeks went great & then when he bumped it up the pain set in & no matter how much we scale back I can not get this pain under control.

4. Your insurance company won't think a thing if you stop PT. They won't even notice.
5. Your doctor....how adamant was he that you do PT? Was it his idea, or did you ask him about it and he agreed to it?

My idea. In fact I had no pt with the right one in April. This one has just been so slow going I asked if I could start it.

What goals did he give the therapist to work on, do you know?

I saw the prescription. I believe it just said something like strengthen abductor muscles. Does that make sense?

Did your OS have any plan if the PT didn't help? What's the next step? MRI? Something else?

I do know that the prescription asked what my expected outcome was & my Dr wrote fair. I go back and see him Feb 11

6. You have been through a whole bunch of surgeries over the past few years. That's a whole lot of shaking going on in there! There's a whole lot of healing that still has to happen. Wait and see is not a bad plan.

This what I am wondering

7. If it hurts, don't do it. What about spending the winter following the mantra....lots of rest; icing; controlling pain. Just walking to get some exercise. Give all your inflammation time to settle down.

I'm thinking this might be what I need to do. Just suck it up & deal with it & accept that I'm not going to walk any time soon. Trying to push it aint getting me there anyway.

8. What does "push through the pain" actually mean? Just keep doing painful things while hoping the pain will magically disappear on its own? Isn't that what football players and Olympic contenders do? And then they live on steroids for a long time? And get brain damage and knee replacements when they're older? Oh wait a minute....push through the pain....that's what we women do when we have babies. We learn to breathe effectively through the pain...which is very short-term although at the moment it feels like forever....and then we get a baby as a reward.

I have no idea what it means. I am just depressed & feeling hopeless. Between the 2 surgeries I haven't walked without some sort of aid since April. I can't stand & sweep my floor, carry a basket of laundry, or most of my household duties. I never thought I would be begging to be able to do these things but I am!

Okay, I'm done with my thoughts. Don't know if they are helpful or not....ignore anything that doesn't help. There are no simple answers to much of this, but time does have a way of healing a whole lot of things.

Thank you for taking the time to answer my questions Sharon. I really do appreciate it so much.

 

[alexthecat]

You know, these soft tissue problems can take a long time to resolve. Not days. More like weeks. It sounds like PT is just going to keep aggravating your body. Why not give yourself a vacation until January? This is a busy time of year for most people, so you can probably find other things to do with your time. Just do normal stuff (not PT exercises) and take lots of time to use ice and/or heat wherever you have pain or stiffness. That's a good way to relieve pain and easier than meds, IMO. But meds are cool too, if they help you.

That bit about strengthening your abductors is part of the standard protocol for post-THR PT. It sounds like the PT may have pushed you to progress too quickly though.

 

[Angie68]

Why not give yourself a vacation until January?

I think this is what I am going to do. At this point I can't even stand the thoughts of walking in the building!

 

[sharonslp]

Angie, I just re-read the entire thread. I want to wave a magic wand over you! But yeah, at this point you you've tackled everything head on. You had THRs, you were recovering on track and then got hit with the metal issues. You sought out a more responsive OS and had revisions in both hips. The second hip in particular was a rougher surgery all the way around, and after a period of NWB, you finally started to move on with recovery. You developed some pains in different places and asked for PT to try and deal with it. Now...PT seems like it might be making things worse instead of better.

So I repeat....let go of all the pushing ahead. Just be. Use your cane. Sit on gel packs. Forget laundry and floors. Utilize some good pain meds to help you be a happy mom. (See if the consistent tylenol does it. If not, talk to your doc about what else you can try for now.) Coast through the holidays....this is not the time to be the hostess doing all the cooking. Take gentle walks. You see your doctor again in February....till then, just let healing happen. Your 20 year old who thinks you are milking it...she should read this whole thread. And then go ahead and milk it. You have endured FIVE MAJOR surgeries in five years. You aren't milking anything! You are doing your very best to cope. Take huge expectations off the table right now and just be who you can be.

Read enough threads here and you start to see stories about people with terribly intractable problems....but a year or two down the road many of those have finally been resolved. Not always to complete satisfaction, but enough to allow a good quality of life. My crystal ball is as illusory as my magic wand, so I sure don't know how your story will turn out. But I think there is every reason to expect it to be a positive outcome when all the healing is said and done.

Sharon

 

[Josephine]

Should I just quit pt?

Absolutely!

Do I push thru the pain?

Absolutely NOT!

What would my Dr think?

Who cares? You employ him, remember? Therefore you call the shots.

And I'll say it again - you really don't need all this PT. It's unnecessary and is actually causing your pain. Hips don't need it. You will do better without it, truly.

 

[Josephine]

PT told me to alternate heat & ice the evening of therapy. I did, but haven't done it since because I haven't done any exercises. Maybe I should?

Yes! You don't ice in concert with PT, you ice to cool down the angry tissues in your hip and allow the healing to proceed unheeded. don't use heat whatever you do. Heat will just make the angry tissues angrier!

Today I started taking 1000 mgs of tylenol. Thought I would try taking that consistently every 6 hrs to get it built up in my system.

Tylenol doesn't 'build up in your system'. After about 4-6 hours, it's out of your system completely. Same with NSAIDs.

The first two weeks went great & then when he bumped it up the pain set in & no matter how much we scale back I can not get this pain under control.

THERE y'go! The factor that caused all this. Remember that. You were doing great until then.

the prescription. I believe it just said something like strengthen abductor muscles. Does that make sense?

I know what he meant but I don't agree with it because your abductor muscles aren't week, they're injured. You don't try and strengthen injured body parts, you rest them so they can heal!

I do know that the prescription asked what my expected outcome was & my Dr wrote fair.

That's not very encouraging but you don't have to buy into his poor expectations! You are going to be better - if you take that 'vacation'!

Why not give yourself a vacation until January?

:iagree:

 

[Angie68]

Josephine
My OS nurse called me back this morn. She said it sounded like I had a nasty case of tendonitis. When it is in the groin & as bad as mine sounds it can be quite painful & take some time to resolve. She told me to stop all therapy & rest. If it isnt at least a little better in a couple of weeks I should come in for xrays. If it gets better then I should come in for my scheduled appt in Feb. If at that point I want therapy then we can try it again. If I dont feel I need it thats fine too. She thinks I will more than likely do fine on my own. Duh! She said everything you all did. While I had her on the phone I asked what kind of MOM hips I had. She said that I had Johnson & Johnson Dupuy SROM in part of the hip & a Pinnacle ball I believe. They are not on a recall as of now. Does anyone know if you have a recalled part will they contact you? Or do you need to know this stuff for yourself?

alexthecat

sharonslp