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Discussion in 'Hip Replacement Recovery Area' started by wonkyhipoy, Aug 10, 2018.
Happy Belated Three Month Anniversary!
I hope you have a wonderful week
Hi all, sorry I have been absent for a while. It has been a hectic season to be sure. Anyway, I wanted to provide a bit of an update. I saw my surgeon and discussed the pain I had been experiencing weight bearing. He said everything looked good and the pain I have been feeling is something he sees commonly.
After the appointment, everything seemed to be settling down and I was doing really well. I put up Christmas lights even and was walking a lot. Unfortunately, this all came to a screeching halt a few days ago (Tuesday). Suddenly out of nowhere I am having really bad pain with weight bearing. I can go a few steps (sometimes 100 feet or so) completely pain-free and then suddenly I can barely walk… when I do, I am wincing in pain. It is quite a scary thing. The pain is difficult to localize, and what is weird is a start feeling it below my knee before I feel it on the front lateral side of the hip. I have not been taking any painkillers recently, but have started taking Tylenol again today. I feel no pain while sitting or at rest, only when bearing weight… so I thought the painkillers would be unwarranted (and they don’t seem to help much)… but I gave in today and am now taking 1000 of Tylenol every 6 hours.
Okay, so now I need to vent a bit here to my fellow bonesmarties. I am starting to get really frustrated with this recovery of mine. Everything goes well for a week or two, and then I seem to have a fairly significant setback. This latest one has me quite worried as I am 4 months post op now, and I certainly did not expect to be unable to walk at this stage. Also, this latest setback doesn’t appear to stem from overdoing it as I have been deliberately taking it easy. I am concerned that the hip prosthetic is not healing into the bone… of course, that is based on of scary google searches, so my concern is probably unwarranted. But I am at a loss as to why I am feeling this pain so far out from surgery. Perhaps @Josephine can comment on my X-rays (I have posted the 6 week and 15 week X-rays for comparison).
Being in pain around the Christmas season with a little four-year-old is a little depressing too. It has me quite down at the moment (which is rare for me). Guess I just need a little support from all you guys… you know, people who understand because they have gone through similar things.
Anyway, I will try to remain positive and hope this latest setback resolves itself in a few days like all the others I have had. In the meantime, please drop a note if you have had a similar experience at the 4-5 month mark (or if you just want to say hi!). Would love to know how you made out.
So sorry to hear this and it must be very frustrating. I hope you get a resolution to this soon. Keep us posted xx
Hopefully @Josephine can comment.
I'm really sorry you are struggling so.
Something doesn't sound copacetic to me.
@wonkyhipoy I am sorry to hear about your new really bad pain when weight bearing. That seems really odd at four months out but what do I know....I haven't got there yet! I hope Josephine can weigh in on it, and if it persists, I'd definitely contact the OS's office about it.
This new development is really hard to deal with, particularly with the holiday upon us and wanting to enjoy it with your family.
Will look for Josephine's viewing of your x-rays and hope this latest nasty pain can be resolved quickly.
Thinking of you.....hugs!
Stopping by to wish you a Happy Four Month Anniversary.
Wish you were feeling better though. Josephine has been away from the forum for a few days and may have to play a little catch up when she returns but you'll be on her list, so hang tight.
Wishing you comfort as you wait.
Thinking about you, @wonkyhipoy.
Hope this is a super small glitch.
What are you worrying about in regard to your hip? It looks fine to me.
Answer these questions again for me
2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).
3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?
6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and
7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)
Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
Thanks for your response/ The surgeon did not really discuss the xray, so I was not sure if there was something you would see that could be the cause of the pain (like poor fixation). Glad to hear they look fine.
2. The only pain I experience is when weight bearing... and not consistently. One moment it is fine, then I move the wrong way and it hurts to bear weight... pain ranges between a 3 to a 6. No real stiffness or other soreness really.
3. I have started taking the Tylenol at 1000 mg every 6 hours... but previously only as needed (which was rare).
6. It feels quite low compared to my pre-surgery state, but on reflection, I guess quite high. In spite of a desk job, there are days where my watch tells me I have walked between 7-10 km. Up until a few days ago, I was doing scheduled walks of 2-3 KMs a day.
7. None at all. I am doing some gentle stretching, but no actual exercises. No PT either. I am seeing a specialist sports PT (just yesterday for the first time), but that was more for an evaluation and potential IMS/Acupunture if the problem continues. I do see a massage therapist as well.
It seems I constantly tweak something with moving... usually some form of a twisting movement. The pain seems to move around, but the PT believe the source is the gluteus medius and the trochanter/IT band. Can pain from there refer to the knee/upper front thigh?
Also, the PT had said that I should consider using a cane to unload the muscles when I tweak something... not for long, just for a day or so. Is that common?
(I am using a cane when I tweak)
I see nothing untoward in your replies requiring a response from me. All seems good and regular. And yes, it is usual to be using canes if you have a pain. Currently my left knee is playing me up, it's coming up 4 yrs old. But I'll use a cane if the need arises. Why suffer needlessly?
@Josephine, sorry I should have been more clear in my questions.
1. Can pain from a trigger point in the glute medeous or the muscle that attaches to the greater trochanter refer to the knee?
2. Why am I having trouble bearing weight sometimes so far out after surgery (4½ months)?
3. Any idea why twisting movements seem to aggravate the pain?
4. Based on my activity level answer to your question #6, am I doing to much activity?
5. Could the hip capsule be the source of the pain (something my previous PT suggested)?
Would appreciate any answer or advice as this is very frustrating to be felling this pain.
The muscle that goes from the greater trochanter to the knee is the IT band (ilio-tibial) so any pain anywhere along the length of the ITB will be painful. Though the attachment at the greater trochanter and the insertion at the lateral tibial condyle.
Look at the images above. You twist/rotate the knee and it pulls on the ITB which is inflamed!
That's one of those questions I tend to label "how long is a piece of string"!
I'd suggest you hide your Fitbit in a drawer and stop counting KMs! NORMAL daily activities is all you need. (see here Activity progression for THRs)
Thinking of you and wishing you all the best this Christmas @wonkyhipoy
Hope the New Year is being good to you.
Hoping you have been able to get some answers to your ongoing pain.
Pop in when able...love to hear how things are going.
You just passed your Five Month Anniversary!
I hope all is going well. With any luck your pain is easing.
Let us know how you're doing next time you stop by. We care.
Wishing you much happiness in 2019.
Hi @Josephine ,
I just saw my surgeon (7 months post-op, cementless). I have had trochanter pain which has slowly gotten better over time and is almost non-existent most of the time. I expected that today’s appointment would be a “see you at one year” kind of appointment. Instead, my surgeon gave me some uncomfortable news.
He said that the xray showed some settling of the stem (less than 1 mm). He said that if he were to examine 100 hip replacements, 40 would show some settling. However, because I am also feeling pain, he said it may indicate failed integration. He said that some folks heal more slowly, which is why settling can occur, but in others, it can indicate failed integration.
My pain levels are actually quite low now (0-2 and only near the end of a long day). In fact, I just got back from Disneyland (6 days) where I walked between 12 and 15 km per day mostly pain-free (other than my back).
Anyway, I am surprised by the news and don't know quite what to make of it. I was so surprised that I did not think to ask the one question on my mind now... how much settling is normal?
My surgeon told me that I should not worry about this yet.. to wait to see how things go as everything else looks good. I have read a ton of articles that state that only subsidence greater than 4 mm is clinically significant (mine is less than 1 mm), but that fail to indicate over what period of time.
I have read a few of your response on the forum and it seems that this “settling” always means the stem is loose, but I may be misinterpreting your responses (https://bonesmart.org/forum/threads/grannyhippys-recovery-thread.32353/page-12#post-995302).
You are the expert here, so could you clarify for me. In your experience, is minor settling in the first six months common, or is it indicative of an impending revision? Also, can you tell me what is meant by the term "second stage stabilization"?
1. Pain levels are minimal including stiffness.
2. Activity level is fairly high. Stationary bike, walking, weight lifting (not heavy, just cable machine while sitting on a bench).
3. No Physio or exercises
4. No pain meds except a little Tylenol when my back acts up.
I hope you get some reassuring answers to your question---1 mm seems very minimal so hopefully it's nothing to worry about!
I'm so sorry you're dealing with this. It seems encouraging that your pain has decreased over time
and is often non existent. You mentioned you're fairly active and rarely take a Tylenol. One would think you would be suffering more pain and experiencing an escalating discomfort if there was failed integration.
If you have a copy of your x-ray, please post it for Josephine. If not, I'd encourage you to obtain one for her to view.
Since Josephine is the expert here, let's have her weigh in. Hopefully she is able to offer you some insight or encouraging news. I will look forward to her response. Wishing you comfort and peace of mind as you await answers.