THR Nutcase's recovery journey

[Nutcase]

Hi everyone!

Must start by admitting that I have read a lot on this forum the last couple of days trying to convince myself that everything is fine, recovery wise. I'm a bit over whelmed by all the kindness and willingness to listen on this forum, It's amazing.

My journey started a little over 5 weeks ago, on February 15th, when I had a LTHR done via direct lateral approach (gluteus meduis and vastis lateralis was cut). Apparently I was 'petit' because they had to use mild force to get the femur head out of its socket. Everything else was normal. Nausea from the pain killers post-op, standing beside bed a couple of hours after surgery, walking with sticks and going home day after surgery.

2 days later something happened. All of a sudden i couldn't lift my leg to get in bed och even lift it more than 2 cm above the floor (both of which I could do previously). I also developed a really big nice hematoma originating from the op-wound (around the location of the trochanter) and stretching all along my groin. I didn't feel anything when it occurred, suddenly I just wasn't able to get into bed, not even with help (lifting the leg was just not possible due to the pain). I was terrified! Since it was Saturday I reach out to the hospital on Monday but the nurse made me feel a bit stupid for worrying since It was so soon upon surgery and since I did no longer take long-term pain killers (I was not subscribed any).

Since this incident I have fallen deeper and deeper into 'the black hole' (hence my nickname ;)). Basically I'm worried that I will never walk normally again. I still have a massive limp if I'm trying to walk without crutches (which I don't), I am not able to stand on one leg, my vastus lateralis seems to be completely dead. I am still very swollen/stiff from the op wound and along the groin. I have been doing the basic rehab exercises and walking, thats it.

However, I do ice and elevate since I found this forum and it's actually makes a difference, if only for a short while and fist thing in the morning it also feels better. I also see a PT and I know I should give it time, but It's hard. I also know that my blues isn't making it better...

Sorry for rambling, but feels good trying to put words on my feelings.

 

[Freyagirl]

@Nutcase i wish more surgeons provided better recovery information. At least you have found this forum and can see that you are not a “nutcase” but just another person struggling with the aftermath of a very challenging surgery. Your difficulties just a couple days after surgery were experienced by most post op hip patients as the swelling sets in. If you had known, you could have gotten ahead of it a bit with ice and elevation and not been so stressed by the loss of function. I wish you had been able to talk to someone about the hematoma, it’s scary. And now you have the post-op blues. The recovery is a much longer uphill climb than “advertised.” Please keep checking in with this community for support, suggestions, encouragement, and often just some humor.

 

[myglasshalffull]

You are not a "nutcase" You are recovering from a very traumatic surgery to your body. Lifting leg off bed first week is called "log leg."
Feeling sad will come & go during recovery, probably off & on first 2-3 months until you begin to regain some independence.
You have come to the right place for advice & sharing anything & everything regarding recovery. I was not planning a hip replacement but fell on ice & fractured my hip so I was very ill prepared for a lengthy recovery but I found this forum & it answered all my concerns & fears!
Welcome, & rest, ice & elevate, get up, walk around for a bit, grab a coffee & then go back to relaxing.

 

[Layla]

Hello and to BoneSmart! I will leave our Recovery Guidelines and type more in a post below.

HIP RECOVERY GUIDELINES
As you begin healing, please keep in mind that each recovery is unique. While the BoneSmart philosophy successfully works for many, there will be exceptions. Between the recommendations found here, your surgeon's recovery protocol and any physical therapy you may engage in, the key is to find what works best for you.

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

If you want to use something to assist with healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.
4. PT or exercise can be useful BUT take note of these
BoneSmart philosophy for sensible post op therapy
5. At week 4 and after you should follow this
Activity progression for THRs
The recovery articles
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
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?

Nutrition is of paramount importance. Available here are dietary tips, nutrition basics and additional food supplements. These articles are both general advice on food and specific guidelines aimed at people both pre- and post-surgery.

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

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.

 

[Layla]

First, thank you for the kind sentiment in regard to the forum. We're happy you find it a safe place to share and gather information from.

You are not a nut case! Your feelings and concerns are real and normal. Five weeks post op is early days into a recovery that can last a full year for many and even longer for some. Many notice improvement into their second and even third years post op. You will find this through reading others threads on the forum.

The process of dislocation can be aggressive and that naturally results in pain. Your leg endured major trauma, in a very small area, although controlled. Your muscles, tendons, ligaments and other soft tissue is going to cause you discomfort and pain for a while yet. I am surprised you weren't prescribed any pain relievers. What is your surgeon's protocol for dealing with post op pain?

Regarding the hematoma,
I have read that they can be drained surgically in some cases and depending upon their size and location can take longer to reabsorb. This process can take a month, or even a few months. Many have dealt with hematomas and you can read their threads if interested by using the SEARCH at the top right side of the page, typing in key words and all threads where it's been mentioned will pop up.

Here’s a tip -
Try heel-toe walking when you're limping.
This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.
It takes a concentrated effort, but I believe you'll notice a difference. Give it a try.

The swelling and resulting stiffness does decrease the ability to be comfortably mobile. That's where icing and elevation will help. Articles here -> ice and elevate

In addition, Post Op Blues happen to many Post op blues is a reality - be prepared for it
I understand that's cold comfort, but please realize it is temporary.
Take the advice of the dedicated members that shared some wisdom above. With patience and time, it really does get better. Brighter days are on the way! Thanks for joining us!

 

[Nutcase]

Thank you all for the warm welcome

Your difficulties just a couple days after surgery were experienced by most post op hip patients as the swelling sets in. If you had known, you could have gotten ahead of it a bit with ice and elevation

I really wish I have found this forum before the surgery. Hopefully I have not made matters worse not icing.

Feeling sad will come & go during recovery, probably off & on first 2-3 months until you begin to regain some independence.

Trying to keep this in mind. Also trying to see the positive in me actually knowing I'm down right now.

What is your surgeon's protocol for dealing with post op pain?

Oh, I did get pain killers, just not any long term effective morphine. I had paracetamol, oxynorm and some kind of long term anti inflammatory medication.

Here’s a tip -
Try heel-toe walking when you're limping.

I've actually trying this, based on what I've read on this forum Problem is I'm too weak in my thigh to be able to balance on one leg making, especially the pushing-off hard. I'm also really stiff in my upper leg, from the scar area all around the groin. Feels like I'm having a football under my skin

Joke aside, It's the weakness and stiffness making me limp that really worries me.

 

[Eman85]

However, I do ice and elevate since I found this forum and it's actually makes a difference, if only for a short while and fist thing in the morning it also feels better. I also see a PT and I know I should give it time, but It's hard. I also know that my blues isn't making it better...

Most don't ice long enough to see the benefits, it takes good ice packs and a few of them so you can rotate them, or an icing machine. Read the guidelines on icing in the recovery guidelines.
PT, what is the PT having you do? The part of the operation that causes the pain and long recovery is the trauma to the muscles as our hips are dislocated. Once they are stretched it takes some time to heal before you can attempt to regain strength.
A downside to this recovery is it gives us a lot of time to think, for many of us that's not good as we always think the worst.

 

[springchicken]

Hi - just wanted to say I had a lateral approach LTHR two days before yours, and I’m also still on two crutches, limping a lot when I try without them, and experiencing pain and swelling. You’re not alone!! I’m finally seeing a little improvement each day now, but I still definitely have moments of frustration and fear that I’ll never walk normally. This forum has really encouraged me to see recovery as playing the long game, which I don’t feel like I was prepared for before surgery. We’ll get through this!!

 

[Plainleg]

Regarding your hematoma. About 8 weeks after my THR it looked half a baseball was forming right underneath my scar. I completely freaked and talked to and emailed surgeon’s office with pics. They said just to wait. I was so worried it was an infection or something, plus my thigh pain, I went and saw my GP who said it was a giant hematoma and would takes months to reasorb. It was probably there all along but I didn’t notice it until the swelling around it decreased. I had a complicated surgery, but she said all major surges can have this particularly if a blood vessel is cut. Just knowing what it was made me feel much better.

 

[Nutcase]

PT, what is the PT having you do? The part of the operation that causes the pain and long recovery is the trauma to the muscles as our hips are dislocated. Once they are stretched it takes some time to heal before you can attempt to regain strength.

Oh, I did not know about the stretched muscles part... I only have quite light exercises, nothing including any resistance yet. I use a stationary bike for mobility, I'm walking in figure eights, forward and backward, I'm trying to stand on one leg and also some light strength training for the glutes. I'm not doing anything that hurts.

Hi - just wanted to say I had a lateral approach LTHR two days before yours, and I’m also still on two crutches, limping a lot when I try without them, and experiencing pain and swelling.

So nice to see someone in a similar position. I will definitely check in on your progress journey here I really hope everything i looking brighter for you. I'm looking forward getting rid of this blues and getting som appetite back, but as you said, I don't think sleep deprivation is helping out

Regarding your hematoma.

Thank you for sharing! It's nice to know you're not alone and even though mine isn't visible since a couple of weeks, I think that is contributing to the stiffness in my upper thigh. Good to know it will go away, but patience isn't my strong side ...

 

[Jaycey]

I'm trying to stand on one leg and also some light strength training for the glutes.

This is not the time to do any strength training. You are not in training, you are healing. No exercise is needed except gentle stretches and walking.

 

[Eman85]

Not trying to freak you out but to perform the operation they completely dislocate our leg then turn it to gain access to the joint through the incision. That is the difference between anterior and posterior and which muscles get stretched the most. It takes time for that soft tissue to heal before it can be strengthened.

 

[mendogal]

@Nutcase I agree with Jacey that it's way too early in your recovery to tax your body with strength training.

 

[Nutcase]

Thanks for the input. Just to clarify, it's not strength exercises, more of mobility exercises and I don't do anything that hurts.

A question though...
I have started to transition to one stick, instead of 2, during short walks outside (have been using one stick inside for a couple of weeks already). Today I have a new soreness at the very bottom of my buttock and stretching down the back of my thigh up until mid-thigh, approximately. It doesn't hurt when I sit or stand still, only when i walk. Guessing this is because new muscles are used when I walked with one stick yesterday, but thought I would confirm it with you guys

BTW... can walking with one stick activate any sleeping muscles making me able to stand on one leg?

 

[mendogal]

It may be that you're activating a different muscle or muscle-tendon combo with the transition to one stick - support structures get awful finicky after surgery and continue to readjust.
The main thing with changing to one stick is to
make sure you're not leaning, skewing, or limping.

It's also possible it's a sciatica pain caused by the little piriformis muscle in the buttock impinging on the sciatic nerve. This can happen post op with both hip and knee replacements.

Whether it's muscle or sciatica, the basic treatment is ice. If it's far away from the incision and swelling, some folks try a little heat as well.

 

[benne68]

have started to transition to one stick, instead of 2

It's very important to pay attention to your gait as you wean off assistive devices. As mendogal said, be sure you aren't leaning or limping.

Practicing heel-toe walking is the best way to work on your gait. This involves striking the ground with your heel first, then rolling through your heel to your toe, and pushing out of the step with your toe.

Here is a visual

Slow down and concentrate through the entire step. It can feel awkward at first, but with practice, will become more natural. After a week or two, you'll notice a difference. Give it a try.

 

[Nutcase]

Whether it's muscle or sciatica, the basic treatment is ice. If it's far away from the incision and swelling, some folks try a little heat as well.

Since I'm not sure haw far 'far enough' is I iced yesterday, for approximately 40 min. No difference afterwards but felt nice at the time The thing is I only feel the soreness during weigh bearing (as in taking a step on the op leg), it stops immediately when releasing weight. I'ts hard to describe the feeling, not really pain, more of a swelling/pressing soreness. I would say (having googled) it comes from the top of the hamstrings, where they attach to the bone.

Practicing heel-toe walking is the best way to work on your gait.

Thank you for the great picture. I'm practicing heel-toe walking everyday. It's hade to get it to stick, but I agree that it is way harder to limp when I'm being mindful of my gait. I'm always very careful not to limp or skew when I walk.

 

[Jaycey]

@Nutcase I found gentle hamstring stretches post my LTHR eased a similar pain. I did them from a seated position pulling toes toward the nose. If you try these, start very gently as you hamstrings may be very tight.

 

[Nutcase]

@Jaycey Off course! I have no idea why I didn't think of stretching Thank you! I will start immediately.

After feeling really sore at the bottom of my buttock/back of thigh this morning, it eased. Seems like the soreness/stiffness comes and goes like a rollercoaster...

 

[Jaycey]

Seems like the soreness/stiffness comes and goes like a rollercoaster...

This whole recovery process is a roller coaster ride. Just hang on!