Revision THR hip replacement gone bad<

[Josephine]

Are you suggesting that I proceed with resting and babying of this bad hip? And then time takes over the walking improvement?

Indeed I am! The discomfort and pain you are getting is a sign that your hip is not yet ready to face the big wide world!

I have about 4 days ahead before any pt session and I will do what you and Irish Joe suggest.

4 days will not do it. 4 weeks at a minimum, 14 would be even better.

 

[zinnia]

I had a massage Thursday to work on some of the muscles my trainer wanted tending to so blood could circulate in there to help healing. Then a training session Friday in which he followed up the massage (deep tissue; I could feel the "knots" being manipulated) with passive stretches. Today, Saturday, I am hurting; about a #6 or #7 when I move a certain way. But just like all muscle pain, it stops when I stop the movement. Walking is hard today. I have decided to rest for these 4 days before I see my trainer again and just take the Tramadol through the day, icing often with feet/legs up and only minor household activities. This is all very depressing at this point. I am liking what everyone is saying about the muscles being in trauma and need to heal. No exercise at all? Josephine suggests that bike riding might be appropriate when I am not hurting.

 

[zinnia]

Josephine, "14 would be better". But it will be 2 years this October. I know I am 82 now (80 and in excellent shape having been a yoga and exercise buff forever). I know 80 year olds that are in worse shape than I am and they walk just fine. It is depressing to hobble around like a robot for about 5 minutes and then have to resort to the cane again or a walking stick or both! I've had periods of lots of time with tender loving care to these muscles. . .after revision surgery, only 50% weight bearing for 8 weeks? Then 2 o3 with bed rest following the fracture; then about 8 or 12 weeks with the bursitis when I did nothing it was so painful. 14 weeks is another year. I may never walk again?

 

[Josephine]

I had a massage Thursday to work on some of the muscles my trainer wanted tending to so blood could circulate in there to help healing.

Not sure I concur with her philosophy!

I had a massage Thursday to work on some of the muscles my trainer wanted tending to so blood could circulate in there to help healing. Then a training session Friday in which he followed up the massage (deep tissue; I could feel the "knots" being manipulated) with passive stretches. Today, Saturday, I am hurting; about a #6 or #7 when I move a certain way.

quod erat demonstrandum

I have decided to rest for these 4 days

4 days is unlikely to resolve anything. If you have activity initiated pain, you need roughly 4-6 times as many days to rest it.

No exercise at all?

Nope! Not even one! Just walking.

I know 80 year olds that are in worse shape than I am and they walk just fine.

Yes, but you have to remember that they didn't have your hip or hip history and you didn't have theirs!

I may never walk again?

It's much to early to be making that assumption. You still have plenty of time to be improving provided you stop trying to knock seven bells out of that hip!

 

[zinnia]

Okay, I'm listening; you've got my attention. You're calling for up to 2 to 3 months of no exercise just walking.
But don't push the walking either?

 

[Josephine]

Don't push it, yes. Walking in moderation which is maybe a mile a day - half a mile there and half a mile back!

 

[JennyHipcakes]

@zinnia Inflammation is so painful (bursitis). Has anyone suggested cortisone? Ice and rest are great, but cortisone shot might really go to work on the inflammation.

 

[zinnia]

I did have cortisone shots in the beginning of the hip bursitis, but they did little if any good.

Ok, ½ mile there and ½ back tomorrow. I'll let you know.

 

[Irish Joe]

zinnia.
In my daily life I meet many people of all ages. I'm a lifelong observer of group behaviour and and enjoy how people carry on in there daily life.
The happier 'older' people are those I believe who do what they can and do not fret over what the can't do.
When I began having problems with my hips I was 49 and really active and readjusting my activities caused me many down days. It took quite a while for me to be content with my situation.
Do what you can I say and what you are comfortable with. I think then when you feel better when you will realise that this new you is where you need to be.
Keep well.
Joe......

 

[Jamie]

@zinna .... almost a month since we've heard from you. Have you been taking things easier? How is it working for you? How is your hip pain?

 

[Irish Joe]

Ditto @zinnia.
Joe......

 

[zinnia]

Hello Joe and Jamie. Thank you for caring to ask.

I have been gone for about 3 weeks to visit my son and also to attend a conference cruise to the western Mediterranean. We had a 9 hour flight to Barcelona which set off the bursitis again which made it hard to trek around Barcelona for 4 days. By the time we got to the ship and set sail I was a mess and in a lot of pain. But after several days of rest I began to set out again and enjoyed the trip immensely regardless of the bursitis.

The results are not good, however. I'm afraid I am back where I was and rather desperate at the moment. I am on the cane, of course, and not walking at all on my own at the moment. I can walk that mile, half going, half coming back but it exhausts me and I have developed an extremely low BP in the afternoon.

I start back with my trainer again tomorrow who is well aware of the need to work around the bursitis. I plan to seek out another surgeon to get a second opinion on what may be going on and how to proceed because I can see no reason why I can not walk without assistance.

So here I am. Back again whining to you guys, knowing you'll listen. At least I hope you will and maybe even give me some more advice. I sure could use it.

 

[Josephine]

it exhausts me and I have developed an extremely low BP in the afternoon.
I start back with my trainer again tomorrow who is well aware of the need to work around the bursitis.

Zinnia, if you find moderate activity exhausts you, WHY are you starting with another trainer? Makes no sense to me. You need to favour the fatigue right now. And the bursitis. Pain like that can be very wearying.

 

[Irish Joe]

Hi @zinnia.
Please try not to fall into this trap. You can see that all your issues stem from overactivity.
On Holiday.
In the Gym.
At PT.
Always when you pull back you feel better.
Take it easy, walk slowly, smell the roses and try to be a little easier on your body. It will reward you if you do with less pain and more comfort.
Keep well.
Joe.....

 

[zinnia]

Josephine and Joe. . .Thank you for your replies. My work twice a week is with the same trainer. He is helping me to learn to breath to relieve the pain and to move more easily. I don't do anything difficult with him and I always leave feeling just fine with no follow up distress. I have been favoring the leg and using ice religiously. Walking a bit without the cane around the house. My stamina is not back up again yet but there are good signs it is coming. I sleep well and the BP has come back to a low but normal level. I hope to get a second opinion within a week or two about the fact that I have never really fully recovered and more help with the bursitis issue. The pain level is reduced and I hope it will continue to do so. It is very very hot here so there is no chance to walk about outside except for short periods of time. I do go shopping and lunch with friends but I am learning not to fill my day with activities and to rest a great deal. I am smelling the roses, Joe. Thank you for that. And, Josephine you directness feels like you are holding my hand. I am listening if not always paying attention. But I feel I am getting better thanks to you both. Best, Nancy

 

[zinnia]

Hello Josephine and Joe, it's Zinnia back again.

I have been going through a very hard time since last I was on line. I lost all ability to walk without assistance with increased pain with every move. I went to a new surgeon and the xray showed that the acetabular replacement had shifted to an angle which has been my problem since the beginning of the year, not bursitis at all.

Further surgery is scheduled to replace the acetabular cup only. It seems my pelvic bone never grew into and stabilized the cup which caused the shift/shifting.

But I have many questions: for instance would the year end xray though stable then, not have shown bone growth then and if not why wasn't that a concern on the surgeon's part and why would this surgeon say the xray looked good then?

Secondly, why can't they position it with glue - it was positioned with screws and shifted anyway?

Do you suggest any further questions I should ask at my pre-surgery meeting with the surgeon. I trust this guy; my primary gave me the go ahead on this surgeon. He has a remarkable reputation. I don't want to go through this again. It has to been done in such a way that I can finally walk, garden, able to engage in daily activities without pain. I am in a great deal of it now. Hope to hear from you both.

Best regards,

Nancy

 

[Jaycey]

zinnia -I'm going to tag @Josephine for you so that she can give you input on the surgery you facing. I'm glad you are working with a new surgeon.

 

[zinnia]

Thanks, Jaycey. I have missed being here.

I am pretty deeply depressed about the third surgery, 2nd revision. But both my husband and I feel pretty good with the new surgeon. I had my appointment with my primary doctor to get cleared for surgery and now dates for the pre-op meeting with the PA and additional blood work. The surgery is Nov. 28th, as soon as he could do it. He says it isn't an emergency but it needs to be done pretty quickly.

I have been developing a list of questions for the PA and am not going into this without reasonable answers. I have been reading again some of the experiences others have been through and I am encouraged by their bravery.

Thanks so much all of you who have encouraged me. Please don't forget me; I need all the prayers and thoughts I can get.

Thanks, Jaycey. Look forward to hearing from Josephine. Meanwhile, I will lick my wounds, so to speak, and try to be glad that at least there is an answer to what has been wrong all this time.

 

[Josephine]

I went to a new surgeon and the xray showed that the acetabular replacement had shifted

So put simply - it's loose!

Further surgery is scheduled to replace the acetabular cup only. It seems my pelvic bone never grew into and stabilized the cup which caused the shift/shifting.

That's another good definition of 'loose'!

would the year end xray though stable then, not have shown bone growth then and if not why wasn't that a concern on the surgeon's part and why would this surgeon say the xray looked good then?

Well obviously he just wasn't looking for it. Though I'm only a nurse, I have had many years experience and training that has enabled me to read xrays and I can see the faintest of signs of fractures and loosening implants. But I've known many young surgeons who simply cannot see what I can see. Perhaps your first surgeon was one of these. If all he was looking at was the placement of the implants, it would be very easy for him to just not see the faint clues of loosening.

why can't they position it with glue - it was positioned with screws and shifted anyway?

By glue do you mean bone cement? Bone cement is not a glue. It doesn't stick anything to anything else. It's a filler like grout the builders use and just provides a filling between two surfaces. Read this to get more detail about it Cemented and uncemented hips.

I also think that the surgeon who did this replacement has demonstrated a degree of incompetence if he used a cup that was designed to be supplemented with screws and still failed to get it properly and securely seated. An example of very poor surgical skill in my opinion. For what it's worth, it's likely that your new cup will be secured with bone cement but I would ask that directly if I were you, just to be sure. In my experience, it's not a good idea to use another uncemented device where one has already failed to bond with the bone.

As for other questions, the first and predominant one that comes to my mind is to ask this surgeon how many revisions he did last year. This shouldn't be a 'in my career' number and neither should it be all the hips he's done. For a very experienced and skilled revision surgeon, the number for 12 months should be around 50 upwards.

 

[zinnia]

Thank you, Josephine. I've read the cemented and uncemented hips article and find them very interesting to be sure. And I will read them again before my pre-op.

My new surgeon has a way he encourages bone growth using my own blood to encouraged the bone to grow and he has had success with that formula. But I am troubled and want to push for using bone cement for the reasons you suggest. Can both methods be used at once? The bone grew in the femur implant device or around it. What ever, it grew and it is stable; no need to revise that part of the hip.

I have also written down the questions you suggest and will ask at pre-op. I am very antsy about this surgery for obvious reasons. I am anxious about having another failure. I never really got the chance to walk well because of the extended recovery time necessary after the 2 surgeries. I started to walk unassisted at the one year point but then this cup must have started to shift and the pain and the reduction in movement began - not bursitis.

I am also convinced that the femur was weakened by the emergency revision and the spontaneous fracture of the femur was caused by that and the PT having me do leg presses. It was after that PT session but at home that the femur got the hair line fracture.

The result of all this is that I am going to follow your recovery plan by the day on this one and walk, walk, walk with or without an assist. I will be back to pester you again.

I am so grateful you and everyone is there. Probably after the pre-op. Thanks one and all for sharing your stories. You can't know how they inspire and cheer me on, especially now.

Is Joe around?