THR acetabular cup problems

[allj]

Hi
I had anterior hip replacement 8 weeks ago at New England Baptist in Boston w Dr. Carl Talmo. He wasn't much on bedside manners but went with him because he was at a renowned orthopedic hospital. 1 day in the hospital and told there were no restrictions. Recovery was really, really hard, ie. painful, for at least the first 3 weeks.

When I went for my follow up 6 weeks post-op I met with his nurse practitioner and noticed there was one wire at the top of the femur in the xray. I was told it was to add support - there was no mention of a bone crack.

I am walking pretty well but have significant buttock pain esp after sitting.

I had a torn labrum in the rear and the pain that drove me to get surgery was no worse. I tend to have bad luck with surgery like chronic pain from a trapped nerve from hernia surgery but don't want to over react. Anybody have any thoughts on this, comforting or not?

Thanks Alan

 

[Pumpkin]

allj,
Welcome to BoneSmart, glad you joined us.
Sorry to hear you are having a difficult time.

I am going to tag our forum Nurse and Director @Josephine for you. She will probably have some additional questions for you.
Do you have an X ray you can post?
A few tips on posting xrays

I am going to leave you our recovery guidelines, the articles are short and will not take long to read.

Hip Recovery: The Guidelines
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
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

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?

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.

 

[anny]

Hi @allj .....sorry to hear your recovery is a bit fraught, it must be worrying to discover things about your surgery by 'accident'. I haven't had my op yet so don't have any suggestions about what might be going on, but could you contact your surgeon again and get some clearer answers? And Pumpkin has tagged Josephine for you, so I'm sure she'll be able to point you in the right direction. Hoping that it turns out to be just a blip, but you will get a lot of support on the forum whatever happens

 

[Cas]

Hi and to the forum. Am no expert and Josephine will be along to give you medical advice. The only thing I can say is that we all have the butt pain. It does get better with time but can be quite uncomfortable. I think that's quite normal as it is with everyone but josephine will help with that. Hope you have a wonderful recovery. People on here will help all they can so keep posting! Cheers Carol

 

[Jackie222]

Hello @allj, sorry to read that you are having concerns over your surgery Josephine will he able to offer advise.
I think the pain in the bottom when sitting is perfectly normal. It sometimes still feels like I’m actually sitting on the implant! I have no doubt that this will pass in time

 

[Gone again]

Hello Alan and congratulations on the THR. I’m at 5 weeks past my second THR and sitting upright at a table or in the car is still the most uncomfortable position. I’ll have to stretch before taking a step. Lying down is no problem. I can get up and start walking. I hope you get an answer on the wire. I’d be calling for an explanation. I still have various pains. My knee is the worst but every recovery is different. All the best my friend. @allj
Bill

 

[Berber7227]

I am 7 weeks PO for BTHR, anterior. At first Dr appointment, saw x-rays! I have a screw in each cup! Was told if you need one you get two, if you need none,you get one! Had no clue?

 

[allj]

Thanks all for the support and words of encouragement. Why did I think once I was able to walk without a cane progress would be short coming??? I am still more than uncomfortable. I hate having to take oxycodone long term but have to take 2-3 a day to function and then it only moderately masks the pain. I stopped doing the exercises that I did when I started recovery since I was able to do them with minimal effort/pain. I thought just walking would do the trick but it didn't and may have made things worse so cut back and started using a cane more to take the pressure off the leg.

Thank you Pumpkin: I read your helpful post about not needing exercise but the pain in my butt screams at me. Is there anything I can do beside ice to reduce the pain there? I really am having a hard time lying around. Should I do gluteus or other exercises? If so does anyone have an exercise list including pics or even just a list without pics. Without this site I would have tormented myself with doubts. Thanks again for all the good vibes.
Impatiently,
Alan

 

[Pumpkin]

alan,
I will tag our director and forum nurse @Josephine, she may have some questions to figure out why you are having troubles.

Please post your exact surgery date, a moderator will add it to your signature for you.

Thanks!

 

[Josephine]

I am still more than uncomfortable. I hate having to take oxycodone long term but have to take 1-2 a day to function and then it only moderately masks the pain.

Well I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[allj]

I had surgery 11/8/2017
By all means ask any questions either by PM or in an online post if it would be helpful to others.
Alan

 

[Josephine]

I never use PMs. It robs the forum of necessary information.

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are.

This would be for what you have been doing in the last 3-4 weeks

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

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?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

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
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[allj]

Hi Josephine – thanks for taking the time to do this.

I wasn’t prepared for such a difficult recovery that would go as far as test my faith. It’s hard not to think something may be wrong when one has been through a failed surgery and also doesn’t know what is normal. Thanks again.

1. The surgery was done using the anterior approach

2. I have pain on the side and front top level with the bottom of the scar. It starts as a 2-3 and increases to 5 or more depending on my activity level. The pain is mostly dull and sore feeling in conjunction with a stabbing pain.

The worst pain that is in the center, top center of the buttock. It can start at 0-1 and by noon it is a 6. It is a pinching, sore pain and that gets much worse when sitting. I also have pain just below the buttock muscles toward the inside juncture of my legs that is the same type and level

3. The meds are 5 mg oxycodone. I usually start taking them about noon, but sometimes when I wake up and sometimes a few hours after noon. I usually take another ½ more about 3:30 and then maybe another around 8PM.

I am in Private Practice so can make my own schedule. I have been working 2-3 day a week but need to work at least 3 or more days a week on a regular basis. When at work I have to sit for long periods of time causing significantly more pain and more meds. On those days I can take up to 3 - 3 1/2 oxycodones.

4. I stopped icing. I can’t do this at work. Maybe, I need to do this when I get home?

5. When I sit in a chair that isn’t in front of my computer, I usually elevate my leg on a hassock (Does this count?) maybe an hour or so at most a day. When I can’t sit anymore due to butt pain I will lie down for ½ - 1 hr.

6. The last week or so I have been doing housework, etc less than my normal pace. I had to snow blow my long driveway a few days ago. I was sore at the end of it and subsequently had more pain but to my surprise was only in a little more pained than usual.

7. I usually do 1 maybe 2-3 exercise sessions a day.

I was doing the following exercises and tried to do a modified bow as well. I couldn’t raise my leg at all and the muscle at the lower back, guessing internal abdominal oblique muscle. I had pain in what’s left of my femur. I was then instructed by my MD not to do this exercise now.

Thomas test stretch 10x
Buttock contraction 10x
Sitting kicks 10x
Standing and sitting knee raises 10x
Bridging with not surgical leg and extending the other straight 10x
Pilates leg lifts
Rainbows 10x
Pilates bicycles 10x
Hamstring stretch – more than short time
Iliotibial band stretch
Some yoga exercises for core twisting
Try to walk about 1/2 mile a day but it's been too cold so I pace my floor for 20 or so minutes.

PT was only prescribed for 4 visits. The nurse said she would prescribe it but I would likely be in worse pain. She recommended I just walk.

 

[Josephine]

starts as a 2-3 and increases to 5 or more depending on my activity level
The worst pain that is in the center, top center of the buttock. It can start at 0-1 and by noon it is a 6.

That 5-6 is about okay for 9 weeks
The buttock pain is almost certainly Piriformis syndrome.

3. The meds are 5mg oxycodone. I usually start taking them about noon, but sometimes when I wake up and sometimes a few hours after noon. I usually take another ½ more about 3:30 and then maybe another around 8PM.

I suggest you stop the oxycodone and switch to Tylenol 1,000mg 4 times a day.

When at work I have to sit for long periods of time causing significantly more pain and more meds

This will be the piriformis. You need to get a large ice pack (gel type), freeze it and sit on it when you're at home.

4. I stopped icing. I can’t do this at work. Maybe, I need to do this when I get home?

see above

6. The last week or so I have been doing housework, etc less than my normal pace. I had to snow blow my long driveway a few days ago. I was sore at the end of it and subsequently had more pain but to my surprise was only in a little more pained than usual.

You're doing too much! Snow blowing your drive was a big no-no and doing anything but the most trivial household chores is out too.

Did you read the recovery guidelines Pumpkln left for you in post #2? There's one about Activity progression I suggest you go back and read it again.

7. I usually do 1 maybe 2-3 exercise sessions a day.
Thomas test stretch 10x
Buttock contraction 10x
Sitting kicks 10x
Standing and sitting knee raises 10x
Bridging with not surgical leg and extending the other straight 10x
Pilates leg lifts
Rainbows 10x
Pilates bicycles 10x
Hamstring stretch – more than short time
Iliotibial band stretch
Some yoga exercises for core twisting
Try to walk about 1/2 mile a day but it's been too cold so I pace my floor for 20 or so minutes.

Also in the recovery guidelines was a paragraph entitled BIG TIP. I suggest you go read that again too!
Basically is says NO EXERCISES. You should have listened to the nurse. Any and all exercising it only going to make your pains worse.

 

[allj]

Thanks Josephine. My hip decline started with piriformis syndrome and progressed to a torn labrum, then to a hip replacement. After the labrum tear my hip was frozen - unusual for hip. I worked through this and notably even though I had limited motion again, pain sitting was no longer a problem. It's a real kick in the buttock to have this again. Thanks for trying to help. It's much appreciated. I don't know if this is part of your expertise but do you have any suggestions about the piriformis (prolotherapy, exercises, etc??)

 

[Josephine]

My hip decline started with piriformis syndrome and progressed to a torn labrum

Those two conditions are completely difference and un-associated. One is outside the joint and the other inside it so the piriformis cannot 'progress' to a torn labrum.

After the labrum tear my hip was frozen - unusual for hip

Not common no, but I've seen a few in my time. Nasty experience for you.

 

[Cas]

@allij Hi there how are you doing? Just thought I'd check in with you! Is the butt a bit easier and are you doing less. It's so hard when you are used to being active and then have to cut back so much but it's only for a small amount of time and your hip will be brill. Keep posting - happy healing - Carol

 

[allj]

Carol thanks for your words of encouragement. The surgery really messed up my soft tissue. I had pretty severe problems in the past - piriformis and then my leg froze up - so maybe it's just my luck/fate. The pain I have is from a swollen trochanter bursa, SI joint pain and iliopsoas pain. At about 6 weeks out I felt I could walk ok so did what the surgeon said walk, walk. I went gung ho, so maybe I'm responsible for the trochanter. It's 3 months - I have a great PT person who climbs on me doing deep tissue, stretching and pulling so still hoping to say "all's well that ends well" (I'm just hoping this can resolve by spring).
Thanks again Alan

 

[Mojo333]

I have a great PT person who climbs on me doing deep tissue, stretching and pulling

Jeez, are you sure that's a good thing?

 

[allj]

Nope but so far so good. Here's her blurb: "Sofia is certified to perform the gold standard of soft tissue treatment using the Active Release Techniques for full body, nerve entrapment, and complex protocols". She kept me walking and out of excruciating pain for 2 years before finally getting the hip replacement.