Question regarding recovery after THR

HipHipReplacement

Howdy,

Without going into depth with my backstory (idiopathic bilateral AVN at 16 -> osteoarthritis) that required me to get the chop, I do have a question or two about certain aspects of recovery that I'd appreciate any input on. My right hip was replaced July 2021, so I'm nearing 14 months post op.

My first is about range of motion. I have very little rotation in my new hip. I've just started yoga because of how poorly I can bend, and how much it's hindering me in the gym with certain exercises (hip adductor/abductor especially, there's very little range of motion). With the yoga I can barely do any of the bending. So my question is; has anyone gone through this and improved their range close-ish to what they had previously? And how long did it take you if you did? There are two factors at play here, one being that my left hip is rotten and needs chopping too and that hip really does not bend, which naturally hinders the right. The second factor being I put my replacement off for about six years to continue playing football, and the hip collapsed. Combined with COVID stopping all operations, mine was cancelled and put back 16 months where I was mostly in a wheelchair, so my muscles/tendons tightened, atrophied etc so I'm really starting from square one.

My second question is just a general curiosity. The big ol' chunk I have missing on my hip where the surgeon went in anteriorly, did that fill in again when you regained muscle or did it stay concave for you? My sister who had both of hers chopped said it didn't fill in, but she's also not an active gym goer as myself.

There was another question I've forgotten due to this long drawn out post, but I'll add it if I remember.

Appreciate you taking time to read this!

noddingtonpete

Hello @HipHipReplacement have a look at the following article it might help

https://www.versusarthritis.org/about-arthritis/treatments/surgery/hip-replacement-surgery/

Kind regards

Peter

frogmorton

Hello@HipHipReplacement

My own daughter has AVN due to treatment for cancer. She was lucky as her hip is currently ok having had percutaneous core decompression at 18, but her shoulder was replaced at 19.

Have you seen your post op X-rays? Just wondered because Lucy's shoulder doesn't have a gap because the prosthetic is in the space. Well that's what it looked like to us anyway.

You know in your shoes i would ask to see a physio because they should be the very best people to help you get your range of movement improving as much as possible.

Ask the other question when it comes back to you one of us might just know the answer!

Take care

Toni x

stickywicket

If your surgeon didn't tell you what to expect from your new hip maybe you should try to contact him and ask. The AVN has probably dictated which implant was used and, I think, how much can be expected of it. A physio and tailored exercises, might be of more use right now than yoga. But, if a physio prescribed the yoga, maybe find out what he/she expected of it.

HipHipReplacement

@frogmorton @stickywicket

Thank you for the replies. I've undergone physio since the operation, and been discharged due to my progress. I did request a follow up due to lingering discomfort and was told it was hamstring tightness. I assumed I'd have some issues as my leg was lengthened. I've been told consistently that it'll settle in time, but with no change in 14 months I'm starting to doubt that, hence my question to see if anyone was further down the line that could provide their experience. Especially with the concave incision area filling in, it's not so much a functional issue, purely aesthetic so not an area of concern for the surgeon or physio.

I do not believe the AVN made a difference to the implant, other than it had to be THR not resurfacing. The hip matured in my early 20's rather than the THR happening with active AVN.

I have another follow up with my physio to see my progress next month so I'll ask the questions again but I'm just getting very few answers other than it'll improve in time so let's wait and see. But considering I can't sit for much longer than 30 minutes in the same position I'm growing weary of this approach.

I should also mention that I was intending to discuss this with my surgeon at my one year appointment, which should've been mid July, but has been twice pushed back and is now end of November, sadly.

As for the X-ray, I grabbed a photo of it but it looks fine to me and the surgeon liked what he saw on my three month check up. Attached a copy of it anyway.

stickywicket

14 months on is a long time to be still unable to sit for any length of time. I don't recall that after my THRs. Nor with my husband after his.

He has a bit of a concave side. Not a lot. I can't see mine.

I'm not fluent in 'x-ray' but can't help wondering if the large screw is a factor. I know they do put them in sometimes and they can sometimes be removed when the implant has bedded in. Did the surgeon mention it? Is it worth an ask?

HipHipReplacement

https://community.versusarthritis.org/discussion/comment/698905#Comment_698905

I'll certainly ask. I'll raise some things with my physio next month and stick it out until my appointment with my surgeon in November, providing it's not delayed a third time.

Not entirely sure about the screw. He did say the hip was in significantly worse condition than he expected when he was in there. Not entirely sure it's consistent with my surgeons methods, or due to the condition of the bone. I'll raise that too.

With regards to sitting pain, on a comfortable chair I'm not too bad, but at the cinema for example, I get intense pain in the hamstring and glute. Not too sure I buy the physio's explanation of tight calf from just sitting.

RogerBill

Hi @HipHipReplacement I have a similar large screw in my replacement hip which was fitted 12 months ago. Before my op the surgeon didn't mention anything about a screw but he did say the stem would be cemented in the thigh bone. After the op when I saw the screw in the x-ray I checked on the internet and found that one or more screws were regularly used to fix the cup so I didn't enquire why one had been used one in my case. I suspect, as you say, the use of screws is dependent upon the condition of the pelvis. It'll be interesting to see what reason your surgeon gives for using a screw.

My hip operation used the posterior approach and was done with the assistance of a Mako robot. Fortunately my range of motion is reasonably good; much better than before the op but not as good as it was 10 years ago. I'm OK sitting for reasonable lengths of time provided it's not on a hard surface. Before and after the operation I did spend a lot of time doing the exercises recommended by the physiotherapist and others such as Lou Grant's (a physiotherapist based near Leeds, UK who had a hip replacement a few years ago and who has posted lots of free videos and advice online). My problem is now more with my other hip and lower back. I think sometimes these problems also cause pain my replacement hip. I used to enjoy regular 10 mile walks but now 5 miles at a slower pace on good surfaces is more my limit.

HipHipReplacement

Hey @RogerBill really appreciate that reply.

Like yours the screw wasn't mentioned, but I agree it was probably due to the bone quality, as he made a point of telling me how bad it looked in there (don't wait ten years too long to get it replaced whilst still playing high impact sport, I suppose!). I do know the stem itself was uncemented, and it was also a posterior approach.

I'm certainly aware my recovery is longer because of how bad it had got before the operation, and I probably expect a bit too much as I don't like being limited, but I'd definitely be disappointed if this is as good as it gets, especially at my age.

RogerBill

At 70 I believe I'm older than you, but glad to be of any help @HipHipReplacement A couple of additional points. To my untrained eye your x-ray looks similar to mine. If so, I guess it'd support your physio's diagnosis that muscle tightness is at least contributing to your restricted motion. My leg on the replacement hip side was a little shorter and the lengths were equalised by the operation. I know this because of the way I had to work on improving my balance. Initially I had to concentrate on how I how walked - still do but to a much lesser extent. I got a balance cushion and balance board to help with this and they also help a little with building muscle strength.

Unfortunately recovery does seem to require a long, boring grind of exercises. But fortunately the exercises can generally all be done at home without any expensive equipment. So no time consuming journeys to the gym and the exercises can be done in a number of sessions each day. My physio gave me some resistance bands for use with some exercises. A foam roller is used with two of Lou Grant's exercises to help tissue mobility and reduce tightness in the quadriceps and gluteals which she says is often a problem in people having had hip problems.

MillieMc

Hello,

Hey,

My aunt underwent an AVN surgery last year, but her surgeon told her the recovery period in between 3-12 months, and he was correct. She got well soon entirely after ten months. I think your surgeon is not good at follow-ups after surgery. Yoga is a good practice, but I think a specialized physiotherapist in hip procedures can help you to resolve this. I will discuss your thoughts and worries with her and let you know. Take care.