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Hip Replacement

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  • #61
    I had THR via anterior approach on Dec. 20. Started PT that day in the hospital. I spent 2 nights in the hospital. Started PT on Jan. 3. It was great. Flew through all the regular stuff, then started focusing on getting ready to ride. I think I started riding in early March, but could have started at 60 days. Absolutely no pain.

    The weirdest thing about riding is that my proprioception was off because I'd been so collapsed to the right. Now that I'm straight, I felt twisted to the left. But PT gave me more exercises to help.

    Now for the first time in a couple years I can drape my right leg on the horse's barrel. Both feet are pointing straight ahead in the stirrups. I'm confident and relaxed riding. My gait is absolutely normal.

    Comment


    • #62
      Originally posted by stryder View Post
      I had THR via anterior approach on Dec. 20. Started PT that day in the hospital. I spent 2 nights in the hospital. Started PT on Jan. 3. It was great. Flew through all the regular stuff, then started focusing on getting ready to ride. I think I started riding in early March, but could have started at 60 days. Absolutely no pain.

      The weirdest thing about riding is that my proprioception was off because I'd been so collapsed to the right. Now that I'm straight, I felt twisted to the left. But PT gave me more exercises to help.

      Now for the first time in a couple years I can drape my right leg on the horse's barrel. Both feet are pointing straight ahead in the stirrups. I'm confident and relaxed riding. My gait is absolutely normal.
      Yup, that's the point of not putting it off. It's not going to get better
      I wasn't always a Smurf
      Penmerryl Sophie RIDSH
      "I ain't as good as I once was but I'm as good once as I ever was"
      The ignore list is my friend. It takes 2 to argue.

      Comment


      • #63
        I had a hip replacement January 2012 using the posterior approach by a very experienced hip specialist--that's all he does--hips. Titanium shell and femur stem, ceramic femur head, and highly crosslinked poly shell liner. I was in pretty bad shape going into the surgery --was in a lot of pain, using a cane and walking like a 100 year old, rather than a 51 year old. Muscles on that leg had atrophied--it wasn't pretty. I had spinal anesthesia and it was great. I woke up quietly, no pain because I was numb from the waist down. Spinal wore off slowly so I had lots of time to get adequate pain meds in me before it wore off totally. Much easier to keep up with the pain that way.

        Non-cemented and I was full weight bearing from get go. I came along with recovery pretty quickly. I was originally told 12 weeks before riding, but at 7 weeks, I was given the OK to ride if I could comfortably do so. Unfortunately I couldn't do it because of arthritis pain in the other hip. The new one felt fine at that point, though.

        I know the anterior approach is all the rage now, but personally, I would rather the surgeon be able to physically see what they are doing in there, rather than rely on radiologic equipment and to check the hardware placement. Yes, a few more muscles are traumatised with the posterior approach, but with an experienced surgeon, recovery can still go pretty quickly. I belong to an online support group for hip replacement patients and I've found reports of nerve injuries and dislocations to the front with anteriors, more so than the posterior. Seems like the posteriors come out of surgery with everything working OK and just start their healing without much drama. There is a period of restriction for things like bending more than 90 degrees and crossing your legs, but that period goes fast (mine was for 6 weeks) and it didn't seem that inconvenient after the first week or so.

        I sometimes wonder if some surgeons are jumping on the anterior bandwagon because they can draw in patients who want the anterior ... but they might not be that well trained in the procedure. I was just looking at a rthopedic group's owebsite the other day where the primary focus of the ortho surgeons seemed to be complex fractures and pelvis reconstruction. But, then I saw a section about their doing anterior hip replacements too. Seemed odd to me because it was like it was an extra thing they added into their practice and that was the only type of hip replacement they did. There is a lot of competition in the joint replacement world these days ... Stuff like this concerns me. Just my 2 cents.

        I had the second hip replaced by the same surgeon but had to go to a different hospital. That was in June 2012. The surgery went fine and I felt even better and had better post op mobility than after the first one--I got out of bed the next morning with very little help and walked in the hall for more than 50 feet without batting an eye! I thought recovery was going to go at lightening speed--it had been so much more difficult with the first hip at that point because I had been so weak prior to having the surgery. The problem that occurred, though, is that I had to go to a different hospital for hip number 2, and their physical therapy was much more aggressive. I don't know why I didn't refuse some of the more painful exercises ... but I didn't. I gritted my teeth, cried, and just forced my way through them. I ended up getting a hip flexor tear and although the hip itself is fine and healing great, the tear is delaying my overall recovery. My surgeon thinks that it may be up to 6 months before the groin pain is gone and the tear is healed. That is such a bummer because I started out SO well.

        ****Advice for anyone undergoing a hip replacement, or... really any ortho surgery like it: Although PT immediately post op is not easy and it does involve some pain, it shouldn't be severe pain--if it is severe STOP and refuse to do it. You don't need to go great guns on PT in the beginning to recover just fine. Starting with some basic exercises and walking is all you need during those early post op days; you can advance to more intensive exercises as time goes by. You may need a friend or family member to attend the first couple of PT sessions, just to watch out for you because I know my judgment was clouded between the stress of the surgery and the meds, and I tended to just do anything they wanted me to do, even though it hurt like "you know what" and I told them so. They just pleasantly said "Oh you are doing fine; keep going." Well, "keep going" ended up with an injury I didn't have going in. So, just be on the lookout for overly aggressive (yet usually well meaning) physical therapists and stand up for yourself if necessary.****

        My riding will probably be delayed until spring of 2013--I'm a wuss and don't tend to ride in the winter. But, I wasn't able to ride for more than 2 years prior to surgery, so I guess waiting a few more months won't kill me.

        Good luck to anyone considering this surgery. It's not a walk in the park (it's a major surgery), but it's very doable and it's absolutely life changing to go from feeling that awful arthritis pain to having a joint that moves fluidly and feels great. The joint prostheses they are using now are lasting a lot longer too, so it's nothing to be able to get 20+ years out of your first replacement.
        Horse'in around in Upstate NY

        Comment


        • #64
          DM, I agree with much of what you have to say.

          I had the anterior approach on Dec. 20, and one of things I wanted to know was how many anterior approaches had my surgeon done. He's done more than 400, so I'm not one of his early practice cases. I think this number is important and indicates a better outcome. I waited for 3-4 months for this particular surgeon, and I think the wait was worth it. The surgeons available in a month or so? I would have to think about that, and weigh the benefits vs. risk.

          As to your comments about physical therapy: I don't think it should hurt. I overdid some on my own, but never, ever did my PT push me to do something I wasn't capable of doing. Maybe that's the difference between having someone with experience (and I'm certainly not saying that your PT doesn't) and a less-experienced one. But I've been working with this PT for 15 years or so, and he's remarked a number of times that his approach has changed as he's gained more experience. I also think it's important to say on my own behalf that I'm done, that's uncomfortable. Be your own advocate and if you can't, absolutely bring someone along with you.

          I agree that it's a wonderful surgery.

          Comment


          • #65
            Hi Stryder, I'm glad you are doing so well and happy with your new hip. Isn't it great not to have that pain????? Yipppeee!!!!

            You did your research to find an experienced surgeon--good for you!!!! That is so important, no matter what approach you choose, but I think it's even more important with the anterior, since it is newer.

            About the PT problem I had--the damage was done the first post op day at the hospital. They seemed so into their "circuit training" type system that they completely ignored that I was having so much pain doing a couple of the exercises--heck, I was only a little more than 24 hours post op and they had a ton of exercises for me to do--I thought it would never end. Maybe they don't have too many people who will just push through the pain and "just do it" like I did and other patients never get to the point of injury??? I don't know. If I had been clearer headed at that time, I would have refused to do the "OMG!" exercises where I think the injuries occured. But, I DID make it very clear that "this hurts SO bad!" and I was crying, so I do put quite a bit of the responsibility back onto them. Oh well, it's in the past, and I will heal. The good news is that the hip itself and the other muscles involved feel great!

            Happy riding!!

            Dorothy
            Horse'in around in Upstate NY

            Comment


            • #66
              DM - Wow. I think the only thing I did first day post-op was walk a little, get in and out of bed with assistance. Leg pumps and heel slides in bed.

              There was no circuit-type training. The PTs I had in the hospital were bright but seemed quite young. I'm generally agreeable but I don't think I could have gone along if one of them had really pushed me. Sure, a few more steps I could manage, but I'm under no delusions that I have to let them hurt me.

              I can't imagine the frustrations you're experiencing: you finally get the surgery, and now you're hurting even more!

              I think eventually that most hip replacements will be done via the anterior approach because the recovery is easier. But not everyone is a good prospect for it for one reason or another. Not all surgeons want to re-learn the procedure, and some of them have done thousands the other way.

              A fellow rider at my barn is starting to think about having her second hip done. She's a retired physician and has been amazed at my recovery. But her surgeon of choice is the same fine surgeon who did her first one, and he does not do the anterior approach. She's chosen the human over the procedure because she was a history with him. I was able to choose the human and the procedure.

              Dorothy, I hope you continue to recover, and that your experience here will help some other rider facing the same procedure.

              Comment


              • #67
                I just want to say that both here, and via PM with a member who has had this procedure, I'm getting a lot of support and am collecting my "question list" for my surgeon. So, the more you can all post about your experiences, types of prostheses, any negatives in terms of your range of motion, and all your other experiences, the happier I am to soak it all in. A million thanks, you don't know what it means to me to think that someday I will might be able to be on a horse again.

                Comment


                • #68
                  MM, I hope you'll be astride again someday, too!

                  For the surgeon, I'd ask:
                  1. How many (of this approach) have you done?
                  2. How many have returned to the hospital due to complications?
                  3. What's my expected recovery time?
                  4. How much functionality can I be expected to regain?
                  5. Which appliance will you choose for me?
                  6. Has it ever been recalled?

                  Because hospitals have recognized that joint replacement is a high-demand area, some are building new joint centers. These are purpose-built facilities. I think it's a benefit that these areas have never had really sick people in them. But not everyone has that option.

                  I'd also like to know about the general infection rate at the hospital.

                  My surgeon writes a blog about joint replacement:
                  http://blogs.valleymed.org/joint/

                  Helpful information.

                  I don't have any limits on my range of motion, and I can do things I haven't been able to do for years. One of the best things is that my other hip and both knees no longer hurt! Neither does my back.

                  Good luck to you!

                  Comment


                  • #69
                    Stryder--my first hip PT first post op day (January 2012) was like what you experienced (same surgeon; different hospital). I was fine with that. We went to a "gym" the second day in a group and did more structured exercises and that was still fine. Left the next day. I progressed quickly and felt better every day.

                    The first post op day PT at the second hospital for the other hip in June 2012 was "holy crap!" I don't know why they have chosen to be so aggressive with post op PT, but they have. I did decide to phone the PT supervisor (who is a very nice man and wasn't on the scene when I was having such a hard time) and discussed my concerns. He said he will definitely speak with his staff and remind them of the importance to watch the patient's response and listen to them more carefully and stop if they are having a hard time. He didn't say anything about changing the program, which I subtly recommended ... but I can't control that. I feel better about talking with him and think I can let it go more now.

                    MM--Stryder gives a great list. I would add--discuss *prior to surgery* the plan for post op pain management and make sure your surgeon is going to make sure you get adequate pain medication. It varies SO much. I am on a great online website/support/info board for joint replacement that I recommend you check out www.bonesmart.org It's great!! On that board, I've read about post op pain management experiences ranging from what the patient needs to stay pretty comfortable, to surgeons prescribing very little pain medication and wanting patients to "tough it out" or "you shouldn't be feeling that bad"--That kind of thing--you need someone who will listen to you and who is reasonable in this area.

                    Recovery from any surgery hurts. It will get progressively better after you get some healing time in ... but you need to have adequate pain medication post op while in the hospital and while you are recovering at home, and there is no valid reason for not doing this with a joint replacement. Tylenol may be enough for some people after the first couple of days ... but that's definitely not the norm. Some surgeons just don't seem to understand that, as odd as that sounds. You need to be comfortable enough to walk and do your PT exercises; you can't do that if you are in a lot of pain.

                    I have a friend who had a hip replacement with my surgeon who is great about pain management, and then the next year had a shoulder replacement with a different surgeon who is stingy with pain meds. She rationed her pain small amount of narcotic pain meds so much that she has been unable to do her therapy the way she needs to ... 8 months post op, she still has significant deficits with her shoulder and a lot of residual pain and scar tissue build up. Hips come around faster than shoulders in general, but she attributes lack of adequate pain control to her slower-than-average shoulder recovery. She did great after the hip replacement and recovered in record time with adequate pain medication post op and at home.

                    I would also ask how many *hip* replacements they do in a year. The more the better. My surgeon does almost 500 per year, which is pretty high. He is like a machine doing these and has excellent stats and rarely has any complications. He could do this in his sleep and is a hip specialist and well known nationally and internationally. If they don't do more than a couple hundred a year, I'd look elsewhere.

                    If I think of anything else, I'll let you know. But, do check out the bonesmart board. This is the best place I've found for support and information for joint replacement.

                    Dorothy
                    Horse'in around in Upstate NY

                    Comment


                    • #70
                      Dorothy - Excellent point about pain management. My surgeon (and the hospital) are very aggressive about managing pain because research shows that people in pain don't heal as fast.

                      Every time any of the staff came into my room, they asked about it. 1 meaning no pain whatsoever, 10 being worst imaginable. They wanted me at about a 2. No more than 3. If I was in pain before the next load, they figured something out.

                      I went home with a bottle of narcotics and Meloxicam, plus heavy-duty Tylenol, and took it as instructed. Not because I'm a weenie (and maybe I am) but because the surgeon was very clear that pain interfered with my recovery, and would prevent me from being as active as he wanted me to be.

                      But it didn't take long to get off the narcotics because I couldn't drive on them, and there were places I wanted to go. Like to the barn!!

                      Comment


                      • #71
                        I know what you mean about wanting to go to the barn. I hobbled out with my walker (and supervision) just a few days after I got home. I'm fortunate that my horses are on my property. It was a little difficult getting the walker through the grass, but I wanted to see and touch my horses!! :-)
                        Horse'in around in Upstate NY

                        Comment


                        • #72
                          Originally posted by dm View Post
                          I know what you mean about wanting to go to the barn. I hobbled out with my walker (and supervision) just a few days after I got home. I'm fortunate that my horses are on my property. It was a little difficult getting the walker through the grass, but I wanted to see and touch my horses!! :-)
                          I'm with you! I couldn't get my own shoes on but by god, I was going to the barn. So DH drove, helped me out of the truck, someone brought my mare into the crossties, just so I could feed her a carrot.

                          Comment


                          • #73
                            Thanks for the updates!

                            Dorothy, you poor lady. I cannot imagine how frustrated I would be suffering an injury from PT. That's like my worst nightmare about surgery, I'm sure I would be super bitter and crabby. Your attitude, on the other hand, is spectacular! So kudos to you!

                            I was the same way with going to the barn when I had my hip fracture. I had my mom drive me out to the barn (I didn't have the farm then) and my horse was in the arena when I wheeled in on the walker. My friends put me in a chair in the arena so my horse could nuzzle with me. :-) He kept taking the walker with his teeth and trying to heave it to the side. I think he wanted to crawl into my lap, which is a funny visual because he was a 17.3 hand chunk of muscle!

                            Comment


                            • #74
                              Originally posted by stryder View Post
                              I'm with you! I couldn't get my own shoes on but by god, I was going to the barn. So DH drove, helped me out of the truck, someone brought my mare into the crossties, just so I could feed her a carrot.
                              Now that is a dedicated horse addict! :-)
                              Horse'in around in Upstate NY

                              Comment


                              • #75
                                Originally posted by Steepleview View Post
                                Thanks for the updates!

                                Dorothy, you poor lady. I cannot imagine how frustrated I would be suffering an injury from PT. That's like my worst nightmare about surgery, I'm sure I would be super bitter and crabby. Your attitude, on the other hand, is spectacular! So kudos to you!

                                I was the same way with going to the barn when I had my hip fracture. I had my mom drive me out to the barn (I didn't have the farm then) and my horse was in the arena when I wheeled in on the walker. My friends put me in a chair in the arena so my horse could nuzzle with me. :-) He kept taking the walker with his teeth and trying to heave it to the side. I think he wanted to crawl into my lap, which is a funny visual because he was a 17.3 hand chunk of muscle!
                                Another dedicated horse addict! :-)

                                Oh, Steeple--I have had my moments when I've been SO angry about the injury. Luckily, though, it's nothing permanent, so I'm very grateful for that. I also just started with a new outpatient physical therapist to work on strengthening while healing and he is great. I think there will be a happy ending to my story.
                                Horse'in around in Upstate NY

                                Comment


                                • #76
                                  Hi all!

                                  I had an appointment with a hip replacement doctor on Monday and am feeling much more optimistic now. He is one of the leaders in minimally invasive surgery. I will have THR of the right hip with a porous device. Not sure of the size of the ball yet. Surgery would be outpatient, up and walking that day, full weight bearing (as tolerated). No muscle or tendon is cut during the procedure. Driving in a week, would be back on horseback in 2-3 weeks depending on how I felt. Most importantly, I would no longer have the pain and would have close to all my range of motion restored. This astonished me because this is the first time I thought that was possible! Since I ride dressage, the deeper I can get in the saddle, the better!

                                  I felt such a sense of relief to hear all this that I almost started crying! So I am going to talk to the family to see when would be a good time to do it. Since I live alone on the farm, I would need to have someone come stay with me for a week or so. I originally thought about doing it in the winter, but my trainer said why not just do it in the late summer and the horses can just live outside? It would definitely reduce the work involved for whoever comes to help me and reduce my stress level accordingly. So that's my current thought process. I will have more of an idea when I visit my parents next week and talk it over with them.

                                  Has anyone had any issues related to osteoperosis or britle bones and hip replacement? I have a vitamin d deficiency and am wondering if that will be an issue at all. I have a running list of follow up questions for the surgeon but thought I would ask my trusty COTH friends for their input first!

                                  Comment


                                  • #77
                                    steepleview, no answers to your direct questions, but I'm happy you're moving ahead toward a solution.

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