Struggling

[WillW]

I’m just over 3 months post op and I’m having what feels like an exceptionally difficult and challenging recovery. I was doing well for the first 5 weeks. I don’t think I over did anything- but since then I’ve been having so much pain when walking.
Bursitis on the lateral side, pain in the front, the groin, and my glute just blows up with inflammation. I can’t really strengthen it without it blowing up. On a good day I might be able to walk just under .5 mile before it starts hurting and I limp. The only thing that really seems to help is if I just sit on the sofa 90 percent of the time. Even swimming blows my hip flexors up - I can get away with a mile if I use a pull buoy. I’m actually in some ways feeling more disabled now than before the surgery and I just see no end in sight.

Maybe 3.5 months is still super early? Any insights or advice from anyone would be appreciated- I can’t imagine trying to spend 6 more months like this

[jimbone]

Will,

Your symptoms don't sound like the usually expected recovery.  Without being alarmist, it would probably be wise to get a consultation with your surgeon to find out what's going on.  Some imaging should tell the story and if your doctor doesn't/can't provide you an explanation get a second or even a third opinion.  Most of the top surgeons can review your xrays and give their opinion so you can make a more informed decision.  If there is something wrong/misaligned it would be better to address sooner than later.  Sorry to hear you're struggling.  Best wishes and keep us informed.

[WillW]

Jim

Thx for your response. I agree. Everyone else seems to be doing back handsprings by now. At least walking ok. I did speak with my surgeon; my 8 week x ray was good. I then spoke with him 2 weeks later to share my concerns- he said he has seen this and expects it to pass in a few months . I did get an MRI. It showed some glute tendinitis which is not so unexpected I suppose. More concerning to me was it showed what was either fluid or inflammation measuring 6x10x3 cm. I did forward it to my surgeon but he wasn’t too concerned. That was Jan 31. I’m going tomorrow morning to get another one and then I do have an appointment with a hip surgeon I know near me who will take a look. He doesn’t do resurfacing though but I know and trust him. Do you think that Dr Su or Dr Gross would be willing to take a look and give me an opinion? I know some surgeons don’t really want to get involved in the work of other surgeons.

[jimbone]

Will

I'd absolutely encourage you to seek the opinion of other surgeons, especially if you are considering Dr. Gross or Dr, Su.  From what I've read they are very open to providing their medical evaluation and interference/conflict between other surgeons doesn't seem a primary concern.  Among the top surgeons my observation is they are scientist/physicians first and committed to the best result of the patient based on objective evidence.  It may be geographically impossible for you to realistically considering Dr. Pritchett in Seattle as a viable surgeon should you need one, but I would strongly advocate you seek his opinion prior to any final decision- he knows his stuff.  Best of luck, keep us informed and hope you find some relief and resolution soon.

[WillW]

Jim

Dr Pritchett is my surgeon. I agree - I think he’s an excellent surgeon with a very good device. His opinion was that while outside the norm, he has seen long term inflammation of the area beneath the incision including the trichromatic bursa. The other thing I experience is that my glute med doesn’t fire well when walking and gets easily inflamed. He said he has seen that also and that it would come back. I will get another MRI this morning and another x ray this week just to make sure nothing has moved. Dr Pritchett is probably correct but I do want to get a second opinion. If he’s correct than I guess I’m just one of those people that is having a slow challenging recovery. I went into this very fit and did a lot of pre-hab, but I’ve read for reasons nobody can explain some people have difficult recoveries that can take up to a year to get back to normal. I really hope that’s not the case- but if it is I really need to get my mind to be ok with it.

[jimbone]

Will

Getting the advice of a surgeon you trust is a good idea along with current imaging.  There might be some inherent conflict  if that surgeon doesn't support HR over THR but that's a speculation.  The opinion of other HR surgeons - Gross and Su would be something I'd pursue as well.  One of my impressions of Dr. Pritchett has been he seems to me to have a strong confidence in the body's ability to heal and recover despite it taking longer than expected.  That's a subjective impression maybe even a projection but one I am comfortable with.  At my 1 year exam I mentioned a specific movement that still seemed restricted- to go from lying on my back to rolling up straight forward to a squat in order to stand up- I needed to roll to the side and make this movement in two stages.  His reply was "That might come back", words to that effect.  It's not anywhere near as essential a function as what you are struggling with but pointed me to the idea that muscle/soft tissue healing were longer term and specifically focused.

Did you do any PT after surgery?  I was lucky to have found an excellent therapist that worked with me probably 6 weeks or so and it helped a lot.  I had a similar issue with my glute med as well and it was a good 4 months before it resolved.  It wasn't as severely impacting as yours and I never developed a non-weight bearing or walking issue although I would develop some slight general soreness after a 1.5 mile walk until months 3-4 but that resolved.  Initially I was unable to do the "Baby Pose" fully- attempting it casued a sharp limitation and some associated discomfort ad feeling of vulnerability.  Sticking with it for a good 6 weeks during months 3-5 it finally released and no longer is an issue.  I mention it only to reinforce the idea that the body wants to heal but on its own time.  I understand that doesn't offer you much in the way of assurance- just an observation.

Very early- weeks 3-4 one exercise I practiced was balancing on my operated leg- done at a counter at first for balance and eventually free standing.  It seemed counter intuitive as initially it felt threatening to the device but it soon helped re-establish both strength and confidence in the hip.  If you think PT might be a good support approach ask about those two exercises and see if incorporating them to your routine might help.  Bear in mind- all PTs are not equally qualified so if you go that route- maybe even again- be sure to find one that understands your goals and limitations and respects your objectives over their preconceived protocols.

Another beneficial treatment I relied on was regular deep tissue massage therapy.  I was very fortunate to have a very skilled and talented LMT work on me and their therapy was essential to my recovery. 

Lastly- I had swelling and tightness in my quads for several months following both my procedures and at times was concerned it was going to be a permanent restriction but with time- maybe 6 months each- it too resolved.

You're doing the right things to deal with this- seeking other opinions and not making premature conclusions or letting your understandable concerns overwhelm you.  While you wait for further consultations it might be best to go easy on yourself and even take a few steps back- do your walks with either crutches or a cane if that provides enough support not to increase inflammation and just practice the basic 1st step exercises given at hospital discharge- heel slides, abduction, bridges ect.  Try to find a compromise with continuing to move to your ability without flare up until you get some more information.

None of the above can be considered advice it's only meant as encouragement while you get this worked out.  Stay in touch and keep us informed with your progress.  Best wishes.

[WillW]

Jim

Thank you again. Your words do provide some encouragement and even a touch of hope. Yes, I’ve been doing PT since week 2. They’re a bit lost and I’m starting to work with another PT that I believe understands not so much resurfacing vs THA but more the impacts of the surgical approach. Today I was able to go through activities of daily living that amounted to about .75 miles, but am now icing. I find that wearing a girdle acts as a good compression device and wear them often although shopping for them can be a bit embarrassing.

I think good massage and possibly some active release work would be helpful. Thx for the tip.

I just got my 2nd MRI this morning and while I don’t have the report left I can see there is a lot of either inflammation or fluid or possibly both at the lateral aspect of the hip especially at the trochanter and trochanteric bursa. I will get a back up x ray just to be sure and I’ll be taking all images to a hip surgeon on March 8th. I would like to get the opinions of some of the people that do lots of HR as well though. I will reach out and make inquiries on Monday. It’s entirely possible that for whatever the reason I’m just experiencing a ton of inflammation and in a few months things will lighten up. I will keep you posted and thank again for the interactions, inputs and ideas. It’s been super helpful
Will

[jimbone]

Will,

Good approach, take it a step at a time and consult with the experts.  Your surgeon is top notch and if he's counselling patience it may be all it will take but being proactive as you are is always best imo.  Do stay in touch here and don't let it get you down.  Care choosing the right PT could make a world of difference.  Let us know what the other HR doctors say about the new imaging.  If icing and a brace/girdle works stay with it. 

[WillW]

Jim

It’s been about a month since my last posting. I did find a local hip surgeon that I trust although he doesn’t do HR. He confirmed what the MRIs showed: the area around my incision, my glute med, and even posterior joint is full of fluid. Lab tests suggest no infection. I agreed with the assessment that there’s likely no infection now and my symptoms are slowly improving, it makes sense to try and let it absorb as putting a needle in to aspirate the fluid could create an infection.

I’m still at 4.5 months icing a lot but definitely improving. I was able to walk just under 3 miles the other day and can now swim without a pull buoy -

I do have some low back pain that I believe is related to compensation but my glute med is finally online.

I’ve settled into acceptance that I’m going to likely have a long somewhat challenging recovery with this, but at least it does at this point feel like some forward momentum again

[jimbone]

Will,

Good news, great to hear it even if it's less improvement than you'd been hoping for.  3 miles indicates a strong improvement from a month ago and is clear progress.  With infection largely ruled out sound like the scariest prospects are behind you.  As mentioned, my glute med was troublesome as well and took 3-4 months to finally release enough to begin stretching effectively.  Other were running 5ks by then, so go figure.  Are you benefitting from continued PT?  Not sure of your location but I could make a recommendation for a PT in Tacoma who was very effective for me.

I'd also guess some of the backpain might be related to just your reduced activity.  As a previously active person, physical restrictions can set muscle groups up for spasmatic-like episodes.  It has for me at least and when finally able to get moving again they worked themselves out.  That is one of the reasons I relied on and benefited from good deep tissue massage work to help balance things out.

Do you keep a gym membership?  Controlled, light weight machines for all muscle groups were helpful for me to get back on my feet as was swimming which I see you pursue.  An excellent exercise one of the members recommended to me was the Bosu Ball.  Began with just balancing- using a PVC pole for extra balance and worked up to squats- even single legs partial squats eventually- and found it super helpful to rebuild the external rotators and that stubborn glute med.

I'm glad to hear you're making progress even if it's slower than preferred.  I'm not a Mr. Sunshine type of guy but going through HR really did teach me gratitude for small benefits and reinforced what I already knew- they would add up and gradually accumulate to regained operational function.  I'd bet given your recent improvements yours will as well as it sounds like you have all the requisite perseverance and patience.  Slow and steady wins this race.  Keep us informed and yourself moving forward. 

[WillW]

Jim
Thx for the response. Definitely doing better. Still can blow up easily - it’s just going to take time. I do swim and do gym workouts. I’m starting to at least feel semi normal again. I need to find a new PT- I’m in Santa Cruz California- nobody hear has even heard of resurfacing. One might say the protocol to some regard is dictated by the surgical approach, but I think there’s more to it then that. I’m looking around for a new place. The glute med has come back online which is helping. Some of my back pain may be from compensating, on the other side it’s from the 3 herniated discs. I’m dreading the repair process for that. Still - progress is progress- I’ll take it. I’ll need my right hip done and hopefully that will be a smoother glide path.

I think at this point patience is the hardest part!
Will

[jimbone]

Will,

The back/disc issues might not be as much to dread as expected.  I herniated and then ruptured a disc [L3 IIRC] about 35 years ago and have a few more fairly deteriorated.  Back surgery for the rupture was the call from 3 surgeons which I declined, not being able to see myself then at 30 as "broken".  3rd doc said I could go conservatively and see if things stabilized over a year which, after 2 years or so they did.  Back pain and flair ups were a regular part of life which I fought off through daily stretching, gym membership, too much Ibuprofen and regular deep tissue work.  It worked pretty well for 3 decades but as the hips faded with OA I learned HR was going to be my only option.  Dr. Pritchett told me flat out, the hips would need to be addressed before any consideration of back surgery- the back had also begun to give me trouble again.  So I did bilateral HR and by the time I was well into my 4-6 months of recovery I noticed my back issues were no longer.  It's been stable like that for the last almost 4 years and feels as though I've dodged that bullet.  There's good hope for you there as well.  With the hips not strong enough to do their job the sacro-illiac takes a lot of undue burden that transfers itself up to vertebrae that otherwise might do OK.  You might find more relief than expected when you are back stronger on your feet.  As far as PT- they're not all right for HR patients.  I'd done some pre-surgery PT and can attest there are some hacks and quacks out there and others that seem to be more like gym trainers wanting to motivate someone into Triathlons who really just want to get back to golf, tennis, skiing or their activity at a less than elite level.  I was lucky and found one able to discern the pace of recovery I was able to achieve and supported me on that trajectory, but it took some shopping and luck.  He'd worked with THR patients but not HR and had the back round, skills and perception to be of great value.  BTW- he worked in the hospital PT dept. and my experience was that, that was the place to locate the best care.  Some PT shops have a more mercantile approach to health care IMO, hospital setting seem to be more patient focused.  Also wanted to mention, a few sets of glute contractions- 10 reps of 10 seconds- per day seemed to accelerate getting that glute med firing again and stair climbs were another reliable routine.  Keep at it Will, you'll get there yet, patience and perseverance are your best friends.