How hard should I push my recovery?

[mwpierce]

Hi All,

I had my right hip resurfaced on August 12th 2014 by Dr. Pritchett in Seattle WA. Things are going pretty well for me but I don't know whether or not I may be pushing things too fast. I don't have good success listening to my body about my limitations so I'm hoping you all can give me some guidance.

I was told I could bear weight on my hip as tolerated. Well, I can tolerate a lot so I stopped using crutches on day 8 and have been walking without aid since; the first 3 days without were rather clunky but now I'm doing pretty well. My right leg is a bit longer than the left due to my left needing a resurfacing too and I feel pretty tight around the front of my leg/hip area (I can lay  flat on my back with no problem but extending behind me when I walk feels a bit tight, not painful, just tight). I can walk up/down stairs normally but my right leg is definitely weaker than my left.

On day 22 I wandered down to the gym at work and did 15 minutes of no resistance recumbent exercise bike, which felt OK. Next day I did another 15 minutes then once around the weight circuit, making sure to not do anything that pressured my hips (no leg press, 20 lb  hip adduction/abduction for one set of 15), which  felt pretty good. Next day I did 15 minutes again on the recumbent but no lifting; had a slight fluid leak out my incision which left a 2" diameter stain in my shorts, so I'm thinking that I pushed it too far. Today I did nothing but my post-OP PT exercises and walked. Pain has been taken care of with aspirin and tylenol since day 10 with it being, for the most part, 0-1 on a 0-10 scale.

This is giving me, what I think is, a possible false sense of confidence. I've read the stories here about people who have dislodged or loosened their resurfacing components and I think I would be someone who could unwittingly do that by pushing it to far too fast.

I'm starting PT on Tuesday, 09-Sept-14, so I should be able to get  an indication of my limitations then, but I would like the advice of people here on this board; am I pushing it too fast? When should I expect to be able to bike again (I only live 1 mile from work and feel I could do it now without a problem, but should I)? I know I won't be running again for about a year after I get my left hip done (hopefully in Nov-14), how about things like rowing, or eliptical training, etc? Any advice would be appreciated.

Thanks,

Matt

[chuckm]

Mwpierce, welcome to the site. Protocols for hip resurfacing recovery have been evolving quickly over the last few years.
Most people on this site I think would agree that you don't "push" your recovery. The reason you don't push your recovery is that you cannot push your recovery.
The things that need to heal in the first two to three months are your BONES. And, you cannot push your bones to heal.
You are confusing pushing the soft tissues like muscles and tendons. Those you can "push" and they will respond by strengthening. The problem with pushing the muscles and tendons early on is that they are all attached to the bones which respond by breaking.

Seek the advice from your surgeon about when to begin pushing your recovery. My surgeon had me wait three month before focusing on "pushing" things to regain strength.

Chuckm

[John C]

I agree with Chuck; some of your biggest concerns should be about bone strength (especially femoral neck), and bone growth into the prosthesis. This is different from recovering from just a soft tissue injury, in which case things keep improving from soon after the injury.
I would share with you three points from my understanding as a fellow patient:
1. The bone remodels itself after the surgery, breaking down old bone and building new. This makes the bone at its weakest and most vulnerable at about three months post surgery.
2. Many surgeons consider the risk for femoral neck fracture to be mostly over past six months. Because of this, my surgeon discouraged things like riding a bike outdoors for that period; not because the soft tissued could not handle it, but because a fall on the resurfaced hip could cause a fracture.
3. There is some theory that micro movements between the prosthesis and the bone due to minor impacts during the early healing period can lead to ineffective bone ingrowth. It sounds like you are being careful on that count.
Your post shows a lot of wisdom, just be sure that you are taking into account the processes that the bone is going through, and not just the soft tissue healing from the surgery. Be sure that your PT is completely on top of the resurfacing protocol, since rehabbing a resurfacing is totally different than with a THR, since the THR does not involve the femoral neck which has been cut off.
Dr Pritchett should be your best resource for what you should and should not do along the road to recovery.

[Jason0411]

Steady to start do as you are told i learned the hard way about bone reforming. Don't undo your surgeons good work they get very grumpy with you.

[Ken B]

I've been trying to read up on recovery and similar to what John pointed out the major points seem to be acetabular (and femoral if cementless) in growth bonding and femoral healing and in the case of a BHR stabilization of the cement/bone interface of the femoral component. I do understand that the cement fixation is labeled as immediate but there are sources that indicate an extended healing process of that interface with final stabilization of the different tissue layers taking some time. Different sources cite one to even two years with regard to these items.

My surgery is scheduled for later this month and I'm trying to get mentally set for a conservative recovery period. If I'm capable it will be only beneficial resistance for the first six months and maybe as much as a year. That will mean walking only with some PT stretches and very low resistance exercises possibly mixed in. Maybe some mellow road biking at 6 or 7 months. If the muscles go a little soft relative to what they are now so be it - I've built them up before I can do it again. But sub-optimal healing at the interfaces is not something that I'll be able to fix without getting opened up again if that ends up being the cause of eventual failure.

I've seen on Youtube all the folks that go kiteboarding at 3 months or squat with weight at four or five months etc etc and I'm not qualified to say they are wrong to do this but I want to give this thing a chance to heal and bond as good as it is going to get or at least close to that before I "push" it. I've been a frequent windsurfer for over twenty years and I'm seriously considering not going for it again until spring of 2016 because that can be some pretty high impact activity. And then if all is well I'm going to beat the beans out of it for as many years as I can and whatever happens happens. Frankly this is going to be difficult especially if I'm lucky and month four or five comes around and I'm feeling pretty good but I hope that I can do it. What you indicated does not sound too heavy duty but if you're questioning it at this early stage it might be a good idea to dial it back for a while and let a bit more healing take place.

[mwpierce]

Thanks everyone for your responses, you've given me some good food for thought. When I went to my 2 week post-op appt. Dr. Pritchett said that I could start biking again if my seat was high enough to avoid breaking the 90 degree rule. I hadn't considered the consequences of falling off my bike so I think I'll just exercise bike in the gym until the 6mo. mark. Since I can walk as much as I am capable of I think I'll do that instead. I see a physical therapist in two days and can discuss things with him. I'll also send a query off to Dr. Pritchett about what I can do in the gym (he knows better than the PT) and see what I'm allowed to do there.

I definitely want the optimal healing on this (as does everyone who's had this done) and thanks again for everyone's input.

Matt

[Dan L]

Simply follow what you were told to do-- and not do-- by your surgeon, and you'll be fine.  The uber athletic here are often chomping at the bit and jonesing for the workout endorphins they miss, and some, IMHO, have done some really dumb things far too soon by not following restrictions and prescribed therapy or exercises.  My surgeon had a guy doing leg presses when explicitly told not to, and lo and behold, his femoral neck fractured and he was on the revision train.  Another was blowing snow at 2 weeks post op in a northern Ohio winter.

It may seem like forever to get back to where you want to be, but be patient and you'll do really well.

[mwpierce]

Hi All,

an update on my hips. Had them both resurfaced in 2014, no problems and they both work well. My left leg ended up being a bit shorter than my right which changed my body dynamics a bit (causes my right knee to be irritated) but nothing I can't deal with. The only reminder that my hips have been resurfaced are the surgical scars. All in all it worked out great and I'm very happy with the ongoing results.