Additional restrictions

[VancouverWA]

I'm post op 3 1/2 weeks (July 27, 2011), right hip Birmingham resurfacing.  During surgery, the surgeon had to remove quite a few bone spurs which left a narrower femur neck just below the new  cap.  Accordingly, my surgeon placed additional restrictions on my recovery for two months from the date of surgery:

1) Maximum 50% pressure (i.e. 25% of my total body weight) on my right foot
2) Use of a walker the entire two month period
3) No driving

Has anyone had similar complications and resulting restrictions?  My scar is completely healed, my spirits are good and each day the residual pain in the incision area lessens.  I can get around pretty well in the walker and my stamina is good.

I'm getting a little concerned that I'll have a harder time getting back to a normal gait after 2 months of being on a walker and not being able to place more then 25% of my body weight on my right foot.  Also, I am still experiencing a fair amount of clunking in my hip; I've read on the site this is normal but I'm wondering when this will start to go away and if the additional restrictions are delaying the strengthening of the muscles and tendons around the joint.

Thanks and any comments/advice are appreciated!

Tom

[John C]

Hello Tom,
My hip had gotten so bad, that I was on crutches for about 2 months before the surgery. I think that it slowed my initial ability to get off crutches after the surgery, but the difference probably only lasted a week or two.
I would not worry about the clunking; I still had quite a bit at 3 1/2 weeks. Since weight bearing and walking does have a lot to do with strengthening and tightening those muscles, your clunking might last a bit longer than someone who was weight bearing earlier, but in the big scheme of things, it will not make much difference.
As far as your gait concerns, I would really work on how you use the walker. Make sure that the height is correct, and try to take as normal a stride as possible. The walker will take some of the weight, but you can still work on a full stride with good mechanics. When I was at about 4 to 5 weeks, I would usually take my crutches for long walks, even though I really didn't have to, because they could take some of the weight, and allow me to work on taking longer strides and really getting rid of the limp.
You may not be ahead in the recovery process right out of the starting gate, but remember that this recovery adventure is a marathon and not a sprint, so I am sure that you will be right up there with everyone else before you know it.

[VancouverWA]

Thanks John; good to know about the clunking!

[Luann]

Hi Tom,
 I live in the outskirts of the Portland area. I had my sx done in Vancouver by Dr. Sparling (who says he has now done over 500 HR). I am assuming that from your location, you either used Dr. Sparling or Prichett?
 Dr. Sparling seems to be more conservative than most any other Dr. I've read about on this website. I was not alllowed to really put any but the slightest, weight on my leg until about 6 weeks after my sx. I was to use crutches or a walker. No driving. No lifting anything heavier that 10 lbs.  He even adviced me not to work until the 6 weeks were over.
 After that, I got the 50% lecture. Then finally, (I think at about 2 months) as much weight as was comfortable. I felt way behind eveyone else on this website! Even after 2 months, I was using a cane. I am an equestrain, and I was not allowed to ride or do any really physical activity until the 3 month mark.
 I too, had an enormous amount of bone spurs. In fact, that was really the only "damage" to my hip. A person would of thought I was bone on bone, however, if they had watched me walk!
 I followed my Dr's orders faithfully. When I was finally released to just plain try to walk with little or no assistance, I improved rapidly. I only used the cane for about 7 days.
 Dr Sparling told me at the time I had the proceedure done, that he had had only two failures and both were due to femoral neck fractures. Take your restrictions seriously, let bone intergrate, strenghthen and heal. You will be just fine after the 2 months! You sound determined and anxious to get back to life so I have no doubt that when you are released to walk unaided, you will do fine.
 I am at 14 months now, and do anything I want, more or less. I have given up only the most obnoxiuos riding I used to do. I still do cutting (rowdly horse showing involving chasing cows), and trail riding. I hike for miles. Sit comfortly for hours... live a normal life.
 Good Luck, keep positive. You will have piece of mind after the 2 months are over, that your bone is strong and healed.  Lu

[VancouverWA]

Hi Lu and thanks very much for your note.  It sounds like you had a similar experience and it is encouraging to know that things will be back to normal in due time!

My insurance is with Kaiser Permanente, and I did eventually find a surgeon in their Clackamas office that performed the surgery; however, he declined to operate due to concerns with metal-on-metal joints.  I ended up having the surgery done at San Jose Medical Center in San Jose, CA as a visiting Kaiser member.  This had some drawbacks as Kaiser's Oregon/Washington network doesn't 'talk' to the Kaiser Northern California network so there were some communication and coordination problems in the process.  Good news is that I've been home in Vancouver for one week and it's great to be back home.

[VancouverWA]

Lu, it appears that Dr. Sparling's office in Vancouver is very close to where I live. It's ironic that I had to travel to California to have my surgery when someone so experienced is so close! 

[fenceman]

Dr. Brooks at the Cleveland Clinic also wanted 6 weeks on crutches with little weight bearing.  I had switched myself to 1 crutch after 4-1/2 week because it was easier to hold things or open doors and still put little weight on my leg.  I did drive 5 days after surgery (against all orders) with the non-op leg but it was rough getting in and out of the car.

[VancouverWA]

Dr. Brooks at the Cleveland Clinic also wanted 6 weeks on crutches with little weight bearing.  I had switched myself to 1 crutch after 4-1/2 week because it was easier to hold things or open doors and still put little weight on my leg.  I did drive 5 days after surgery (against all orders) with the non-op leg but it was rough getting in and out of the car.

That must have been hard getting in and out of the car at 5 day post-op.  The 12 mile drive home from the hospital on Day 4 post-op after my surgery (as a passenger) including getting into and out of the car were not fun.

[Tin Soldier]

A quick note here that might help with the conversation, but it might not.  You might ask your surgeon about removing or not removing osteophytes on the femoral neck.  I'm not a surgeon so I don't know all the details about it, but it seems to me that removing osteophytes/reshaping the femoral neck below the compenent, may add to decreased vascularity and decreased bone growth in and around the new component.  This may be debated in the HR community, not sure.  I would think that there could be circumstances where there is so much bone growth on the femoral neck that some of it has to be removed so you would have decent ROM.  When extra material is removed from the femoral neck, it seems wise to have longer restrictions for the neck to heal.   Interesting topic.

Tom - That's how insurance is I guess, bummer.  There is also Boyd in Salem and I thought there was someone at OHSU, if you are looking for another surgeon.  Not sure if Kaiser covers either.   

[VancouverWA]

Thanks Tin, good points.  I wasn't aware of the potential for decreased vascularity so I plan to look into that.  My surgeon did mention that he needed to remove the bone spurs to get a proper fit on the cap and also to ensure a good ROM so that parallels your comments.

[Luann]

Hi again, Tom,
  Yeah, Dr. Sparling is close, and Dr Prichett has done more than anyone in the area, so that's why I assumed you must have seen one of them. You know what they say about assuming!
 Please DO follow your Dr's advice.  (Shame on Fenceman!!!)
  Tin, isn't most of a bones vascularity come from deep within? I do not think reshaping a little and taking off bones spurs would have much effect if they were mostly superficial, or just slightly into the surface. I had a number of them on my femoral neck, too, at least close to the ball/head. I was not told of any increased risk.      Long live hipsters, Lu
 

[VancouverWA]

Updating, I asked my Kaiser PT yesterday about using Dr. Sparling for my left hip (which also has dysplasia and advanced arthritis).  She said they may make an exception based on logistics but it would likely have to be reviewed by Kaiser's medical board.  I plan to follow up on this with my primary care physician.

I should mention that I have generally had a very good experience with Kaiser but you do have to be fairly assertive advocating for yourself at times.  This was particulary true with finding and arranging my R hip resurfacing.  One thing I found through the process that was somewhat puzzling was Kaiser's attitude toward a) physical therapy and 2) vitamins and supplements.  That, however, is a subject for another thread at some point.

Lu, thanks for your reminder to mind my doctor's orders; you can never hear that enough, especially at this stage where I'm starting to get my energy and drive back.  Every day is a mental exercise to slow down and concentrate on healing.

[FlbrkMike]

Sorry for the late reply.  I had a similar but not exactly identical situation.

After my first procedure my only restrictions were 120 degree hip flexion (which I couldn't come close to anyway), no outward rotation and no crossing the center line above the knee.  The weight restriction was "as tolerated" and I was encouraged to do as much as I could as far as walking.

During the second procedure the surgeon apparently had some trouble placing the acetabular cup and had to pound on it more than usual.  As a result he put me on "toe touch only" with crutches for a month, meaning basically no weight.  This was a precaution to ensure that any bone damage (which did not appear on the x-rays) would have a chance to heal.  It was frustrating because, to me, the second one didn't feel any different than the first and I wanted to get going on the rehab.

I guess the "take-away" from this is that no two people, and even no two hips, are the same.  This surgery is not an assembly line activity and the surgeon must make decisions on the fly.  Any extra precautions are only to ensure proper recovery.  Better to be conservative than to have to deal with negative consequences later.

[VancouverWA]

Very true, FlbrkMike!

[Tin Soldier]

I agree, it may seem assembly line when you are rolling into the OR, but there is a heck of a lot going on and a lot to know, and that is why I am not a surgeon. 

Lu - I believe there is vascularity in the outer edges of the bone much like the cambian of a tree and also within the internal portions of the bone.  How that all relates to bone strength and regrowth is a question for the surgeon.  I sort of think of bone strength being a bit like wood strength.  When building a native American bow, the knots (osteophytes, if you will) are left on the limbs of the bow, which help to strengthen that area of the bow, which has already lost some of the elasticity due to the knot formation.  There is a reason our bodies create osteophytes, to protect and strengthen the bone where it was damaged.  Removing them may not be the best solution.  However, I would think any ortho surgeon would be fully knowledgeable about the details of the bone and would have good reason for removing or leaving osteophytes in place, depending on the circumstance.

Vancouver - Let's hear the insurance story (maybe in the insurance section).  I can really get into that stuff.
.     

[VancouverWA]

Updating, I went for follow up xrays/exam on my right hip resurfacing Friday 9/30 at Kaiser's Clackamas, OR clinic.  I was released to use a cane (full weight bearing) and to drive.  A subsequent appointment with the PT also went well learning how to use a cane walking and going up and down stairs, along with some new exercises.  Needless to say, I felt relieved and even more so, liberated!

After a pretty full day Saturday which included a fairly mild session at the health club and running errands with my wife, I notice that I had some deep hip joint pain (moderately sharp tweaks) when putting full weight on my right leg.  There has also been some general numbness in my right lower leg.

Are these kind of new pains normal when you first transition to a cane, based on the additional restrictions and extended time on a walker?

[DGossack]

That sounds normal as I transitioned from crutch to cane and then no support.  I would imagine that you would have some additional and longer lasting twinges since you were not weight bearing for so long. 

Did you have exercises that moved your hip through it's range of motion?  That would help.  I found aqua jogging was a great way to move the hip without impact.

Best wishes

Dan

[VancouverWA]

Thanks for the advice, Dan.  This last week the twinges have subsided and I seem to be getting around better with the cane now.

I purchased an floatation belt that I'm looking forward to trying out but haven't so far because the pool at our health club is undergoing repairs.  Hopefully this weekend I'll be able to give aqua jogging a try.

[DGossack]

Great to hear you got a flotation belt.  I just got out of the water tonight.  I love the aqua jogging especially when things are a little achy and stiff.  It seems to loosen things up and the hip feels better after aqua jogging.

Best wishes.

Dan