30 Days Post-Op --- Walking Questions??

[Ron]

Hi All-

I am just now 30 days post op from left hip CEMENTED resurfacing. I am still using a walker and on a 50% weight bearing restriction to my operated hip.  I have been told to walk, but if I feel sore or if the hip feels "agitated" to "listen to your hip" and sit/lay down.

I haven't ventured outside -- I just walk around the inside of the house -- quite frankly only as I need to (but occaisionally walk laps around the dining room table!).

The home Physical Therapist I had (sessions concluded on 7/21/07) said I was where I was expected to be and that "listen to  your hip" thing again. But I am concerned....I have read some people walking half a mile, three times a day. I don't know if my CEMENTED procedure creates less ability than the cementless type or what. I feel OK, just a little stiff in my leg and of course a bit guarded that I will trip or will somehow apply to much weight to that leg so think I am a bit tentative about doing more.

Any ideas/experiences/suggestions?  I have a doctor's appt next week where I will address this -- but am worrying a bit already!

[Pat Walter]

Hi Ron

Was there a special reason for you to be at 50% weight bearing for such a long time? Most people that have hip resurfacing have a cemented stem on their femur bone.  That is still pretty standard. There is a lot of discussion between doctors and people about whether it is the best method, but is currently still most used. 

My BHR has a cemented stem.  I know sometimes doctors have reasons to keep you from full weight bearing - but your doctor should have explained that to you.

Most US doctors are more conservative than overseas doctors.  For instance, I had my hip resurfaced by Dr. De Smet in Belgium in March 2006.  I was in the hospital 2 1/2 days, then stayed 9 days at the Holiday Inn after surgery in Belgium. We were 100% weight bearing right after surgery.  Of course, you really could not put all your weight on your leg right away, but within a week or less, we were walking full weight bearing with the aid of a crutch.  I changed from 2 elbow crutches after surgery to 1 crutch at 4 days post op.  I walked the halls of the Holiday Inn and after about 5 days post op, was given permission to sight see in town.  I walked a few blocks.  By the time I came home 10 days after surgery, I was walking about 3/4 of a mile outside in our park with one crutch. After 4 weeks, I did not use a crutch.  Dr. De Smet's rule is you can stop using a crutch or cane when you no longer limped.  I did PT here for a week and they could see that I was no longer limping.  I still took my cane with me on long walks because I would sometimes get tired and feel I needed the support.

I would definitely ask your doctor why he has not let you walk more - even with crutches.  Normally, walking is the very best exercise.  That is the only way your muscles start to work again.  We had PT right after surgery and then I decided to do some when I got home. They only kept me 1 week in PT in the US because I was doing so well.  They could not find much more to do for me other than suggest I walk and ride the stationary bike.

About 6 weeks out when I was not on crutches and walking about 1 mile a day, I would get very stiff after sitting.  My first few steps really hurt a lot, but then got better as I took more steps.  I decided to do some water therapy that many other hippies have done.  I have a PT work with me in the pool and have my exercises and stretches listed here http://www.surfacehippy.info/poolexercises.php  Water walking in water about neck deep is really good for your muscles. 

I would call your doctors office and ask more questions.  Normally, surgeons have you walking quite a bit after surgery.  Again, I don't know if you have a special problem.  I could not imagine not walking and exercising for 30 days after surgery.  I walked the whole Wal Mart store after I got home from Belgium.  It was so wonderful to be able to walk without pain - even with one crutch. 

Please try to find out why you are not allowed to be walking if you don't know.  Exercising your muscles are the only way to get them strong after such major surgery.

We were always told to listen to our bodies so we would not do too much.  But never told not to walk and walk really as much as possible. Of course, again I don't know what doctor you used or what their thinking might be.  The US inexperienced doctors are quite different than the overseas doctors that have done hundreds to thousands of hip resurfacings. Dr. De Smet has done over 2400 hip resurfacings.

You also have to remember that we all heal at a different rate.  Some of us are lucky to heal more quickly than others.  No one knows why and no one can tell ahead of time how long it will take you to heal.  Being patient is important and time is your friend.  I would make sure that you give yourself the time you need to heal, but if you feel you need to do more - you should talk with your doctor.  You also need peace of mind to know that everything is healing properly and why a doctor asks you do do certain things.

Keep in touch and I hope you will be walking outside without a walker soon.

Pat

[Vicky]

Hi Ron,

The first question I have to ask is who was your doctor and how many resurfacings had he done prior to yours?  If you did not have any special or unusual condition prior to your hip resurfacing then there is no reason you should be put on such a conservative rehab protocol.  That sounds worst than a THR rehab.  Of course if your bone density was very poor or you had large cysts then that is a different story completely. 

Most resurfacing devices are cemented, now the majority of docs NEVER cement the actual stem portion, only underneath the ball, the hollowed out part of the ball.  So, Pat, I think you meant that the ball part was cemented and not the actual stem as I know Dr. DeSmet is against cementing the actual stem. They also do NOT cement the acetebular side of the device.

It will tell us a lot if we know who your doc is and what his experience level was.  Cory Foulk who is sort of the poster child for resurfacing is working with Smith & Nephew now to educate the US docs on activity level following resurfacing.  I was full weight bearing right after surgery as are many others.  Cory ran a marathon 2 days short of 3 months post op and has entered 4 Ironman Triathlons and came in 11th in the Ultraman World Champions all less than 1 1/2 years post op from his BHR resurfacing.  Can you please tell us if there were specific reasons your doc put these restrictions on you or if he has the same restrictions for all his resurfacing patients.

Vicky