Clunking of hip

[captainahab]

Hello everyone;     My surgery was 21 days ago at Cleveland with Dr. Brooks.   Everything went very well and my recovery has been almost pain free ( just sort of a ache).  Been on the crutches for the whole time with a 75% max on the affected hip.  Question?  When I do the stretches of the hip - sitting down and bending over to the floor, like tying my shoe- my hip feels a clunk!!.  There's no pain so I wonder if that just normal getting use to the implant.  Do others go through this and finally everything "smoothes" out?  The therapist gave me the impression that range of motion was the real goal for the first several months. 
     Also why the many different recovery protocols for the same surgery among the many talented surgeons.   Some are on crutches for 6 weeks, some drive in two weeks?!, others turned loose in 6 months, and others reduce activity for 1 year.    Just curious if anyone knows the best way or each doctors past experiences?   

[Pat Walter]

Congratulations on your new hip.
Many people have clunking.  My understanding is that everything is still very loose from surgery.  It will take time for the muscles and ligaments to tighten up.  Some people take more time than others.  I had the clunking for quite awhile, especially for certain movements. 

Every surgeon has different recovery protocols and each surgeon has a different way of doing surgery.  Even if it is posterior, they all do it a little different.  They use what is most comfortable and best for them.
My surgeon, Dr. De Smet, just wanted people to walk, walk and walk.  That is what I did.  He did not recommend PT.  We are all different. The one thing surgeons worry about is that they don't want PT that is too excessive.  Amazingly we all heal - some quicker than others.  If you are an athlete, you will most likely eventually do more extensive PT.  Normal active, not super athletes, heal with with or without PT.
The overseas surgeons have less restrictions than the US surgeons.  Might be something to do with our legal system plus surgeons want the best outcomes for their patients.  I used one crutch as all did that were with me a few days after surgery.  I used it for about 3 weeks.  I did walk, walk and walk.
Good luck.  It is always best to listen to your own surgeon since they know your particular situation.
Pat

[John C]

Hey captainahab, Welcome to the other side. As far as clunking, not only is everyone's recovery different, but it can be very different for the same person on the other hip. I had lots of clunking with my first hip ten years ago with even minor movements. It gradually went away over the first few months, though I will rarely still feel a slight slip when stretching. My second hip which was done 7 weeks ago has never even hinted at a clunk or slip.
One thing that you said did get my attention. Did Dr Brooks use a posterior approach? Most surgeons who use a posterior approach have a 90 degree restriction for the first six weeks, which would preclude bending over to tie your shoes. I think that it is less of an issue for lateral or antero-lateral approaches, which may be why no one has mentioned this. Maybe something to ask them about, especially if that is what triggers the clunk?
As far as different protocols; the surgical approach is one reason for different protocols as mentioned above. Also, some surgeons like Dr Gross will vary the weight bearing rules depending on a bone density scan that he does right before the surgery. His normal instructions are weight bearing as tolerated with no real restrictions, for lower bone density cases he will prescribe crutches and limited weight bearing for six weeks, and in more worrisome cases I have read of him restricting weight bearing for 8 weeks. I think that is maybe a good example of why we all need to follow our own personal instructions, instead of trying to extrapolate that what is prescribed for one person might be good for another.
Lastly, regarding the PTs goal of pushing for range of motion early in recovery, I would make sure that the PT is clear on Dr Brooks protocols for resurfacing, since some surgeons are concerned about stretching too aggressively during the early months, since there are some issues that may be different than rehabbing a THR which is what most PTs are familiar with.
It sounds like you are having blue ribbon recovery; stick with Dr Brook's protocols and you should be great.

[captainahab]

Thank you for the replies.  Yes Dr Brooks did say to walk no more than 5 miles in a day.  Right now I'm between 2.5 and 3.5.   The approach must have been a lateral as there were no restrictions on the range of motion.   No 90 degree restriction.   I guess I'm just impatient, but all in all the recovery seems OK. 
    When I do get a way from the crutches is there a limp for a while until the leg recovers its strength.  Is there anything that might help minimize the limp post-crutches.   I could go one crutch for a while, or use both but alternate them as I walk?  I'll talk to the Dr. Brooks PT dept also, but value observations from others that have been here before.   

[Glenn Urban]

Congratulations on the surgery. You are walking a lot already...that is probably the best thing to do imo.


I believe I was crutch free around the 2 week mark I think, but one crutch would be used for extensive walking toward the end of that time frame. I tried to walk without any crutch at day 10 for my follow up after the first hip was done, and it was a mistake. I flew to Seattle from the Bay Area to see my surgeon and flew back the same day, and would have sold my soul for one crutch to get me to my car. But then a few days later, I was walking without, and yes, with a limp, because there is pain/pressure/golf ball/monkey fist in there reminding you that someone did slit your leg and pop out your leg bone and mess around and then put it back.


I agree, there is a wide range of recommendations for what can and cannot be done when you read the posts on this site. Some of it is a head scratcher. I was told 6 months for jogging on softer surfaces like a high school track, and one year before hitting the pavement to run, yet, I have read people's posts here who had the same surgeon I did doing things much quicker than the recommendations I received. 


I think I cheated a little here and there as well, but made a mistake of moving some heavy objects too soon in the recovery game and receiving a very strong warning from my hip and leg to knock it off. The pain was an eye-opener.


My Achilles tendons did not want to go along with the program when I first started trying to jog, which ended up keeping me from running for longer than I had expected.


Now that the Achilles tendons have decided to behave, I am starting to really enjoy my new hip sockets.


I went to PT for my first hip, and skipped it for my second hip. I knew the drills and did what they had suggested, but, it seems like walking, and a little swimming, and a little of this and that does wonders. My PT people had never heard of this surgery. My surgeon's right hand helper said the protocol for recovery was pretty much the same for a full hip replacement.


After running my first 400 in maybe 8 years the other day, I was AMAZED at not only how much fun it was to make it around a high school track again, but how utterly out of shape I felt at the end. One of the best things I have ever experienced since my younger days...legs spent, shoulders spent, cardio in the yellow zone...it was awesome, even if it was slow by anyone else's standards.


You will be so happy you had it done. I wouldn't worry about the temporary limp. It will soon go away.
I am so happy with this surgery I talk too much when I post on this site. So I try not to post too much.   Good luck and enjoy your new hip.


Glenn

[John C]

I agree that one crutch is a great transition solution. You can carry it along for walks, use it for a 100 yards if you start limping, and then try it without the crutch for awhile. I found that it was a great way to keep the quality of my gait up while I was getting rid of the limp.
As far as getting rid of the limp, there are lots of great exercises. Building strength among all of the stabilizing muscles around the hip is key, particularly the abductors which are really key to eliminating a limp. When your doc says you are ready, some exercises that worked for me are side leg lifts, clam shells, sidestepping with sports bands, and any single leg balancing. One of my favorites that fit right into my walks was doing a high knee lift with each step, and holding the knee up for 5 to 10 seconds on each step. You can mix that with using your hamstrings to pull your heel back to your butt with each step, and again holding for 5 to 10 seconds on each step.
Keep watching for and enjoying all of those small victories along the way.

[karlos.bell]

  Hi  captainahab.
Clunking takes some time or it comes right soon.Ligaments and tissue has to come right again.My opinion depends how long you had your hip issues.
Mine is getting less and less after 3 years.
Good luck and good on you.
Cheers K

[Saddlepal3]

Consider using trekking poles (not Nordic poles) as you transition off crutches. They provide support but help to keep your body upright as well as some upper body strengthening.

[ArthriticHip]

Hi Captain - I also had my hip resurfaced by Dr. Brooks, 4 1/2 months ago today. I can speak to most of your questions. As it relates to clunking, I experienced lots of it in the first 6 weeks. Like you, no pain, but it was pretty consistent during the PT exercises, bending over, and even walking. I called Phil (Dr. Brooks' assistant) and he assured me that this was normal. He said that this was going to eventually go away as my hip muscles and tendons regained strength and were able to better support my hip joint. He was right. At 4 1/2 months, I do not get clunking during my PT exercises, or during normal walking. If I bend a certain way, I do still get the occasional clunk, but it no longer concerns me. My hip feels so much better that it's not even worth thinking about. As you're aware, Dr Brooks is extremely conservative about his recovery recommendations, which I'm 100% OK with. I was very careful not to break the 75% weight bearing rule in the first 6 weeks. Dr Brooks says that your bone will continue to heal and strengthen up to 12 months, so he feels it doesn't make sense to release you to high impact activities until your bone is as strong as it possibly can be. Given all of the effort I've put into this surgery, a few extra months doesn't seem like a big deal if it improves your chances for a better recovery. 5 years from now I won't care what I was or wasn't "allowed" to do in the 6th month. I couldn't be happier that I had the surgery. My flexibility has greatly improvedl, and I'm 100% out of pain. I returned from a vacation to Hawaii last week, which required a 12 hour plane ride. This would have been unbearable before surgery, but post-surgery...no pain. Swam in the ocean, hiked 5 miles, etc....all no pain. For the next 7 1/2 months I'm going to enjoy living a pain-free life, and when Dr Brooks gives me the OK I'll get a little more ambitious. Good luck and feel from to PM me if you have any questions you'd like answered off line.