3/20 Biomet Uncemented Left Hip Resurfacing- Dr

[jimbone]

I think I misread your post and thought your workouts were causing you concerns due to pain.  By day 16 I was definitely doling upper body work, but at home as I was a long way from being allowed to swim/sauna or stretch in the jacuzzi.  I started doing dips between a pair of chairs, a bicycle inner tube for chest/arms/shoulders'legs. Truth be told- it was hardly enough.  It felt like those muscle groups were getting worked and they were to a degree but returning to the gym at 7 weeks after 6 week restrictions were lifted I learned how much strength had really been lost.  A single pair of pull ups demanded my full attention and were my limit, 40 pushups and hit the wall.  I recently reviewed my workout schedule since mid Nov. 2018 [my 7 week release] and   I've skipped 6 days.  I found the key, for me, was consistency and a great deal of patience and self care.  I push it, sometimes to the point of soreness the next day, but not to where there is nothing left for the next day, and the days I took off were because there wasn't enough there to get the maximum benefit from the effort and the day off let the body heal up.  The progress made is completely reassuring I am moving in the right direction.  I suppose sounding an alarm against overdoing it reflects my reading of other archived folks who ended amateur athletic pursuits by not accepting new and temporary restrictions.  Balance is key.  Sounds like you;re doing well, great to hear it.

[John C]

As mentioned, the lateral quad was the longest issue for me as well. After six weeks, I did a lot of quad extension work, starting with an exercise band for resistance. After six months, it continued to be the sorest muscle when skiing, so I massaged and rolled it after skiing each day. I would not call it a big problem, but at 8 to 11 months, it is still the sorest muscle in terms of skiing endurance. At 11 months, I would say that it is about 90%, and still improving. Based on my earlier hip 10 years ago, I expect it to eventually get back to 100% by 18 to 24 months.

[Rn2md]

Thanks again for the insights. I’m aiming to strike a balance to favor overall constant forward progress, even if it’s slow, with minimal to no set backs. So far that has been my course.
I noticed that many others have had the prolonged soreness and swelling of the quads as well, which is reassuring.
It would still be interesting to know exactly why this still occurs in a specifically conditioned person. For example, I was intentionally strengthening the quads pre op with this post op problem in mind, and I would be doing multiple sets of leg extensions with 340 lb, in sets of 25-30 reps each. And of course, squats and lunges too. I also saw some others pre op routines which seemed pretty rigorous too, and they still seemed to have the same kind of quad soreness/swelling.
I wonder how much harder it would have been, had I not done that prep work....

I’m just happy to still be moving in the right direction.

For now, I’m just keeping up the phase1 exercises, icing it daily, walking with a lighter cane now, and machine based upper body gym workouts. Will keep everyone posted.

Thanks again  for the feedback and comments

[Rn2md]

And I have also been trying to massage it, which also seems to help. However  I don’t think I’m allowed to do any lower body work with bands yet.

[John C]

Nope. I did not start the bands until after the six week clearence. It sounds like you are the ideal rehab patient. Keep up the good work.

[Rn2md]

19 days out and noting continued improvements in walking, self care activities, and some early recovery of general fitness. I have a slight 4mm leg length increase from the surgery, and I started using an insert on the opposite shoe to compensate, which seems to help balance when walking. Had a machine based gym workout focused on chest, shoulders, abs, and triceps, taking great care not to do any weight bearing on the hip.
I even experimented with a few sets of bodyweight calf raises, thinking it could further help advance the walking. That went fine too. Won’t take it to any extreme though. Don’t want to have a dilemma confusing calf muscle soreness with potential DVT.
Tomorrow I’ll focus more on back and biceps, then hit some abs again. The crunch machine seems pretty good at this stage, since it’s easy to get in and out of, and doesn’t cause any stress on the hip. Already using the whole stack of weights again on that. Feels good.
Next early goal is to lose the cane, which hopefully can be in the next day or two.
Meanwhile, I’ve definitely been able to use the cane for many workarounds concerning multiple various every day tasks in addition to walking. Everything from helping put shoes on, closing car doors, picking things up or moving them out of the way, even getting dressed, lol. I’m sure I’m not the first to notice these other uses for it though.

[Rn2md]

20 days out-
Took my first unassisted outdoor walk today while carrying the cane, about 1/2 mile. Walked to the gym to kill two birds with 1 stone.
Not a fan of the the awkward waddling gait that I have without the cane, but at least I can manage without any pain. I’m sure the gait will improve as I walk more.
Continuing the upper body workouts, which Im enjoying.
Incision still looking good and healing.
I also tried some modified reverse lunges on the non operated leg using a wall to stabilize myself.
That went fine too. I need to be able to lower my body for certain work related activities to resume next week.
So far so good

[John C]

I would pass on one of the most common recommendations from PTs. They emphasize the importance of gait quality, and will recommend using whatever walking aids allow for the best gait. Doing without is okay for getting around inside, but PTs recommend that for any long outdoor walking, a person should continue to use aids whenever the gait starts to deteriorate. My experience confirms that walking quality improves fastest if quality is valued over getting rid of aids too soon. Up until about four weeks, I carried one crutch for longer walks, and would use it periodically for portions of the walk, whenever I felt my gait was anything less than ideal. Keep up the good work!

[Rn2md]

Ok. Thanks.
I’ll continue with the cane for longer walks and intermittently otherwise. In general, I’ve noticed people most often reported issues when advancing too far, too quickly. So I’ll plan to continue the reasonable stepwise progression.

[Rn2md]

31 days post op today-
Over the past week, I’ve noticed significant further improvements on the speed and ease of walking. My wife has difficulty keeping up with me when she comes along now.
I still have a limp without the cane. So Im electing to still use the cane until my gait normalizes completely. The limp is also improving almost daily though. I don’t think I’ll have it for too much longer. We’ll see.
I walk 1-2 times daily about 1-1.5 miles. That seems to be the sweet spot, since more than that seems to still cause a little swelling and soreness in the quads and not speed up healing.  I have to hold myself back somewhat. But it’s much more comfortable to walk now than it was preoperatively. No hip pain whatsoever. I still use the ice machine most evenings after settling in, mostly for prophylaxis and comfort. I also feel like it may still help promote healing on some level and may prevent swelling after long walks. It’s soothing anyhow, even in the event it isn’t helping otherwise. The incision looks great.

Still Regaining my upper body strength in the gym and expanding my repertoire to also selectively including some work with dumbells and barbells in addition to machines. Nothing that places any stress on the hip of course. But it’s a boon for morale to have such consistent progress.

Already thinking about the 6 week follow up visit with Dr. Gross. How time flies!

[jimbone]

31 days.  It really goes quickly doesn't it and the return to health is like the coming of Spring except with even better weather.  Sounds like you are right on track- remember Dr. Gross doesn't expect an unaided mile from patients until 6 weeks.  2 more weeks you're likely to see another big jump in improvement.  One thing I found helpful starting right around 1 month was to begin walking on some steep hills- not far and not fast but each day made a little more elevation on the big hill out behind the house, although it's street walking- off road broken ground was still a long way off.  About week 5-6 I also started in stair climbing. There is a 20 step flight outside the building at the track I walked.  I found both of those- hills and stairs very beneficial to the glute repair.  Quads stayed sore and tight for a long time- but not as weak- I had a Pro Sports Thumper- hand held percussive massage deal and found it helped loosed a lot of tight tissue.  I am still working on getting the quads stretched out to a feeling of normal at 7/9 months.  Have seen a lot of progress but still see a large room of improvement as well as the capacity to get there.  Sure Dr.Gross will be pleased with your progress.

[Rn2md]

Thanks for the feedback Jimbone.

I have a hill near my house that is not too steep and have walked it a few times. Also do some stairclimbing in the house once or twice a day. Tried doing more stairs than that last week and it felt like I may be overdoing it, so now I just use the stairs only if I need to get to the second floor. Ill probably start a more recreational use again though, since now I'm probably further along.

Have an achy feeling in the buttock of the operated side if I sit too long. Then its achy again on standing, but goes away with ambulation.

Ive seen people describe similar things here. So thats probably normal.

I havent bothered to try tying shoes on the operated side yet, but probably will try in earnest in the next week or two. All my shoes are pre-tied, or else I use slip ons. The shoe horn and the device to put socks on are still very helpful.

[jimbone]

The sitting/standing thing is very common I believe.  I certainly experienced it and watched it fade over the months but it hasn't disappeared entirely- maybe it will or not it's hardly crippling, more just an annoyance.  At 64 next month I sometime question how far I'll be able to recover a 40 year old's response time/strength while the ongoing negotiations with Father Time continue but I don't fret about too much and try to enjoy the challenges and developments.  Gotta be realistic. 

One symptom I read someone else mention- which made me feel relieved I wasn't the only one- is a certain level of discomfort when going from weight bearing on one leg back to both.  For example- standing to put your pants on you lift one leg and stand on one- when you are back on both feet/legs I would feel a distinct discomfort.  It felt very othopedic to me and concerned me.  Over time and with practice this condition has reduced itself probably 90% or more and is now mostly a rare occurrence.  I think it's because the tissues surrounding and supporting the joint are healing themselves, getting stronger and more stable so the joint is less stressed.  I should mention in the 2nd month [at the latest] my PT had me start standing on one leg- with hand support at first- and then without and building the time to 90 seconds.  I found that a very helpful exercise but needs to be introduced only when the body is ready.  It did leave me feeling vulnerable at first but very helpful soon thereafter.

Everyone struggles with the shoes and socks.  My standard was complicated by the instruction I received from a coach as a teenager sitting on a bench putting my shoes one when he said "You're never old as long as you can put your socks on standing up".  So that was how I measured that process.  It was every bit of 10-12 weeks before I was able to do the socks standing- with a shoulder against the wall- and while I finally was able to bend over to tie my shoes on the left leg by around 3 months, the right leg- which got two screws in the cup and gave me more grief healing- took a lot longer.  I was really only able to bend over to tie the right about a month ago at 6 months and then only after a full work out when I was stretched out and loose.  Now a month later it is becoming a more natural act but still a conscious process that takes effort.

I'll bet you'll start liking the hills and stairs more in another 2-3 weeks.  It will really get the glutes a good burn and you'll know the workout is getting them stronger- a perfect motivator.  In all it sounds like you're doing real well, clearly physically fit going in which as you know makes a big difference and you haven't even made your 6 week check up.  The whole process strengthens our patience as much as out joints.

[Rn2md]

I seem to be doing much better now with standing one-legged on the operated side, most noticeable when putting pants or shorts on. I dont need any balancing aids or a wall now. It never occurred to me to use that as a specific exercise for the hip. That's good to know.

I guess I don't fit the definition of youth yet, as defined by the socks standing up rule. I still need to sit and use the sock device. Hopefully, my cat-like 41 year old reflexes will be returning shortly though, and return to top form. 

Im definitely looking forward to turning things up a notch with the hills, stairs, and exercise machines. But Ive read the many cautionary notes from those that went before, about the mishaps and disasters from overdoing things. So I guess Im like the race horse stuck in the paddock for now.

[Rn2md]

5.5 weeks post op-

Mostly Walking without a cane with mild residual limp at this point. The limp worsens beyond 1-2 two blocks if I’m not using a cane. But it isn’t that obvious for short walks, like within the house. The everyday walking around the house and office is pretty close to my post high intensity workout baseline that I had preoperatively. My walking speed is essentially at baseline.

Also, there is a soreness in the hip joint area that starts showing up on unassisted walks beyond a block. I feel it with each step I take, once it showed up. Not painful, but kind of a nuisance though. So I back off if I start to notice it. Usually rest or cut the walk short. I guess that will go away soon. Maybe it’s the uncemented implants telling me to Hilo’s back and wait longer for ingrowth.

There is a new issue that’s shown up though over the past week or so. It’s a twingy kind of ache radiating down the back of the thigh and also towards the back inner part. I notice it mostly when using my left hamstrings for something like moving myself forward in a rolling office chair or getting up from a low position without enough assistance. Today was probably the worst, since I got up out of my low slung sports coupe with some drinks in both hands and no free hands to help propel myself up and out of the drivers seat. When I stood up, I had a mildly painful twinge in the back of my thigh, just below the buttock. It was obvious that something was strained or at less stressed to its limit. When I got inside, I got into bed with the ice pad on and just completely rested it for a couple hours. Took a Tylenol just in case, which I had weaned off of about 2.5-3 weeks ago. I don’t feel it anymore. Guess it’s just one of those ways ones body reminds them not to outpace the healing process.

Otherwise Still use ice machine after workouts or walks in general, for what it’s worth.

The upper body workouts continue to intensify and I use a workout app to track progress.

The quads soreness issue hasn’t shown up in a couple of weeks. So that seems to be resolved for now. Once I start the next phase of exercises and up the intensity, I may see it again.

[jimbone]

You're doing everything right and were clearly prepared for the procedure done by one of the top surgical teams available your chances are as good as it gets and my money is on it with odds.  I found it very helpful to track the progress forward as well.  Marking the small improvements and larger milestones made for greater reassurance and reinforced the efforts.  Even the setbacks, small as they were and the occasional twinge or unusual occurrence that could be alarming, when noted in the journal were kept in perspective as the dissolved in the wake.  You mention a soreness in the joint that shows up when walking.  On my second hip the surgeon needed to secure the cup with two screws.  Healing from that was quite different than the first.  I experienced a soreness in the screwed joint for several months, both walking and at rest, but intermittently and always reducing in intensity.  I read elsewhere in a thread that some folks experience difficulty when coming of weight bearing as in weight bearing of on one leg and then shifting to both- they will experience some level of discomfort.  This was very much true for myself and something I monitored carefully with the intention that if it hadn't cleared up by 6 month I would get a consultation and imaging.  As it gradually tapered of and was gone by month 4.5-5 or so I no longer worried.  It will still show up now once in awhile now at 7/9 months but rarely, less uncomfortable and quickly fades.  I will ask about it at my 1 year check up but currently chalk it up mostly to soft tissue damage and healing right there at the joint which is why it felt orthopedic to me but I no longer think it is/was.  I have been very careful about impact related damage.  Te first 5 jogging strides I attempted at month 4 told me immediately I was not ready, again at 5 months but at 7 I have been able to to short 50-100 yard jogging paced, 5 MPH stints without undo feelings of impact.  When it feels impactful, I stop.  I will take the time to build strength in the tissues before subjecting the device and bones to do the work.  My work was uncemented as well.  Your experience sounds similar to me and if things quiet down with rest/ice/tylenol I would guess you are just being a good patient and working your way through it.  The time that takes will be revealed to you cause there's no telling.  I've let my sense of vulnerability guide my recovery decisions and for me it seems to be working.  Are you able to do any hamstring stretching?  That was and is a challenge for me that is now gaining traction but straight legged/palms on the floor are nowhere yet in sight. 

[Rn2md]

Thanks for the perspective.

The hip soreness with increased walking sounds much like what many others have described as they build their walking distances. I didn’t feel that at all when using a cane, even with longer distances. I guess it’s just a matter of building things up again from scratch, only without the cane this time. The process of bony ingrowth supposedly starts at around 6 weeks, which is around now for me. So I may just have to either keep using the cane a while longer or settle for shorter distances for the time being.

I haven’t risked an earnest hamstring stretch yet, because I was pretty sure that wouldn’t be allowed yet. I have been gradually reaching more toward my left shoe, which I can now tie as of about 4 days ago. That’s without pushing it though. If I hadn’t known better, I might have tried to make a conscious effort to hit that milestone sooner. But I think it just would have just risked a painful setback if I did.

Running is definitely a ways off, but I’m confident I’ve set myself up as well as possible to get back to it. I look forward to trying it out with the new hip when it’s time.

[John C]

Sounds like you are doing great. Right on schedule.
As far as walking longer distances; rather than cutting the walks short, I just always carried the cane with me until it was a non-issue. If a pain started, I would just use the cane for a block or two, and often the pain would go away and I could continue without using the cane for another stretch. You get pretty good at doing twirling tricks with the cane on those long walks.
As far as the hamstring issue, all I can say is that recovery is a little bit like playing the arcade game whack-a-mole. Things will keep popping up in all sorts of different places, which Dr Gross's recovery sheet says to expect for up to a year. Not only are we recovering from surgery, but all of our muscles around the area are relearning how to work after our years of limping and compensating. It feels so great to walk like I am twenty again, but it took awhile for my whole body to readjust to that kind of movement.
As for shoe tying, when you start the phase 2 exercises at 6 weeks, some of them directly address that, so it will come. Shoe tying is not something Dr Gross would suggest pushing for prior to six weeks. For me, shoe tying is now easier than it been in twenty years, so I am pretty stoked.

[jimbone]

Rn2md-

Patience, practice and perseverance.  But patience first. I have to question the wisdom of 340# leg extensions effect on the knees- but you are younger and more of athletic.  Wisdom has been defined as learning from another's experience.  My favorite line from Stone's "Any Given Sunday" was,
"Every athlete wants another chance".  You've been given yours.  Use it wisely.  Best wishes.

[Rn2md]

So I started the Phase two exercises yesterday.
All went fine, except for the side leg raises.
I can’t seem to do those at all, just maybe a couple inches, and it feels uncomfortable, extremely weak, and tight.
It’s also uncomfortable to turn onto my side without a pillow between my legs, same feeling as above

Anyone else notice similar issues at just over 6 weeks?