Was my surgery not a success?!

[joshb7_]

Hi all,

I am posting because I am 11 months post op and I feel that my hip and body are no where near the level I was expecting or hoping for.

I am an active 30 year old PE teacher who is (was) into playing sport, football, tennis, running, surfing etc... I have done good stints of rehab on and off in my 11 month recovery but honestly feels it doesn't make much difference. I still have lots of lower back pain, especially from standing a lot, trying to run, cycling and anything that requires a bit of muscular endurance. I have been told that there is nothing wrong with my back and that the pain is from the hip. The trouble is now my left hip is starting to really go downhill and the impingement affects my range of motion of this side. My big concern for my new right hip is that whilst the constant tugging in the groin has gone, and the range of motion in extension has become easier. I find it difficult and restrictive in bringing my hip up to 90 degrees and beyond. Therefore, sprinting and kicking a football still feel a million miles off.

Even when trying to stretch it feels like there is not much stretch taking place, just a feeling of ache. Please could people share their experiences and give feedback on whether you think this is normal progress at my stage in recovery or if you think that at 11 months for a sporty individual who is committed to rehab that I should be further down the line. My surgeon had anticipated in me perhaps returning to running and football at 4-6 months. I have made only limited progress since the 4 month mark in reduction of my groin pain.

I am desperate to get back to being more active and being able to do simple movements and not feeling like I have the body of an 80 year old. I can't comprehend how Andy Murray at 4/5 months is almost playing tennis again and I can't even run ten minutes!!!!

Look forward to hearing from you if you can offer advice.

Many thanks,
Josh

[jimbone]

Josh-

Please clarify something for me.  Your operated hip is not performing as well as you had hoped for but it is your unoperated hip that is causing you pain?  Is that correct?  Also, 30 is young to be needing this procedure in general; what was the reason you had HR in the first place?  Was it OA or like many a shallow hip socket that led to other orthopedic difficulties.  I ask because the site is not a place we can come for medical advice but sharing similar symptoms and histories can sometimes lead a person to ask the right questions or seek the right treatment from their doctors.  Also- it is very common for someone to have HR on one hip that has reached the end of its useful life only to find the other hip, which has been carrying the load for the more severely compromised hip has now sort of "given up" or been just used too hard and needs a re surfacing as well.  That is what occurred with me, along with many others I've read here, and while I knew the second hip had moderate to severe OA from the x rays, after the first hip got done, the second one went down hill all the way to completely unfunctional within 2 months so it was resurfaced as well.  After both were done, recovery proceeded steadily and today at almost 9.5/11.5 months I am doing very well, pain free, developing strength and increasing ROM on a weekly basis and have plans to do some serious and challenging mountain hiking come summer.  Even given that level of recovery- which BTW is no where near what some people achieve-I still have not yet developed a smooth, consistent, natural feeling stride trying to run.  I continue to work on it and expect improvement but even at this late stage I need to accept I will heal at the rate and to the limit that my body allows- regardless of my intention- although that will certainly aid the process.  It would be worth discussing with your surgeon and seeking some more imagining to find out if it's the second hip that's throwing you off.  Hopefully others will pitch in here with more meaningful insight and you will keep us apprised of your progress.  Best of luck to you.

[Pat Walter]

Hi Josh
11 months does seem like a long time since surgery and feel like it is a point where everything should work well like it use to in the "old" days.  Every body and every person are different.  There are no normals.  No matter what our mind wishes, the body has it's own rate of healing. There are many who are out doing fantastic things early in their recovery, yet there are some people that took a year or two to get back to something close to normal. A lot depends on your own body and how long you waited for surgery. Also what was wrong before surgery. The longer people wait for surgery, often, the longer the recovery because the whole body has to heal since it was all out of balance trying to compensate for a bad hip. We can't give medical advice since we are not doctors, all people can do are share their own stories.

It is also difficult to separate hip and back pain. If your surgeon has told you the hip resurfacing is correctly placed, then it probably is not the hip resurfacing.  Only a surgeon can tell. You can also get several other opinions if you send some emails to the top experienced surgeons with a digital copy of your x-rays. It might be good to have a second opinion.

Some people have also pushed too hard with physical therapy and caused problems. There are many things involved which we can't speculate on.  Your surgeon would be your best source of information. Many surgeons don't let their patients run until after a year. So pushing 10 minutes of running might even be too much at this point. Patience is the best policy.  If things are hurting, stiff and not working well, maybe a little down time and easy activities would be best. Many surgeons don't even suggest PT, they simply want to you walk, walk and walk.

Also if your other hip has problems, I don't see how your body can function normally. As you know, when a hip has a problem, the rest of the body has to compensate. It seems one operated hip and another bad hip could certainly cause you problems. Again, only your surgeon can tell you about that.

We all heal at different rates and some people never quite heal to the point of returning to their optimum performance. Most people do heal well, fortunately. I understand your frustration and hope you can find a solution.
Pat

[joshb7_]

Hi Jimbone and Pat,

Thanks for your responses.

Jimbone - the left hip is giving me a bit of grief in terms of limited range of motion (similar to how my right hip was before the surgery). My right hip which was resurfaced is also troublesome. I cannot  seem to bring my knee to my chest without pain and limited range of motion. This is somewhat similar when bringing my hip across my body also. Just tried going for a jog and again my lower back and hips feel sore, stiff and painful.

Mentally I am now finding the process somewhat difficult as I have undergone a right hip arthroscopy prior to my resurfacing, and almost ten years on and off trying to rehab and feel my body is as bad and immobile as it has ever been.

I almost feel it is not even worthwhile trying to strengthen my core and glutes as it seems to just fatigue me and bring on niggles and pains, rather than help make improvements.

I have emailed my surgeon to get feedback on my latest set of scans (9 months). Do you think the problems are being caused by soft tissues being tight and weak, rather than the resurfaced hip or could the resurfaced hip be placed incorrectly? There is no pain on normal activities except where the groin and hip flexor attach. This has improved over time in fairness.

How long did it take you guys to return to running freely? Do you think active release massage or other techniques may work?

Thanks,

Josh

[blinky]

I am sorry your expectations are not met. Can we ask a few more questions?

How aggressively have you tried to come back? What were you doing at six weeks? Six months? Can you walk fine? How far? Can you do those simple, basic post op exercises, like the leg lifts and clam shells? I wonder about stepping back and trying to come back from an earlier position. Walk and do those easy exercises for a few weeks. Maybe start walking say two miles and build up.

I could do quite a bit eleven months out, but I did have plenty of niggles and my RoM was limited. My running stride was restricted, for example, even though I could run up to about five miles slowly---12mm. I did have trouble bringing my knee to my chest, but I could do it. I remember being able to do pigeon pose, but not pull my knee to my chest when on my back. I could sit cross legged, but not for super long. Two years out my back ached if I stood too long, like after a day at museums. All of these issues have gotten better, some with time, some with conscious effort, like ab work. I did not have one single, identifiable problem that persisted as you seem to have.

ART helps. I started myofasial massage at six months. Can you get in the pool? I think water exercises help, too.

[joshb7_]

Hi Blinky,

Thanks for your response. Six weeks I think I came off any walking aids and just did walking and my normal life as rehab. My surgeon Ronan Treacy advised not to worry about doing the post op exercises and that it will heal itself through walking. Six months, I was swimming, some physio exercises targeting glutes etc... Pushed it more in the 6-9 moth phase with some loading like leg presses, quad machine etc... Sometimes think this fatigues everything and then brings on the onset of groin irritation and lower back ache. Part of the problem I believe is that I have had this hip issue for almost 10 years so my body has gone all out of whack, compensating and tightening all over. For exanple, I have now issues with my left hip, right trapezius/shoulder, back not functioning well hence the lower back pain. However, it almost feels like no amount of strengthening or stretching seems to permanently change this. Massage will make me feel good for a bit and then it reverts back.

At least now I can squat and my right hip is not impinged like it used to be. My left now does though. I will try to get back to doing a lot of swimming and ab work and isolated glutes. Clams etc are all fine for me.

Did your range of motion and running stride increase? My concern is that I was told maximum range of motion occurs at 9-18 months, and currently I am far off what I need to return to sport. For example, I cannot bring my leg up to do a kick very well. Could it be that the muscles just dont want to do it because they have been shut down the last years? If so, wondering if I just try and practise kicking with a soft ball if the soft tissue/fascia will relax a little and restore more natural movement?

Does anyone have good advice on what rehab to be doing or any suggestions of a good physio/PT in the South East? I find it strange that cycling still gives me lower right back pain after my new hip.

Thanks,

Josh

[jimbone]

Josh-

I find a very good deep tissue therapist a necessary asset to rely on every 2 weeks- some of that is just age.  I'm just a week shy of 8/10 months only started running slowly on the treadmill a month ago and not much progress since- although I'll take what I can get.  That's something that is very slowly beginning to feel "normal" or as I remember normal as I haven't been able to run in at least 5 years.  Chest to knee- not yet but progressing- the baby pose is finally paying off- I could feel the glute minimus that was giving me grief and restrictions begin to give way and stretch out about a month or so ago and it's getting stronger and longer every week- that is a good pose for both glutes and flexors.  I do a little running/walking in the pool but mostly to eliminate impact but also allows for a long stride to reinforce that feeling in the muscle memory.  I get the fatigue thing as well.  If I exercise 5-6 days in a row, cardio/stretching one day and then the same with weights and machines the next, usually by day 6-7 I am tired out.  Have adjusted this to just skip or go very light on the days when I just don't have the energy to put in a hard work out.  I give it a day or even two if needed to recuperate.  This may not be much help but I'd suggest the baby pose for glutes and flexors, pool running [great cardio in any case] and knee raises when on the parallel dip bars for the flexors and psoas.   As Pat mentioned- a second or third opinion may very well be in order if only to clear your doubts and maybe give you some new ideas for advancing.  Best wishes.