9 weeks postOp significant discomfort and limited ROM

[bcmaughan]

Hi All

I had an Adept resurfacing implant put into my right hip on 21/01. I have had significant problems with it and just really wondering where I should be at 9 weeks post Op as am quite depressed with it and in constant discomfort. I had a lot of swelling after the operation which I think is possibly not too unusual and obviously my movement etc was significantly impacted until this went down a bit. The real problems seemed to kick in after 5 or 6 weeks once my movement and activity levels went up. I noticed on standing on my operate leg and doing a slow gentle sort of half squat on one leg that there is a pretty noticeable clunk when I start to put weight on the leg. It sort of feels like if you put fists together with knuckles together and slip one fist acros the other. Like something is shifting in the joint itself. I notice as well that there is some very tight pain in groin. If I lie down on back with legs bent and let my operated leg fall inwards it feels like something is pulling in my groin. When I am walking I can feel quite weird clunking a lot of the time and the whole joint sort of feels like it is inflamed inside and offers very limited range of motion indeed.  Sometimes when I try to stand with wide legs it feels as though there is something sort of catching/clicking and then letting go inside the joint (as if it would have been with the symptoms of a labral tear I think). The discomfort is really quite bad and nothing like what I was expecting at this stage as it seems most people after a couple of months are pain free and happy with it.

I went for a 6 week checkup and the surgeon said that the xray was good that nothing has moved and he is happy with the positioning. He tested my mobility with me lying on my back and there really is very limited movement because of this tight groin situation. He suggested that I get a dynamic ultrasound to identify the source of clunking and to possible get an injection into the psoas tendon sheath. However all this has likely been put on hold at present because of cv. As has my physio stuff. So I feel kind of helpless and unsupported and quite worried by this now. I am a gardener and have started back at work now but working seems to aggravate it somewhat. Am I expecting too much too soon. Grateful for any advice or help please as am finding this really soul destroying after hoping it would be a great thing for my quality of life.

[autoazure]

Please do not worry too much at such an early stage of recovery! Your joint capsule and soft tissues/muscles/tendons/ligaments and nerves are still many months from recovering. I found it best to continue moving using a crutch to walk outside for about a mile) and daily gentle leg exercises. It may seem to you like the whole joint is moving however, that metal head and cup are well fixed in place. I too had the Adept and it is one of the best available with special tools to ensure it is fitted in the exact correct position. I look forward to hearing how you are progressing in the coming weeks and months. Don't worry about lack of support, once the follow up shows that all is well it is time to start the slow road to recovery by gentle movements and walking/slow jogging at walking pace! If it becomes painful STOP and rest!

[bcmaughan]

Thanks very much for reassuring reply. But constant discomfort and clunking/grinding etc is normal at this stage? Seems not to be from what I've read. I have to work and have been advised gardening OK but no impact stuff. There is no chance I could even gently jog with the discomfort I have anyway. I'm fairly good with pain but can't cope with this it's really debilitating.

[catfriend]

No, IMO this level of pain isn't normal this far out from the surgery. While everyone is unique in how they heal, at your stage I was walking a few miles at a pop without problem, and swimming multiple times per week. I was still in physical therapy to work on specific issues, but nothing debilitating. You should be healing quite well by now, and able to perform a good number of activities. There are some people on this board who have mentioned being on a slower protocol, but as long as you're not then you should be further along.

Swelling up hugely a few days after surgery is pretty common. Also, everybody overdoes it with activities at some point or another. It may be that your body isn't ready for squats. I am bothered by the fact that you mention constant problems and that it is debilitating. I would definitely have more questions for my surgeon. It is unfortunate that you can't do pt etc because of the coronavirus situation.

[bcmaughan]

Thanks catfriend. That is my feeling too. I keep trying to look on the bright side but am struggling to. Yes I can go to work and do gardening etc but am in constant (and I mean constant not the odd niggle) debilitating discomfort. It is as bad (but a little different) than I was pre surgery. I thought that the surgeon must have had some concerns to recommend a dynamic ultrasound and psoas injection as a first port of call after only 7 weeks post op (the ROM was terrible when he tested it!) - but it looks like I won't be getting them for some time now with the coronavirus situation!

[jimbone]

It is difficult for anyone on the forum to provide much more than personal experience.  The most common sentiment being we all heal at our own rate and it is best to be persistently gentle with ourselves as we heal.  You mention you are a gardener which I will assume includes a lot of kneeling and getting up and down from the ground.  Getting up from the ground without the use of hands or support is actually a recognized measure of both health and longevity.  I can assure you at 9 weeks i was only barely able to do so and it took a good month or two before I could do so reliably, regularly and without strain.  I agree your discomfort levels seem higher than usual and concerning but I'm sure you understand it is in your best interest not to over react.  I would suggest getting a second and third opinion.  Can you get your imaging to any other HR surgeons?  The well known ones here will generally examine and offer an opinion.  That consensus would help give you a more informed perspective.  One legged squats, even partial, at 9 weeks??  Nope.  That was a 6 month minimum ability for me.  While we wait out the current virus circulating I would recommend taking a few steps back and focusing on the easiest, gentle, basic stretches and exercises we all start with, don't be afraid to rely on some minimal medicated support, self massage and avoiding anything that over does it.  Might even consider a crutch or cane for a week or so to see if that relieves the discomfort.  While some people's surgeons might not have an established "slow" protocol doesn't mean some of their patients don't need one.  Keep us informed and best wishes.

[imgetinold]

Hey, Bcmaughan,


It's been a while since you posted.  Any improvement.


One thing I didn't see in the other replies was staying on top of your surgeon.  From what you said, he doesn't seem to be keen on helping you.  Can I ask who your surgeon was?  Do you know how many resurfacings he had done prior to your surgery?


Anyway, I hope you've recovered more by now.  This really can, and should, be a life-changing surgery.

[bcmaughan]

Hi and thanks for your interest in my predicament! My hip is definitely not good. The clunking/banging is getting worse. Happens most of the time even just walking along. If I stand on operated leg and bounce a little it makes a loud clunk easily audible to someone standing nearby. It feels quite unstable and like either something is loose or there is bad impingement. I've sent xrays to 3 internationally recognised experts. 2 out of 3 suggested might be a problem. One said impingement and other said didn't look like cup was in all the way. My surgeon was Mr Eastaugh Waring. I think he'd done 400 or so resurfacings but not 100% sure. It's kind of hard to get to see him or discuss with him. I went recently but only saw another member of his team. I'm not sure they are taking me very seriously as they seem sure clunking is psoas tendon flicking over metal ball of prosthetic. I feel sure it's not as it's very uncomfortable over whole joint. They didn't seem interested in listening to the clunk though. They referred me for a dynamic ultrasound which I'm having tomorrow actually. I want to then go and get a second opinion and have Mr Treacy lined up for that. It's all been quite frustrating as it is certainly not a miracle cure for me. I tried to jog for first time the other day. Got about 1km and then just too uncomfortable do had to walk home.

[imgetinold]

Ugh.....that's awful.  So sorry.

I will only add a couple things.  I never really got back to running.  Once cleared to do so, I tried and developed a deep ache in the operated hip after about 3/4 mile.  This persisted through a round of PT.  Eventually, I gave up because I could literally do everything else.  Tennis, HIIT training, Insanity videos, etc.  HOWEVER, over the last year I joined a boot-camp style gym, and that class worked my lower body more than I've EVER done.  After maybe six months of that class, I was able to run (albeit slowly) just over 2 1/2 miles before the pain set in.  So, I think that training - and the focus it had on all my lower-body muscles - was critical in that small success.

I also remember clunking after my first surgery.  It mostly happened in the period between 6 and 12 months post-op.  It wasn't until 6 months that patients of Dr. Gross are cleared to return to all activity, and that's when I would notice it.  By 12 months, pretty much all the muscles around the hip are strengthened enough to prevent the clunking.

I only mention this suggest that perhaps a focus on lower-body strengthening might help with the clunking.  Now, you may have done this already, and if so please excuse my suggestion.


I wish you the best.

[bcmaughan]

Thanks again for reply and suggestions. Yeah I'm trying strengthening etc but to no avail so far. I do a fairly physical job and am struggling with it. If I do a hardish day I'm limping around next day badly. Had ultrasound which seemed to rule out psoas tendon. I never thought it was that anyway. Some suggestions might be impingement but might need different imaging etc. All quite depressing. Was your clunking all the time just walking about etc? And pain all the time from 6-12 months?

[bcmaughan]

Hi all. Just an update on my hip implant. It is deteriorating significantly and I am now pretty much 100% convinced something is loose in there. I can feel it moving about a lot in certain positions and even when jsut walking around now. I get significant pain standing on one leg that gets worse momentarily when I put my good leg back down again. I can't lunge, jog or anything like that. Any reasonable excercise for a few hours means I start limping badly. I have a slight limp pretty much all the time. It feels loose and unstable. It is all very depressing after hoping for a new lease of life. Anyway I recently had a CT scan which concluded that there is asymmetrical lucency around the femoral stem which measures 4mm at the tip and is very suspicious of osteolysis and micromovement. So it sounds like I am right with there being something loose but it seems unusual for it to be the femoral component as opposed to the acetabular cup. I have been quite frustrated at not getting to see my surgeon lately but seeing other members of his team but I am due to see him on 1st March so hope for some details regarding options for me. Does anyone have any experience of what my options are here? I'm assuming that once it is loose, even a tiny bit, then there is no way it is going to heal itself and will only get progressively worse (as it seems to be doing)? Is it possible to redo the femoral component? I really do not want to have to switch to a total hip replacement as I am still young and active. Very grateful if anyone has any information on this thanks.

[catfriend]

Some resurfacings can indeed be revised. Obviously this is all individual, but all is not lost yet. No matter what happens it sounds like you're in for another surgery (yuck!). I would have some very pointed questions for the surgeon. Did he no place the device correctly? What, exactly, is wrong? If something is loose, why? Not every surgery works perfectly for every person, but I would want answers before I went under that surgeon's knife again.

[bcmaughan]

Thanks for reply. Yes I'm kind of resigned to knowing I'll likely need a revision sooner than later as it's getting worse not better so probably wearing bone away. I knew something wasn't right from as early as 6 weeks after the Op. I had a brief period of being not too bad last summer but it's gone downhill a lot lately. Even climbing stairs hurts now. I definitely have some questions for my surgeon but also accept that sometimes these things just don't work out. I'm definitely not totally committed to having any revision done by the same surgeon though and will get a 2nd, 3rd opinion and go with the best one I can afford and have most confidence in.

[jimbone]

I've heard good things about Dr. Treacy.  Did you get in to see him?  Sorry to hear you're suffering.  I would probably be losing confidence in my surgeon at  this point if they couldn't provide more information or insight.  Hope things work out for you.