Hip replacement complication

Posted by bselby @bselby, Jul 7, 2024

Hello,
My sister had a THR, anterior approach, 20 days ago and was transferred to a SNF four days later not able to lift her leg. She can bend her toes, but leg is numb and can only move it to the side. She gets PT twice a day, and they scoot her foot forward to take a step. She can't make a step alone.
She hasn't seen her surgeon since pre-op, although he did call to tell her she had extensive damage and recovery would be rough.
Now she's being prepped for release in a wheelchair and her husband is scheduled for training on how to care for her.
This seems very unusual and would be interested to hear of experiences with (hopefully) short term inability to lift leg post op.

Interested in more discussions like this? Go to the Joint Replacements Support Group.

Profile picture for robdene @robdene

Yes! Yes! Yes! to this comment: “There is too much hype about how there is little pain and swift recovery which may be the case for many but isn’t for everyone.” Hyde3357! It seems that everyone from PT folks, friends, even a famous meteorologist on national television said that it is a piece of cake! It wasn’t and hasn’t been a “piece of cake” for 10 months! Even my PT said in the pre op exam, “you will be back in the gym in a month!”😳 I am now back in the gym at 10 months post surgery but it’s painful and I don’t yet trust my hip to “stay put.” I’ll get there with perseverance, but not because someone told me it would be a “walk in the park!”

I know that it’s a bit of a tight rope walk in encouraging others through hard times, so let’s be careful that we are frank in our conversations, saying what we know to be true and compassionate without placing expectations on others that might not be within their ability to reach.

I am stepping down off of my soapbox, now! 🤗

It’s so much more beneficial to the patient to say things like, “it’s not easy,”
“ you will need to go at your own pace in recovery,”
“it looks differently for everyone, but you can get through this,”
“I want to support you on this journey. How can I help you?”

Jump to this post

Yes, a little honesty in our medical profession would go a long way. For some reason; from what I had heard and read prior to surgery; I really expected to be walking unassisted in about 5 to 10ndays. I am 3 days short of s3 weeks post op and still deeply need a cane and am beginning to realize that for me; i actually am doing pretty good. I think they hype up the best case scenario because if they told us just how rough it could be; and probably will be; no one in their right mind would ever "elect" to have this done unless they were already practically unable to walk.

REPLY
Profile picture for formerrunner13 @formerrunner13

My hip replacement and subsequent revision surgery was 3 years ago. The last PT I worked with discharged me after 6 sessions and told me that he did not know why I walk the way I do and that there was nothing more he could do for me. I decided that I would continue to do my own re-hab doing the exercises I was given and working out at the gym. At 3 years post surgeries, my hip is good and my leg works OK. I know that it is weaker than prior to surgery. I use a walker now because I am unstable walking. (I also have neuropathy which is not helpful for walking and balance etc. and do exercises for those issues as well.). I have learned two things which may be helpful for your sister. One is to work toward the pain and to not give up. The second thing is I have learned acceptance. It is difficult sometimes. I named my walker "PITA". most know what that stands for. A little humor goes a long way. I have a dear friend with ALS which helps me put my problems/issues in perspective. I wish your sister the best and am sending tons of support.

Jump to this post

What does PITA stand for? I am one of the not so intellectual ones!!! Lol

REPLY

Expectations probably need to be more consistent, it does seem a lot of variable messages from patients (because experience varies), orthopedic surgeons (although in the consent for surgery all consents will cover the % risks for death/infection/clots/swelling/bleeding/dislocation/revision/nerve damage/numbness/failure), and associated health professionals ( physical therapy seems to be enthusiastic as much as orthopedic surgeons). I have tried to read as many sources as possible the past six months, and I believe serious complications occur regardless of anterior versus posterior versus other approaches even with experienced surgeons - and complication rate may be about 1 to 2 % per year. Yan L, Ge L, Dong S, et al. Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2023;6(1):e2253942. doi:10.1001/jamanetworkopen.2022.53942
If you are interested in the article I hope the link works, if not search on JAMA Canadian hip replacement 2023 and you should see the open access article.
Since complications apparently take place at the rate of at least 1 to 2 % per year (apparently forever), what I have concluded is hip replacement is an extremely serious decision, a major surgery, especially risky the first 3 months, and a good outcome that lasts 30 years without complications would be unusual.
Best wishes

REPLY
Profile picture for formerrunner13 @formerrunner13

My hip replacement and subsequent revision surgery was 3 years ago. The last PT I worked with discharged me after 6 sessions and told me that he did not know why I walk the way I do and that there was nothing more he could do for me. I decided that I would continue to do my own re-hab doing the exercises I was given and working out at the gym. At 3 years post surgeries, my hip is good and my leg works OK. I know that it is weaker than prior to surgery. I use a walker now because I am unstable walking. (I also have neuropathy which is not helpful for walking and balance etc. and do exercises for those issues as well.). I have learned two things which may be helpful for your sister. One is to work toward the pain and to not give up. The second thing is I have learned acceptance. It is difficult sometimes. I named my walker "PITA". most know what that stands for. A little humor goes a long way. I have a dear friend with ALS which helps me put my problems/issues in perspective. I wish your sister the best and am sending tons of support.

Jump to this post

PITA: Pain in the A...!

REPLY
In reply to @formerrunner13 "PITA: Pain in the A...!" + (show)
Profile picture for formerrunner13 @formerrunner13

PITA: Pain in the A...!

Jump to this post

Oh my!!! What a great acronym! I'll have to store that for future use. Thank you

REPLY

My x-ray shows moderate to severe osteoarthritis in my left hip, not quite bone on bone though. I can function fine during the day. There's often some soreness and often, I'm told, a very slight limp in my walk but I can still walk relatively long distances and even ride my bike. It's at night when I'm sleeping that the pain, which often goes down to my knee and sometimes lower leg often wakes me up. I find that two arthritic tylenols doesn't do anything for me, and I am reluctant to use Aleve and prescription naproxen very often given the damage that NSAIDs can cause with long-term use and because I'm also on a statin and aspirin. I'm scheduled to go back to the surgeon that I've seen to discuss my case and possibly re-schedule the replacement surgery that I previously postponed. But I am having a lot of second thoughts when I read about the complications some people have post surgery. I question whether I'm really debillitated enough for the surgery since as mentioned above I function fine during waking hours. I think surgery should always be a last resort. I've tried acupuncture, take supplements, work out and do hip-related stretches and exercises and I'm a fit 72 year old. Maybe I'm just postponing the inevitable but as time marches on surgical methods improve. It's cathartic writing this. Thanks for reading through it.

REPLY
Profile picture for elliott1953 @elliott1953

My x-ray shows moderate to severe osteoarthritis in my left hip, not quite bone on bone though. I can function fine during the day. There's often some soreness and often, I'm told, a very slight limp in my walk but I can still walk relatively long distances and even ride my bike. It's at night when I'm sleeping that the pain, which often goes down to my knee and sometimes lower leg often wakes me up. I find that two arthritic tylenols doesn't do anything for me, and I am reluctant to use Aleve and prescription naproxen very often given the damage that NSAIDs can cause with long-term use and because I'm also on a statin and aspirin. I'm scheduled to go back to the surgeon that I've seen to discuss my case and possibly re-schedule the replacement surgery that I previously postponed. But I am having a lot of second thoughts when I read about the complications some people have post surgery. I question whether I'm really debillitated enough for the surgery since as mentioned above I function fine during waking hours. I think surgery should always be a last resort. I've tried acupuncture, take supplements, work out and do hip-related stretches and exercises and I'm a fit 72 year old. Maybe I'm just postponing the inevitable but as time marches on surgical methods improve. It's cathartic writing this. Thanks for reading through it.

Jump to this post

elliott1953 I have always heard that if the pain goes below the knee it is your back causing the pain and not your hip. That is what my hip ortho said and sent me for mri of my back.

REPLY
Profile picture for elliott1953 @elliott1953

My x-ray shows moderate to severe osteoarthritis in my left hip, not quite bone on bone though. I can function fine during the day. There's often some soreness and often, I'm told, a very slight limp in my walk but I can still walk relatively long distances and even ride my bike. It's at night when I'm sleeping that the pain, which often goes down to my knee and sometimes lower leg often wakes me up. I find that two arthritic tylenols doesn't do anything for me, and I am reluctant to use Aleve and prescription naproxen very often given the damage that NSAIDs can cause with long-term use and because I'm also on a statin and aspirin. I'm scheduled to go back to the surgeon that I've seen to discuss my case and possibly re-schedule the replacement surgery that I previously postponed. But I am having a lot of second thoughts when I read about the complications some people have post surgery. I question whether I'm really debillitated enough for the surgery since as mentioned above I function fine during waking hours. I think surgery should always be a last resort. I've tried acupuncture, take supplements, work out and do hip-related stretches and exercises and I'm a fit 72 year old. Maybe I'm just postponing the inevitable but as time marches on surgical methods improve. It's cathartic writing this. Thanks for reading through it.

Jump to this post

Elliott,

Yes, ponder carefully.

Regarding NSAIDS, you might talk with your primary or orthopedic MD about occasionally using celecoxib (once a month perhaps for a day or two). Using the aspirin probably increases risk of NSAIDS however, so it's another risk benefit decision. You might also ease up on exercise occasionally, I have noticed some of my various joint pains get better if I take a few days off.

My situation was similar to yours, except not on aspirin, statin, or any Rx before deciding on surgery. Everything went well until dislocations at 10 and 15 weeks. If you do have the surgery I suggest to be very careful, take it slow, follow hip movement precaution* for at least 3 months, and what ever else is recommended. Currently I have zero pain unless I do approximately 7000 steps, relieved by acetaminophen. Hoping time will allow me to avoid revision surgery, may get a second opinion, right now dislocation is probably a risk bending at the waist or putting on socks.

*precautions vary with the surgeon and some apparently don't recommend precautions, from what I read research is conflicting but if you follow patients out a year or more complications occur (1-2%) regardless of anterior versus posterior etc. If I had it to again I would follow the precautions for both anterior and posterior for six to 12 months and never do ambitious bending ( I am flexible).

If I had it to do again I would avoid surgery if at all possible, but pain interfering with sleep might convince me to do surgery. Would have tried less exercise (less than 10000 steps and heavy lifting), monthly celecoxib or similar, and maintained a healthy weight (healthy diet to maintain weight).

Best wishes

REPLY
Profile picture for drummergirl @drummergirl

I had my first hip replacement two years ago, age 72, normal weight and fairly active. I have no pain in walking or moving my new hip, so cheers to that. However, I had more side effects than I think I should have. I would be curious if anyone experienced any of these effects. My new hip caused a 1/2 inch length discrepancy (like walking after your loafer heel falls off). I have to add an adjustment to every shoe I own. My leg blew up about two weeks after surgery and PC sent me for scan and Doppler. All ok, but no explanation for extreme swelling. Then UTI that required three rounds of antibiotics, but strangely after starting them, I peed like crazy all night and the leg swelling was gone in the morning. Don’t know why this happened. I have a large pad of numb flesh on my hip that never went away and the scar, which was done horizontally across the top of the front of my leg collapsed because it was right where I bend my leg and is tender if I bump anything. Has anyone experienced any of this, as my Dr has apologized, but I have no explanation.

Jump to this post

I had read from this site about leg lengthening. So I asked my surgeon prior if he would be doing this and replied no. I did have significant amount of swelling in entire leg by week 5. So much so, that I could not bend my knee. Quite painful. Per doppler, no blood clots. Since I'd been having knee problems prior to hip and was contemplating TKR, I was given a steriod injection in knee. I also slept with wedge for elevation, swelling subsided for the most part, with much improved pain relief.
Btw, when I had shoulder related, surgeon did lengthened my arm. I realized this when my bra strap kept sliding down. Again, information from this group alerted me their same experience. Did your leg stay lengthened? If so how are you adjusting? Best of luck!

REPLY
Profile picture for beachy @beachy

I had read from this site about leg lengthening. So I asked my surgeon prior if he would be doing this and replied no. I did have significant amount of swelling in entire leg by week 5. So much so, that I could not bend my knee. Quite painful. Per doppler, no blood clots. Since I'd been having knee problems prior to hip and was contemplating TKR, I was given a steriod injection in knee. I also slept with wedge for elevation, swelling subsided for the most part, with much improved pain relief.
Btw, when I had shoulder related, surgeon did lengthened my arm. I realized this when my bra strap kept sliding down. Again, information from this group alerted me their same experience. Did your leg stay lengthened? If so how are you adjusting? Best of luck!

Jump to this post

Hi! No, my leg did not even out, but I did not expect it to. There was a miscalculation by my surgeon that caused my operated leg to be longer, not entirely uncommon. I now have to have the other hip replaced and they will make even. I had read, and in my case I believe, that I incurred damage to my “good hip”, as a result of the operated hip being longer. Makes your gate unnatural.
In the meantime, to compensate, I order Dr Foot wedges online to elevate my heel inside the shoe and for my better heels I have a prescription that allows my shoemaker to add height to the bottom of my heel. Thanks for your good thoughts. Good luck to both of us😊

REPLY
Please sign in or register to post a reply.