Hip replacement surgery set; worried about rehab schedule

Posted by Mamie @mamie, Sep 25, 2019

Hi. I'm hoping someone here might have advice. After getting totally confused and recently even made fearful by doctors, I have decided to go for hip replacement. Kinda brief background: Had AVN in hip after doing splits on icy concrete. Problem not discovered for a few years when I had pain down side of leg (NEVER in or at my hip). Told hip joint had collapsed and leg shortened.

Have had to walk with cane. Getting increased pains in back and same side knee because they are the new pivot points. Two docs said they would NOT do THA because I have no pain; two said joint was too stiff for their approach. One said that I may go through operation and not see any improvement and what was the big deal if I had to rely on a cane and have back or knee pain. He said it would be nothing compared to if I got a dislocation or infection. I said aren't those chances "supposedly" small. He said yes but if I got either, I would wish I had never had a replacement. That made me wonder why anyone ever gets a replacement.

However, then I found a doc who seems assured that I will see better quality of life because of better ROM (no/little rotation in that hip now) and that while problems can happen, precautions are taken and chances are small.

So I scheduled the surgery in early October. Just saw the PT schedule for it and found that I will be in the hospital overnight, then go home which is 45 minutes away. Then the next day I start PT sessions back at the hospital 45 minutes away. The PT is to be 2x a week for 6 weeks before re-evaluation.

I've read elsewhere that the tissue first needs time to heal. Would anyone mind sharing their experiences regarding how much PT is reasonable after posteriolateral approach THA?

Thank you.

Hi @mamie – I have not had a hip replacement but have had two knee replacements. In both cases my orthopedic surgeon started PT in the hospital and continued immediately upon release from the hospital. However, he ordered in-home PT until I was able to drive.. which was 2 or 3 weeks. Again, I can't speak to what is normal PT for hip replacement. I wonder if you could ask your doctor about changing your orders to in-home therapy – especially since you are so far away?

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@debbraw

Hi @mamie – I have not had a hip replacement but have had two knee replacements. In both cases my orthopedic surgeon started PT in the hospital and continued immediately upon release from the hospital. However, he ordered in-home PT until I was able to drive.. which was 2 or 3 weeks. Again, I can't speak to what is normal PT for hip replacement. I wonder if you could ask your doctor about changing your orders to in-home therapy – especially since you are so far away?

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@debbraw I believe. but I could be wrong, that in-house PT is just paid for by Medicare, although that would also depend on your insurance. It is only paid for, for as long as you are home-bound. Once you can get out you are expected to go to outpatient PT.

@mamie Whether it be in-house or outpatient PT, can't you be given PT orders and have them done by a therapist closer to home? I had my TKRs in Boston, which is about an hour away with no traffic. My Pt was done up here in southern NH though.
JK

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@contentandwell – Good point. Yes. Medicare paid for inhome PT until I could drive. We are in St. Augustine, FL about 1 hour south of Mayo Jacksonville. Once I was no longer "home-bound", I got outpatient PT and I was able to do it here in town w/o taking the long drive to Jacksonville several times a week. @mamie – Can you check with your physical therapist and see if those are options where you are?

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@debbraw

@contentandwell – Good point. Yes. Medicare paid for inhome PT until I could drive. We are in St. Augustine, FL about 1 hour south of Mayo Jacksonville. Once I was no longer "home-bound", I got outpatient PT and I was able to do it here in town w/o taking the long drive to Jacksonville several times a week. @mamie – Can you check with your physical therapist and see if those are options where you are?

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@debbraw. @mamie My doctor simply sent the referral for PT to whomever I wanted to go to.
JK

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Thank you, @debbraw and @contentandwell. I had my pre-surgery appointment Thursday and apparently since I have a husband at home as my caretaker, that is good enough for me to not have in-home PT. Since we live in the country, there isn't anyone around much closer. Ended up opting for the complex where my doctor's office is — even though about 5-10 minutes further — since I was told that if PT had a question, he could call in the doc or one of his colleagues.

Got a new worry! When being shown by pre-op PT how I would have to sit down/get up afterwards — keep operated hip leg straight while bending and putting extra pressure on my very arthritic opposite knee — started getting a lot more discomfort in that knee than normal. Anyone else end up stressing an opposite problem joint during recovery? Wondering if putting an ace bandage or something would support it during recovery.

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@mamie

Thank you, @debbraw and @contentandwell. I had my pre-surgery appointment Thursday and apparently since I have a husband at home as my caretaker, that is good enough for me to not have in-home PT. Since we live in the country, there isn't anyone around much closer. Ended up opting for the complex where my doctor's office is — even though about 5-10 minutes further — since I was told that if PT had a question, he could call in the doc or one of his colleagues.

Got a new worry! When being shown by pre-op PT how I would have to sit down/get up afterwards — keep operated hip leg straight while bending and putting extra pressure on my very arthritic opposite knee — started getting a lot more discomfort in that knee than normal. Anyone else end up stressing an opposite problem joint during recovery? Wondering if putting an ace bandage or something would support it during recovery.

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@mamie as long as you and your doctor are comfortable with the PT you are arranging, that’s what matters. Home PT gives you a head start but if that’s not possible and you have been given instructions for exercises that your husband can help with I’m sure you will do fine.
When I had my TKRs I did not have that problem of the other leg not being much help. I’m sure there are people on here though that have been through the same. I would think an inexpensive elasticized brace from a drug store might help. I used one when my knee was bad prior to my first TKR and it did help a little.
JK

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@mamie

Thank you, @debbraw and @contentandwell. I had my pre-surgery appointment Thursday and apparently since I have a husband at home as my caretaker, that is good enough for me to not have in-home PT. Since we live in the country, there isn't anyone around much closer. Ended up opting for the complex where my doctor's office is — even though about 5-10 minutes further — since I was told that if PT had a question, he could call in the doc or one of his colleagues.

Got a new worry! When being shown by pre-op PT how I would have to sit down/get up afterwards — keep operated hip leg straight while bending and putting extra pressure on my very arthritic opposite knee — started getting a lot more discomfort in that knee than normal. Anyone else end up stressing an opposite problem joint during recovery? Wondering if putting an ace bandage or something would support it during recovery.

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I live in Canada, and was sent home with a book of exercises for first six weeks to do at home, Gehenna had checkup with surgeon and saw a physio for 5 min! He gave me second set of exercises, and no further follow up. I and a year post TKR, and doing more walking and recumbent bike, but still get very sore with stairs and housework. My other knee is very arthritic, kneecap displaced and bone on bone, but surgeon said” come back in a year. As long as you aren’t using cane or walker you are doing fine” So on I chug!I hear what you are saying about your other knee, the same is happening with me. I can’t get a brace that works over the kneecap etc, so just keep doing what I. An. I am envious of you folks who have physio. I may have to seek one out

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@mamie

Thank you, @debbraw and @contentandwell. I had my pre-surgery appointment Thursday and apparently since I have a husband at home as my caretaker, that is good enough for me to not have in-home PT. Since we live in the country, there isn't anyone around much closer. Ended up opting for the complex where my doctor's office is — even though about 5-10 minutes further — since I was told that if PT had a question, he could call in the doc or one of his colleagues.

Got a new worry! When being shown by pre-op PT how I would have to sit down/get up afterwards — keep operated hip leg straight while bending and putting extra pressure on my very arthritic opposite knee — started getting a lot more discomfort in that knee than normal. Anyone else end up stressing an opposite problem joint during recovery? Wondering if putting an ace bandage or something would support it during recovery.

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Hi @mamie – As I said, I haven't had hip surgery, just knees, but I know for sure that asking one limb to carry the lion's share of the work can throw all manner of things out of whack. In fact, after my first TKR, my doctor thought I might be able to get 2 or 3 years out of the other knee since it was not having to do all the work anymore. I like JK's idea of a brace. Anything you can do to help the stronger leg will be positive. Will you be using a walker at first? I would think you might be able to use it to push up. Did the therapist say anything about that?

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@debbraw

Hi @mamie – As I said, I haven't had hip surgery, just knees, but I know for sure that asking one limb to carry the lion's share of the work can throw all manner of things out of whack. In fact, after my first TKR, my doctor thought I might be able to get 2 or 3 years out of the other knee since it was not having to do all the work anymore. I like JK's idea of a brace. Anything you can do to help the stronger leg will be positive. Will you be using a walker at first? I would think you might be able to use it to push up. Did the therapist say anything about that?

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@mamie @debbraw. A walker is a great idea. I used one after both of my TKRs and more recently after my fracture. I have also used an elevated toilet seat with handles on either side. These were recommended after my first TKR.
JK

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@glasgow46

I live in Canada, and was sent home with a book of exercises for first six weeks to do at home, Gehenna had checkup with surgeon and saw a physio for 5 min! He gave me second set of exercises, and no further follow up. I and a year post TKR, and doing more walking and recumbent bike, but still get very sore with stairs and housework. My other knee is very arthritic, kneecap displaced and bone on bone, but surgeon said” come back in a year. As long as you aren’t using cane or walker you are doing fine” So on I chug!I hear what you are saying about your other knee, the same is happening with me. I can’t get a brace that works over the kneecap etc, so just keep doing what I. An. I am envious of you folks who have physio. I may have to seek one out

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I need to apologize for my spelling on that one! I’m obviously losing my vision too!!

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@glasgow46

I live in Canada, and was sent home with a book of exercises for first six weeks to do at home, Gehenna had checkup with surgeon and saw a physio for 5 min! He gave me second set of exercises, and no further follow up. I and a year post TKR, and doing more walking and recumbent bike, but still get very sore with stairs and housework. My other knee is very arthritic, kneecap displaced and bone on bone, but surgeon said” come back in a year. As long as you aren’t using cane or walker you are doing fine” So on I chug!I hear what you are saying about your other knee, the same is happening with me. I can’t get a brace that works over the kneecap etc, so just keep doing what I. An. I am envious of you folks who have physio. I may have to seek one out

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Hi @glasgow46 – I am definitely a big fan of physical therapy. If you are getting sore with stairs and housework AND have a 2nd bad knee, you might benefit from some sessions just to get tips on how to maneuver. You said you might seek one out. Are there therapists in your area?

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There are some physios, I’ll just have to find one that is good with TKR. Stairs are a slow and sometimes precarious situation, as my unoperated knee gives out. I was an RN for many years, understanding my patients more and more!

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