Total hip arthroplasty/replacement surgery

[caveman27 208]

Well, I'll be getting this surgery pretty soon, like this week. Got some questions for guys here who have had it.

Anyone else get this procedure done?

How long did recovery take before you were able to skate? Play hockey?

Do you play forward/defense or goalie? 

Any complications in playing hockey?

 

[YesLanges 127]

Recovery time depends substantially on the surgical approach. Posterior approach will require more convalescence, more rehab, more time to resume full activity, and more restrictions during recovery.

I suffered with this shit for 5 years because I was too afraid to get the surgery and incapable of deciding between THA and BHR. THA surgeons all recommended against BHR because of the potential issues with metal-on-metal hardware; meanwhile, BHR surgeons presented BHR as a no-brainer for several reasons and downplayed (or completely ignored) the MoM issue. I also cared more about the least invasive procedure with the least amount of pain and the quickest recovery. The BHR guys also (mis)represented BHR as less invasive, when, in fact, it's much more invasive because of how much access to the joint it requires. Finally, last year, I found an experienced THA surgeon (Alexander Neuwirth at NY Cornell-Weill) who uses a plastic ball in a ceramic cup and does it with a minimally-invasive anterior approach. Up to that point, the only THA surgeons on my insurance plan used metal components and/or only do the posterior approach. I was still very skeptical about believing what he was telling me about how my being an ideal candidate and my current physical condition meant that I'd recover very quickly; and I was even  more skeptical about being back on the ice in "6-8 weeks." 

He was right. Surgery was March 12th around 7:00 AM and the only reason I didn't leave the hospital even a few hours earlier than 4:00 PM was because I was still dizzy from the pain meds and because it took me that long to produce any urine to be sure there were no issues with that. As soon as my head cleared, I walked around the ward basically carrying my walker in front of me without needing it. I used it for safety to get to the car and from the car to my apartment and that was the last time I touched it. I spent much of the next week lying on my massage table because it allowed me to angle my head down and feet up to keep the swelling down. Swelling still moved all the way down my leg and peaked at 7 days. Zero hip pain and some minor discomfort in my quads for a few days. Started upper body training after 7 days because I was still feeling sort of weak; but I could have started immediately if I'd wanted to. Zero prescribed rehab because I have my own gym at home and zero post-surgical hip precautions: the anterior approach allows you to bend at the waist and to do everything except torque your hip by twisting your body while standing on that leg. I did nothing besides my normal leg training for rehab (eliptical, leg extensions, squats, leg curls, hyperextensions, and some band work for abductors & hip flexors). For the first 6 weeks of training, I substituted reverse hyperextensions on a big exercise ball for traditional hyperextensions, because I didn't want that pressure directly on the hip joint. I also waited 6 weeks before doing my abs by hanging upside down on my inversion table.

I started walking up and down the hallway outside my apartment daily for the first two weeks and after my two-week check-up, I got the go ahead to get back on the eliptical and to start light leg workouts. I worked out pretty hard for the next 4 or 5 weeks and at my 6-week follow-up, he told me I could get back on skates. I got on the ice 7 weeks to the day from my surgery and within a few of hours on the ice (over 2 weeks), I was pretty much back to normal. Been going to sticks and pucks 2-3x/week since early May and have my 4th game tomorrow night. I slip some extra neoprene padding under compression shorts over my hip right on the joint, just in case I get knocked off my skates and fall directly on it. He said the biggest risk is a direct impact only because the titanium implant is so much harder than the surrounding bone that the femur could crack if I fell directly on the hip hard enough. Other than that, the only risk is high-impact sports, which my surgeon doesn't recommend (at all, ever) for recipients of THA. That's no issue for me, because I don't do anything high impact and all of my cardio is on the eliptical. I'm mainly a center and while I'm not that great a player, I typically cover more ice in any game than anybody else on the ice. My surgical hip is now one of my only joints that never hurts.

Ultimately, the long-term results are the same whether you have anterior or posterior THA, and (functionally), even if you have BHR. The posterior approach typically takes about twice as long to get back to full activities, requires rehab, and involves some more pain, especially initially, and there are strict hip precautions (i.e. no bending past 90 degrees at the waist and no crossing legs) for a few months. BHR is also a harder recovery than anterior THA, but is fine, as long as you're not one of the unlucky few who have metal ion issues.

Let me know if you have any other questions. 

 

 

Edited September 1, 2021 by YesLanges

[caveman27 208]

Thanks.

I got anterior approach total hip replacement (today) for left side. I don't know if he put in a ceramic ball or other. I'll ask in my follow-up visit.

The anesthesiologist did a good job and I wasn't nauseous post surgery. I had ACL reconstruction decades ago and I was totally nauseous afterwards. I was given ginger ale and nausea medicine and I threw it up.

I have prescribed physical therapy which I'm going to on Wednesday. I'll do that until I really don't need to go and can things on my own. I've been to this same physical therapy office a bunch of times through the years for other surgeries... I should get frequent flier miles. The post-op surgery nurse gave me a bunch of exercises to do at home until then.

My doctor does have BHR training/experience but he didn't provide that option. 

My right hip was worked on three years ago and got scoped. Same orthopedic surgeon who worked on me today. He said it was looking worn and I will probably get total hip replacement for that in the future. 

Did your doctor give you the "okay" to go back to work, to drive, to exercise/run/lift/play hockey? If so, when did that happen.

 

[beerleaguecaptain 999]

Best of luck on your recovery.  I had arthroscopic labral repair and the bone shaved down so thats nothing like what you are going through.  Keep us posted.

[mojo122 535]

10 hours ago, caveman27 said:

Did your doctor give you the "okay" to go back to work, to drive, to exercise/run/lift/play hockey? If so, when did that happen.

I was retired when I had mine done so can’t comment on that.  Good PT is a must. I was back driving shortly since mine was left and not right. Was back to full gym workouts (elliptical, lateral, and weights) within a month. I was an avid runner pre-replacement, but my surgeon said my running days were over because it would be too much pounding. I was back recreational skating at 3- months but was advised to wait 6-months for hockey. Was basically because although the stem is cemented bone continues to grow around it, and bone grows ever so slowly. That was 6-years ago and haven’t had any issues since. Good luck with the rehab and getting back on the ice. 

[Vet88 674]

23 hours ago, caveman27 said:

Did your doctor give you the "okay" to go back to work, to drive, to exercise/run/lift/play hockey? If so, when did that happen.

Mine was bilateral BHR resurface with a posterior approach, I'd have preferred an anterior approach but no surgeon in my country does this (or if they did they were not skilled enough). I chose the BHR due to its track record and if and when it falls apart I then start again with a replacement.

It was 3 months before I got back on the ice (the surgeon pleaded with me not to fall over as ideally it would take another 6 weeks before the hip socket had completely knitted around the implant), it was around 2 months after that before everything worked as it should so 5 months all up. Posterior approach comes with it's issues, the biggest is if the surgeon doesn't take enough care when putting the cut muscles back together, it can end up turning your toes inwards as he shortens the adductors that control this motion. But it allows for better access to the joints and therefore is easier to get the alignment of the inserts correct.

I've had mine 10+ years, if you get to this point you will most likely have the joints for life. Once recovered, I never thought about them, skated as hard as I ever had. I'm still on the ice every day, hours at a time. Gluteal and hamstring tendinopathy is the biggest issue now (had it for the past 18 months), can't go as hard as I used to without pain killers. I suspect there may be some MoM issues but I had a full diagnostic review (MRI, dye injections and tracings) last year and the joints are fine so I've just got to live with it, my surgeon told me to stop thinking I was 20 years old instead of approaching 60, lol.

Good luck with your recovery and getting back on the ice.

Edited September 5, 2021 by Vet88

[caveman27 208]

 

On 9/4/2021 at 8:40 AM, dkmiller3356 said:

Best of luck on your recovery.  I had arthroscopic labral repair and the bone shaved down so thats nothing like what you are going through.  Keep us posted.

 I had that done 3 years ago on my right side but the doctor ended up not shaving any bone down since it was looking like I would be due for a hip replacement soon.

[caveman27 208]

The surgery was successful and I'm in the recovery phase. Doing physical therapy and walking. My post-op check-up is later this week.

One thing I wasn't expecting was being very tired all the time. That lasted for over a week. 

I'm off pain meds now which is great. The thing that worried me the most was having to be off a blood thinner for a week before the surgery, because I had a heart attack over a year ago. 

The procedure was out patient so I was home the same day. I bought a walker but hardly used it. That was a waste of money. Also got out my crutches as back up, but never used those either.

It will be awhile before I get on the ice to skate. 

  

[beerleaguecaptain 999]

Keep working at it!!!!  I'be scared to be off my thinners too...  scary shit.  (5 stents)

[mojo122 535]

On 9/14/2021 at 2:58 PM, caveman27 said:

The surgery was successful and I'm in the recovery phase. Doing physical therapy and walking. My post-op check-up is later this week.  

How are things going now that you're a good month post surgery? 

[caveman27 208]

4 hours ago, mojo122 said:

How are things going now that you're a good month post surgery? 

OK. I've been going to PT twice a week. My physical therapist said I'll only need to go once a week starting next week. I go to the gym to work upper body and I also walk. I've gotten a lot of my flexibility back so now I'm working on gaining strength and massaging out the surgical area. I feel about 90% back to normal.

[Vet88 674]

On 10/26/2021 at 10:18 AM, caveman27 said:

I've gotten a lot of my flexibility back so now I'm working on gaining strength and massaging out the surgical area. I feel about 90% back to normal.

I can't stress how important it is to keep stretching your hips / groin etc for the rest of your hockey playing days. Over the last few years I wasn't doing any stretching and my hips gradually got tighter and tighter to the point I'd find it hard to pick a puck up some days after a hard practice. I was seriously considering giving up playing and winding things right back to just a couple of coaching skates per week. 2 months ago I worked with a top figure skating coach to put together a stretching program, 1 hour every night without fail (even if I have to drag myself off a sick bed) and I'm back to pain free skating. If you had told me 5 years ago that I would need to stretch just to keep skating I'd have laughed at you, now I'm a convert.

[caveman27 208]

5 hours ago, Vet88 said:

I can't stress how important it is to keep stretching your hips / groin etc for the rest of your hockey playing days. Over the last few years I wasn't doing any stretching and my hips gradually got tighter and tighter to the point I'd find it hard to pick a puck up some days after a hard practice. I was seriously considering giving up playing and winding things right back to just a couple of coaching skates per week. 2 months ago I worked with a top figure skating coach to put together a stretching program, 1 hour every night without fail (even if I have to drag myself off a sick bed) and I'm back to pain free skating. If you had told me 5 years ago that I would need to stretch just to keep skating I'd have laughed at you, now I'm a convert.

The stretching I've done lately was for my physical therapy which I just ended. 

I got to keep it doing now. 

[beerleaguecaptain 999]

I agree....  I stretch every morning and foam roll too.  Also before games.  This is an absolute must.

[noupf 42]

On 11/18/2021 at 3:09 AM, Vet88 said:

I can't stress how important it is to keep stretching your hips / groin etc for the rest of your hockey playing days. Over the last few years I wasn't doing any stretching and my hips gradually got tighter and tighter to the point I'd find it hard to pick a puck up some days after a hard practice. I was seriously considering giving up playing and winding things right back to just a couple of coaching skates per week. 2 months ago I worked with a top figure skating coach to put together a stretching program, 1 hour every night without fail (even if I have to drag myself off a sick bed) and I'm back to pain free skating. If you had told me 5 years ago that I would need to stretch just to keep skating I'd have laughed at you, now I'm a convert.

How old are you and what sort of stretches do you do?  I'm 44 and in pretty good shape for my age, but I do have a slight lower back issue and right hip issue.  I do some basic stretching before I play ( twice a week ),but I've recently started feeling "old" bc of those two issue I pointed out.

Would love to get some more specific stretches to help keep me going.  

[Vet88 674]

9 hours ago, noupf said:

How old are you and what sort of stretches do you do?  I'm 44 and in pretty good shape for my age, but I do have a slight lower back issue and right hip issue.  I do some basic stretching before I play ( twice a week ),but I've recently started feeling "old" bc of those two issue I pointed out.

Would love to get some more specific stretches to help keep me going.  

I'm 58 so it's never to late to start stretching. Watch the following vid, the basis of my strecthing routine is similar to this but first I start with 20 minutes focused on the gluteus medius and IT band, not so much stretching but strengthening and conditioning, these muscles and tendons are so important for hockey. I'll post a link to the group of exercises I do later on.

Then I'll spend 40 minutes stretching, this is the stretching vid, you could pick any off youtube from a figure skating coach working on eagles of box splits. It's advanced stretches but I just went for it and keep pushing it hard, my range has improved dramatically.

 

[caveman27 208]

Six months have gone by so I started just ice skating. I skated for 30 minutes two weeks ago and 30 minutes last week. The second time, I tried to sprint hard, but it felt funny in my hip. I can gradually get up to speed through regular skating strokes. There's some weakness when I do a t-stop on my left foot. I think I need to strengthen more muscles in my left side .I haven't play any hockey yet.

[caveman27 208]

It's been over a year. My left hip has been doing well. I got my right hip replaced a week ago. Almost the same experience as the left hip replacement. I don't remember all the details of my left hip surgery post-op, but I feel more pain at the side of the thigh. Same was last time, I've been very tired everyday. I walked a mile yesterday. It took 32 minutes to do, I may have pushed myself too far though. I'm doing PT exercises once a day and have had one PT appointment since my surgery.