Post-op and PT
Since I had the surgery in the UK but live in the US, physical therapy started out a bit bumpy. Almost all of it is aimed at someone who has had a THR and is therefore trying very hard to limit your motion. What we hit upon finally was to treat the rehab as if recovering from a hip dislocation (you get one of those for free during surgery). In that case movement and strengthening are the order of the day.
At heart I am a martial artist and an athlete, so I took all those years of training and put them into practice. Click here for some notes on conditioning. A big thing is to understand that speed can only come from smoothness. So slow practice of whatever is very crucial. Oh, sure it’s boring at times, but I know that I can spend a couple of boring weeks doing something slowly and get it right or sort of flub through it for months, hitting a plateau I can’t get off.
One thing I did very early on was walk on the treadmill. The idea is to practice. Walking actually takes a very specific firing of nerves in a specific order, of course. Walking ginky for me meant lifting the whole side of my body and leading with my toes rather than my heel. It was quite maddening to say the least, since the body would do the motion whether I liked it or not. So, I got onto a treadmill, one with two handrails. I then held on and turned the machine on its slowest setting (about 1/2 mph) and practiced perfect form. I had a mirror across from me and watched myself and yes, I did put a book on my head from time to time to check my posture. I wanted every step to be exactly like the one before it. Eventually, I increased the speed. Every week I upped the speed and time, so that by about week 6 I was able to walk for a good several minutes at 2 – 3 miles an hour. This is what it takes to walk. Remember that I was hanging on to both handrails because I was supposed to be using two sticks. When I switched to one stick, I switched to one handrail.
By the time I got off sticks completely, I was able to walk a good 20 minutes at a normal clip with excellent form. This took me to the 12 week mark. After that, I keep a weekly mileage goal, although I try to do about 5 miles a day if at all possible. We all know that the work mile comes from Latin mille or thousand, since a mile is 1,000 paces, don’t we?
Leg lifts are also important. Do them both sides and lying down as well as standing, since this varies the load. I was up to a couple of hundred a day. I also practiced isometric exercises by standing in martial arts stances. Looked very much like tai chi chuan, because I moved slowly to get the muscles working in the right order.
One unexpected casualty was my foot. Your feet actually have reflexes to grab the floor in a way specifically that allows you to stand and walk. My right foot got stupid. The fix was really simple. Stand on it for 30 sec – 60 sec 3 or 4 times a day for a month. Start out by holding onto things, but get so you can let go. This was sufficient to retrain the muscles and helped a lot with my gait.
Here is a listing of other topics people always ask me about on the list.
Clunks and thunks. One of the more disconcerting sensations post-op is when the soft tissues glide over each other, entirely analogous to having a knuckle crack. Of course, this is a darn big joint and is bearing your weight, so the feeling is often unsettling. It is called, clunking, thunking or slippage. This is normal and I found that stretching it excessively would cause this to increase for a few days. Stretching here is relative to your activity level, mind you. I found once after a very long drive and a bit too enthusiastic workout that I got the other hip to clunk too. That should put your fears to rest if you are experiencing this.
Dislocation risks. In a THR there is a great deal of fear at a dislocation. While I was given the all clear post-op, meaning I was allowed to do anything I wanted except bungee jumping, I also had the feeling the hip was nice and solid. I can fully support the doctor’s contention that dislocation risk is approximately the same as a natural hip. So, I undertook a pretty stout stretching program at the 3 month mark. Before that I was cautioned that I should let the hip capsule heal to being nice and tight. I found that laying on my back and drawing the knee to the chest was one of the best stretches for me. I could not do that for years. Also the yoga position called the plough is a good one.
Teeth and going to the dentist. As this was explained to me, the bacteria that live in your mouth tend to be sticky, like barnacles, since they must resist chewing action to remain. If these get into your blood system they will stick to any and everything, including a metal implant. Since the body does not have a blood supply into the implant, it cannot fight the infection. Once an implant gets infected, all that can be done is to remove it, treat the infection then do a revision. Therefore, people with implants (not just hips) have to take extra care with keeping the teeth in good shape. I get 3 cleanings a year, just in case. Also, anytime there is a dental procedure of any sort, including cleaning, antibiotics should be taken. A prophylactic dose is normally a triple or quadruple dose taken an hour or so beforehand. This ensures that any bacteria that enter the blood land in a toxic environment. This is no big deal to do at all, but you should really make it a standard part of your dental visits.
Pain in the other hip/knee. Going into this I had so much pain in the other hip that I thought I might need a bilateral (double) replacement. McMinn told me not to fret and wait to see how things stabilized. He was right, the pain was from walking badly. Once my gait got unscrambled and I had regained some strength, the pain magically vanished. I can make things hurt by really overdoing it, but all is within the normal expectations for someone of my age.
Other types of conditioning I phased in starting at the 6 week mark, beginning with just slow stance work. I wanted to be stable on my feet at all costs. I did ask if I could do my stances low. That was ok’ed. They don’t violate the 90 degree rule.
Here are two things you can do that will really help you. When you take your daily walk (not if!), ever so often walk on a line. This forces you to extend your hip and makes you balance. This is simple and effective. Another great thing to do is get a circle about the same radius as your height. If you go to a gym, a basketball court has one of those right in front of the basket. Walk around the circle clockwise for a minute or so, then counter-clockwise. (Look here for more about this.) Your feet are on either side of the circle rather than on it. I found that once I could walk straight, I still had trouble turning. Just a couple of minutes of this a few times a week for a month or so does wonders. Make sure your toes point where you want to go (that was hard for me at first) and your gait is normal.