Post-Op recovery: 1 month milestone
It’s one month today since my hip revision surgery. I find this week 4-6 period of post-op recovery the most boring. The first week is mainly feeling ill and getting over the trauma. Weeks 2 and 3 are about getting more mobile as the swelling and pain subsides; balancing movement with rest. But the second three weeks can drag - I no longer feel ill, I’m not in a lot of pain, but I’m still really restricted in what I can and can’t do. My exercises are still quite restricted, I have to vary my sitting position too regularly to sit in one place for any length of time. And there's not much variety in the days. It's the boring phase!
For those who haven’t read a previous blog post, I had a full revision surgery of my 22 year old hip replacement, one month ago. I’ve had 13 surgeries all due to being born with bilateral hip dysplasia (CDH) with one hip socket missing along with a lot of my pelvis. You can listen to more of my history on this Steps Charity Podcast here.
So what am I up to every day?
Walking, always with crutches.
As well as continuing to march up and down the garden, I’m now also taking a walk around the block each day, on crutches. Walking is by far the best PT for post-op recovery. The surgeon was strict about using crutches for eight weeks, even indoors, and to date I’ve been using them together (ie both crutches go down together as I take weight on my operated leg). As of yesterday, my physio has added a small amount of walking in the garden using the crutches reciprocally, which means a bit more weight through each leg, and a bit more of a natural walking pattern. Sadly, I still can’t walk to the local cafe, as I can’t then sit down (chairs not high enough to meet the precaution height). Nor am I braving the local coop as there are too many ‘hazards’ like people, wet or uneven floors, baskets etc to feel safe. But the daily walk is enjoyable, and extends my bubble beyond the home.
Physio exercises, with some progression.
After a hip replacement you get one NHS physio appointment for post-op recovery and a pack to follow a standard progression plan. So I decided to use a private physio who has worked with me for the last 20 years. She knows my history (so we’re not starting from scratch with me having to explain how different my hips are). She also knows who my surgeon is and how he likes to work. And most importantly, she knows all the ways I can find to ‘cheat’ the movements I find most difficult! Over 50+ years I have become very creative in this regard, but that gets in the way of me exercising the muscles that actually need to learn to work properly. For someone like me, with a complex case, it’s important that the physio doesn’t expect to do much that’s standard, and can be bio-mechanically creative - ie find different positions or props that help me exercise the right muscles safely.
For the last two weeks exercises have been:
- Standing: Heel flexes, Hip abduction, Hip extension, and then standing on my operated leg (with crutches) and moving the other one into various positions (looks like an odd tap dance!) - so that I get comfortable with the left leg taking the weight and encouraging independent movement of each leg.
- Laying: knee/hip bends, hip abduction with knees bent, hip adduction with knees bent (pushing on a rolled towel) and pelvic tilts with knees bent (but still NO bridging allowed).
For the next 3 weeks this has progressed to:
- Laying: hip abduction and pelvic tilts
- Sitting (new position puts more weight through the hips): leg extensions and holds with ankle weights, hip adduction (squeezing a towel between my knees which works the glutes more sitting than laying, and standing from a perch position without using my arms (REALLY hard!)
Short bursts of reading, watching TV, writing, learning to paint :-)
It’s important to keep my brain busy. But I have to be super careful not to sit in one position for more than about 40 minutes. So things I can do in short bursts are good, where I can also switch position between my high seat chair vs. the bed with legs up. I was never an artist at school (I’m very literal, and my creative outlet was always music) but I’ve bought a small watercolour set and a book which is helping me learn to paint natural things like leaves and flowers. Don’t expect the gallery opening any time soon folks! But it’s a very relaxing thing to do.
Visits and calls from friends
I’m very grateful for everyone who has visited or arranged calls/zooms. It’s lovely to see people, hear about things other than my boring little daily routine, and just laugh and enjoy the company of people who I know well. It also adds some variety to my day and means I will still have some social skills by the time I go back to work or choir in the Autumn.
So these are the things, day-in, day-out, that stop me from getting too bored - which would lead to my doing too much, too soon. My surgeon has put the brakes during this initial period of post-op recovery for good reason. So I need to trust in that, until I see him in two weeks' time. Hopefully then I'll find out that everything is going OK and the new hip will have ‘set’ enough, with new bone forming to hold it in place securely. Then, hopefully, the handbrake will the released a bit to allow proper rehab to start - including hydrotherapy. And I'll be rewarded with a chance to see an Xray of my new hip for the first time - Xrays of my hips have always been how I understand and connect with my hip dysplasia.
So until then, thanks for reading this and for following my progress. Stay tuned for the next episode in a couple of weeks xx
Jill Pringle was born with bilateral hip dysplasia in 1971 in Sheffield, UK. She has had various childhood and adult surgeries on her hip and knee. She writes this blog to raise awareness of living with CDH/DDH and being a ‘differently-abled’ walker.
Hip revision precaution height: managing at home post-surgery
It’s two weeks now since I came home from hospital after my hip revision surgery (all due to my hip dysplasia). In some ways time has flown, in others it has dragged. It’s a bit like Groundhog Day; punctuated by exercises, napping, walking on crutches, eating, washing, a bit of TV, a para of the blog and then start again.
What marks out a hip revision surgery is the need to restrict certain movements until the hip socket sets in place securely. So that the screws holding the socket into the filler in the pelvis set. Big movements are a big no. And I have a strict precaution height.
The restrictions are:
- No walking without crutches. To limit my movement and weight-bear sensibly
- No flexing the hip to 90 degrees plus. So I can’t sit on a chair, bed, toilet lower than 47cm (18.5 ins) - my precaution height.
- No twisting or rotating in a way that could allow the ball to slip out of the socket. So no low chairs, no squatting and no stepping in and out of a bath. Flannel wash only for 6 weeks!
- No sleeping on my side even with a pillow between my knees. It is difficult to sleep in the same position all night, but I can only sleep on my back.
- No crossing my legs.
- No hip-bridging exercises. All the physio exercises have quite a small range.
- No driving and extreme caution getting into and out of a car to manage precaution height. We have a mini so this has been fun!
All of the constant thinking, minding how I’m moving, is mentally tiring.
What is a precaution height?
Put simply, the precaution height is the lowest furniture you can sit on. It means you don’t end up flexing the hip too deep when sitting, or standing up from a seat, and so don’t risk the hip dislocating (painful) and then weakening the fixings.
It’s calculated based on the height of your knee to the floor when sitting in a chair (you make the measurement before surgery).
Most dining chairs are about 40cm high. Sofas and toilets can bit lower. I also need arms on anything I’m going to sit on, so I can take the weight on my arms and lower or raise myself up whilst protecting the hip and keeping the leg straight.
This led to me purchase things for home before surgery, like a high seat chair with arms, a raised toilet seat, and a second hand single bed that’s quite high from the ground.
The hospital also sent me home with a loaned sit/perching stool for the bathroom so I can sit at the sink and wash, or at the kitchen counter to make a sandwich. A Leg-Up leg lifter, so when I slide back onto the bed, I have a way of pulling my operated leg round. A sock buddy (weird contraption to pull on socks, which so far has been usurped by boyfriend LOL!), and lots of grabbers to pick things up.
Pain and bruising
The first few days home I was still on power painkillers because I had breakthrough pain from the incisions, the nerve disturbance, and the internal bruising. These also helped me sleep, especially when first in bed. But they do contribute to nausea and dizziness and I don’t need more of that post-surgery!
After three days I’ve been only on paracetamol and ibuprofen, and I would describe it as mild pain and discomfort. Doing my exercises was sore until the bruising and swelling reduced - this subsided after about a week, so 10 days post-surgery.
And I’m on blood thinners, to ensure I don’t develop clots, until the end of July. Which means being super careful not to cut myself or develop any new deep bruises.
Sitting in a chair or perching on the stool was difficult for the first week. Then each day the swelling reduced - it was like an extra bit of my sensation returned. Right now I can can still only sit for about an hour before I have to move due to discomfort. When I first got home this was 15 mins.
The incision/wound
I had the wound checked yesterday by the local GP nurse. It’s all looking clean and healing well (they went in using the same anterior scar from my hip replacement 22 years ago). Thankfully no staples to remove like I had with the knee, just self-dissolving sutures.
What’s worse - hip or knee surgery?
The pain from the knee replacement was 10x that of the hip revision. Those first three weeks of throbbing pain and the lack of sleep for 3 weeks I hope never to repeat. By comparison this hip surgery has been child’s play - pain-wise.
Howvever, the movement restrictions from the hip revision are more limiting right now. I could do more (pain aside), more quickly, with my knee. I didn’t have this 6 weeks of restrictions. So the hip revision is going to take longer to recover from.
Physio exercises
By far the exercising is walking. Weight bearing (with crutches) to build strength and encourage new bone to develop is part of the PT routine.
For the first two weeks I had a few exercises, each with limited range;
- laying: ankle holds, quad holds (pushing my knees back into the bed), hip bends (sliding the heel up to bed bending the knee), buttock squeezes - definitely sore for the first week! Plus straight leg hip abduction which I have never been able to do easily without help.
- standing: hip abduction, hip bend (lifting the knee a bit), hip extension (leg back), and heel raises up to tip toe.
- sitting: seated knee extensions for both legs, strengthening the quads
I’ve been doing these religiously 3x a day. And it’s amazing how much easier they get once my body (and brain) is trained to do them. A marker of progress. Little victories.
Always followed by an ice pack to relieve the pain/soreness from doing them.
Friends on rota - thank you!
After one week home my partner had to return to work (for a rest, LOL) and I’m grateful for the friends who came in on rota that first long weekend, to break up the day and help me. I express just how lovely it was to see you folks; for the lunches, the cuppas, the hair washes, the washing hang-outs, the plant watering, the cat feeding and basically just letting me live vicariously by hearing about things other than my regular Groundhog Day existence.
Of course the biggest thanks go to my loving and patient partner and my emotional support cat. I can’t imagine the last two weeks without them.
And to all of you out there reading these posts, and sending good wishes, thank you and love to you all. Until next time... xx
Jill Pringle was born with bilateral hip dysplasia 53 years ago. She writes this blog to share her experiences of living and walking with this condition, and about her adult and childhood orthopaedic surgeries. Jill is also a proud differently-abled supporter of Steps Charity, who help children and adults who can't take walking for granted.
Post-surgery hip mobilisation and the get home checklist
Restoring independent mobility is a priority after hip surgery. Hip mobilisation reduces the risk of blood clots or chest infections and our joints and muscles were designed to move. But before you can get up it needs to be safe - the sensation needs to have fully returned to your legs, and you need to be strong enough to stand without the risk of falling. In short, being a Fainting Freda is a barrier to achieving this :-)
Fainting and sickness
The day I had my knee replacement 3 years ago I was using a walker the same afternoon. I wasn’t sick because I was awake with spinal pain blocker and very light sedation only.
But for my hip replacement 22 years ago, it took 3 days to get me out of bed due to the sickness and fainting I experienced post-general anaesthetic. My friends all know that where alcohol is concerned I’ve always been a total ‘shandy lightweight’. A couple of glasses of wine on a night out and I’d start puking, and my hangovers were fierce. My body just doesn’t tolerate toxins. So anaesthetics are not tolerated well either. All through childhood surgeries, a lot of vomit was an accepted part of the recovery.
So for my hip revision surgery nearly 2 weeks ago, I wasn’t sure what to expect. I wasn’t having a general, instead they used an epidural pain blocker, but unlike me knee replacement, I was fully sedated. What happened post-revision was more like the hip replacement, with the sickness and fainting, but nowhere near as bad on the sickness. For which I’m thankful.
I was sick twice in the early hours of first morning in PACU, but fast acting anti-emetic injections stopped that. The following morning they tried to sit me on the edge of the bed, but with the epidural still attached, and a catheter still in, I was quickly put back into bed for a bed bath. After breakfast at 930 the epidural was removed along with the arterial line, and by 10am I was wheeled down to the ward in my bed. My legs were not fully thawed, my non-operated lower leg taking the longest to return to full feeling. Hip mobilisation was going to take a while.
Meanwhile, I’m watching everyone else get up an about on crutches. My competitive side was not enjoying this! But I know from my first hip replacement I just need to go with it. My body takes longer. And my surgery was more complex and longer than average.
The first tentative steps on Day +1
At 3pm the physios decide it’s time to try and mobilise me. I move to the edge of the bed and then I’m up and walking a few steps on a walking frame. My new hip feels really heavy and stiff, because it’s swollen. But boy does it feel good to move - physically and psychologically. The physio moves me back to sit in a chair, at which point I start to feel dizzy, and I say “I’m going to faint”. The nursing staff were there fast, I was given oxygen, they kept me focused and conscious. They managed to get me to take the few steps back to the bed, where they could tip the bed back to get more blood to my brain. I didn’t actually faint… so this was progress, but my blood pressure had dropped. The 30 degree heatwave outside wasn’t helping, so they brought me a big fan which is now a static feature by my bedside even at home.
Despite all that, the first night on the ward was quite relaxing all things considered. A nice dinner, chatted to the two other ladies in my ward, and we all read our books until lights out.
Out of bed with some anxiety on Day +2
The nurse assistant got me out of bed and into a chair after breakfast, and I didn’t faint which was a good start. Sitting for the first time felt strange and uncomfortable, but then sitting is not that comfy for me generally. My pelvis is very crooked, and so I can never quite sit straight. But I managed to wash with the help of a long handled sponge, and put on my own nightshirt. Another step towards independence. At this stage in recovery, doing one new thing seriously feels being let out for a night out in Vegas. But I also felt vulnerable in the cubicle. What if I faint and break my new hip? What if they can’t get to me?
I waited for the physios whilst watching the 84 year-old who had her surgery last night get up onto crutches, go off and do the necessary hip mobilisation checklist, then she started packing to leave. It was my turn, first up on the walker again, and then onto crutches. Now, with my history, I’m a dab hand on the sticks, even if I do say so myself! All looking very impressive.
Later the physio came back and I was straight up onto crutches. Yay, look at me, so confident. Star pupil. This feels good. And then, yep, you guessed it, I say, “I’m feeling odd, I think I’m going to faint”. We get back to the bed, she takes my blood pressure which has tanked again, and so I was back in bed and on a drip of fluids. Which to me, was a backward step. I shed a few tears as the physio said no more PT today.
My partner came to visit and brought some lovely messages from colleagues and friends who he’d updated (thank you, they were well timed folks!).
After he left, I lay down and figured out the pay as you go TV. I needed a distraction. Then the nurse came with my blood thinner injection (which is the least painful needle ever really) and I got really anxious. All I could think was - oh no, the cannula made me faint. I got quite upset. He was very patient, let me have my mini-meltdown, then gave me the jab. I settled back to watch Speed (Keanu always helps right?!) whilst taking on the fluids and the breeze of the fan. Watching a movie felt normal and it was the distraction I needed.
This was the longest night. I didn’t sleep at all, the next patient to arrive in the bed opposite was struggling with pain and very vocal, and I almost fainted again when trying to use the loo. So back on the drip, the fan. Was I ever going to get home?
Day 3 - the checklist to get home
It was Friday and I wanted to get home for the weekend. I felt like crap but recognised I needed a plan, and I needed to feel in control. So I started asking the day staff - what do I need to do to get home now?
There were four things:
- Not faint/nearly faint
- Bowel movement and pee without the catheter
- Have an Xray
- Fully mobilised on crutches - on the flat, up a single step, and up and down a flight of stairs
So I had a goal and a plan. I’m good with that, and the fact I asked in itself showed I was ready. I focused on each with determination.
After washing myself in a chair the catheter came out, which made it easier to get up and mobile (dragging a catheter bag around on crutches adds something extra to think about)
The physio got me up and I walked down the corridor on crutches and up and down a single step. I found this easy - up: good leg, crutches, operated leg. Down crutches, operated leg, good leg. When we got back to the bed the physio asked if it was my goal to get home today? You bet it is!! The ward staff said OK, if I could toilet independently.
Shortly after I went to Xray in a wheelchair. I haven’t yet seen the image of my new hip joint, and I’m very curious to see it. I will have to wait until I see my consultant orthopaedic surgeon in 6 weeks.
After lunch, with a bit of extra medicinal help and focus, my bowels finally opened. Poo for victory!
Then the physio took me up and down a flight of stairs, which I already knew how to do. We did my standing, sitting and laying mobilisation exercises so I was clear on them. And proved I could get on and off a raised toilet seat on my own.
We don’t have a walk-in shower at home, so have to strip wash only for 6 weeks (the risk of bending or rotating the hip too far is to big). So I had a sneaky shower in their wet room. Such bliss. Clean hair, the feel of water on my skin. Post-surgery these little moments are so precious. I felt human again.
I then waited for the discharge papers, the sick note, the meds - with the hospital transport already waiting to take me home (we have a mini which won’t easily meet the precaution height of 18.5 ins). Then I was cleared to go. Yippee!!
I was soon cleared to leave, considered fully mobilised. We had to faff a bit with the wheelchair to get me downstairs as it didn’t meet the precaution height. Lots of pillows. It was hard to get into the ambulance, but we managed. It was a 40 min journey, which I shared with a lady who had just had her knee wound staples removed (ouch, remember that one). The ambulance had limited suspension to we felt every speed bump, and the air con couldn’t keep up with the heatwave. But at 5pm, I pulled up at home.
Thankful for home
My partner was there to meet me and with the help of the ambulance driver we got up the two steps. My partner set up a bed for me downstairs, so I have everything I need on one level and don’t need to climb the steep Victorian stairs. Dudley the cat was a bit unsure for a while, but soon came for a cuddle. Another very happy moment.
We ate dinner. We watched an episode of something on the TV (I could sit in a chair for about 30 mins before needing to move). Then got ready for bed. I have never been so thankful for home.
The NHS staff at SWLEOC are incredible. I will also always be thankful for them too.
We’re all differently-abled
As I reflect on this post-surgery mobilisation, I’m conscious that we are all diff-abled. No two people will mobilise the same post-surgery. Some of us just take a bit longer. But we get there.
Until next time, thanks for all the love and support folks xx
Jill Pringle is 54 and was born with bilateral hip dysplasia. You can read more about her experiences of living with this condition, and her various orthopaedic surgeries on this blog, or by following @WalkingJill on Facebook.