Question
Hi Sharon,
I just read your response to Susan who was inquiring about being unable to walk more than a couple blocks 10 weeks post op.  I will be having a THR in a few months and am wondering what sorts of everyday things I will be unable to do EVER after THR.  For example, I remarked to a coworker who's had a THR that I'm looking forward to being able to cut and paint my own toenails again, and she said I will not be able to do that EVER because of the >90 degree bending involved.  I was horrified to hear this.  I knew there would be limitations during the recovery period, but I'd thought after a few months, I would be "like new".  What other sorts of things will I be unable to do?  I'm not interested in athletics, just everyday activities: planting flowers, scrubbing floors, tying shoes? I'm only 47 - this has me quite alarmed.  Also, I'm concerned that my surgeon seems to be one who believes in under-medicating for pain.  Thus far, he's been unwilling to prescribe anything other than NSAIDS for pain (they barely take the edge off). I understand the concerns physicians have about narcotic dependence, but why should I have to suffer while I am awaiting my surgery? Sleeping, working and caring for my home and family are so difficult. I'm even more concerned that he might be similarly conservative with post-op pain meds.  Granted, I'm a lay person, but it seems reasonable to me to prescribe a small amount of narcotics for a limited duration and then wean off of them after sufficient recovery. I know that pain is a normal expectation in this process, but I don't believe in unnecessary suffering. Thanks for any info you can offer.

Answer
Hi NJ

As far as restrictions are concerned, yes, there will be things you should not do again.  I would avoid contact sports, pounding aerobic exercises and any activity that might cause you injury if you fall. But you will be out of pain and you will be able to lead an essentially normal life again.

As far as gardening, you can bend to pot plants, but you cannot bend at the waist to touch the ground.  When you bend, you will have to bring your full body down with you. You will have to get something to sit on or kneel on.  If you do any bending from the waist to the ground that goes over 90 degrees, it's my opinion you are risk for dislocation but again, each case is individual.

You will certainly be able to tie your shoes, put on socks, and give yourself a pedicure and shave your legs.  If you bend, you will have to bend with your knee of the THR pointed outward.  Your Physical Therapist will show you how to bend safely.  If you sit on your bed and bring you leg up on the bed with your knee facing outwards, you should have no problems at all.  

To tie shoes, you sit on the bed or chair and cross your leg into the "4" position, with your ankle of the THR leg resting on the thigh of your good leg and your knee pointed outwards. As long as the knee is always pointed outwards you are in a safe position.

As far as your doctor prescribing NSAIDS, I can't answer for all physicians but there is a terrible problem today with people abusing narcotic pain pills.  These reckless actions put people like you, who really need the narcotic pills at a disadvantage because doctors are afraid to prescribe them for fear of losing their licenses.  It's not fair and I feel badly for you.  

NSAIDS can also be dangerous and can cause internal bleeding in the stomach and if you have any kidney or ulcers in the stomach NSAIDS can be very dangerous to take.  

I don't understand why your doctor, knowing that you are in pain, and waiting for a THR in a few months will not prescribe at least tylenol 3 (tylenol with codeine) for you.  It's not as addictive as something like vicodin or hydrocodone, and it can help.  If you are experiencing side effects such as stomach pains from the NSAIDS, you need to be frank with your doctor and tell him that these drugs are not working for you and you need something stronger until your surgery.

It's a shame that doctors can make people in your situation feel guilt in asking for pain relief.  You can also look up reports to show your doctor that people who are in real pain, such as yourself, and are put on narcotic pain relievers for a short time are less likely to be become addicted than anyone else.  

I had a kidney transplant so I cannot take NSAIDS because they are metabolized through the kidney and can damage my transplanted kidney. I have been put in the position of begging for pain relief from doctors who were afraid to prescribe a narcotic based drug for me even after knowing that NSAIDS can be deadly to me.  It's a sad case.

Back to your case....after your hip surgery, you should have a morphine pump, for a few days.  Most of the pain you will feel will be due to muscles, not the terrible bone pain you are feeling now.  It will be painful, but not the same pain you are in now.  AND more importantly, it will go away.  It's hard to imagine, but I promise you that your pain will lessen.

As I said, you will probably get a morphine or demerol pump for two or three days to be followed shortly with hydrocodone for a few days and then you may be released with vicodin.  Most THR patients are given narcotic based drugs shortly after their hip surgeries.  But you need to discuss this with your doctor prior to surgery so that you both understand your treatment plan and you don't get any surprises after surgery.  You may even want to discuss looking into a referral for a pain management doctor too.  But please be aware if you are on NSAIDS and have any stomach pain, that is a symptom of internal bleeding which NSAIDS can cause.

Also, after your surgery, depending on how fast you heal, you need to understand that you WILL be restricted until your hip mends.  It can take up to six months to heal completely and you can't rush this.  You'll go from a walker, to crutches then to a cane and finally to be able to walk unaided.  

The one thing you MUST do is make sure you follow all post surgical instructions and don't make any sudden movements, don't twist your lower body in another direction from your upper body.  Always keep your shoulders in line with your hips.  Your restrictions will be lifted slowly, and you must give it time.  You will lose your independence for a short time and you need to understand that you will get your life back to normal, it just may take about three months to do that.

I hope I have helped, and if you have any further questions, don't hesitate to email me.

Sharon