Question
Hi Sharon, my dad had a hip replacement about 2 months ago and is in the process of doing exercises to build up the muscles in his thigh which wasted pretty badly due to him limping and not walking much prior to the operation.

Well the first question he asked me tonight was if the muscles in one thigh always grow back to the same size as the other thigh through exercise? I think I read you had both done where he has just had one so I won't be surprised if you don't know that. By the way why did you need them both at such a young age? My dad is nearly 50.

Also he gets a cliking noise coming from the artificial hip while he is doing exercises. Have you ever experienced this and is it anything to be concerned about?

Regards

Francis Costello

Answer
Hi Francis
First of all, good luck to your dad and I am thrilled that he has such a good attitude towards exercising.  I wish he could send me some of that energy.

The reason I had my first replacement was because at 14 I came down with a genetic kidney disease.  My father, who has since passed on, gave me a kidney as a living related donor, and I am proud to say that I am perhaps one of the longest surviving kidney recipients (31 years ago).  Because at the time I had my transplant I was a pediatric case, they had no protocol for anti rejection medications and figured the more medicine they gave me, the better my chances were for keeping the kidney.  Well, they shot me full of prednisone, and I got a disease called AVN from an overdose of prednisone.

Avascular Necrosis, my disease, which basically is a result of too much prednisone.   The blood supply to the hip bones is compromised and the bones basically collapse onto each other.  I was in a wheelchair briefly and on crutches for about two years, not fun for a 14 year old. So, if they did not give me bi lateral replacements, my pelvis would have collapsed and I would have been a cripple.

So, because I was so young, 16 years old, they knew the replacements would not last forever, and every 10 years or so, I have to go in for a revision.  Sadly, each revision takes more bone away and there is less bone to work with. So I have had a lot of bone grafting.  But, I am lucky, I went on to have two healthy sons, work a full time job I love and my husband is very supportive,  and although I can't do a lot of things, I can live a basically normal life.  That was due to very strong parents, and the way I think.  I figure, there are people worse off than me, it's not cancer, and it's not terminal, so I'll do fine.

Now as far as you dad.  My rule of thumb is that if something seems wrong, ask your doctor.  No question is stupid, and if something strikes him as not right, he needs to question his orthopedist.  Because he was not active, there is always a bit of muscle atrophy.  The muscles will get stronger and he should continue to exercise since because when they put the replacment in, the only thing that holds it together is muscle and the stronger the muscle is, the less likely the chance that he will dislocate if he fudges his precautions.  Swimming, stationery bicycling (my husband got me an adult tricycle) so I don't have to worry about falling, weight training with ankle weights (he should not walk with the weights on his ankle) leg lifts, any excercise his Physical Therapist gives him is good.

The clicking may be due to the muscle "slipping" over the prosthesis, it's not dangerous, it's just that the muscle or ligament, or whatever is is getting stronger.  When the put the replacement in, they have to cut through a large muscle to get to the actual hip, and that takes time to heal.  If it bothers him, tell him to ask the doctor, and that should put his mind at ease.  Unfortunately, in the beginning we are very scared of dislocation and every little thing that seems "not right" scares the heck out of us.  For good reason too.  I've dislocated too many times due to a hip getting old, and it's not fun.  The first three months he has to be very, very careful not to do anything to compromise that hip.  If he does, and if he dislocates, the chances of more dislocations gets higher and eventually the hip will have to be done again.  

So tell him not to go over his 90 degree angle, don't rotate the knee inwards, don't bend your body over your lap, and don't do anything stupid.  Don't go out in snow or ice, no contact sports.  And no exercise that puts stress on that hip.  It's a pain in the neck if he was active but he has to listen to his doctor.  I'm not that much younger than him, I'm 46 and fortunately, or unfortunately I've grown up not doing a lot of things, and it's not hurt me in the least.  At least he's not in pain, and he can walk.

Tell him to thank G-d for the little things.

best of luck to you and you family.

Sharon Davis