7 weeks post op total right hip replacement

Thank you for your response, it sounds like you’re doing really well after just 5weeks. I’ve only been to the Dr once since coming out of hospital and that was to have my dressing removed. I’ve seen the physio on two occasions and after him suggesting getting stronger pain relief I’ve improved. I’m trying not to take the tablets too often but maybe that’s where I’m going wrong🤷???I’m due to see him again on the 23rd of this month and my hospital follow up appointment is on the 1st of May. Hopefully things will get better by then🤞🏼

I think I will take your advice and start taking my tablets  every 4-6 hours again and see if that helps for at least another couple of weeks, I think maybe I was being abit to eager to come off of them. I suppose it is still quite early days at the mo. 🤞🏼For a speedy recovery to us both.

Pleased to hear you’re recovering so well, hopefully I will see a good improvement over the next few weeks.  I had the conventional total hip replacement surgery, apparently I have the uncemented new hip type, don’t know if either of these points make a difference to recovery or not. Haven’t really had anything explained to me, I will ask all the questions at my hospital follow up appointment. 

With conventional do mean posterior? If so I had anterior and the recovery is much faster so you don't want to compare the two.  For posterior you may still need to be on your narcotic pain meds at 7 weeks - definitely ask your doc.  I have huge respect for anyone recovery from posterior, I've struggled so much to cope with the anterior approach recovery I can't even imagine how I would've managed the posterior approach recovery!

Hi Horsequartet, I keep reading about how much better anterior is than posterior. My surgeon does about 150 hips a year and prefers the posterior approach as muscles are not destroyed. I was using a walker the first day and then crutches after that. I was able to shower immediately. When I got home I abandoned the crutches. I was able to use my shower, cook, make tea etc. I did have trouble getting into bed but had a sort of strap to help me. The day after I got home I went out to lunch with my sister in her car. I could not have asked for a more successful operation, with very little pain. 

Are you sure it's the posterior approach that doesn't destroy muscles? Anterior they just move the muscles aside, but posterior they actually have to cut through muscles, which is why at least in my area the surgeons try to do anterior as much as possible.  And why the posterior approach has so many precautions and longer recovery time and anterior doesn't.  Here is a video showing how the anterior works and you'll see they don't have to cut any of the muscles or tendons to do it  https://youtu.be/Bwi0i1EtbpI

Sorry I had the posterior approach, I’ve starting taking my meds more frequently today so hoping over the next couple of days the pain will ease up for me. Stupid me really trying to come off of them too quickly. I wasn’t sure to be honest what the difference is between the two different approaches 🙄

The anterior approach doesn't cut any muscles so the recovery can be faster because of that.  I still had all the pain from the surgery itself and the bone being cut and my muscles were very sore because they have to be pulled out of the way, but I don't have the extra pain of the muscles and tendons and ligaments needing to heal.  So be kind to yourself and give yourself plenty of time to recover! There are reasons though not to do the anterior approach including just how some folks anatomy is.  Sometimes posterior is the best way to go in certain situations.

Thank you for all the information, I didn’t get told about different approaches, I was just told I needed a total hip replacement and wasn’t told very much about the procedure at all, only that I would have a large scar and that it would take approximately 3 months to fully recover. All the information on here is so helpful and I now realise how many questions I should have asked beforehand. Thank you again for you’re advice and info.

Hi Horsequartet,

Current advocates claim the anterior approach is entirely muscle sparing, which is not exactly the case. Because of the higher risk of damage to a specific nerve in the thigh, the incision may be moved more to the side, forcing an incision through the muscle bellies of the tensor fascia latae and sartorius muscles, rather than in between. 

The piriformis muscle (1 of 4 muscles that allow for external rotation of the hip) is also cut to allow implantation of the new femoral implant. It cannot be reattached from the anterior approach.

In the posterior approach, the gluteus maximus muscle is split and does not require repair as the whole tendon is not removed.  The piriformis and superior gemeli muscles (2 of 4 external rotators of the hip) are detached and later reattached to bone and will heal over 4–6 weeks.

A lot of surgeons are now going back to the posterior approach as they are able to have more space for the surgery, this technique allows direct, full visualization of hip cup and femur which is not true for anterior, the problem of nerve damage is also greatly lessened, which is the main reason I opted for it. There is a higher risk of injury to lateral femoral cutaneous nerve which supplies sensation to the outer thigh. Also some risk to sciatic nerve from excessive retraction during surgery for the anterior approach. With the posterior approach there is no risk of injury to lateral femoral cutaneous nerve and a small risk to sciatic nerve from excessive retraction during surgery. Risk of injury is less than one percent.

With the anterior approach there is a higher risk of femur and ankle fracture due  to more difficult exposure and positioning. This risk increases in patients with osteoporosis. There is very little risk of fracture with the posterior approach. 

So saying if you opt for the anterior approach make absolutely sure you have a good surgeon well practised in the technique as it is much more technically challenging. If it works it is great. The chances of problems are higher and for the sake of s slightly larger scar, although not always, and being careful bending for a few weeks I was not prepared to take the extra risks.

Hi Horsequartet, I have described below that although we are led to believe that the muscles are not actually cut for anterior, it is not one hundred per cent true. On my surgeon’s website it says “He favours a posterior approach to the hip to preserve the muscles and maximise recovery.” 

The real precaution for posterior is to guard against dislocation, this occasionally happens for anterior but very unlikely and so care needs to be taken in bending for posterior. The chances of dislocation after two months is very small and so things are then the same. 

The real advantage of having a good recovery depends really on how fit you were beforehand, how old you are and your weight, I think your attitude to life also helps. The chances of something going wrong such as nerve damage is higher for anterior than posterior.