Hip Resurfacing (Post-Op Recovery) FAQ
I have been on this board for at least as many years as I have had my BHR and every now and then a post pops up where someone is concerned that something might be wrong because they are having pain, cannot perform "like they used to", or are having some difficulty in their first year of recovery. Well, I offered my services to Debbie to have a "FAQ" post that she might refer people to in order to help understand and answer some questions that appear on this board. This post will mostly be a listing of my past responses to seemingly similar queries posted here over time.
Allow me to preface the body of the post with the obvious; after your resurfacing surgery, you are sporting new hardware. If you have not watched the entire procedure, Dr. Su has it all available from incision to suture, should you be so inclined to view it. I can save you the time and cringe, your leg is pretty much detached from your body, then reattached. Take a moment to consider this when I say recovery will take some time before you feel totally functional, not to mention you will have to put in some effort doing the proper exercises to make it happen.
One additional note: this FAQ is for reference only. I cannot emphasize enough that if you have any difficulty in your recovery that diminishes your quality of life beyond what is considered "normal recovery" after your scheduled post-op check-ups, do not hesitate to contact your surgeon's office. At the very least, request a prescription for physical therapy. Okay, let's begin:
I occasionally get pain or aching in my SI joint, particularly when I'm walking. I do exercises religiously including bridges. I have tried bridges by tightening my abs, tightening my glutes, or tightening both. It turns out that I get more relief when SI pain flares up by tightening just the abs and not the glutesfor bridges. I'm not sure whether this is a possible difference related to the female anatomy because some of the men in this group have emphasized the role of the glutes in reducing pain near the hips.
I don't flaunt my credentials, but I have been in the healthcare field for more than twenty-five years. I have a degree in sports medicine. I say this to preface my statement on your description, based on my many years of experience of injury assessment and evaluation, as well as physical therapy and rehabilitation with clients. When you take the tension off of the hip flexor muscles you will find relief from your pain. The "core" muscles, which are the hip flexors, bring your knee to your chest (flexion). The glutes extend your leg posteriorly. While these actions orient and originate from the hip joint proper, the "S.I." joint is subject to pelvic tilt forces, which are directly affected by the psoas muscle. Tightening your abs will transfer tension away from your psoas.
Back to your scenario of walking, which I regularly counsel my clients on; shoulders over hips, shorten your stride, and contract your glutes in the extension phase of your gait while walking. Chin and head back, proper posture, and improved gait are the first things to consider. If these adjustments fail to yield results, get a referral to a competent physical therapist for a proper assessment and evaluation so that a plan can be made to improve your posture, gait, etc.
I am about 3 months post left hip resurfacing by Dr. Gross using a Biomet device.
In addition to the arthritic pain I had in my left hip from being bone on bone, I have suffered from back pain for approximately 25 years. At this point, I strongly suspect that poor hip mechanics - specifically lack of hip extension and poor pelvic tilt - has lead to a tremendous amount of lower back pain. When measured by the PT, I get -1 degree to +1 degree of hip extension when I should be getting +15 to +20 degrees of hip extension. Essentially I seem to have used my lower back as a hinge/hips due to the hip dysfunction. The right hip may also need to be resurfaced.
Immediately post-surgery much of my pain went away. It was like a miracle and I was so grateful for the magical work of Dr Gross. Now I have gotten 3mo out, I have been having a tremendous amount of back pain and a good amount of random or sporadic hip pain in the surgical hip. The back pain is definitely exacerbated by the limitation in my surgically repaired left hip. Leaning forward to try to put on socks or shoes is a trigger as well as sitting.
I was diligent of doing Dr Gross’s 4 exercises (leg extension, heel slides , ankle pumps, glute/quad isometric contractions) and walking daily up until the 6 week mark. I started physical therapy after that point. Unrelated to the PT, I had pain and setbacks that led me to stop regularly performing any exercises or PT and become frustrated. I have not tried to push the hip very hard. I was hoping for a smoother recovery - especially after the first few weeks seemed to go so smoothly and pain free with exception of pain at the surgical site. I still get shooting pains in the left hip at times. It’s hard to predict and will happen seemingly when walking, shifting my weight into the hip, or sitting. When I wake up, I’m as stiff as a board and my back is agitated. There’s not a whole lot I can do without causing pain, so I have just tried to take it easy and not do much. Patience is wearing thin as the pain persists.
I’m a bit lost and feel directionless right now. I am the kind of person that I need specific instructions and an outline of exactly what to do. I need a good, clear rehab protocol that I can diligently follow like the exercises that Dr Gross initially prescribed. I’m told by my PT that now I’m well beyond those exercises and haven’t really gotten anything adequate to replace them and progress forward. Something that is outlined and prescribed besides just walking so I can build a routine. Does anyone have a protocol that they recommend that they can describe or link to?
While I never try to generalize conditions and always like to have as much information when working with clients, more often than not it is the psoas (hip flexor) muscle that is the major contributor in hip/low back disfunction/issues. Strengthening the glutes and lengthening the psoas muscles with a solid training & stretching program has yielded great results in my personal and professional experience. If your current PT is not well versed in what has been tagged as "dead butt syndrome" (DBS), often referred to as gluteal amnesia, you might need to seek another PT who can better access/address your condition/issue. After all, expecting different results from the same methods is not logical or realistic.
You can do a Google search on DBS and while your symptoms might not align exactly, a competent PT should be able to better assess your condition/issue through specific tests and exercises. Like when most of us in this group began our search regarding our hip surgery, you need to invest in due diligence and be your own advocate through research and second (or third) opinions.
Here's a good article for starting, although you most likely have tried the exercises before:
I do not usually recommend undertaking a new routine without professional supervision, especially advanced exercises where form is crucial. However, I will post a few links for exercises that involve almost bodyweight or resistance bands, which limits the potential for injury. Again, ideally these are done under supervision:
This is a simple routine from Bret Contreras, the "Glute Guy".
Here's a simple glute workout you can do at home. No equipment required except a couch.
- Bulgarian split squat
- Single leg hip thrust
- Side lying hip raise
- Frog reverse hyper
- Frog pump
- Extra range side lying hip abduction
Do as many reps as possible with each exercise while keeping a consistent tempo on each rep. Match the number of reps you get on your weaker leg with your stronger leg. Rest 60 seconds between exercises. Perform 1-4 rounds.
#6 is pretty tough, as is #4. You can substitute this for #6 until you build up your strength:
Here is a better explanationof #5:https://www.youtube.com/watch?v=HyCiZVMMDW4
Use the core workout to build up a base (everyday) then mix this routine in once or twicea week.
Three years after my resurfacing, I continue to feel periodic twitching, a slight ‘looseness’ (small shifting in the hip joint) and mild sensitivity when I pivot from or fully extend the hip joint under load (while doing leg weights). The mind reels about loose screws, etc. Any guidance here hugely appreciated!
I would venture to guess the sensation is more muscular tightness than hardware looseness. I spent the weekend refinishing floor trim on my hands and knees. While not physically demanding, one of my hips tightened up and my right BHR was squeaking. It has happened before after a day of shoveling or too much stress on the hip. It will take a few days for it to loosen up and stop being tight & noisy, but one just has to remember that daily stretching might be needed to keep things moving properly. The squeaking is my warning, but I've always had tight hips. My hips "click", but that is the sound of tight muscles snapping over bony protuberances.
Anyway, getting back to you, do some diligent hip stretches after your workout, when you get up, or before you go to bed. The noise and sensation should subside in 7 or 10 days if you are conscientious with the hip stretches. The two links below are helpful:
I did a pyramid pose in yoga today. My head did not touch my leg, but my legs were straight and my head was close. It felt great.
But in coming out of the pose, I felt like I had clearly overdone it. I heard/felt a sound/sensation that was not good. This hip resurf is almost 18 years old and I have done this pose for 17 years. Did I do more today than usual? Did I feel/hear a muscular sound? Was my femur about to come out of the acetabulum? I sat for a bit, took 2 ibuprofen and am fine, except my hamstrings feel sore/overstretched.. I'll see how I am tomorrow, but at this moment I think I should see the doc and get some pictures, sooner rather than later. Although it's a bit of a trek, especially during Covid.
Clearly the hip is still in its socket. But I wonder if the device has shifted or loosened? Or if I just stretched it to the limits and and it made noise? Are there muscles, tendons, ligaments that make noise? Any thoughts?
Chances are a tight muscle just "blipped" over a bony protuberance. If there is no swelling/bruising, you are most likely fine. Give it a day or two and gauge how things are going before being too concerned. If there was no impact, like jumping down from a height and landing hard, your device is probably fine. If there was a catastrophic event, you'd be immobilized with a severe deficit in movement/pain and would need to seek immediate care.
This last response pre-dates our current board, so the question cannot be accessed. This also seems to be a good place to end this post, as it is rather long and covers a lot of general points, the most important being that I still do a set of SPECIFIC exercises EVERY DAY to address my hip/core. MAINTENANCE is key because your devices are now a part of you and ANY TIME you are experiencing issues related to the hip/ core, you need to GO BACK TO THE BASIC REHAB EXERCISES listed above.
I'm going to add my two cents to this thread from my perspective, working with patients who have soft tissue issues described here, as well as a bilat BHR recipient. While I'm not making any excuses for any surgeon's "lack of concern" with post-op issues, there seems to be a piece missing from the patient's view.
To look at hip surgery with a comparison to computers, the surgeons deal with hardware, not software. They build the hip with the hardware and tell you what you can do performance wise. They hand you a Rx for P.T. and as long as their X-rays and diagnostics show no hardware issues, their job is done. The rest, muscular and associated soft tissues, have issues that vary widely from individual to individual, often regardless of age or gender.
In all of my consultations with Dr. Su, he has taken time to answer any and all questions I have had, ending our time asking "are there any other questions?" each time. I expect he will do the same when I see him this coming Monday. I have been nothing short of impressed by him and his entire staff at every stage in this journey.
Now, at his point in my recovery my right hip has ZERO restrictions, like nothing ever happened. My left, however, has an obvious restriction and has had it since the procedure, (I actually noticed it in recovery when I first woke up post-op). I'm coming up on a year since that hip was done, and at six months post-op my right hip was 100% heading into surgery for the left.
Fact of the matter is that no two surgeries will proceed in the same way. I had almost no swelling post-op with the left and did not need any pain meds post-op once I left HSS. I was back to work in 10 days and walking without a cane or the like in two weeks, but the left hip tightness continued and still has to this day. I resumed running (pain free) on schedule and have become stronger over the course of my recovery in every way, but still this singular issue persists.
Again, I have not taken the time to specifically address this very specific issue because the percentage of time it is actually an issue is when I attempt full range of motion and/or specific tasks taxing that particular muscle movement to perform outside of daily tasks, (walking, climbing stairs, rising from a chair, etc.) So it is only now that I actually have the time to address it, but I was also waiting to get the word from Dr. Su that there were no irregularities with the hardware.
Understand that I also work with patients who come to me with these very issues on a daily basis and more often than not I can increase their progress through the work I do with them in the office as well as the exercise homework I prescribe, based on my assessment during the session. However, there are times when the issues either take multiple sessions or are just too daunting for the client to follow through to see the results actually happen. Other times their issues are beyond my pay grade and I refer them to their specialist or physical therapist to insure there a no other, underlying issues. There are also cases where the issue persists and never completely resolves, for whatever reason, but there is always room for improvement, which in itself is progress.
As someone who at 45 had always been physically active and pushed my physical limits on a regular basis, it was tough to have one hip surgery, let alone a second six months later, but considering that prior to my first surgery I could barely walk and prior to my second I was unable to run for more than a mile, the fact that I have run distances of more than six to eight miles regularly less than year post-op at a pace of sub-nine minute miles is nothing short of miraculous to me. This is not to say that I will settle for what I have accomplished so far, but I view it as an opportunity to continue to improve. I just need to keep working at it.
Sorry if this is either long-winded or too "life-coach inspiration" but after three years of declining health due to hip issues and a surgeon who told me I would never run again and told me resurfacing was worthless, I tend to choose to seek information that will help me progress to the point where I can not even think about where I was pre-op. I also know that with more miles comes more maintenance, so not a day goes by that I don't do all of my exercises, stretches, etc. to continue toward that goal.
Jason D Peringer ATC CSCS LMT