How do I cope with a THR?

[Pat64]

Hi Everyone,

I haven't posted here for a while but I read all the daily posts and I have learnt a lot about RA through them. I have had RA for 5 years and finally got to clinical remission about a year ago. After a recent MRI scan for a painful right hip, I was so shocked to find out that I have OA in this hip and that the cartilage is very badly worn. I now have difficulty with stairs and socks and can only walk short distances. I have been told I will need a total hip replacement and to be honest I am absolutely terrified of the surgery. I have other medical conditions, including osteoporosis. I'm also really worried about stopping my drugs (Arava and Sulfa) before and after the surgery, in case I flare and also that I might not get back to full mobility as I was very active before.

It would help me a lot to hear from anyone who has had a THR, with both good and not so good outcomes and how you have coped. Many thanks. Pat 64.

[ruth_p]

Hi Pat, I had my right hip replaced 12 years ago and my left a year later. Since the replacements I have been back to normal, I work full time and cycled and did yoga and went to the gym. Unfortunately my left hip has now worn and I am having revision surgery next week. The right one is still fine. I had to stop my biologic injection one before surgery and two after, I can continue my mtx throughout. I hope this helps. 🙂

[Downtime]

Hi Pat, I’m sorry to hear about the hip. I think these days a THR is a routine op and very successful. A friend of mine recently had one. She recovered very quickly and is now back playing tennis regularly. She doesn’t have RA though which is a complication because of stopping meds but I think that can be managed. I’m sure on this forum someone will have had one and let you know how this impacted on recovery. Best wishes x

[Pulfs in reply to Downtime]

Hi there I've had RA 24yrs and in last 10yrs have had 2 THR and 2 TKR on methotrexate which I didn't have to stop. Had to make sure my retuximab Infusion was a couple of months before op. My mobility is ok but as I have trouble with my feet I get some bad days.overall the op was a complete success and as long as you do the physio recovery is good.

Good luck when you have your op x

[thelmar]

Hi

I had a THR 3 1/2 weeks ago. Had to stop mxt 2 weeks before and after and biologic 4 weeks either side. Am getting around the house without crutches or any support. Do use a stick for short distances outside and I have a rollator for longer distances (had that anyway for other problems that I have). So many other pains have disappeared. I am surprising everyone with the progress I am making. I know the importance of doing the exercises and have surprised myself that I am doing them as instructed!

Rheumatology did say that if I flared I could phone up and go for a depo injection but (am touching wood here) I haven’t needed it. Am now back on mtx and have biologic infusion booked in for next week. Fortunately I am now able to take CBD again as I had to stop that as well.

Please feel free to PM me if you have any questions.

Thelma

[RebeccaMB]

Hello Pat, I too was terrified about THR but had my hip done in January and despite an initial week of hell now I'm back to normal life. In my case it hasn't fully resolved the range of hip movement because my hip damage had been there for so long so all the muscles/ligaments etc don't have the range of movement I would like yet. I documented the early days and weeks on my blog - if you Google the beesley buzz total hip replacement you should find it. Or the first post is here thebeesleybuzz.blogspot.com... it makes for grim reading initially but I stopped monitoring it so closely after about 6 or 7 weeks so I guess things were back to "normal" by then. Saga also have a good week by week diary which I found helpful to read. I was in pain at night beforehand when I came off meds but it is worth it in the long run. It's worth having people around to help you in the first week Or two after coming home from hospital and go easy on yourself. I found it frustrating feeling helpless but it is so important to look after yourself. Emotionally I found it tough in the early days and I felt like it was a mistake to have the surgery but now I know it was the right thing. And it has made me a stronger person emotionally and mentally having gone through it and come out the other side. Wishing you all the best with it. Xxx

[BoneyC]

Hi Pat,

It was in the news recently that there's a 91 year old male who had both hips replaced when he was 23 (just before start of NHS) and has never needed revisions. Amazing!

However, he doesn't have RA. I wonder if you already had some OA before dx with RA?

I had my first THR in Dec 2008 (age 34). My surgeon requested I stop MTX 2 weeks prior to surgery. The op went well until 2 months later when I felt very sick and was admitted back to hospital. A CT scan revealed infection in my thigh which necessitated numerous wash out and debridements - fasting, surgery, sickness. The bacteria was bacteroides capillosis found in human bowels - I can only assume my bowel was nicked during surgery, but of course they told me there was no way of knowing what caused it. Considering I was told there was a 1% infection risk (usually MRSA) I was not concerned and thought I would be ok.

After months of IV antibiotics, the THR had to be removed (Girdlestone's Procedure) and I was left with no hip, packed out with blocks, but with a shorter leg and couldn't walk. Oxycodone didn't help and it was absolute hell! I don't want to frighten anyone, but I was fit and well, never had infections before, stopped MTX as advised, wasn't overweight, a non smoker etc. 7 months later I had a second THR but they had to cut a tendon resulting in no external rotation on the right. 6 months later I had the opposite side hip replaced which went ok. Same surgeon for all. My hips are very stiff, I cannot bend to touch my toes, or put socks on, do up shoes etc. I have to use a long handled grabber and long handled shoehorn. I can no longer drive manual cars, but have an automatic.

At the end of the day, its your decision, I was in agony with hip pain and it was the only option. My surgeon has never discharged me, I see him every few years for check ups.

[Paula-C]

My brother in law had a second hip replacement two days ago, was back at home yesterday evening. I spoke to him on the phone last night and he said he's in no pain at all and walking about using crutches. He needed new ones due to OA, not RA. He recovered very quickly last time and hopefully he will do the same this time. He said last time he was a little anxious having ii done, but this time he wasn't because he knew what was what and there's no need to be worried about it.

He did say last time that once the epidural was in his pain went and never came back in that hip. Don't think he relied on painkillers post op.

Good luck with whatever you decide to do. xx

[flow4]

Hello Pat. I had a THR 4+ years ago, before I was diagnosed or on any meds. (I also have OA (though psoriatic arthritis not RA) and no one is sure whether the joint damage is straightforward OA or a secondary effect of untreated PsA). For me, it was a life-changing surgery - I had been living in awful, constant and worsening pain for years and had a 70-80% reduction in pain almost immediately. As a result of the dramatic drop in pain, I also had a significant improvement in my mood and mental health - which has continued to improve as I have been diagnosed and effectively treated with dmards and biologics. I have been able to start working full-time again... Unfortunately, I have other damage, to my hands and feet particularly, because I was untreated so long, so I can’t walk or cycle as others can after a THR, and still have some functional problems; but I swim and have done things like kayak, and my hip is problem-free Recovery was tough at times, and those 12 weeks felt long... But 220 (or so) weeks on, they were just a time bit of time, and certainly worth it!

Good luck!

[flow4]

There’s a really supportive Facebook group by the way, which you may like to join... Total Hip Replacement Forum.