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admin | Runners Hip Pain | 28.05.2014
A 74 year-old woman with a past medical history of coronary artery disease, aortic stenosis with mechanical valve replacement, and diabetes, presents with right wrist and hip pain after a mechanical trip and fall at home.
Physical examination reveals an afebrile, tachycardic, alert and oriented woman in marked discomfort secondary to pain.
Retroperitoneal (RP) hematoma or hemorrhage is a rare but potentially life-threatening diagnosis. For spontaneous hematomas, it is important to keep a high index of suspicion in patients with coagulopathies. Hip precautions are ways of moving around that help prevent hip dislocation or separation of the new joint until the joint has time to heal. The exam is notable for right lower quadrant tenderness, right wrist deformity and swelling, and decreased sensation to the right inner thigh.
In trauma, one must be cognizant of the clues in the trauma work-up and associated injuries of the retroperitoneal organs. While you’re in the hospital, your health care team will remind you often about following these precautions. One can think of RP hematomas in three categories: spontaneous, traumatic, and post-procedural. There are case reports of RP hematoma after various procedures (ERCP, vaginal mesh), though classically it is a complication of endovascular and percutaneous procedures. Hip dislocation can be very serious so it’s important to follow your hip precautions until your doctor says it’s OK not to.
She denies headache, lightheadedness, chest pain, shortness of breath, palpitations, nausea, or vomiting.
The common time for following hip precautions is about 6 weeks, but varies based on how quickly you heal.Your New Hip JointProsthetic hip jointThe hip joint is a ball-and-socket joint. The artificial ball and socket used in a hip joint replacement is smaller than the natural joint it replaced.
This means the ball can slip out of the socket when the hip joint is turned at a certain angle and pressure is applied before the joint has had time to heal. When performing hip surgery, the surgeon opens the soft tissues of the joint capsule and separates the thick muscles of the buttocks and upper thigh to get to the joint being replaced. After hip replacement these muscles and stretched tissues need enough time to heal around the new joint and strengthen to hold the joint in place.Once the hip joint heals, the new joint will be held in place by muscles and scar tissue.
The complete healing process can take up to six months or more depending on your health before your hip surgery. Following hip precautions can help make sure your hip replacement heals without complications from joint dislocation. Following hip precautions will limit the movement of your new hip joint until it is fully healed and can help prevent dislocation. Why Follow Hip Precautions?Xray of dislocated hip prosthesisHip precautions are needed to prevent dislocation of your new hip while it heals. Once these tissues have been cut or stretched during surgery, there is an increased risk that the ball can be forced out of the socket before these tissues have a chance to heal. Hip precautions are used to keep your hip joint in safe positions that will prevent dislocation by keeping the ball from pressing against the healing tissues.
Depending on your situation, your surgeon may have you follow these precautions for 6 to 12 weeks after surgery while the tissues get stronger.The approach your surgeon used to open the joint capsule will decide which precautions you need to follow. But most of the time we can only read half of it and what we can read, we can’t understand. Surgeons speak in the language they know and they don’t have a lot of time to edit and prepare handouts in the best way for you to understand.
This is a really useful and inexpensive series of videos on hip replacementHow Your Hip Can DislocateLet’s look at a couple of examples on how your hip can dislocate. You’ll have to use your imagination a little—but imagining it will help you understand what happens in the joint and what you can do to prevent dislocation.How hip, leg, and foot work togetherThis image shows the relationship of your hip joint — where your leg joins your pelvis — to the rest of your leg.
When you turn your foot too far inward, the ball can pop out of the socket — which means your hip dislocates.
Keeping your toes pointed straight ahead is the safest position for your hip until your new hip heals, usually 6 weeks. Bringing your thigh up toward your chest (the direction of the green arrow) rotates the femur and the ball in the direction of the gray arrow. If the ball is rotated far enough, it will pop out of the socket.Bending over does the same thing but instead of moving the ball it moves the socket. Bending your chest and pelvis toward your knee rotates the socket, and if the socket is rotated far enough, the ball pops out.
The direction of your toes can generally tell you the position of your hip.The movements and positions listed below should be followed since not following them can cause joint dislocation.
Lift your foot on the affected leg and turn your whole body in the direction of your affected leg. The most common mistake patients make is twisting their body while keeping one leg still.When turning, take small steps in the direction you want to turn mainly using your “good” leg.

If you lie on your unaffected side, keep a pillow between your legs to keep them from crossing. The problem with lying on your stomach is that it causes your feet to turn too far out or too far in.
When your feet turn too far out or in, the ball of your hip joint is at risk for popping out of the joint socket. After the ligaments and muscles in your hip have had a chance to heal for several months, ask your surgeon if it is OK for you to sleep on your stomach.Do not bend your hip more than 90 degrees. A special bench can be used to straddle the side of the tub that you can sit on while you bathe.
Adjust the bench so your hips are higher than your knees when sitting.Use reaching aids to bathe. You should not bend over or forward to bathe.Use an adjustable shower stool to prevent falls. Be sure to adjust the height so your hips are higher than your knees when sitting.Have someone help put your socks and shoes on.
Bending over to do it yourself puts your hip joint in a position that could easily cause it to dislocate.Use a reaching aid to help with dressing.
Anything you lift adds weight that your new hip replacement must support.Don’t drive for at least six to eight weeks following hip surgery. When riding as a passenger, you may need to add a pillow in the seat to get your hips higher than your knees. This helps you to slide out of the car easily without having to lean or rock forward.Do limit stair climbing.
Therefore, it is important to prevent falls not only while your hip is healing, but afterward as well.
People usually know right away when a hip dislocation happens because you will feel severe pain in your groin and be unable to move your new hip fully.
If this happens to you, call 911.However, in rare cases the new joint can become just slightly dislocated presenting no symptoms.
If you think your hip has dislocated it is important that you seek medical attention as soon as possible.
Do not try to stand up or walk with a dislocated hip—standing with a dislocated hip puts weight on the joint and could lead to more damage. If you surgeon tells you to go to the hospital, call an ambulance to take you.Do not try to stand up or walk with a dislocated hip.
Have someone call your surgeon.Repairing the hip joint quickly can prevent another surgery.
If treated promptly there are several methods used to put the ball back into socket that don’t require surgery.The hip joint can be put back together by your surgeon.
Light anesthesia and pain medication is used.A brace may be needed to prevent another dislocation. This is common practice when the dislocation happened without an obvious reason.In extreme cases the surgeon will have to operate again.
The purpose for the raised toilet seat is to keep your hips higher than your knees when sitting (in this case, on the toilet) which is one of your hip precautions. You should use the raised toilet seat for as long as your doctor has you following hip precautions that is usually for 6 weeks.Q. One of your hip precautions is not to turn your toes inward to prevent dislocation of your hip. Put a pillow between your knees when rolling or turning over onto your stomach or from your stomach to your back.Q. Yes, you can lie or sleep on the operative side but not for the first 6 weeks as there may be some discomfort in the scar area.
If you are a side sleeper and sleeping on the non-operative side, you should sleep with a pillow between your knees for the first 6 weeks. Dislocation occurs with bending at the operated hip of more than 90 degrees, turning your toes inward (of the affected leg), or your knee going past your belly button (of the affected leg).
You will start with a walker and then use a cane based on how quickly you progress with healing.Q. Following hip precautions is the best way to make sure a dislocation doesn’t happen and possibly go unnoticed. She had a hip replacement in 2000, and in the last 5 weeks, it has become dislocated 3 times, always in bed at night, probably she turns on her side without realizing.
You should have no problems getting back on the motorcycle, but I strongly recommend you have a physical therapist or MD assess how you sit on the bike; that is not too flexed forward (a more upright seated position is preferred). Also to make sure you swing your leg over the seat correctly, which is the same as getting on a horse. I was having troubles in my marriage and i was almost giving up because my partner wouldn’t find anything good in me anymore and it looked like we were not meant to be because he hardly talk to me or even touches me .
Now it has been more than 8 weeks and I have started giving full weight lately at first I gave 30% then 50 n now total.

I want to know if and by when could I resume riding and working and also walking normally without any walker, cane etc. Please help.Thank you once again for all the shared information it has been really very helpful. This plan come to find out will only address part of the necessary components of post op hip rehab. I see that the weakness in my leg was not solely related to the swelling, and that I not only need (professional) gait training but muscle strengthening excersise to have an optimal outcome. Continue to have constipation problems now that I am home.When I first awoke in the recovery room, it felt like my stomach muscles had been ripped apart. I’ve dislocated twice myself and decided that in order to free myself of this fear, I want a revised hip. I’m wearing a brace now too, and am afraid to take it off so empathathize with your dilemma. I plan to practice meditation to help me deal with the anxiety and do all the muscle strengthening exercises my healthcare providers have recommended. Amanda Sanborn says: November 15, 2012 at 2:14 amHi, my name is Amanda and I had my hip replacement done 5 months and I was wondering if I should be worried about getting sick and it affecting my hip?
I am able to bend down with no pain, walk up and down the stairs, I dance a little salsa from time to time to see how it feels and I feel fine. This view is from the back — that is, as if you were looking at a person standing in front of you and they are facing forward.
Imagine further that the femur (thigh bone) — the one with the ball on the end — extends down to the foot. In this view, their foot would be pointing straight ahead and the ball fits nicely into the socket and the hip joint is stable. One line represents your chest, and the other is your thigh — it doesn’t matter which one is which. To protect your hip, never let the angle between your chest and your thigh be less than 90 degrees. The retirement home she is due to return to are so willing to do anything to stop the hip coming out again, but they need guidelines.
The hip came out in 2012 last time through bending down too far, and once again in h ospital when she wasn’t wearing a brace. Any tips anyone can give about preventing dislocations in bed to spare our mother more anaesthetics and trauma would be gratefully received. Obviously at 95 she is no longer a spring chicken and nor is her hip, but we feel that a more imaginative approach could be made. She has some good days where she can walk a small distance with her immer frame and then some terrible days where she is almost bed-ridden. X-rays have been done and all looks ok, does anybody else have this and is this normal and how much longer until she is more or less pain free? Because of genetic complications that actually created my need for the replacement, I have a lot more metal than most.
Having said that, I was on crutches rather than the walker less than 48 hours after surgery.
I am getting around without the use of an aid when indoors, and I only use the cane as a precaution when climbing stairs or going out.
I am sore and have muscle fatigue and stiffness at night or early in the morning, but that is normal. I still follow hip precautions and modify activities, but I am happy to say that I am out and about and doing normal things.
We applied for a Blue Badge from Fife Council and were refused basically that they considered my wife could walk well enough and do the shopping (my wife uses a shopping trolley as an aid and I pick her up with the shopping at the checkout). Fife Council claim that they have a remit with EU rules and they have to be proactive when assessing a persons application for a blue badge. Since application my wife has got worse and finds walking very difficult and I frequently have to go back to the car and drive to where she is. I understand in America you can obtain a temporary form of blue badge whilst waiting for a hip replacement – why can’t we have this available in Scotland?
We do have a right of appeal but I feel it would be pointless due to the attitude of Fife Council. When the initial application was made on line we had a telephone call from the council and even at that stage the gentleman who phoned indicated he did not think the application would be successful since my wife can do the shopping.You quote that a doctor should be able to help gain a blue badge but Fife Council will not confer with a doctor or physio and use an OT for assessment.
EMG, NCV reports confirm same, appreciate if someone could advise for recovery on mentioned email id please.

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