Cracked Femur and micro-motion in the stem
Posted , 7 users are following.
HI everybody: It's been 6 1/2 months since my anterior, non-cemented THR and I have been in severe pain the entire time.
My surgeon said he was confused and had never seen my symptoms before. The worst of the symptoms were an inability to go from walking to standing, thigh pain near the lower tip of the device, and an upside down U shape of pain around the top of the device.
I was referred to a another surgeon for a second opinion. The new doctor is very experienced and respected. He said that my femur was broken during the operation, plusI likely have micro-motion due to a loose stem.
He was very positive about my eventual recovery. He said that the cracked femur appears to be healing and he expects that the pain from the micro-motion of the stem will go away as the bone grows around it over the next 6 months. While I was happy to finally have an explanation for the pain and the inability to go from sitting to standing, I'm skeptical that this will heal. My pain is getting worse, not better.
My 3 questions are these:
1) Is it realistic to believe that the femur can heal while the device is loose in my leg?
2) Does micro-motion of a loose stem ever go away as the bone heals?
3) Is it likely that a revision surgery will be needed to fix this?
Thanks so much for your answers. I read these discussions and posts nearly every day.
0 likes, 14 replies
linda81469 randy67379
Posted
Hello Randy! Wow so sorry to hear what you are going through. Honestly, to me a loose stem is not a good thing! Are you walking on it? If it needs to heal you probably should be non weight bearing so the bone can grow into your new hip. It takes at least 6 weeks. My experience is.... I had a total right hip replacement July 18 within three weeks I dislocated it how and when I don't know I think I was walking on it and doing exercises for at least one week if not longer so by the time I went in to see the doctor for a follow up was when we discovered it was dislocated he was going to try and do a closed reduction, meaning pop it back in, but he couldn't so he had to cut me open again this time I believe it was posterior, my first surgery was anterior, and discovered that the ball of the hip was caught up on the cup kind of on the back of the cup, the stem was loose everything about my hip was completely no good he had to do a total hip revision now he put two bands around my femur because he had noticed some very small fractures in the femur so in order to make sure that the new stem of the hip was going to take he put these two, I don't know exactly what they are, bands around the femur said I wouldn't feel them! I had to be six weeks nonweightbearing no hip flexion past 80° and no type of exercises on that hip. Was a very hard thing to go through as I am very active but I had no choice because I'm not sure with the first time around I dislocated it because I was not being very cautious on things that I really didn't know I shouldn't of been doing. 😞The six weeks was mainly so that the bone could get a chance to grow into the new hip I am now eight months I don't have any more bone on bone pain but now I'm dealing with this nerve pain on my thigh sometimes it feels like I've traded one pain for another, but getting back to you I'm thinking maybe that's what needs to be done for you, if to be maybe nonweightbearing so the bone can get a chance to grow around stem. A revision is no walk in the park!! And for me within 3 weeks!! What does your dr say about the loose stem? I just don't think you should be walking on it as you may further damage it as I damaged mine. 😩 Wishing you all the best and for a speedy recovery. Let us know how you are doing!! Hugs 🤗LD
randy67379 linda81469
Posted
Hi LInda: Thanks for your great response. It took 5 1/2 months to diagnose the cracked femur. During that time, the surgeon had me doing all types of physical therapy that was very painful. Now, I understand why it hurt so much. About the worst thing you can do is leg exercises with a broken bone in your leg.
At each follow-up appointment, I said my leg felt fractured and the stem felt loose, and the first surgeon assured me that x-rays don't lie and I didn't have either problem.
The surgeon who gave me the second opinion said the leg was definitely fractured and the stem is probably loose. He said that the fracture is healing and the stem would probably tighten now that the bone is healing and growing. I hope he's right, but I've never heard of a loose stem becoming tight again.
My walking has improved, and I no longer use a walker or a cane, but the pain is far worse than before the surgery. Instead of having pain sometimes when I walk, it's now painful 24/7 of every day and night.
There's nothing on the internet that addresses whether a loose stem can tighten up was the bone grows around it, so it's not clear to me if that is likely to happen.
There's no choice but to give it more time, but I'm finding it hard to believe that it's improving, when the pain is getting worse.
Thanks, again for your advice and help.
Rocketman_SG6UK randy67379
Posted
They never ever warn you about surgical errors before the operation do they. I am not medically trained, but here's my view .
1. Can the femur heal when the stem is loose - I doubtit, unless you are motionless - the motion of walking must surely stop it from healing.
2. Will the motion go away - I guess only if the bone heals and then starts to grow into the coating on the stem to stop it moving.
3. Revision surgery must be highly likely - I have seen where surgeons use wire to hold together split femurs. This is a MUCH more complex operation than the original THR.
My background - engineering, not medicine. My THR was fine until someone noticed that my ceramic acetabular socket was not sitting correctly in the titanium shell. Underwent revision 10 weeks later to try to correct it. It failed. The ceramic is jammed at a crooked angle. Basically it could fracture at any time - hopefully not when I am abroad. I am now with a different surgeon at RNOH Stanmore (UK), who are the experts in difficult cases in the UK.
Best of luck
Graham
vicki_04437 Rocketman_SG6UK
Posted
I noticed that your now under RNOH Stanmore, did your previous surgeon refer you there or did you contact them yourself?
I have been reading how good they are there with difficult cases which my daughters is.
Thanks Vicki
Rocketman_SG6UK vicki_04437
Posted
I had to go to my GP after the failed revision - I just insisted on them as a friend who is a nurse told us that they are the country's top specialists. Having seen some of their patients walking around with various cages surrounding their legs/ankles etc, I can well believe they are the tops in the UK.
AnnieK randy67379
Posted
Randy, I am so sorry about your serious complications from THR. I think your questions should be directed to orthopedic surgeons for answers. I wonder why the second surgeon didn't address these issues? Perhaps you need another opinion, too. It's too bad that your original surgeon was so clueless that he didn't realize the femur was broken when he was putting in the stem, and that he wasn't able to diagnose the problems afterwards either. All the best to you in this journey.
I had a complication after THR with soft tissue injury, and my original surgeon had no idea what was going on. I had to find a second ortho, who did the surgical repair.
renee01952 randy67379
Posted
Wow indeed - I just re-read your previous post and it seems that it did not get any better since then -
I am not sure what to tell you ...
I agree with previous comments though - to walk and do exercises with broken femur and loose stem and thinking healing is taking place, does not feel logically to me - but I am a medical person either ...
is 3rd opinion possible ?
walking with walking aid might also not be conducive to healing ... eventhough you had the anterior approach, your femur was still cut, joint removed and protheses put in - your body might not come in to balance and need some support with walking ...
maybe a stupid question, but, in addition to the pain, do you also limp?
I hope you will be able to sort this out soon with the right person -
please let us know how you are getting on, okay and come back here anytime ..
big warm hug
renee
randy67379 renee01952
Posted
Thanks, Renee, for your helpful comments. It seems you help everyone on this site.
I've worked hard to stop limping, but still have a small limp most of the time.
The surgeon with the second opinion seems to be good and certainly has a strong background. Harvard, Yale & Duke Universities are among the best in the US. He's the head of the US Hip Replacement Society and he was reassuring. He said I should improve over the next 6 months now that the fracture is healing.
My concern is that he's very good friends with the surgeon who operated on me, so it's impossible to know if he's being truthful.
It just seems hard to imagine that a loose stem inside of a fractured femur can heal. He said It would be good for me to walk and ride a bicycle. He said my foot is angled when I walk and he has me doing exercises to strengthen the muscles around the device.
Other than that he said to wait 6 months ans I will probably be better. If not, he said he would take me as a patient.
There's a lot of pain and it doesn't make sense tome that
renee01952 randy67379
Posted
I don't know, Randy ... it doesn't make sense to me either ...
Apparently the 2nd surgeon already noticed that some healing is taking place and that is a good sign ..
When in doubt and in a lot of pain, maybe going for a 3rd opinion at a different medical group, is what I might do ..
I can only imagine that you are constantly aware of this loose stem and fracture and are not very confident walking or riding a bike - and also paying attention and correcting your angled foot ..
let us know how you are getting on, okay ...
angel blessings
vicki_04437 randy67379
Posted
Hi Randy, my daughter is having similar problems, her consultant thinks her reolacement has loosened due to her uncemented joint moving and her having poor bone quality.
She's recently had a hip aspiration just to rule out infection and she is having bone scans and MRI scans done next week.
Our consultant is very wary of revision surgery as he fears that will involve a lot of bone loss but he has said with movement like she has its the only option apart from trying to live with the pain and lack of mobility, my daughter is only 18 so that's a big ask!
Hope that you get some answers.
Best wishes
Vicki
randy67379 vicki_04437
Posted
Hi Vicki: I"m very sorry to hear about the problems your daughter is having. When using the un-cemented method, there's apparently a 3-15% chance of a broken femur, depending on age, bone loss and if you're female. Your daughter's age and probable lack of bone loss at this time in her life are both in her favor if she needs a revision.
The second surgeon I visited has great qualifications and, if he's being truthful, has given me reason for hope. He said that if there's micro-motion in the stem that the bone will sometimes heal around it and make it stable. Sometimes not, and a revision is necessary.
A revision is often more difficult than the initial surgery but not always. I have two friends, both in their seventies, whose device was "recalled" by the manufacturer. They both had revisions and recovered very quickly.
The second surgeon said that only about 80% of these surgeries are smooth and easy and that the other 20% can easily take up to a year to heal and sometimes longer. His advice was to wait until a year has passed.
The surgeons feel that if the device is implanted correctly, that they're not responsible for ongoing pain, soft tissue damage or other problems. Importantly, the surgeon is sometimes not qualified to discuss these types of issues.
I'm very pleased to have had a second opinion from a qualified surgeon who didn't perform the operation. He reassured me and gave me some hope that it would turn out OK. Also, he confirmed what I had been saying for months that my leg was broken. My actual surgeon kept telling me that wasn't possible.
I'll keep you in my thoughts and please reach out to me if there's any questions that you have. I'm not a doctor, but feel I'm becoming an expert on hip replacements.
Randy
vicki_04437 randy67379
Posted
randy67379
Posted
Hi to everyone on this thread. I have some good news and a question. It appears that my broken femur is healing because I'm now much steadier when walking and can go from sitting to standing much quicker... maybe 1 or 2 seconds instead of the 10 seconds it was taking me before, so I'm definitely improved over the past few weeks. Thank you for all of your great advice.
My question is about the incision pain. It doesn't appear to be infected, After 8 months it is still red, with a small blue spot or two and it is extremely painful to the touch, especially the small blue spots. It's painful to touch it with my hand or even to have light clothing touch it. Intense, searing pain. Is this normal? Is it nerve pain? Will it likely improve? Is there anything you would recommend to aid the healing.
Thanks so much. This blog has gotten me through some tough times.
AnnieK randy67379
Posted
Glad you are doing so much better with the steadier walking and sitting-to-standing, Randy. That intense pain on the incision at 8 months, though, doesn't sound normal to me at all. If it were me, I'd be talking with a physician about that, preferably your orthopedic surgeon.