KB, Femoral Neck Fracture After BHR Revised To THR
“I had a lightening bolt of pain from my hip to my knee. I could not walk another step. I knew I was in trouble”
I had my right hip resurfaced at the age of 51 in October of 2006, not long after the FDA had approved the procedure here in the U.S. I was eager to get some pain relief from my osteoarthritis and was thrilled to find out I was a candidate for resurfacing. I was a good patient and followed the post-op protocol, went to P.T. and faithfully did all my exercises. My range of motion was horrible before my surgery and was still not showing any improvement at 3 and 4 months out. During these first few months I had the usual groin pain and start up pain that I had been reading about on the Surface Hippy site. Unfortunately, I did not find this site until after my surgery. It was there that I realized how detailed the surgery was and how important it was to use an experienced surgeon, experienced in resurfacings, not just THR’s or in general orthopedics.
I persisted with my rehabilitation by walking and pool therapy, I continued to see my physical therapist. At that time, the only restrictions from my surgeon were no running or high impact activity. Four months out from surgery, my P.T. had started more aggressive therapy to “break up scar tissue” which he thought was preventing my ROM from improving. He would force my hip to go into external rotation and flexion which it could not do very easily. The day after one of these grueling sessions, 5 ½ months out from the surgery, I noticed I was having a very difficult time doing my straight leg raises while at home. Over the next few days my leg felt very heavy and achy. It became very difficult to lift my leg to walk up stairs, get in and out of my car or pull on a pair of pants. I started using my cane again because I was limping. I thought I had overdone the exercise routine; maybe my leg was just tired. Three days after that P.T. session, while at home one evening, as I was walking across the kitchen, I felt a lightening bolt of pain that went from my hip to my knee. Apparently, this is classic for a femoral neck fracture. I called out to my husband to get my crutches; I knew I could not walk another step. I was in trouble, I had a big problem.
The Fracture is Confirmed
The next day on March 28th I had an x-ray and it was confirmed that I had a femoral neck fracture. My fracture was slightly visible near the lateral lower edge of the femoral component (the cap). More of the fracture was probably under the metal cap which could not be seen and there was a tilt in the femoral component now. I was given a choice of revising to a total hip replacement or I could see if the fracture would heal because it was minimally displaced. I did not want a THR at the age of 51 (thinking of revisions later on) and decided to gamble on trying to see if the fracture would heal. I sought out other opinions about my situation; I sent my x-rays to three overseas surgeons and met with two other local surgeons. None of them thought this could heal. I was determined to keep my BHR and thought maybe I would be an exception. I had no idea how hard this would be.
Waiting To See If the Fracture Would Heal
I started out non-weight bearing for 5 1/2 weeks, I had no pain during this time but it was exhausting going about my everyday life this way. I gradually started to add some weight to that leg and the idea was to go from two crutches to one, start using the cane and then eventually be unaided. Over the next four months I had on and off pain, mostly on. Five months out from the fracture, I had started to take walks unaided and was starting to feel like maybe it was actually healing. I had been going in for x-rays every few months and more often when I was experiencing more intense pain. Each time, I was told the x-rays showed that no more movement in the femoral component had occurred. All along, I had been getting my x-rays on disk and also the clinical reports so I could keep them in a file at home. At one point I had asked about the possibility of AVN and I was told that the fracture could cause AVN to develop, this was a risk. My surgeon attributed my on and off pain to my muscles and ligaments.
In October of 2007, I saw my surgeon, had an x-ray and he said he thought the fracture had healed. I had been keeping a journal and I had gone 55 days without pain. He said to come back in one year unless problems occurred; I was rather surprised at this, I did not feel ready to be released. I only made it one month; pain returned deep inside my hip and I was very concerned. In November, now 7 ½ months since the fracture, I went in for yet another x-ray. The surgeon was not in and I would have to wait for him to call me with the results. His comments were, no change, still the same, stable. I started to wonder if I should give up at this point, just have the THR. Why weren’t the x-rays showing anything? Was the pain all in my head? The ups and downs of this whole process were getting to be too much.
My Hip Was Failing—the Surgeon Missed This
Over the next three months I managed to go on with my life, we went on a vacation and I started a Pilate’s reformer class. In February, after the 5th Pilate’s session I had pain on the side of my hip which was different to what I had previously experienced, but then again Pilates was new to me. I remembered that I had never actually seen my last x-ray taken in November because it had been discussed over the phone. I picked up the disk, printed out the x-ray at home and compared it to an x-ray of the day I fractured. There it was, plain as day, there had been change, my femoral component was tilting, my hip was failing. The surgeon had missed this! It was so obvious, how could this happen? It did not take a trained medical person to see the difference between the two x-rays. I confirmed the failure with 3 other overseas surgeons and a local surgeon, they all agreed that my hip was failing and I needed a revision to a THR, the sooner, the better. I had been walking around for 3 months with a failing hip, I had been doing activities that I shouldn’t have been doing. Angry and shocked, I decided to go in for another x-ray to see if my surgeon would now pick up on the failure, give him a second chance. Again, he was not available and would call me with the results. A few days later I got a call and once again he said there was no change, my hip looked stable. Sadly, he still did not see that my hip was failing. I told him of the four other opinions. I confronted him in person, we looked at the x-rays together and he eventually admitted that “maybe he had missed the change”.
In March of 2008, I had a revision to a THR using a different surgeon in my area. A large piece of avascular bone was found in the femoral head component when it was being removed. A previously undetected fracture on my greater trochanter was discovered in which a screw was placed for stabilization. My ROM is greatly improved, much better than after the resurfacing. My recovery is going very well.
Words of Wisdom
• Choose a very experienced surgeon. Ask them how many failures they have had, find out specifically what kind. Speak up and let them know your concerns. Ask for tests or scans if you feel they are needed; I did, but the surgeon did not feel it was necessary. I should have insisted.
• Follow your gut feelings (I eventually did)
• Try and use a P.T. with knowledge of resurfacings. Share the McMinn Center site with them. Ask them to do some homework on the surgery and the recovery process.
• “No Pain, No Gain” does not always apply.
• Keep a journal whether things are going well or not.
• Keep your own records of x-rays, clinic notes and OP reports. Look at your own x-rays!
• When in doubt (keep looking) get a second, third and fourth opinion!