Cannulated Screw hip repair

[Teddylegs]

Thanks so much Snibgo - will do!

[goatwarden]

I second Snibgo's advice. The physios in the hospital told me nothing and listened to nothing I told them; I was sent home with no support and no information. Luckily I had medical insurance, so it was easy to get my GP to refer me to a private physio. Had I not been to see her then I suspect I would still be struggling now to bend my leg at the knee (due to trauma caused by going through the muscle to fit screws) let alone walk. Typically a private physio costs around £40 per session and even a single session could help significantly; £40 is a tiny investment to enable walking.

You must be pretty tiny if they only used two screws (small bones don't allow sufficient "land" for the standard three screws to engage.) This may well be why the join moved, as three are normally used to give a clamping and anti-rotation effect. I doubt the movement is anything to worry about but do follow their advice about non-weightbearing until there are good signs of bone fusion.

[Teddylegs]

Goatwarden - thanks for that!
We did have physio sessions in hospital - but they were inconsistent, run by largely unqualified staff and aimed at total hip replacement patients who could actually weight-bear from the first couple of days. Having said that, I found that kicking, throwing and then bouncing a large gym ball (obviously whilst sitting) has been one of the most useful exercises that I brought home with me.
I suspect that my GP is waiting until I can weight bear – because he normally arranges NHS physio help quite promptly. I am doing exercises to keep my circulation going; have an excellent range of movement and can twitch all my leg muscles. However, I have had some numbness on the lower thigh (just above my knee) ever since the operation – and guess that this must be the nerve damage that I was warned about.
I am a girl and yes - relatively small. Looking at the X-Rays I could see that there would definitely be no room for the placing of a third screw!
Although they successfully reconnected the blood supply to my femur, 13 hours had elapsed since the break and (naturally enough) I remain concerned about the possibility of bone death.
Post-operatively, I was variously told that the procedure has a 30%; 40%; 50% failure rate - and then - that bone death was ‘in the lap of the Gods’. Take your pick!

[brickatius]

Here I am nearly 7 months post accident. After 12 weeks of non weight bearing I had further x-rays which were inconclusive and I could hardly bear to put any weight on the affected leg. More x-rays and a bone scan later it was decided that the fracture had not healed and that I needed a total hip replacement. To give the NHS due credit they got me in within 2 weeks. That was 2 months ago and I'm now equipped with a titanium and ceramic hip. Pain free at last and walking without crutches, I've got the go-ahead to get on a turbo trainer to try to build up the muscles that have wasted away through lack of use. It's going to take some time and effort but i will get there in the end. It has been a long and at times depressing haul but there is now a light at the end of the tunnel. Good luck to anyone else who finds themselves in the same predicament.

[goatwarden]

Brickatius, you have my sympathies although I am glad you have got to a sustainable state even if it is dependant upon some bits you didn't grow yourself. Knowing how depressing I have found it all, despite it all being fairly straightforward for me so far, I can only imagine how I would have felt in your position.

I had my six month check last Wednesday. I was beginning to worry whether I was experiencing the beginnings of avascular necrosis, as I had started to feel a dull ache a lot of the time. I wouldn’t call it pain in as much as if I had to put up with it forever it wouldn’t really be a problem but worry because I haven’t really had any significant pain even immediately after the accident. However at the clinic they x-rayed me and told me there was no signs of whitening around the cartilage, so no indication of AVN. Great news; I put the ache down to the fact that I have been doing my first prolonged job since the accident for the last three weeks and it involved lifting a lot of timber and constant bending and kneeling.

The doctor I saw this time was not a hip specialist but told me all about the potential difficulties and risk factors for AVN. I then showed him a print of my "before" x-ray (don't know why he hadn't already seen the real thing) and told him it was not only badly displaced, but out for 20 hours before fixation and he suggested I was an ideal candidate for AVN and was surprised they had managed to fix the bone so accurately.

Encouraged by the prognosis, I asked if I was safe to ride a real bike yet (at six week check the consultant had advised me that a turbo was OK but not to ride a real bike for a year!). The doctor was somewhat illusory but came down to admitting they didn’t like to tell patients it was OK, in case they broke and blamed the clinic (fair enough in today’s world) but that I could probably ride if I wanted to. He suggested the issue was that the screws can present a stress raiser in the bone, so a potential source of fatigue failure when subjected to repeated stress cycles; this did make me wonder why they suggest using a turbo is fine as that would still cause the stress cycles.

On the strength of this advice, today I rode the five miles round trip to the Post Office and enjoyed it greatly. Hopefully tomorrow we will get to take our first ride on the new tandem which has been sitting idle in the garage since collecting it in February.

[goatwarden]

I thought it was a good time to revisit this thread, as I am now nearly 14 months post accident and broadly doing really well.

Yesterday I had my screws removed and all the advice I was given was that I was immediately fully weight bearing. This is fine, my only impediment to walking is that the scar is sore (they reopened the original one). However I am very conscious that I must have three cylidrical voids of approx 6mm diameter trough a bone with a section of approx 22 mm diameter; this is plenty to bear the weight of normal movement but I assume impact isn't a good idea for a while.

Has anyone else had their srews removed? If so, any idea how long before the holes fill themselves in?

[snibgo]

For me, 16 months after -- no one has ever said they would remove the screws. I thought they were permanent.

Mind you, the hospital did recently write to tell me I had missed an appointment. Shame no one told me I had an appointment. Perhaps they want their screws back.

Did you get to keep yours?

[goatwarden]

No, I was most upset when they told me I couldn't have them back. It seems they are paranoid about infection. I told the consultant that there is a door in my old house secured with some beautiful stainless steel screws which previously spent a year in my mate's leg, but it didn't sway him. He did promise to show them to me, but I took that as the hollow promise it was since they were doing the removal under general anaesthetic!

I originally thought the screws were permanent, unless they became uncomfortable but had a fortuitous 9-month review with a different consultant, who was far more positive and interested than the usual people, who told me that at twelve months it should be plenty strong enough without the screws and it was my choice whether they came out. I suggested, with tongue in cheek, that without the screws I might, should I repeat the original accident, be fixed in the same way. I was quite surprised when he took this completely seriously and added that, should I have the same accident with the screws in place, I would probably bend the screws which would mean no other option than a full hip replacement. At that I became quite convinced I would like the screws out at the earliest opportunity!

[wkb21]

Yesterday I had my screws removed

Did they tell you why they were removing the screws? I had this operation a couple of years ago (entirely successful) and was told that the screws would be left in because they would be no trouble, would not affect joint strength, and that removing them would simply present a risk of infection for no good reason.

My repair restored the leg to its pre-accident condition within 9 months.

[goatwarden]

Yesterday I had my screws removed

Did they tell you why they were removing the screws? I had this operation a couple of years ago (entirely successful) and was told that the screws would be left in because they would be no trouble, would not affect joint strength, and that removing them would simply present a risk of infection for no good reason.

My repair restored the leg to its pre-accident condition within 9 months.

I originally thought the screws were permanent, unless they became uncomfortable but had a fortuitous 9-month review with a different consultant, who was far more positive and interested than the usual people, who told me that at twelve months it should be plenty strong enough without the screws and it was my choice whether they came out. I suggested, with tongue in cheek, that without the screws I might, should I repeat the original accident, be fixed in the same way. I was quite surprised when he took this completely seriously and added that, should I have the same accident with the screws in place, I would probably bend the screws which would mean no other option than a full hip replacement. At that I became quite convinced I would like the screws out at the earliest opportunity!

[Teddylegs]

No, I was most upset when they told me I couldn't have them back. It seems they are paranoid about infection. I told the consultant that there is a door in my old house secured with some beautiful stainless steel screws which previously spent a year in my mate's leg, but it didn't sway him. He did promise to show them to me, but I took that as the hollow promise it was since they were doing the removal under general anaesthetic!

I originally thought the screws were permanent, unless they became uncomfortable but had a fortuitous 9-month review with a different consultant, who was far more positive and interested than the usual people, who told me that at twelve months it should be plenty strong enough without the screws and it was my choice whether they came out. I suggested, with tongue in cheek, that without the screws I might, should I repeat the original accident, be fixed in the same way. I was quite surprised when he took this completely seriously and added that, should I have the same accident with the screws in place, I would probably bend the screws which would mean no other option than a full hip replacement. At that I became quite convinced I would like the screws out at the earliest opportunity!

Initially, I was led to believe that only had 2 cannulated screws ( like the majority - I actually had 3 ) but got no decent data until my second trauma follow -up appointment. A little way down the line, instead of remaining beautifully flush (like in the diagrams) my screws began backing out really badly and causing a lot of discomfort.
After a year, my surgeon supported the notion that I'd be better off without the screws- and like many patients - I wanted to keep them as a souvenir. I was very grateful for the healing that they promoted and felt quite 'attached' to them ( well - they were attached to me!) Although the screws caused a lot of irritation and restricted my walking ability; as a newly-diagnosed osteoporosis patient I was slightly wary of anyone messing with my fragile bones!
Anyway they came out yesterday - 54 weeks after my repair -and although I must be very careful whilst the area is healing (increased risk of fracture if I stumble) I have been assured that in 2 months the holes will be completely filled in.
I went in ( day-case) after midday and was home by 17:30 and - yes it stings a bit - but I'm sure you'll agree that it is nothing approaching the pain of the original trauma!
Since the initial accident, I have been going to regular hospital physiotherapy and had a 6-week course of hydrotherapy (blissful warm water) as well as swimming at the gym for an hour each day. I also use a Carl Lewis horse-riding simulator ( £50 on ebay and great fun for the entire family) to strengthen my inner-thigh muscles and improve my core.
I had a 'last hurrah' swim yesterday morning and will have to wait for a couple of weeks before I can get in the water again. I haven't been on my beloved bike since the day before the fall and I'm really hoping that I'll be 'back in the saddle' within the next month.
In terms of keeping the screws - they officially have to refuse you - since they are considered 'hazardous medical waste' - but somehow mine were handed to me in a plastic bag by a kind recovery nurse so I could (ahem) look at them. Needless to say a modest cheque for hospital funds is now heading their way.......

[goatwarden]

I am most envious that you have your screws back. I hope you will find a good use to put them to; I may have mentioned above that there may still be a door in my old house secured with a beautiful stainless steel woodscrew which previously spent a year or two in a friend's tibia.

When I went for my six week check-up, my screw holes were still pretty visible on the X-ray; he didn't really give any reliable period for them to fill-in completely. He told me I was OK to run again if I wanted but to avoid jumping off buildings for six months.

[sophiehip]

I am most envious that you have your screws back. I hope you will find a good use to put them to; I may have mentioned above that there may still be a door in my old house secured with a beautiful stainless steel woodscrew which previously spent a year or two in a friend's tibia.

When I went for my six week check-up, my screw holes were still pretty visible on the X-ray; he didn't really give any reliable period for them to fill-in completely. He told me I was OK to run again if I wanted but to avoid jumping off buildings for six months.

I'm unsure how I write a post? This was the only way I could see how to do it!

I was 25 when I broke my hip, I slipped on wet grass! Any way, I was told that I was going to keep my 3 cannulated screws in forever. This is now not the case, they have been rubbing (quite painfully) against my thigh muscle causing me all sorts of problems for the last 2 years. I have had every possible physiotherpy, ranging from hydro pool sessions - accupuncture (all of these have been unsuccessful therefore I am still struggling)

I saw my surgeon every few months in the beginning (he was very aware of my pain) but after about a year and 3 months he decided that he didn't want to see me again until 2 years from the day I broke it had past, as he felt my hip wasn't strong enough to have these screws taken out. I decided to be referred to another surgeon at a different hospital.

I saw him on Friday, I will be operated on in about 8 weeks to have the screws removed. I am very nervous and would really appreciate advice or tips on all things to do with such removal please.

I am very appreciative of this forum where I can find out and read other peoples experiences.

I hope you all get better soon!

[snibgo]

Hi, and welcome to the forum!

There should be a button bottom-left of the page labelled "POST REPLY". Click on that to reply to a thread.

My sympathies about your hip. I've still got my screws, 19 months after they went in, so I don't know what the removal entails. I suspect the extraction is no worse than the insertion.

Good luck with it, and all the best.

[goatwarden]

I'm unsure how I write a post? This was the only way I could see how to do it!

I was 25 when I broke my hip, I slipped on wet grass! Any way, I was told that I was going to keep my 3 cannulated screws in forever. This is now not the case, they have been rubbing (quite painfully) against my thigh muscle causing me all sorts of problems for the last 2 years. I have had every possible physiotherpy, ranging from hydro pool sessions - accupuncture (all of these have been unsuccessful therefore I am still struggling)

I saw my surgeon every few months in the beginning (he was very aware of my pain) but after about a year and 3 months he decided that he didn't want to see me again until 2 years from the day I broke it had past, as he felt my hip wasn't strong enough to have these screws taken out. I decided to be referred to another surgeon at a different hospital.

I saw him on Friday, I will be operated on in about 8 weeks to have the screws removed. I am very nervous and would really appreciate advice or tips on all things to do with such removal please.

I am very appreciative of this forum where I can find out and read other peoples experiences.

I hope you all get better soon!

They keep telling me how serious my injury was for a "young man" (46!), so, at 25, it's probably even more of a concern. However your youth is on your side in respect of the fact that you should heal quickly. It is unfortunate that all the NHS is really set up to do is try and ensure that you are mended to a state where you won't be a future burden; it doesn't have much spare capacity for niceties such as getting you back to where you started. However there are some people (must have superhuman inner strength to rise above the drudgery of normal hospital business) whoare really interested in helping. I have come to believe that no medical personnel can really be of much help to you, however dedicated and interested they are, and getting back to where you were before the injury is really best dealt with by you directly. It is important to ignore the bad news (lots of people frighten you with threats of impending avascular necrosis, but in fact there are very few reliable statistics available on its frequency or of specific risk factors influencing it's probability of occurrence. The only thing worth considering is that it is nowhere near as common as most consultants would seem to like you to believe and youth is a significant factor against it's likelihood.) and work out for yourself how to avoid things that hurt whilst working to strengthen the muscles which protect the joint. Also it does take a lot of hard work to strengthen the muscles; if you just get on with life your body is all too capable of avoiding using the tender bits, thus allowing them to atrophy, whist other parts get overloaded to compensate.

The worst part of having my screws out was, having been led to believe they would just make a couple of punctures, being told by the surgeon on the day that he would reopen the original scar. This meant that I was limping again for a couple of weeks due to discomfort from the recut muscle, lost muscle bulk in the meantime and am still having work hard to get back to where I was at the end of 2011; in fact I felt back to where I had been a year before.

However I am back to riding reasonable distances now and able to enjoy the beautiful conditions at the moment. When I went for my six week check-up, following screw removal, I saw "MR. Positive" (I have never seen the same doctor twice. They seem to be about 60% "you've had a very serious injury, it will probably never be fully healed and could still go horribly wrong yet" and 40% really positive and helpful; I find both attitudes pretty useful as the pessimists want to keep an eye on me for a long time, so good if their worst predictions come to pass, and the optimists give me some encouragement and hope.) who was very happy and content to fully discharge me on the spot. I still intend to go to my regular six-month appointment (arranged prior to screw removal) in May. No doubt I will see another pessimist then, who will tell me off for daring to get back on a bike only 18 months after such a serious injury and tell me to come back every six months for the rest of my life.