Hip Surgery/Recovery/Hardware Removal

[DIYPatriot]

First things first:

I'm not a doctor. My professional background is in 1's and 0's and all things electronic. I'm a very healthy and athletic guy and score in the 290's and above on my PT tests (at the 17-21 yr old std). Prior to my injury, the only times I ever broke a bone were from sports and those were ribs and fingers and I either taped them up or kept on trucking as is.

I realize (and truly appreciate) that there are numerous contributors to this forum and while I'm not seeking medical help or advice (I did read the sticky prior to posting), I am seeking "been there, done that" advice if you have any time to offer it.

My situation
A few months ago, I was injured while rock climbing. Thankfully, I didn't suffer any compound fractures, however, I broke my hip and required surgery. Getting off the mtn was a bitch. Today, I'm in the phys therapy/recovery phase and was finally able to begin running last month. My ortho has given me a good prognosis and says that I'm a great candidate for removing all of the hardware.

I'm curious about the procedure to remove the hardware (contained in the report below). I'm also curious about what it might entail and what I should expect during recovery. For instance, how well does the bone heal from the removal of those things? What about the muscles around that area? Aside from the initial fracture and the first 24 hours post-op, the most painful part of the entire experience has been bouncing back from the incisions into the muscles around the site of the operation. Sitting for more than an hour hurt like hell.

In short, has anyone out here had any experience with the removal of their hardware (other than the type that Bradley/Chelsea Manning wants the taxpayers to remove )? If so, what was your recovery like? How did it impact your muscles/other tissue? What types of questions should I ask my surgeon next month when I see him? I want to make sure I'm going into this thing with as much info as possible.


The following is from my operative report:

Preoperative Diagnosis: Displaced right base of the femoral neck fracture.
Postoperative Diagnosis: Displaced right base of the femoral neck fracture.
Procedure: Open reduction and internal fixation, right proximal femur with intramedullary nail.

Indications
XXXX is a 35 yr old male who sustained a right hip injury on 01/09/2014. X-Rays revealed a displaced right base of the femoral neck fracture. The patient presents for surgical repair. The above surgery was recommended. Risks and benefits were explained. He expressed understanding and agreed to proceed.

Description of Procedure
Patient was brought in the operating room, placed under general anesthesia. He received 1 g of vancomycin antibiotic prophylaxis. He was carefully positioned on the fracture table with the right leg in longitudinal boot traction, the left leg in a well leg holder. X-ray image was obtained of the right hip; there was noted to be a displaced base of the femoral neck fracture. With longitudinal traction and internal rotation, a near anatomic reduction was achieved of the hip. A surgical timeout was performed and correct surgical site was confirmed. The right hip was then prepped with betadine solution and draped in the usual sterile manner.

A 2-inch incision was made just above the level of the greater trochanter. A guidepin was inserted under x-ray image at the tip of the greater trochanter and an entry portal was created and ensured to be well positioned on both AP and lateral projections. The guidewire was advanced, I then reamed over with the entry reamer. Once the entry hole was created, I inserted a short InterTAN nail 125-degree angle. It was seated slowly.

Next, a lateral incision was made and using the external jig, a guidewire was inserted through the lateral cortex across the nail and into the femoral neck and head. It was ensured to be well contained in both AP and lateral projections. Next, indirectly measured the length of the compression screw that was needed. It measured 90 mm. The drill was used to create a channel for the complimentary compressing screw. This was drilled to the appropriate length. The anti-rotation bar was placed. I then drilled over the guidewire for the lag screw, the appropriate length lag screw was then placed over the guidewire and then engaged with the complimentary compressing screw.

Excellent fixation was achieved. I ensured the screws were well contained in the femoral head. Next, using the external jig, a distal locking screw was placed through a lateral stab wound. The acceptable anatomic alignment of the fracture was ensured. All hardware was well contained. The external jig was removed. The wounds were irrigated with copious amounts of saline solution. The wounds were closed with a 2-0 Vicryl and 3-0 Monocryl. Steri-strips were applied. Xeroform and direct pressure dressing were applied. The patient was then released to recovery in awake and alert condition. There were no complications.

Estimated Blood Loss: 75 mL.

Thanks in advance for taking the time to read through this.

[Boomer-61]

Ask yourself if you are having any problems with the hip? If not and you've returned to your routine activities then why bother removing the hardware? You can always make things worse with more surgery.

[DIYPatriot]

Good point. Two months ago, I was having sleepless nights and unable to get more than three hours of sleep at a time without having to pace the floor. Not that it bothered me a whole lot, but it bothered my wife because she's a light sleeper. Aside from the sleep issues and the pain of sitting still on long flights and/or car rides, I am pretty good to go these days and expect to be cleared for all physical activities soon.

One of the thoughts I had was the long term effects of keeping the hardware. Will it cause more trouble later on in life if there's metal inside me? Or will I grow accustomed to it and roll on as if it was never there?

I didn't have x-ray images available at the time of my last post. I'm including them now. Thank you for your response.

[Mr. Freeze]

It shouldn't bother you, activity-wise.

I tell people unless:
1. It gets infected (deeply, not just superficial), or
2. The hardware breaks before your bone has a chance to heal, or
3. Your bone doesn't heal for some reason,
that there is a very good chance they will be taking their implants with them for the rest of their days.

Kids are different, but your growing days are well behind you.

From a long-term standpoint, I would be more concerned with developing arthritis substantial enough to warrant a hip replacement, or the life-long likelihood of fracturing below a short nail such as that one.

[DIYPatriot]

Originally Posted by Mr. Freeze

It shouldn't bother you, activity-wise.

From a long-term standpoint, I would be more concerned with developing arthritis substantial enough to warrant a hip replacement, or the life-long likelihood of fracturing below a short nail such as that one.

Thanks for the reply. What has been your experiences with people breaking it below the nail? Is that something that happens often or is it just one of those things that could happen if I decide to take another fall from the side of a mountain? I'm an active person and have never had a history of broken bones or stress fractures. The mental aspect of this has been an unexpected consequence, too. I thought I was invincible and that nothing could break me. So much for thinking

[Mr. Freeze]

It is not a common occurrence by any means, and is somewhat of an academic exercise. At your age with that fracture, it is still dealer's choice as they say, to use a short nail. The guys I trained under disliked them, so when I see one, it piques my interest. Some surgeons look at it like anything that can be treated with a short nail can be treated with a 4-5x cheaper sideplate. But mechanically, there is a slight mismatch between the strength of your femur and the strength of that nail, which would most likely manifest itself at the tip of the nail. However, I would not loose sleep thinking, "Is today the day?"

If anything, I would become more active, with the mantra, "Hey, at least I can't break my right hip again."

[DIYPatriot]

Originally Posted by Mr. Freeze

If anything, I would become more active, with the mantra, "Hey, at least I can't break my right hip again."

I knew I should've gone with the 2-for-1 option!