Fall from ladder will result in a LTHR I found this forum for the first time today - so glad that it, and you all, exist! The support is greatly needed. After weeks and months of scouring the internet for information related to my scenario, I discovered that the vast majority of hip fractures and replacements are related to people with degenerative joint conditions and hardly any relating to "high-energy trauma", as mine was. With that said I will post a rather lengthy and detailed account of my scenario in the event that someone else in my condition might some day happen upon it. Almost one year ago (Nov 19, 2010) I had a horrible 9' fall from a ladder. I landed very hard on my left side. I am 6' tall and 200 lbs. Suffered a severely displaced femoral neck fracture. Prior to emergency surgery OS informed me that he was optimistic that I would heal successfully, but that there was a 20+ % chance that AVN would set in. He set my femur with three 4" long screws. I was non-weight bearing for 4 months. Significant muscle atrophy in the entire leg. Upon gradual weight bearing I experienced significant pain in ALL muscle groups surrounding hip (groin, hip flexors, glut, IT). Majority of pain (even to this very day) was deep in the gluts. Had xrays taken every month. Bone looked good for first 5 months. In the 6th month the images showed one of the screws starting to penetrate the femur head and threatening damage to the cartilage. The OS schedule me for immediate surgery to have that screw removed. My wife and I questioned the original placement of that screw - suspecting that it was improperly placed and it was never noticed until a 3rd "frog leg" view was taken (because I was complaining of continued sharp pain). After surgery the OS released me until Sept (as bone was looking healthy). The Sept images showed the first signs of AVN - the femur head was collapsing - we knew then why that one screw started to penetrate. Had images taken again last month, and the AVN was even worse. The evidence of AVN, coupled with my continued pain, and a lack of confidence in the guidance provided by my OS prompted us to look for a joint specialist for further direction. My original OS informed me that "no surgeon would touch me for a while" because of my age. The 2nd opinion I received was from an OS who is very conservative and believes strongly in preserving the joint as much as possible. He suggested I have a "hemi-resurface" (metal cap on original joint). He said I needed to have this procedure soon as I was about to quickly lose the integrity of my joint. He said the procedure had an 80% chance of success. That advice did not sit well so I sought a 3rd opinion with Dr. Freedhand of the Coon Joint Institute. He informed me that my AVN was too advanced and that any type of resurfacing had a huge risk of failure and that I was in need of a THR. He has a great record, lots of experience, and uses computer assisted technology and minimally invasive surgery (only one night in the hospital). So, I have scheduled a LTHR, Direct Anterior, for December 4th with Dr. Freedhand (what a name for a hip surgeon!) It is a bittersweet decision for me to make. I have learned that many hip patients eagerly await their hip replacements as they have been in pain and discomfort for many years. I was a completely healthy 44 yr old contractor prior to my fall. The last thing I ever suspected to go through at my age was a hip replacement. So, it is with reluctance that I go forward. I am not fully confident that I will recover pain- free, as I suspect that a lot of my pain continues to be caused from major soft tissue damage (torn periformis) and not from AVN related pain. With that said, however, I fully understand that the AVN will eventually lead to greater pain, as attested to by many on this forum. The stories and comments by many on this forum will help me move forward with courage and confidence.