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Where & How does AVN related pain hurt?

Discussion in 'Hip Replacement Pre-Op Area' started by HandyAndy, Nov 6, 2011.

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  1. HandyAndy

    HandyAndy Member

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    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.
     
  2. Jamie

    Jamie Administrator

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    Re: Fall from ladder will result in a LFHR

    Thanks for starting your own thread and for taking time to provide such detail about your experience. It's always sad to hear of problems like this related to an accident, but I think you have done an excellent job getting the proper help. You instinctively knew what you needed and kept searching until you found the right surgeon.

    I understand what you are saying about the possibility of pain after your hip replacement from some of the soft tissues surrounding the joint. But....you will have a funcitoning hip. And soft tissues can heal and return nto normal. It may take some patience and determination, but you'll get there!!!

    Stick with us....we'll be here to support you in whatever way you need. You may not have gotten to this point of needing your hip replaced like the majority of our members, but once you have the surgery, you'll have a bunch of folks here going through recovery just like you are.
     
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  3. Poppet

    Poppet Honourary Moderator

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    Re: Fall from ladder will result in a LFHR

    Welcome HandyAndy.

    I would like to echo Jamie's reassuring comments. This forum is full of wonderful people, information and support - you will receive all three.

    You have had a rough trot and deserve and will get a better quality of life.
     
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  4. HandyAndy

    HandyAndy Member

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    Re: Fall from ladder will result in a LFHR

    Dear Jamie & Smja - Thank you for the warm welcome and encouraging words! They are like drops of cold water on dry lips. These are scary times for me and the more I read on this forum the more relaxed I become.

    Btw - my OS will use an X3 Stryker implant, ceramic on plastic.

    I also noticed I used the wrong acronym ("LFHR") when I should have used "LTHR". I know everyone knows what I meant!
     
  5. Poppet

    Poppet Honourary Moderator

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    Re: Fall from ladder will result in a LFHR

    Hi there again - we will be twin souls HandyAndy. I am having exactly the same combination :)

    All good for both of us, soon our troubles will be over. Pop by my thread if you want to catch up on my story :)
     
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  6. Jaycey

    Jaycey Moderator

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    Re: Fall from ladder will result in a LFHR

    HandyAndy, welcome to BoneSmart. My goodness you have been through a lot! But sounds like you are now on the right track.

    You are right in pointing out AVN can advance very quickly. Best to get this done ASAP and move on with life. As Jamie says, once you have a new hip all the muscle and tissue will strengthen again. Mind you this can take some time so patience is needed. But in the end you will love your new hip!
     
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  7. Renate

    Renate Sr Bonesmartie

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    Re: Fall from ladder will result in a LFHR

    Welcome HandyAndy, glad you found this forum. You sure have been through a lot. A few years ago my husband fell from a ladder onto concrete. He shattered his elbow and shoulder and needed surgery. You are never too young for a hip replacement. With a good surgeon and patience you'll get a good functional joint back. And you'll probably need a bit of physio. It'll work out. Good luck.
     
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  8. Juliep

    Juliep Graduate

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    Re: Fall from ladder will result in a LFHR

    Welcome HandyAndy!! As everyone else has said, you are not too young for your THR and you will be glad when you have it done. I didn't have no dramatic fall like you did, but my diagnosis of AVN in both hips hit very rapidly. I am very glad that I did both hips in a quick time frame and I no longer have hip pain. Only discomfort is from the muscles/tissue still healing and I know it will just take time and time again. I do have knees to look forward to next.

    Hope you find all the information on here very helpful as it has for all of us when we have gone through our surgeries.
     
  9. HandyAndy

    HandyAndy Member

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    I joined this forum yesterday and posted my story titled "Fall From Ladder leads to LTHR", which detailed my severely displaced femoral neck fracture. From the onset of my injury everyone involved in my recovery has been keenly focused on my bone and it's healing. Overlooked has been the soft tissue, of which I know was badly damaged from the force and torque of my impact. In fact, I never complained from the pain associated with my broken bone - it has always been the muscle strains and burning sensations that have bothered me. The ride to the ER in the ambulance was dominated not by pain from the broken femur, but from a spasming lower back and upper glut muscle. It was intense muscle pain. Morphine did nothing to for it.

    Several OS, PTs, and everything I have read online have stated that AVN related hip pain is found in the groin areas. My groin has always felt "tight" since the accident, but it never burned or ached while walking. The only major pain I have experienced has found deep in my glut. My PT was dumbfounded because I was constantly complaining about deep glut pains and the not the typical groin pains that he deals with. After 4 months of PT I finally asked my PT to stop focusing on my groin and quad areas and to flip me over and focus on my piriformis. In addition, I started massage therapy about a month ago in which we focus specifically piriformis and glut pressure points. It has helped!

    I am doubting whether or not I truly need a THR at this time. Regardless, my femoral head does have AVN. The surgeon whom I am scheduled for a LTHR with, immediately upon viewing my xrays, said I am not a candidate for anything less than a THR. But I weigh his comments about what is visibly identifiable versus what is possible for me physically. Is it possible that the pain I have been experiencing all along is only related to the soft tissue damage, and even though AVN is evidenced on my xrays it is not a source of my discomfort? And if this is so, would it be prudent for me to give my natural joint a chance to exist with AVN, so long as serious pain does not ensue? Or am I fooling myself?

    I am not looking for a way to escape surgery, I just want to do what is right for my body. I know the success rate is great, but a THR is major surgery.
     
  10. Jaycey

    Jaycey Moderator

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    HandyAndy, it is natural to question your choice to move ahead to surgery. However I must remind you that the AVN pain will only get worse - not better. Typically things can get very bad very fast. And (unfortuately) the longer you put off surgery the longer you may need to recover.

    I put up with groin pain for years. In my case it was not correctly diagnosed. I too had deep massage and tons of PT. In the end my hip collapsed and I had no choice. I had to wait 6 months for surgery which did cause lots of muscle atrophy.

    In the end the surgery is your decision alone. But why wait until things are really unbearable? Life is just too short!
     
  11. Juliep

    Juliep Graduate

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    Andy, the AVN pain will only get worse and not better with each day. From what I have read by the numerous others on BoneSmart that have AVN, it has been pretty rapid with everyone. I went from just hurting in December of 2010 to both hips replaced this year.

    I had awful groin pain with my right hip and with the left, just like you, mine was way into the glutes and deep into the buttocks really. When I mentioned it to my OS he said that really wouldn't be because of your hip but when he did another xray of my left hip the femoral head was near collapsed.

    I just find that the AVN in the hips and knees is an awful pain. My knees have gone from not to bad too hurting all the time everyday and that has been in just a few months time.

    Don't wait and miss out on life !!
     
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  12. Josephine

    Josephine Forum Admin and Mother Hen Administrator

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    Re: Fall from ladder will result in a LTHR

    That's good, Andy. Now I can address some of the points you raised.
    He was doing exactly the right thing by trying the screws first. There is a significant problem with those intracapsular fractures because the blood supply to the femoral head is significantly compromised. The head gets its blood from three sources, two of which are disrupted by the fracture. The remaining one is the bone itself and, provided there is no evidence of ischaemic necrosis (a term for early AVN) on the admission xrays then internal fixation was certainly the way to go. It's really not good medicine to dive straight in with an arthroplasty, one really has to give the fracture a chance to heal. And he was right to suppose that, given your age, there was a really good chance of it succeeding.

    However, it's all in the reduction of the fracture at the first surgery and it's awfully difficult to get that spot on, specially if, as you say, you are a big feller! Hips are phenomenally difficult things to reduce.
    And this is what happens if the surgery wasn't successful - that the head begins to deteriorate and collapse, leaving the screws protruding. And needless to say, a protruding screw can plough up the lining of acetabulum very efficiently! It's really nobody's fault as such, just an unfortunate turn of events.
    Well, that's not entirely true, you know. There are any number of youngsters of 20 and up who've had hip replacements because of developmental issues. I don't expect they relish the thought either.

    But I know what you mean - one day you're clambering up ladders without a care in the world and suddenly you're the wrong end of a surgeon's scalpel! Not nice at all.

    But figure this: lots of youngsters your ages have hip replacements and do extremely well. You really must read that section in the forum Library Stories of amazing hip recoveries. People have gone back to all sorts of activities without too much problems.

    I know some surgeons are overly cautious and tend to make it sound like you're going to have to spend the rest of your life doing nothing (nothing that excites you, anyway) but that's not true. Certainly high impact stuff like jumping and trampolining are not advised as is bungee jumping! But there are heaps of other activities that are okay. You may just have to adjust your outlook a bit. And surely it's worth it to not have this awfully painful hip any more, don't you think? :wink1:
     
  13. Jamie

    Jamie Administrator

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    Go back and read Josephine's explanation of the diminished blood supply in your damaged hip in your other thread. To me, this is a key point for you to consider as you decide about your surgery. Your joint no longer gets an adequate blood supply. Given that, I don't think there is any "living with" the necrosis (dead bone). My feeling is that it will continue to die back. Although you might not have pain directly related to the necrosis now while it's relatively small, you will have if it enlarges and the bone begins to fall apart.

    If it was me, I would not want to get to that point. It can result in a lot of needless pain for you and could possibly make the surgery that must follow more difficult. I say, have the hip replaced and get on with your life.
     
  14. Poppet

    Poppet Honourary Moderator

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    Hi Andy

    I would absolutely echo Jamie's advice. I have severe AVN and the Acetabulum has worn away and is pushing up into the pelvis. I delayed a number of years for surgery, couldn't get my head around it... I am scheduled for 14 Nov and am already thinking about not letting the left side go long.

    This forum has taught me that early intervention to get on with ones life is the way to go however, we all have our own journey and demons to deal with to get us to the operating theatre.. Good luck :)
     
  15. HandyAndy

    HandyAndy Member

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    I appreciate everyone's response. I am hearing you all loud and clear! Clearly, my AVN will eventually cause me greater discomfort than it currently is. I thought to myself "what would my OS would tell me if I posed the same question to him", and I am sure he would echo what you all have spoken. I will accept my destiny and move on. Hopefully, my insurance will cover everything and I will be able tp keep my Dec 4th surgery date. Seriously, thank you all for responding today! I promise to update my status as I enter post-op. Heck, I might even need to vent my anxiety as I enter pre-op. So grateful for this forum. - Andy :thumb:
     
  16. Jamie

    Jamie Administrator

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    Andy....you come here and chat any ol' time!!! We're here for you. And don't hesitate to post if you have a question or concern. We'll help you get to this and I, for one, am looking forward to rejoicing as you go back to the things you love.
     
  17. DaveGM

    DaveGM Senior

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    Andy

    I cannot answer your questions as to whether surgery is right for you just now or not but I can say as a fellow sufferer of AVN of the hips that you should not shy away from having the THR operation.

    Only 18 months ago I was still diagnosed with trapped nerves.

    Two weeks ago (like Julie) I have had my seconf hip replacement. I don't regret it. Quality of life was diminishing prior to the ops and the AVN progresseed quite quickly.

    My advice to you is go for it. It may seem to be something you don't want to contemplate and something you don't really want to have to face up to but in the end I am certain its all worthwhile.

    regards

    Dave
     
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  18. alexthecat

    alexthecat Forum Advisor

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    Re: Fall from ladder will result in a LFHR

    Andy, I fractured my left hip in an accident in July 2009. Like you, I had the fracture pinned and, also like you, that was not successful. I underwent more surgery to re-pin the fracture in Sept 2009. That sort of worked... until the femoral head died about six months later and then it was time to move on to THR.

    So, I had my left hip replaced in March 2010. I was a runner, training for a marathon, before the accident that fractured my hip. I'm not a runner anymore, but I do lots of other things and I'm cool with that.

    I started hiking the hills near my home about three months after THR. I bought a mountain bike a couple of months after that. These days, I'm doing everything I did before the injury, but I'm still not a runner. As Jo said, you may need to change your outlook a little, but there are still a lot of fun things that you can do with an artificial hip.

    I hope you will stick around and keep reading and asking questions. It helped me a lot to find people who were going through THR around the same time I was.

    One note about recovery from THR: I think you may be pleasantly surprised at how well you recovery from this surgery. At least, I was. It's really nothing like having that fracture pinned. I found the post-op pain to be a lot less and the recovery period to be much quicker.
     
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  19. HandyAndy

    HandyAndy Member

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    Re: Fall from ladder will result in a LFHR

    Alex, it is so refreshing to start hearing from people who have traveled this path before me...what a relief! I can't thank you enough for chiming in here and sharing your thoughts and experience. I do plan on sticking around. Everything about this forum is positive and I am growing more courageous and accepting of my outcome. Thanks again. Andy
     
  20. alexthecat

    alexthecat Forum Advisor

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    Re: Fall from ladder will result in a LFHR

    Andy, I know that feeling, believe me! When they told me I needed THR, I was like, "more surgery???? You have got to be kidding me!!!" :hissyfit: Unfortunately, waiting around and delaying surgery wasn't going to get me where I wanted to be.

    Do you see the picture next to my name above? That is me, after a day of skiing, about 9 months after my THR. That was a great day. If you want to see what my early recovery was like, there is a link to that in my signature.
     
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