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49 y/o with AVN, planning on THR

Prem1234

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Dear All,

I just wanted to introduce myself as I’ve been recently diagnosed with AVN.

In 2017 when I was 47 I suffered an intracapsular fracture of the Neck of my Left Femur after a freak accident and falling onto concrete.

The fracture took a while to diagnose at Hospital as it was not displaced, in the end a CT Scan confirmed I had a fracture. After speaking with the consultant I had 3 Cannulated Screws inserted to secure everything while I healed. I was on crutches for 12 weeks and could not weight bear for the first 6 weeks.

I have always played a lot of sport including football (soccer) etc up until my mid 30s. I was fit and healthy before the accident and I went to the gym at least 3-4 times a week as well as play golf, mountain bike etc. In November 2018 I had the screws removed as they were causing me pain, I could feel them when I rolled over in bed and when I weight trained. Within a month or so I was pain free !!

In April 2019 I had hip pain again at the front of my hip and in my groin, I put it down to a Hip-Flexor strain or tendonitis so I rested a bit but decided to push on, eventually I thought I might have a Labral tear. I went back to my Consultant for an MRI who confirmed I had AVN with some collapse of the femoral head. This hit me hard as I did not expect that diagnosis as it was over two years after my accident with NO previous signs of AVN .

I am now 49 and probably like us all I don’t want the procedure but I’m only putting off the inevitable. So I plan on having it done in the next couple of months. I have been doing a lot of research on the best surgeon in my area, procedure and components to enable it to last a considerable time and allow me to get back to sports and the gym.

My Current thinking is to have it done using the minimally invasive posterior approach, with a COP or COC prosthesis that is not cemented.

I'm particularly interested in Cemented vs Non Cemented views, and what if anything does get cut in the MIS Posterior Approach ?

Thank you for reading my story so far and if you have any advice or words of wisdom they would be gratefully received.

David
 

Jaycey

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@Prem1234 Welcome to BoneSmart! Sorry you joined the AVN group - it hits hard and far too many of us needed surgery due AVN. Best you proceed as soon as possible so you can get back to living again.

A couple of articles from our Library might answer you questions. In the end let the surgeon make the decisions about approach and cement versus non-cement. They will assess you and take your life style into consideration when making these choices.
THR approaches or incisions
Cemented and uncemented hips
 

BruceH

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Hi David,

I'm 53 and just had my Surgeon consultation. He told me in great detail what he would use, how it would be attached (no cement or screws, bone growth only), and how all of my bones would be modified. In a nutshell he's machining my body parts to an exact fit for the artificial hip components. He also told me under what circumstances he would use screws, etc. and I don't fit that profile.

He will be using what he called a "lateral posterior" approach and I'm fine with it. My understanding is that it only adds a few weeks of healing time vs a minimal invasive procedure. The advantage is better visualization of the joint and using a robot assist to measure and precisely modify my hip.

What I've picked up from the forum is to choose the surgeon and let the surgeon choose the rest. I think it's good advice.

Have you watched any hip replacement surgeries on you tube? Once I got over the initial shock I found them quite informative.

Good luck with whatever you decide.

Bruce
 
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Prem1234

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@Jaycey, thank you for the welcome and your reply..... the links to your library make interesting reading.

@BruceH thank you for your reply and sharing your information it sounds good. I've only looked at Animations of the THR online so far but will try and pluck up the courage to watch the real ones.

I have had one consultation so far where the surgeon said he uses a more standard Posterior approach as the visualisation is much better and he does not cut any 'major' muscles (I should of asked what he does cut). Next Friday I have got a consultation with another surgeon who uses minimally invasive technique that he calls an 'ultra Posterior' approach, where he does not cut any muscles or tendons etc but does have to take one down in size during the procedure. I'll share any further information he says.

Many thanks again

David
 

weezie44

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@Prem1234
Hi David- I don’t have recommendations, but wanted to let you know my daughter has almost the exact same story as you. Freak fall fractured her femoral neck, fixed w screws via orif, screws removed 2 years later, no problems- until pain started this summer (4 years after original fix). Thought is was bursitis, until mri revealed AVN w partial collapse. We were shocked as her pain level didn’t seem to indicate the severity of condition. THR is recommended, but she is 19yo so tough to swallow. I have many of the same questions you have so I will be interested in responses.
Just wanted to let you know you are not alone with this experience. AVN can be devestatingly quick and quiet.
 
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DesertDiva

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Hi David,
I'm so very sorry for your diagnosis, as I have the same one but in both hips. At the moment, I'm "inconsolable" as I experienced groin/hip pain in mid-March and got shuffled around in the medical system before I finally got a diagnosis. Physical Therapy (McKenzie Method) only seemed to increase the pain.
I'm retired, but spend about 50% if the time traveling in my RV and towing my car. I live alone and the thought of being confined to my house is devastating to me. Two doctors asked me about alcohol consumption (1-2 glass of red wine with dinner) and have I had a lot of steroid prescriptions. I've been on Prednisone maybe three times for dust related allergies, had maybe five steroid shots in my whole life.
My first surgery is next Tuesday, September 24th and I'm in a word "terrified." Avascular necrosis (AVN) is a cruel diagnosis and I've been told that for me it just "happened."
 
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Prem1234

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@weezie44 I'm so sorry to hear the predicament (I've read your post now) that you and your daughter are facing and yes it almost sounds identical to the situation i am in apart from the age difference. I'm sure we all have the same concerns around how long the replacement will last etc but the good news is that this time frame seems to be increasing with newer materials and techniques. I am going to see three consultants in the UK before I make my final decision. I've already seen one, I've got the second one on Friday and the 3rd one who I believe help pioneer the Minimally invasive fast recovery procedure in the UK (Hugh Apthorp) in October so I will share their advice and views on here.

Wishing you and your daughter all the very best
 
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Prem1234

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@DesertDiva I'm really sorry to hear that AVN has also impacted you in such a devastating way. I can understand how you are feeling as it feels like such a big and final surgery that unfortunately it looks like we all must eventually face when diagnosed with AVN. In the UK they say that THR is the most successful orthopedic procedure they perform however that still does not take away the concern and fear we feel.

From people I have spoken to and the things I have read you will feel the immediate benefit from pain reduction after your procedure. I will be very interested in your road to recovery (I have read your thread). Do you know what procedure you are having and how they will perform it ?

Hoping the 24th goes very well for you.
 
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DesertDiva

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@DesertDiva I'm really sorry to hear that AVN has also impacted you in such a devastating way.

Thank you - it was just such a long and painful journey to get a diagnosis and quite a shock. I'm not a "stay at home" type of person and I have a 1998 Lazy Daze RV and tow my 2002 Honda CR-V. I usually spend part of the winter in Mexico with my RV-ing friends.

I will be very interested in your road to recovery (I have read your thread). Do you know what procedure you are having and how they will perform it ?

Actually, I don't know the details. The only part I do know is that it's Mako robotic assisted surgery and I had to have a CT scan of my pelvis for correct placement and sizing. The orthopedic surgeon is highly recommended and several people have commented on his skill. I'm just trying to get through this emotionally as well as physically.

Hoping the 24th goes very well for you.
Me too! You don't know how much it means to me for the comment, as I'm feeling so many emotions at this time.
 

mlc7

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Hi Prem1234 and DesertDiva,
first I want to say I am sorry about the complications you are experiencing and I am eager to hear how things are going with both of you.
I had a hip fracture in March, followed by 3 cannulated screws and 12 weeks toetouch with crutcher and a walker. My recovery went well until about a week ago when I started to experience groin pain. My suspicion for AVN is high and will be having imaging done next week. I was told that the only solution is total hip replacement but then I read that some institutions are doing stem cell treatment in early cases. I doubt thta will be an option but was wondering is anyone has been offered anything else than THR?
 
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Prem1234

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Hi @mlc7, Yes your story sounds very similar to mine, Fingers crossed your symptoms are nothing serious, what type of fracture did you have ?

So from what I've read and what my consultants have said is that stem Cell treatment is not an option if you have AVN due to a trauma, in this scenario AVN is generally due to interrupted/damaged blood vessels that feed the Femoral head leading to the bone dying and recovery from this is very very rare.

So a bit of an update so far is I have seen two consultants....with the third one on Tuesday this week (I'll feedback what he says).

My first consultant said my only option is THR and I was booked in on 17th Oct to have it done ( I have cancelled this appointment as I don't feel ready and wanted to explore all possibilities).

The Second consultant was a lot more positive, he listened to my 'AVN story' and advised that we monitor my situation and have an MRI in 3 months to determine how progressive the AVN is. Obviously if my pain increases etc go back to him. He also said if I'm not in too much pain and I can still do what I want to do to hold off having the THR due to my age and live style etc.

I did ask him if I could ever 'recover' from this on my own....He said the 'Cold Medical' answer is no.....However he has seen some good results from people living a healthy lifestyle with a healthy 'Bone' friendly diet. I found this quite refreshing from a Consultant...I'm a realist and under no disillusionment I am only putting off the inevitable :(

I have got quite a high pain threshold due to previous injuries etc but for the past 4 weeks my hip pain has decreased with a current Oxford Hip Score of 34/48, I do take pain relief and Ibuprofen only after over doing it or before playing golf (I use a buggy now and don't walk).

Wishing you the very best with your imaging and please share your results.
 

mlc7

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Hi Prem1234,
I had subcapital fracture. I too was told that if AVN develops it is not something it would respond to decompression+ stem cells because artery is interrupted. However, I emailed a Mayo doc that has been doing stem transplants and he said maybe if it is early stage.
I also have high pain threshold (skied the rest of the hill down after I broke my hip and drove home; took only 2 tramadols after pinning ) so I am worried there is more damage but I don’t feel pain. We will see next week.
I probably will seek second opinion as well before proceeding with THR if AVN is confirmed.
I will post what the finding and recommendation are as soon as I know.
 
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Prem1234

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@mlc7
Hi mlc7, Oh that sounds interesting and wow to ski off the slope after breaking your hip is some feat !!
I hope you don't have AVN and from what I've read <10% of people who have a non-displaced fracture like us suffer from AVN so fingers crossed. If you do and it's just over 6 months since your accident you might have more options.

My second consultant did say that if there was no femoral head collapse there is a procedure where they can drill into the femoral head and inject a 'compound' to sure it up and delay a THR. Unfortunately I've got a partial collapse, the consultant described it as a thumb print on my femoral head so this is not an option for me.

He did think my AVN was due to my accident two years ago and not having the cannulated screws inserted or removed, with hindsight I'm thinking I should of left it to heal on it's own. BUT hindsight is a wonderful thing, If I had have left it and but still had AVN I'd be thinking I should have had it screwed.

Wishing you the best positive outcome.....

David
 

mlc7

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I got some good news today. No ON on MRI just a defect in cartilage. I still have pain so I am not sure that cartilage defect explains it but will take the good news for now.
 
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Prem1234

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@mlc7 I'm hoping that is the best news for you, although hopefully your consultant will be able to elaborate more about the catrilage defect and what if anything needs doing...

fingers crossed
 
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Prem1234

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So an update on my thread.... I had the initial session with the third consultant on Tuesday where he reviewed my previous Xrays and the MRI that was initially used to diagnose my AVN.

He asked the normal questions around pain and mobility etc and went on to explain my MRI and AVN. He said he would expect the THR to last around 25 years and he has kick boxers, tennis players and I know of two ex-professional soccer players who he's replaced their hips and all living life to the full.

He gave me the same advice as the second consultant which was to hold off having the THR and he would MRI me in 3 months time to track the AVN. I did tell him that for the past 4-6 weeks I did feel an improvement in my hip and I've been back in the gym using the cross trainer and weights but no squats or leg press due to the pain. He said you will have good and bad times with the hip and really to have the THR while having a bad time as we are all 'human' and think we might be healing/recovering when we have an improvement (again nice and freshing from a consultant).

He said to carry on using the hip as usual taking into account any pain etc and if it gets worst to get back in touch with him.

So that's my plan, if I don't have any increased pain etc I will have the MRI in 3 months to track how the AVN is doing and see how things pan out.
 

mlc7

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Prem1234.
I am glad you are getting more opinions. I scheduled another one for myself just in case this was AVN. My orthopedist told me that some people can live with AVN for awhile and things calm down. If I were you I would have the same plan as you. Wait until it becomes inevitable. On a positive note I was told that THR nowadays last 20 years and I know a man in 50s who is an avid biker and has absolutely no issues with his THR.
And one more thing I was told ... One day hospital stay for anterior approach and driving within 2-4 weeks if all goes well.
 

ANP63

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Prem1234,

I hope for your sake that the pain does ease and you are able to put off the THR. I was diagnosed with AVN in my left shoulder in 2016. Tried cortisone shot, but it didn't work at all. TLSR went great in 2017 and I have full use of my arm. Later in 2017 was diagnosed with AVN in my right shoulder. TRSR went great in 2018 and I have full use of my arm. Later in 2018 I was diagnosed with AVN in both my hips. I had a Bilateral Core Decompression done in January of this year, and it didn't go so well on my left hip as it is now collapsing as well as having a Labrum tear as well as Bone Marrow Edema. I am tentatively scheduled for LTHR Dec 16th. They say that hindsight is 20/20, but I wish that I had not had the CD and just went with the replacement. The recovery for that was worse than the recovery for my TSR's. I would be pain free by now. On a normal day to day basis, my pain level is about a 5 or 6. Pain meds have not really helped all that much. On a bad day, my pain level is 8 or 9. Some days it is so hard to get moving. All in all my AVN progressed very quickly. I am going to ask my OS about the possibility of having a full body MRI to see if I have it any where else that might be in the early stages that we can do something about it.

Best of luck to you and I hope you continue to be able to enjoy life.
 
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Prem1234

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I'm so sorry to hear about your journey over the last 3 years but thank you for the kind words and sharing your experiences, with the pain levels you're experiencing as soon as your LTHR is done fingers crossed that you will be pain free and can get your quality of life back.

I have read that after Core Decompression is unpleasant and that it can take a long time to get back to normality and the same with fixing Labrum tears. My recovery after the internal fixation of my hip fracture took over 12 weeks before I could get off of crutches and I would have been almost fully recovered if I’d had a THR.

Did they share why you’ve got AVN have you been on prednisone for a long period of time ?

Wishing you as much comfort and be as pain free as can until your THR
 

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