Revision THR Cerclage Wire Broken Greater Trochanter Displaced

Hello @MaryMurphy,
I'm so sorry to read of all that you are going through. You seem to be happy with your current surgeon, but I do wonder whether he has the expertise to sort this out for you. I'm in the UK, so not familiar with the setup at the Rothman Institute. I would hope that he will consult with colleagues with more experience of femoral reconstructions as this seems to be more than just a case of fixing a broken cable. Please do ask why it has happened at your next appointment. It must all seem overwhelming to you at present, but with the right surgeon, post operative management, and a huge amount of patience on your part, I'm sure you will do well and get your life back on track. Sending very best wishes. :console2:
 
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@helenium Thanks so much for your response. I really appreciate this. I am sitting wondering how the cable could have possibly broken. When I saw my surgeon the first time it appeared broken- he seemed unraveled. He gave me very little info and said to come back in three weeks and left the office abruptly.

Then when I came back three weeks later- he sat and looked at the Xray and said the piece was displaced and in non union. He very briefly sort of muttered that the non union caused the fragment to move and that caused the cable to break. I kind of sort of argued that I thought it was aggressive physical therapy- and he was not open to me showing him the exercises I did that I thought were "tough".

He was on the fence about fixing it. So- how do you think it broke? My primary was far more patient and kept looking at the images and he said he thought it was the small metal connector slipped off the end- which means it could be floating in my leg.

I appreciate any other eyes chatting about this because my family is just so fatigued and will not sustain any discussion and I really want to know how or what I could have done to mess up my fracture TWICE before I get opened up again so I can totally adapt to the safest recovery plan.

The Rothman surgeon said I have a bad habit of blaming myself for the first break and he asked me what i do to relax- he suggested there was nothing I did wrong to dislocate it the first time- now it happened again- and I agree that I need to push the topic when I see him.

In the US- in the metropolitan Washington New York Corridor ( equivalent in the UK as London to York) - Rothman is one of the top most respected ortho facilities - second to the Hospital for Special Surgery maybe in New York or Hopkins in Baltimore.
Many thanks for your response
 
I am going to pick up a disk with original images so I can have the best images. Looking for "theory" as a retired teacher I always seek explanations. My former boss suggested I "let what happened go" and move on with my life.
Fat chance, as a "research oriented teacher" I don't settle until things make sense. I can deal with any outcome as long as it makes sense.

So I started this mess a year ago when my April surgery failed and the femur fragment dislocated.

Can anyone pipe in that- the reason the first femur fragment dislocated was because the surgeon drilled a hole in the bone that was weak from infection and probably should have put a plate and multiple cables.

With the weak bone on the lesser trochanter side and the stupid cable in the middle rather than all the way around- I was happy go lucky and lifted my four year old grand-daughter out of a car seat- out of the pool and one day I actually picked her up when she was crying about spilling water beads of all things- and all this lifting and weight on this shaky leg caused it to just dislocated.

That is my theory about the first mess.
 
Part two- I find a surgeon at the highly regarded Rothman institute. I really like him - the way he studies my images before speaking etc.

He does the revision in August and puts in the plate with the multiple cables. He puts me on "toe touch" weight bearing for weeks and weeks and I follow his instructions like it was my job. I don't cheat- I worry so much that I exercised GREAT caution. Then he put me on 50% weight bearing and I was also very careful.

Finally Dec 8th- he says I am free for full weight bearing and Physical Therapy.

I wait to start Physical Therapy until the end of Feb bc I don't like walking and driving in snow and ice. Again- I am being very careful.

Sometime in late March I feel like I am getting shot with an arrow and or stung but hornets. The pain will come on suddenly and then I can move or massage it away so it goes from zero to ten then back to zero.

I have an xray and he tells me the fragment is in non- union and dislocated and the cable broke.

HOW did this happen????? This is what is bugging me!!! It did not happen until I started Physical Therapy but also I moved a heavy bookshelf when I was mad.

If I know possible reasons it happened- I WON"T do them again when I get it redone!

Does anyone think he should have told me Dec 8th it was in non- union and not started Physical therapy?

Does anyone thing the PT should have been mild -not aggressive because it was in non-union?

Was he recommending PT without guidelines because it was in non-union to try to stimulate bone growth with activity??

I can't in good faith get another revision until I understand how my second cable failed.

When I ask him- he just says I started with a really bad situation and this may be the best I can do- which is an answer I am not OK with and if he does not change in June I can go around this busy metropolitan area and get another doctor- I have great insurance- BUT I LIKE HIM and I love the office and his staff.

How did this cable break and the fragment dislocate???

Thanks to anyone that is thinking about my thread.
 

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Does anyone think he should have told me Dec 8th it was in non- union and not started Physical therapy?
You had stuck by the rules to allow the fracture to heal, I assume you also had abduction restrictions during this time. Your revision was done in August 2021, so if any bone was going to grow it would have been evident by December.
The greater trochanter was anchored by the claw plate and cables, by December I would think that would have been as good as it was going to get. There are many muscles attached to this chunk of bone, and as you became stronger so did the forces acting on it. It might not have been anything specific that you did that caused it to move. As frustrating as it is for you, you might never know.
Was he recommending PT without guidelines because it was in non-union to try to stimulate bone growth with activity??
From my understanding, after 3-4 months it was too late to stimulate bone growth.
BUT I LIKE HIM and I love the office and his staff.
However much you like him, there might be a limit as to what he is able to do.

In my case, I had an osteotomy of the GT in 2014 to enable removal of a well fixed mal-aligned stem. My surgeons are not keen to use claw plate fixation, so I had just cables and toe-touch weight bearing restrictions (less weight than it would take to break an egg). It was evident at my 6 week post op check that there was no bone growth at all, I had a non-union fracture. I had another revision on that hip in 2019 using a different fixation method. There was no guarantee that it would work, I was blessed with an amazing surgeon, it's taken a long time, and I am doing very well.

That is why I would encourage you to seek out the best reconstruction surgeon you can find. I wish you well.
 
:banghead:working on making my thread shorter
 
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"The greater trochanter was anchored by the claw plate and cables, by December I would think that would have been as good as it was going to get."

This sentence was very helpful to read. Thanks @helenium
 
@helenium - This sentence is very helpful.

"I had another revision on that hip in 2019 using a different fixation method. There was no guarantee that it would work, I was blessed with an amazing surgeon, it's taken a long time, and I am doing very well."

Rothman keeps saying no guarantee- I asked him to get creative and he paused and said he could use other graft stuff and new cables- I said "buckle up" and I KNOW I would not be as aggressive with physical therapy- picking up my grandchild or moving furniture- even moving heavy groceries - for a year. Yipee- thanks for the supportive response.
 
Hi again @MaryMurphy I know you are trying to figure this out.. it's a lot to wrap your head around and I understand it completely, but none of us should even be guessing at what has happened, unless someone has been through something similar.
I will say that I thought the same as one of your options, that maybe they thought some exercising would help stimulate the bone since you were on toe tap pressure, then 50% for quite some time.

But I am not a surgeon or even a doctor.

I am sure that this is indeed maddening to you, and am so sad that you are struggling so.
It may be time to attempt to get your mind and body into a happy space so you are as strong and healthy as you can possibly be for your next follow up appointment with your surgeon. At least, that is what I would be doing.
Oh and making a list of questions for your visit. :console2:
 
I am still looking for the folks who had cerclage wires- specifically ones that failed as I am on failure number two.

I picked up a disk with clean images from the hospital to capture as well as possible my first cerclage wire failure.

I did get some encouragement that number three may be the charm but i want to understand - if possible why they fail.

This post has images side by side.
  1. The first image has the initial controlled fracture.
  2. The second image was taken after the holes were drilled.
  3. The third image is when the fragment was completely dislocated and in non union. By this time I could not get up from a seated chair as the fragment was behind the hip but does not show that much in the image.

In my next cable- I would not be full weight bearing and I would not babysit grandchild full time.
 

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@MaryMurphy ,
Be sure to write down all your questions before your appointment, noting everything you have questions about on your x rays. Your surgeon or a second opinion are best to ask about your x rays.
 

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