Femoral Neck Fracture -> ORIF -> THR = Panic

[azdrew]

Hi there, I was glad to find this community while doing research. I'm 10 days away from a THR and I'm starting to panic.

Last October I took a hard fall on my road bike and ended up with a femoral neck fracture. The original orthopedic surgeon recommended ORIF over THR at the time thinking we'd have better success with being able to maintain an active cycling lifestyle.

Things went "OK" with the screws in place (riding with some, but not unbearable pain - I even did RAGBRAI in July), but still had pain with range of motion, due to the hardware (at least we thought), and after a CT scan showed things looked good we took the screws out.

After that the pain got progressively worse, to point this October the Dr. was calling this fracture non-union and recommending THR.

I begged off initially, asking if we could try 5-6 weeks on crutches, to see if it may heal up. We scheduled the TR for Dec 23 "just in case".

I was so sure that this would heal up, I wasn't too worried about things, but now only 10 days away, things still aren't feeling well and I'm in a state of panic about everything.

I'm kind of bummed about some restrictions about impact activities like jogging, etc, but I'm not much of a runner anyway. But I am terrified about how this could affect my cycling.

I cycle about 150-200 miles a week, 4-5K miles per year. I've been seeing a lot of conflicting stories, from this being fine without any restrictions, to mentions about severely shortened hip replacement lifespan, restrictions on riding style (upright/recumbent), or restrictions on distance (no RAGBRAI, for example).

Losing my cycling would be devastating to me. Anybody have experience on cycling life after THR?

-Andrew

 

[Pumpkin]

Azdrew,
Welcome to Bonesmart, glad you joined us.
We have a cycling club, here is the link, you will find others like yourself, most are back on their bikes..
https://bonesmart.org/forum/threads/cycling-club-for-us.12123/page-77#post-856709
I am going to tag @referee54 , he is an avid cyclist.
Here is an article about sports after joint replacement, Sports after TJR: knee replacements not harmed by most sports
Most likely you will be able to return to cycling, give your hip a chance to fully heal, and the more you will be able to do after THR.

Hope you are feeling better about .

 

[Mtnmama]

@azdrew I'm scheduled for my first hip replacement tomorrow. My surgeon has assured me that, if all goes right, I won't have any restrictions on cycling. It was my biggest fear. I ride long distances and live in Colorado so hills are a must. I love riding and it keeps me sane. Because I'm pretty strong now he thinks I can start on a spin bike at 2 weeks and my road bike at 6 weeks, weather permitting. I think that's a little optimistic but I'm hoping he's right!

 

[Hip Hip Hooray!]

I'm riding my bike every day now. I had both hips replaced on August 18th. I had a bike accident last September. I was wearing a helmet but hit a downed sign on the sidewalk. I flipped in the air and landed on my face. Had a concussion and was unconscious, but I recovered quickly. I was just in the emergency room for a few hours.

My surgeon's asst. told me I could start on the bike with no resistance right away. It didn't feel good. Caused me a lot of pain the next day, and I had only 10 mins. on the recumbent bike. After that, I waited. Now, everything is fine. The tissue was just too sensitive and tender. Now I use the regular bike at the gym, set on 8. I ride a beach cruiser around the neighborhood.

It's just important to be sensible, and to let your hip heal from the surgery first. There's plenty of time. People who rush back into fitness too quickly seem to be the ones who have problems with pain and injury post surgery.

 

[azdrew]

Thanks for the replies. Everybody I am talking to says this will be the right thing to do, but I still can't get rid of a small pit of doubt.

The one thing I'm not sure about with me is how most people who undergo THR are in quite a lot of pain prior. There are days when I don't feel all that bad, but my pain tolerance may be high - my wife insists I'm miserable and am making her miserable.

My biggest fear is that a lot of the pain is from the knee, which I didn't have before the fracture. The Dr. and my PT feel this is related to the hip and the IT band, but I can't be sure. Once I'm recovered I definitely plan to do a bike fit if I'm still having issues.

I am encouraged by the procedure the orthopedic surgeon went over with me yesterday. He's going to do anterior procedure with ceramic ball and crosslinked polyethylene liner. This seems like a great option. He says if things wear out its a minor procedure to just replace the polyethylene, possibly even the ball, and its not nearly as bad as a revision.

I've ruled out some of the radical options like an intertrochanteric osteotomy, because if that doesn't help and I do need THR, then the THR is much more complex. I can't get by with doing nothing, because the Dr. says if it hasn't healed in a year, its not going to heal and I need something to support with without danger of it slipping more. My other option would be adding some screws and plates, but that leaves me with my current leg length difference, plus I may just go back to the pain and discomfort I had with the screws in earlier this year.

I did get quite a bit of support from a local bike group, and everybody assures me there will be no limitations to my cycling and I should be able to get back to normal. I'm still feeling depressed about losing out on some activities like jogging, but I don't run now anyway, I guess its the removal of the future options that tears at me.

So if everything sounds so great, why am I still so anxious about this?

 

[azdrew]

@azdrew I'm scheduled for my first hip replacement tomorrow. My surgeon has assured me that, if all goes right, I won't have any restrictions on cycling. It was my biggest fear. I ride long distances and live in Colorado so hills are a must. I love riding and it keeps me sane. Because I'm pretty strong now he thinks I can start on a spin bike at 2 weeks and my road bike at 6 weeks, weather permitting. I think that's a little optimistic but I'm hoping he's right!

I hope your replacement went well! Thanks for the encouragement.

 

[Hip Hip Hooray!]

I have the ceramic ball and the polyethylene liner, too. I didn't realize that it's a minor procedure to replace the liner or ball. That's good to know. I had the anterior technique, as well. I've been really happy with the results.

I didn't think I was in that much pain, either. But, it sneaks up on you. It really doesn't get better, and the deterioration can be very depressing. At my pre op appt, the doctor even said to me, "Wow! You just jumped right up on that table." When she asked me my pain level, I answered, "About a 3." "Then why are you having the surgery?" she asked. She thought I was too young. But, I was limping, people were commenting on it everywhere I went, and I couldn't get hired. It's weird how we can adjust and try to cover up the changes. I think I was in denial. My boyfriend at the time really wanted me to do it, and I couldn't face the thought of it. He could see how poor my mobility was, as he watched me walk and try to get dressed. I really struggled with putting on socks, shoes, etc.

It's normal not to want to do the surgery. It's frightening. The thing that helped me the most was to remember that I'd be asleep through the whole operation. I'm so happy that I did it, now. It's much easier to get on and off the bike, too. The liner really changes that friction that develops when you are bone on bone.

 

[Toddlermom]

If you weren't anxious, it would be abnormal! Sometimes it feels like it is easier to negotiate your known mobility issues rather than face the unknown. That is normal. It might not be productive to solving the problem, but is a natural response.

And you probably don't even understand your own pain levels. Last week, I had a physical therapist pull on my ankle to briefly create some space in my hip joint......and I didn't remember what it felt like to be without hip pain. It was lovely, and very fleeting. (Currently bone on bone) I am ready to experience that feeling every day-

 

[Jaycey]

So if everything sounds so great, why am I still so anxious about this?

We have many members who returned to sports like cycling post THR. The implant your OS is using is usually used for younger more active patients - so you are in good hands!

Of course you are scared - we were all in that space pre-op. Just come here, post often and discuss your concerns. If you read on the post op side I think you will find the main comment is "why did I wait"!

 

[azdrew]

Thanks everyone for the encouragement. I went in on Wednesday for the CT scan for the Mako System, and I was in a lot of pain and limping a lot. At that point I was convinced I was doing the right thing.

But then yesterday it started feeling a lot better, which is driving me crazy. I would prefer if it kept hurting rather than feeling better.

If it weren't for the non-union fracture and the warning from the Dr. that I shouldn't leave it with no support, I'd probably postpone. But if I don't do the THR then I have to go with DHS plates, so its some surgery no matter what.

Everyone I talk to says THR is a much better choice than plates, so why do I keep screwing with my own head?

 

[Jaycey]

Everyone I talk to says THR is a much better choice than plates, so why do I keep screwing with my own head?

Because you and everyone else would like to avoid surgery at all cost. In my experience the earlier you get this done the shorter the recovery. If you limp around for months (years) it is very hard to break the habit and other parts of your body start having issues. Life is too short - get it done and get back to cycling!

 

[alexthecat]

I went with the DHS plate for my nonunion hip fracture. Six months later, I was back for THR, after my hip collapsed. Those were six very miserable months in my life. THR is a much easier and less painful recovery, in my experience. If I had to do over, I'd skip the DHS and go straight to THR.

Also, I wouldn't recommend waiting until you are in unrelenting, severe pain. I was on crutches and could tolerate only very limited weight bearing by the time I had THR. There's no real benefit to putting yourself through that, if it can be avoided.

 

[azdrew]

Thanks @Jacey and @alexthecat. I also was able to talk with an OS who I occasionally ride with in a cycling group, who also recommended skipping the plates. I'm also looking forward to getting my leg length back to matching.

I go in tomorrow at 5:30am for 7:30 THR surgery. Dr. told me to get rest tonight. Not feeling too confident about that.


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[Toddlermom]

Andrew-
Can't wait to hear how much better you are feeling a few weeks post op! My surgery is In February, and I will likely be looking for some encouragement. Once I get closer, I anticipate being nervous too....

Cori

 

[cjorad]

How are you feeling azdrew?!

I had a THR 4 years ago and I cycle about 200mi/week for the last 2 years. I definitely had to work back up to distance but I ride with absolutely zero discomfort now. I have ceramic on metal components.

My close family friend (62yo) rides about 100 miles per week for the last 6 years with zero problems and he has the same components as you.


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[Josephine]

I was so sure that this would heal up

Trust me, they almost never do!

My other option would be adding some screws and plates. I've ruled out some of the radical options like an intertrochanteric osteotomy

Neither of those would have worked anyone. Intertrochanteric osteotomies for hip AVN is a no go. They really don't work. And adding a plate and screws to the trans-cervical screw doesn't make any difference. The femoral head is generally doomed from the moment of fracture, very few ORIFs succeed in restoring the blood supply.

I'm kind of bummed about some restrictions about impact activities like jogging

Well it's really up to you at the end of the day. It's been my experience that patients given cautionary advice like this will do their own thing in the end and that's if they don't just plain forget after a few years.

But I am terrified about how this could affect my cycling.

It won't affect it negatively at all, my dear. Have a look here to see what some other hippies as got up to with their new hips. Stories of amazing hip recoveries

So if everything sounds so great, why am I still so anxious about this?

But it's perfectly common for people to range between uncertainty and outright panic. This is a big deal and you will be handing yourself over into the care of total strangers that you will probably not even set eyes on and letting them do things you have no idea about and that is scary. Only crumb of comfort I can offer is that these strangers do this several times a day, every day of the week. Or to put it another way, for you this is a big, unknown and scary deal, for them it's just another day at the office. But you can trust them. I used to be one of those unseen and unknown people in the OR and I took care of every individual that came into my care just as much as if they had been my own mother or father. They will too because they are professionals and know their job. So the only thing you really have to fear is the unknown and that we can help you with. Read around here and be educated. It will help you greatly.

 

[azdrew]

I'm a week and a half post-op, and feeling pretty good. Still quite a bit of incision and muscle pain, but I don't have the sharp deep pain any more. I'm still a little wary of knee pain, but the entire leg is quite sore still.

I had to promise my OS I wouldn't attempt to get on the bike, even trainer, until at least this coming Thursday when I have my 2 week followup appointment. I've been cautioned against being over aggressive on recovery, and I definitely don't want to start going backwards. I'm hoping I'll get cleared to at least do some light spinning on trainer after Thursday.

 

[Lseven]

I do quite a bit of cycling road and mtb myself for many years. I'm 9 or 10 weeks post op and I don't foresee any issue with getting back on the bike. Through december I was on a stationary 5days a week for 30mins each. At the end of that I was even standing up on the pedals some. To start I had to keep the seat quite high but after about a week got into a normal seat height for me. (cranks might be a tad shorter on the stationary). The only issue is a 90degree bend restriction so I'm sitting more upright on the stationary. I haven't set a bike up on a trainer yet and may have to make some adjustments for sitting up. In the long run I don't think there will be a problem with full normal position. Maybe not a full bore TT position but I haven't had need for that for a long time. Should be able to get lower than I have the last couple years of the hip going bad. My knee bugged me a bit at first too. The IT band seemed out of whack and annoyed. The spinning really helped that more than anything I think. Seem to have slightly different knee alignment but just trying to keep my toe turned in a bit to help that work in well. GF got a fatbike this year so she's been out riding it and I just hike the mtb trails for now. Might put the studded tires on my mtb and get at some easy stuff. Don't really want to fall off it just yet so nothing too challenging.

 

[azdrew]

The only issue is a 90degree bend restriction so I'm sitting more upright on the stationary.

Were you posterior procedure? I was anterior and I asked about any limitations, and my OS said I had no limitations on leaning forward. My main restriction is kicking the leg out backwards, which has me a little confounded as to how to best mount my bike. I currently swing my right (bad) leg out behind the seat. I may need to try the opposite.

My knee bugged me a bit at first too. The IT band seemed out of whack and annoyed.

I've had knee problems since my original fracture a year ago. My PT said it was likely IT band related. Hopefully he can help me get this sorted out when I start up PT in a week or so.

 

[Lseven]

Surgeon referred to it as 'anterior lateral'. Near as I can figure it's pretty much lateral but whatever. So 90 degree restriction for 3 months I think. No restriction for leg going backward. At the end with my bad hip getting on the bike got pretty awkward. You can step over it while it lies on the ground and pull the bike up under you. May take some more thinking to get on a bike mounted in a trainer. I can't really do my regular IT stretches right now but it seems ok once I got it worked in early on which was further out than you are right now. A lot about anteriors seems to go quicker though.