Revision THR Femoral Shaft Stress Fracture Stem Tip

[Vik]

Looking for some advice, feel completely lost, from my history you can see how complicated I am, but how mentally strong I am, but hoping for some help…

History attached
Latest X-ray attached

Second opinion arranged by my surgeon, 2nd opinion surgeon states solutions are:
1) try Forteo injections with Human Growth Hormone to strengthen the femur.

2) revise the stem again.

I have complete faith In My surgeon.

I have done Forteo before.
I am not comfortable with take HGH, especially the risk of developing carpel tunnel syndrome which would effect my ability to coach tennis and my other deep passion - drawing.

What do I do ?

 

[Jaycey]

@Vik Welcome to BoneSmart! You have certainly been through a lot with this hip. I realise your surgeon assisted in getting a second opinion on your situation. However, I would recommend you find a surgeon who is in no way connected to the group you have already worked with. You need a fresh set of eyes on this problem.

Where are you located? Perhaps our members will have a surgeon recommendation.

 

[Vik]

Hi All,

I am beside myself with my THR, and at the absolute point of fear. If I know what is ahead I can handle anything, not knowing and waiting kills me.

I have developed a stress fracture below stem tip, the pain was very bad. I have been non weight bearing / bed rest for 7 days, my surgeon wants 3 weeks non weight bearing and then we re-assess. The solution if it doesn’t heal is plate the femur.

Has anyone experienced or seen this? Pain is manageable keeping off my leg and ice packs. (I have a very high tolerance to pain).

I am beyond thankful to anyone who has some advice and put my fears to rest, so I can get some sleep instead of worry.

 

[Newhip_Pol]

Hi, Sorry to hear of your problems. I don't have any specific experience to be able to offer advice but rest and immobilisation of the fracture site sounds sensible at this stage. When was your hip replacement done? Do you have any underlying conditions that might interfere with healing? High pain tolerance is not a good thing when trying to heal because it would be too easy to overdo things. Hopefully others will be along soon with specific advice to add. Take care.

 

[Vik]

Thanks @Newhip_Pol

THR - 2014 (April)
Revision - 2014 (Oct)

No underlying conditions, I’ve had bloods done, bone density done all completely normal.

Barrel Stave grafting April 2022 - enigmatic thigh pain.

 

[Newhip_Pol]

Had to look up barrel stave grafting - only to find it related to healing of long bone fractures! Obvious next question is 'was there incipient fracture causing the enigmatic thigh pain'. Did you have MRI at that time?
First article I found on femoral stress fracture included the following statement:
**Distance runners and military recruits often train themselves to “push through the pain.” Exercising beyond the body’s normal limits makes you more likely to develop these fractures.**
All the info suggests that healing and recovery are entirely possible if you go steady and include lots of rest.
BTW If you think I'm being impertinent with my questions & comments do let me know but as a recovering hippie I am intrigued by your story. Look after yourself.

 

[Vik]

@Newhip_Pol any advice / guidance is welcomed

Barrel stave grafting was performed due to a mismatch in the stiffness of the implant stem and host bone. The grafting effectively increased the bone mass and therefore strength of bone.

I have had MRI’s, x- rays, Bone Scan (which showed a small uptake in Oct last year) 360 scan, Gallium scan. Mid thigh pain for 3 years nothing remarkable on scans. Pain became insidious 12 days ago, had the x-ray above and stress fracture showed.

Also I haven’t started any new exercise routines I just live a normal everyday life, this happened walking in my daily life.

 

[Newhip_Pol]

Wow! That's a bummer (if you'll pardon my French!)

 

[Mojo333]

Hi @Vik
I'm sorry to see you back with a stress fracture
You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:

• That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
• If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
• Having only one thread will act as a diary of your progress that you can look back on.

I have developed a stress fracture below stem tip, the pain was very bad. I have been non weight bearing / bed rest for 7 days, my surgeon wants 3 weeks non weight bearing and then we re-assess. The solution if it doesn’t heal is plate the femur.

Has anyone experienced or seen this? Pain is manageable keeping off my leg and ice packs. (I have a very high tolerance to pain).

I imagine that 3 weeks non weight bearing and lots of concerns is extremely hard...
I know I have seen hip members over the years who have had fractures that have healed and some that required plating but did fine with recovery (but I think most were ones that had this happen during or directly after their THR)
I cant remember specifics on who.. may come to me.
Hopefully someone who may have had similar circumstances will see your post.

 

[myglasshalffull]

My goodness, this is a lot, I'm so sorry it's so difficult to keep facing these physical challenges.
As Mojo mentioned some have fracture soon after initial surgery. At my 4 week visit the X-Ray showed a small fracture on femur. I was advised light weight bearing for 4 weeks and would revisit and another X-Ray, if not healing then more surgery. However, I was very lucky and fracture did begin to heal on its own.
My best wishes to you, I'm sure you are beyond concerned.

 

[Mojo333]

I cant remember specifics on who.. may come to me.

Well, my glasshalffull, that certainly did Come to me...

@Vik
I know that due to the amount of procedures and this very long journey to get this hip on track, this must seem like yet another hit.

I hope you can find some (non-hip) distractions for your down time ...as you know stress is certainly not helpful to healing...

 

[Vik]

@myglasshalffull thats great to hear you healed! That’s so positive thank you for sharing

 

[Vik]

@Mojo333 yes distractions! Two more weeks before I know what surgeon will do. Meanwhile my father who turned 80 had a THR mini hip and is off his walker (after 2 yrs on it), walking and playing doubles tennis. This op does give quality of life back…, me still waiting.

 

[Mojo333]

Meanwhile my father who turned 80 had a THR mini hip and is off his walker (after 2 yrs on it), walking and playing doubles tennis.

Wow! Tennis must be in the family blood!
I don't don't know what the weather is "down under" right now, but perhaps you can get some help getting outside, or in the car for a drive...
I guess you have a bit of cabin fever at this point.

 

[Vik]

@Mojo333 its supposed to be summer here but we are pants and jumpers! Knowing Melbourne it will be boiling next week. My Mum and partner are fab getting me out in the sun and my sausage dog is loving my rest orders

 

[Vik]

Hi All,

Update completed the 3 wks non weight bearing.

Saw surgeon and did X-rays again. He said it is healing, so I am allowed to:

- walk with one crutch
- start hydrotheraphy
- start exercise bike

It’s been awful, I walk a bit and my leg hurts, one day puts me out for the next day and I just go back to non weight bearing. Today I’m in bed all day with ice packs and it just aches in mid thigh.

Still no explaination why it happened, and won’t it just happen again if we don’t know why it happened in the first place?

Feel this is just a painful round about of dysfunction, meanwhile I am losing my business / life because I can’t walk

 

[Mojo333]

Oh, @Vik
I'm so sorry that you are feeling so down.
It's very encouraging to know that the fracture Is healing. And with all that you have gone through, and your life being so engrained with the sport of tennis... I'm sure this recovery process must be extremely hard for you.
Along with the healing fracture, of course you are also dealing with the soft tissue injury from the surgery.
I think you will have to be very diligent about not doing anything in excess for some more months while healing (as I know that whatever may be deficit in strength and tone you are disciplined enough to regain)

You have expressed complete faith in your surgeon, but I suppose if you got a copy of the xrays, you could seek out a separate opinion.

This will definitely be a marathon, not a sprint and I am aware, due to your profession, that this is a strain in so many ways.
You can always vent here...we are rooting for you.

 

[Caison113]

Gosh what a journey! I just finished reading your medical history and … wow. I will stop complaining about my aches and pains post-surgery. What is so perplexing is the nerve issues. Seems they really threw you and your doctors for a loop. I would consider the stress fracture more “normal” in the sense that it’s much more visible and probably common. I would have to think it will heal appropriately as long as the implant is seated properly. You’ve had the bone scans, so you can rule out osteoporosis or something like that. The good news is that it shows healing. The pain definitely takes a while. I suppose you are sick of hearing it, but time is probably the only thing that will show improvement.

In other news, my daughter is studying in Melbourne this year. She’s only been there a couple of weeks (arrived when it was 35 degrees and up but luckily it cooled off significantly.

 

[Vik]

Thank you @Mojo333 and @Caison113 and thank your for reading and genuinely caring, made me feel so nice people really do care.

It does get you down from time to time the pain and dysfunction, I am pretty strong mentally and physically, as long as I can plan! When you are on pause it is a bit tough.

But today has been ok pain wise - haven’t done much yesterday and today and pain is ok. Shall see how the week goes.

Nerves issues were awful, and last one in the July surgery last year, everyone said it was a swollen lymph node. But the pain was like getting stung by a 1000 bees. My surgeon said he didn’t believe it was a swollen lymph node. I woken up in recovery my surgeon rang over “Vik, Vik you awake.? Everyone was wrong! It was a neuroma, it wasn’t a swollen lymph node at all. Now I have the pathology to prove it! You must have been so frustrated with pain. Anyway I’ve fixed it.”

It’s sucks to be in pain.

Your daughter came in the heat wave! That was unbearable the Friday hit 41 degrees! Totally insane. Hope you daughter loves Melbourne and the study abroad experience! I hear accomodate etc is crazy here, so many internationals struggling to find places to stay?

 

[Mojo333]

Hi @Vik

We get some crazy hot weather where I live ... usually in July.
I dislike cold so much I hate to complain about the heat but I was a months into my BTHR recovery during our Summer heat wave and it was quite ALOT

But the pain was like getting stung by a 1000 bees. My surgeon said he didn’t believe it was a swollen lymph node.

that sounds miserable...I'm very glad your surgeon listened and found answers!

It’s sucks to be in pain.

Yes, it does. I'm glad you have been feeling some better.
Recovery can certainly be tedious and boring...
Hope you can find some distractions to give your mind a bit of a reprieve...
Hope the rest of the week shows lots of improvement!