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[THR] Problems with cerclage wires on femur after THR

Discussion in 'Hip Replacement Recovery Area' started by Bear1, Apr 11, 2019.

  1. Bear1

    Bear1 new member
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    I had a THR in 2013 wherein my femur was broken when the implant/stem was being "pounded" in. In the recovery room it was determined that the femur was also broken above the knee and the implant had become loose. It was redone the following day resulting with five cerclage wire straps holding the femur together. Since then my ability to walk any distance, or have pressure on my thigh (like a grandchild jumping on it) is very painful. The pain is like lightning bolts when a sudden pressure like the grandchild jumping onto the thigh or catching myself falling, and a “snagging like” feeling regarding the muscel coupled with pain at times when walking. In general, the more activity the worse it is for several days after.

    My original OS told me the pain would go away in no more than three years. It is much worse now. Two other OS decided, after extensive testing, that I have “hardware irritation/AKA hardware impingement” and the only recourse is to have the wires removed which would be serious surgery open to many undesirable outcomes. Both said they would not undergo it if it were them.

    My concern is that the constant irritation may be causing additional scar tissue which may be responsible for the increasing pain. Does anyone have any experience with this?

    Thanks

    Bear 1
     
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  2. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Hi,
    Welcome to BoneSmart. Thanks for joining us here. I'm sorry for the outcome of your THR and your painful long-suffering. I'm am tagging the forum Nurse @Josephine, with 50+ yrs experience in Orthopedics to weigh in on your situation. She resides in the UK and with the time difference will not be online anymore this evening. Please check back periodically in case she has questions. Following are threads of two members who successfully had cerclage wires removed. It may offer you some hope for a favorable outcome -
    https://bonesmart.org/forum/threads/relief-after-removing-cerclage-cable.49633/
    https://bonesmart.org/forum/threads/hitch-get-along.48703/unread
    Wishing you comfort as you sort this all out.
    @Bear1
     
    Last edited: Apr 12, 2019
  3. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Bear1 As Layla pointed out we have a couple of members who had this hardware removed and both had a great result. Sounds like you need to find another surgeon.
     
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  4. Bear1

    Bear1 new member
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    Thanks Layla and Jaycey. I appreciate the info and look forward to learning more from Josephine. Drew
     
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  5. Layla

    Layla FORUM ADVISOR Forum Advisor

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    You're welcome! I will look forward to Jo's response also
    Enjoy the weekend!
    @Bear1
     
  6. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    What a story! You have my sympathies. But I'd like a little more information if you can:
    1. an xray of both areas - the hip and the knee. You can post these in here A few tips on posting xrays
    2. the full date of your surgery.

    Gosh, what kind of surgeons have you been seeing? I've seen these hardware items be removed on numerous occasions with no problems. Thing is that they are simply nylon straps, much like cable straps, and they really aren't that difficult to remove.
     
  7. Carriemay60

    Carriemay60 post-grad

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    @Bear1 I think they are very similar to what we call zipties on this side of the pond. I just had mine removed as part of a revision surgery. I don't know too many details yet but my OS told my husband it was in a bit of mess and likely causing some of my pain.
     
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  8. Bear1

    Bear1 new member
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    Thank you for your interest Josephine.

    My original surgery was December 12, 2013. I was in the recovery room and had some water before they realized that my femur was also broken below the first area and the stem had come loose. Due to the ingestion of the water it was decided to redo the procedure the following day, December 13, 2013.

    I do not have copies of the Xrays. I will get them next week from my new OS located in St. Petersburg, FL. Regarding the five cerclage straps they are titanium. As for having them removed I was told removing them is a "serious" operation by the new OS. He gave a 70% chance that there would be improvement.

    I sought opinions from two other surgeons after being told for three years that things would improve by my original surgeon.

    The new OS, as well as a second OS, both seemed unwilling to consider the pain stemming from the wires. From what I have read this appears to have happened to others as well. I am by no means a wimp regarding pain.

    I will get back with you as soon as I can get the images. At the moment we are out of town.

    Thank you again for your consideration.

    Drew
     
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    Last edited: Apr 12, 2019
  9. Lyndam

    Lyndam junior member

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    @Bear1, I feel your pain. It appears you have put up with this for going on 6 years, you must be very weary of it all.

    I only have one cerclage cable, also titanium, at the top of the femur, which has caused me niggly pain for 2 years, recently found to be fraying on the cut end but apparently of no consequence.

    My surgeon has insisted from the start that the cable is unlikely to be the cause of the pain and has stated "I'm not going in there again". It is so frustrating and I really feel for you with five cables in there.

    From my research it would seem the reason they don't want to re-operate unless absolutely necessary is due to the increased risk of infection. I don't know why the risk is greater each time they go in but the stats do support this view. You can google for the stats. It doesn't mean you will get an infection from the operation but chances are increased.

    I would say some surgeons are more risk averse than others, maybe they have been burned before and just don't want to put themselves in that position again.

    The other negative is more muscle wastage from having to re-open the scar.

    The thing I did think about for my own situation, was looking into finding a surgeon that would cut in the opposite place for the revision, so for my posterior/lateral scar I would look for someone willing to operate anteriorally. This is assuming the risk for infection is from the compromised skin layers of the previous op site.

    I'm not an expert of course, but this is what I have managed to glean from others and googling. With regards to your comments on scar tissue, absolutely valid I think. My pain has recently diminished after I inadvertently sat a bit sideways on my thigh, at the time it was like an explosion inside my leg but after the swelling and bruising went down, the old pain had gone.

    No one really knows what exploded, I thought it was the trochanteric bursa, but apparently this would be impossible so it must have been scar tissue. Whatever it might have been, I consider it a Miracle. Pain is just ever so slight now, just hoping this will last.

    I wouldn't recommend 'sitting' on your own leg/painful bits, well actually I would but it did hurt like hell, probably a 10/10 for about 5 seconds, then just a 6 or 7 for a few days, but no, don't try this at home, lol. In my case it was just a very fortunate accident.
    I think you will have to shop around for a surgeon willing to operate on you. I am thinking Florida is a long way from Nevada, but if you read the thread by @BionicButt, her surgeon was very competent and removed her cable with no complications. He also had a really nice manner about him too :).

    At least we have this forum and the company of others with similar problems, imagine going through this kind of thing with no support!

    Hey, best of luck with yours, I'll keep an eye on your thread.
     
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  10. Bear1

    Bear1 new member
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    Thanks Lyndam. I am happy to learn that your situation improved. I agree that when tissue is swollen things are a lot worse. It is nice to learn that there are others experiencing similar issues and that doctors frequently do not take hardware irritation/impingement seriously. Drew
     
  11. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    Quite right but it's more than that. Can you imagine being the surgeon and having to explain to a patient that their hip is now grossly messed up because, though they knew it wasn't wise, they operated anyway! This is not something surgeons take lightly as they have to live with the consequences (as does the patient) for the rest of their lives. Can you imagine how they would feel if said patient said "If you knew it was a risk, why did you do it?"
    This is not so. Removing cerclage cables is minor surgery requiring only small incisions in an already existing scar.
    You won't succeed. It's a surgical point of honour that second incisions are made though pre-existing scars.
    I dount anything did. It was just a painful episode.
     
  12. Bear1

    Bear1 new member
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    Josephine:

    I finally was able to pick up xrays this morning. A 10 year old should have been included to help navigate how to open and copy the images from the CD. I could not figure out how to paste the pdf in the text field; however, I have attached a file with two views.

    Thanks

    Drew
     

    Attached Files:

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  13. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Gosh @Bear1 you certainly have more than your share of wires on that hip! I'm anxious to see Jo's comment on your x-ray.

    FYI you would not be able to paste a PDF into the text field - only an image file. Your attachment is fine.
     
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  14. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    @Bear1 can you please email me those xrays? Because in the format they are in, they are far too grainy for me to see what's going on. josephine@bonesmart.org
     
  15. BionicButt

    BionicButt junior member

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    Hi @Bear1, I'm so sorry to hear about the pain you have endured for 6 years! I have had my cerclage cable successfully removed from around my right femur. It instantly made a huge difference. I had chronic pain around the cable end, which was poking into my muscles. Your ends look flatter than mine, but it sounds like they may be irritating your muscles from your report. @Josephine is right, it is a simple operation with way less trauma than a replacement. I was back home within 2 hours and had no ill effects on my muscles, in fact, they were much happier immediately!

    You can learn more on my thread in this forum: https://bonesmart.org/forum/threads/relief-after-removing-cerclage-cable.49633/or on my blog: https://rhondaashurst.com/hip-adventures. I also include video footage on the blog that shows what I couldn't do before and what I can do now. I am a long-time practitioner of yoga and one of the last things to come back was my one-legged poses, which use a lot of the muscles impacted by the cable. I'm happy to say all those poses have come back now. @Lyndam is correct, there is a chance of infection when they go back in and surgeons are often hesitant to do that unless it is causing a lot of pain and disability. My surgeon seemed unconcerned with that and I think part of it was this special bandage he used (you can see it on my website). It is called a Provena and it suctions the wound to prevent infection. It worked like a charm. I had no swelling and was quickly healed from this minor surgery. My only regret on this end is that I didn't have that danged cable removed sooner!

    One of the differences in your situation is that you have multiple cables down your leg, so I'm guessing that will take multiple small incisions to remove. It might be worth getting another opinion about having them removed. Six years is a long time to be in pain. My surgeon said if I didn't get relief by the end of a year, he was taking it out. He told me that mine was the second cable they had to remove within 4 months due to pain issues.

    I hope this helps. I'll keep an eye on your thread.
     
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  16. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator

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    BionicButt, please don't make my name into a tag in the general course of conversation. You - and everyone else - is more that welcome to tage me any time you have a genuine need for my input, but please don't do it this way. I already get too many tags every day! :tiredwheel:
     

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