THR Relief after Removing Cerclage Cable

BionicButt

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I am 9 weeks out from my second THR this year. My first was in September on my right hip and due to a weakened femur, they placed a cerclage cable around the femur. I really struggled with my rehab on that hip and wasn't sure why. I have bilateral hip dysplasia, so I figured maybe it was just what us dysplasic people go through.

About 3 months after my first THR, my left hip decided to give it up. I had that surgery done in May and they did not have to use a cable around my femur. The recovery on this hip is AMAZING!! I was able to walk without aids by the fourth day. The pain was minimal and I am almost at full recovery at this point. I'm back to hiking 2 miles and swimming 1000 meters in the pool, doing my yoga and tai chi practices.

I immediately knew that the difference between the two hips was the cerclage cable. I still can't bear full extended weight on my right leg, especially extending my left leg behind me while balanced on my right. My IT band hits the cable and snaps over it, then collapses. My muscles are atrophying on that side. My surgeon has agreed to remove the cable in October. I was wondering if anyone has had this done and what the outcome was?
 
Hi - Welcome to BoneSmart!
Congrats on your new hips! Since you're only 9 weeks post op with your latest
you may find some of the articles in the Recovery Guidelines will still apply. Please take the time to read them.

I'm sorry but I am unable to answer your question regarding the cerclage wire. Possibly some will stop by who've experienced the same. The forum Nurse, @Josephine will also be familiar given her 50+ yrs experience in Orthopedics. I've tagged her but she's in the U.K. so there is a time difference.
Check back and enjoy the rest of the week!
 
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@BionicButt
Please leave the surgery dates (month, date, year) of each surgery to be added as your signature. Thanks you.


Hip Recovery: The Guidelines

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)​
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key

Post op blues is a reality - be prepared for it

Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each, member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
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Hi, Very interested to hear how you get on with the removal, can you update this when you have the removal done in October? I have a cerclage cable due to a femur crack caused by hip replacement surgery, at the 6 week check it was obvious something was wrong and the stem had slipped slightly due to the crack, I couldn't put any weight on the leg either. So week 7 I was back in for a revision which included a new stem, bone cement and a cerclage.

It has been a long journey back which I mostly blamed on the bone crack and revision surgery, when I asked my surgeon if the cerclage was causing ongoing pain he said very unlikely and he wouldn't go back in there even if it was! Xrays are good, he said, kind of like pain is not important - different if he had the pain I thought. It has turned out he was probably correct.

Time has helped a lot along with plenty of walking and very very slowly building up strength and mileage. That leg is still a bit weak and it's been 15 months since the revision but I do think it will completely recover. I hadn't really thought to blame the cerclage for the slow recovery as revisions are slower but you have had a good comparison, so now I am wondering if I can blame the cerclage.

I have read stats that say every time they go back in the chance of infection increases quite a bit. I don't understand why the chances are greater but I assume that is why my surgeon was so vehemently opposed to doing that.

Interesting your surgeon has a different view point on this, gosh, they are all so different and I think you are lucky to have one that will go ahead and do this for you. Your recovery from the second op sounds remarkable. I am so jealous, but also pleased that such a quick recovery is possible.

My sister has hip dysplasia also and I have been concerned that it would be a long haul to recovery for her when she has her op, so your post is doubly valuable to me. I will be interested in how you get on and what Josephine has to say about it too. Good luck with it all :).
 
There was a time when the hip replacement surgery was routinely done using a trochanteric osteotomy - taking the trochanter off the femur to make the dislocation easier. This was fixed with a kind of parcel tie of wires to fix it back in place once the replacement was completed.

trochanteric osteotomy wiring.jpg

Trochanteric osteotomy
and wiring

It was the standard for many years. However there were issues with this procedure
a) it often took an hour or more to get the wires in place and correctly tied
b) the wire knots often caused problems with friction on the soft tissue and required removal
c) sometimes the osteotomy, having not be secured correctly, failed to heal and required further surgery to fix it​

So eventually this technique was dropped because of the pain issues, the non-unions and because of the amount of time of often added to the procedure to get the wires in place!
 
Hi @Josephine

Is this what has happened to myself, I have just had the wires removed and have none union. I updated my thread yesterday. Consultant hoping fibrous tissue will set down, but how strong would this be.
Kay
 
Sorry, I missed this earlier.

@Crisps your consultant has faulty reasoning. A situation like that is known as a fibrous pseudoarthrosis or fibrous false joint. It will never convert to a bony fusion because the 'joint' will always be subjected to micro movement caused by the pulling of the muscle attachments on the trochanter which will not be conducive to bone growth. The only remedy is to have the osteotomy opened up, the fibrous material scraped out and then fixed with some kind of internal fixation such as screws or wires. And also use of bone graft in some form.
 
Hi, this is a reply to Lyndam in New Zealand. Sorry, I have been off line due to a family hospitalization... I tried to send a personal message, but it didn't work, so I hope you get this reply. Yes, I will definitely update this thread when I have the cable removed, probably in October.

I also wanted to let you know that I have blogged extensively on my experience with hip dysplasia. This may be of help to your sister. My blog is non-commercial (no cookies) and all content is free and designed to help others. You will find it at "rhondaashurst.com." There is also a contact page where you can connect with me personally. Please tell her I'd be happy to email with her if she has questions I can answer. I'd also highly recommend checking out the International Hip Dysplasia site at: "hipdysplasia.org." And, of course, this site is also very helpful for hip issues in general.

I hope this helps.:)
 
Thank you BB, I look forward to reading your blog and checking out the hip dysphasia site you recommended, I didn't even think to look for a dysplasia site so much appreciate the information. How is your cerclage pain, any improvement?I must say I have been shocked at how slow my recovery has been but since 12-13 months post revision the improvement has suddenly taken off, and I have been slowly building up walking distance successfully, muscles are definitely returning to normal, bringing happiness as I love to walk for physical and mental health. With any luck maybe your cerclage problem will resolve before the op as well. I have recently come to the conclusion that orthopaedics are the super sloths of the medical world :heehee:, I suppose that is why we are called 'patients', certainly has pushed my patience to the limit!
I will PM you as well, I seem to recall my first PM didn't work either, when I tried again it did so don't let the first one put you off if you ever need to try again. Lyndam.
 
Hi Lyndam,

I'm happy to hear that your muscles are returning to normal and your walking distance is widening! One of the things that's been so hard for me, is the shrinking of my world due to my inability to walk longer distances. I went camping last week and didn't factor in that there is a lot of standing and stooping and walking just to set up and break down camp, let alone go for hikes. I overdid it and spent several days paying for it. I forget that I am still only 2 1/2 months out on my left hip and my right hip is not pulling its weight due to the cable... But "my girls" as I like to call them, are good teachers, always reminding me of my "Goldilock's Zone." I am determined to keep it in the Zone when we camp this weekend. At this point, I am not noticing any further improvement of my muscles around the cerclage cable. I am definitely planning to go forward with surgery to remove it in October. Even my massage therapist can feel the difference in the muscle tone between my two sides.

I think at this point, I'm going to leave this thread until I can post the result of my cable-removal surgery, so it will be part of this site. I will start a recovery thread, hopefully next week, that I'm thinking of titling "From Dysplastic to Bionic." I hope my site and story and the International Dysplasia Institute site will help your sister.
 
My hip adventures started about a decade ago (2007-8) with groin pain, especially when hiking downhill. I'd had a horse incident involving my groin, so I thought it was that. The pain wasn't bad at first and I tried all sorts of therapies and therapists to help me heal. By 2017, it was really impacting my life and I was getting desperate to find a solution. During a hike, a stone turned under my foot and a sharp pain shot through my hip, deep inside. At that moment, it dawned on me that something was wrong. I don't know why it took me so long, denial I guess, and I was only 51.

I scheduled an appointment with an orthopedic surgeon specializing in hips. He showed me my xrays and explained to me that I had congenital hip dysplasia in both hips. Previously, I thought this only happened to dogs! There was virtually nothing left of my right hip and my left hip was also deteriorating. He wanted to know what I was doing for pain and wasn't sure how I was walking. My pain wasn't that bad, except when I tried to walk for any distance or stand. I could still do a lot of yoga and Tai Chi, so it never occurred to me that my hips could be that bad.

I had my right hip replaced a little over 2 months later (September 20, 2017), finally coming to terms with the fact that I had to have it done if I wanted to walk and function at all. In fact, since the day I was born, it was always in the cards that I would have to have both my hips replaced. I remember being grateful for 51 good years on my "old girls" before they gave out. I was also thankful I never knew about the birth defect. I had lived a very active, adventurous life, oblivious of my weak hips.

My surgeon is young and specializes in non-invasive techniques and uses robotics to assist in his surgeries. He was able to get my leg length spot on (my right had always been about 1/4 inch shorter). But, there were signs of distress on my femur so he decided to put a cerclage cable around it to shore it up. The cable, I now know, was the cause of my longer and more painful recovery on the right side. My muscles are still not functioning normally and I have continuing pain at 11 months out. I am planning to have it removed in October, 2018.

I was told that my left hip would either go very quickly or would last longer as a result of replacing my right. At the 90-day mark, I was just getting back to walking a mile, when my left hip decided it was her turn! That was a very depressing and discouraging time. I still had so much pain and disability from the first replacement, it was agonizing to consider doing it again so soon. At that point, I thought it might have been my dysplasia that was causing the long and painful recovery. So, I fully expected to have the same problems with my left side. But, again I wasn't able to walk and sleeping was painful, so it was time to buck up and get it done.

My left hip was replaced on May 16, 2018. I must say that the recovery on this hip is miraculous by comparison to my right! I was walking without aids by the 4th day post-surgery. I did not have the pain and disability I'd had on the right. It was at that point I knew it was the cerclage cable that had caused the problems, and was still causing them. At this point, my left leg and hip is noticeably stronger than my right. I can run my hands down the muscles and feel the difference. My right side is literally atrophying. It feels like the muscles hit that cable and just give out. I must say it has improved a lot over the almost year since my first surgery, but it is still problematic and the two sides are definitely out of balance. I very much favor my right side.

I am currently at the 3-month mark after my last replacement and it felt like it was time to get on Bonesmart and tell my story. This site has been very helpful to me, along with the International Hip Dysplasia site. I have very actively blogged about my Hip Adventures at https://rhondaashurst.com. This is a non-commercial blog meant to help all my fellow hipsters out there. If you scroll down, you will see the Hip Adventures theme which has the whole story and I continue to update it regularly. You can also find my Hip Tips and my recovery videos and xrays on the Resources page on my site. All that being said, we are all unique and your journey through will be different than mine. Trust your own body to tell you what it needs. Best wishes on your journey! Please let me know if I can answer questions or be of help.

P.S. I also started a thread called: Has anyone had a cerclage cable removed? If you have any useful information or tips on this subject, please let me know. I will update that thread and this one once I have it removed, but I'd love to talk to someone who's had it done...
 
@BionicButt
You'll notice that I have merged your newest thread 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.
So please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we'll get it changed for you.
If you need an urgent response to a question, just tag a member of staff.
How to tag another member; how to answer when someone tags you

Here are the instructions on finding your thread, How can I find my threads and posts? . Many members bookmark their thread, so they can find it when they log on.
 
Hi Pumpkin,

Thank you for doing that. You chose the title I think best reflects my whole journey. Thank you for the tips.
 
Hi Rhonda,
I think you sent this to Lyndam by mistake, long time since anyone called me pumpkin :rotfl: .
No worries but you might want to resend to the real Pumpkin.
All the best, Lynda.
 
Sorry about that Lynda! And I just realized your name is actually Lynda, not Lyndam. How is your weekend walking going? I did two miles to the Hemlock Grove and back yesterday and feel good today. I think I'm going to try and do that once a week and maybe a mile another time and see how that feels.
 
ah yes, the m of lyndam is the first letter of my surname, it just became my 'user name'.
Well done you, 2 miles is over 3 km and 3 miles is nearly 5 km - you'll be doing the half marathon by next year :). I feel like I inspired you to try longer walks.
Absolutely right to build up very slowly though, as you know I have spent more than a year just doing the 2 to 5 km walks, which has been frustrating to say the least with several set backs over that time, so don't be scared to dial it down when needed and then back up when feeling better. I downloaded a schedule for the half marathon walk which I am adhering to loosely, it is a 3 month build up and I started at 4 months due to my hopeless muscles. Indeed this weekend I struggled and only managed a 8km walk, down from last weeks 10km so a bit disappointed with that, but I will keep doing my short km's this week and hope for better next weekend. Last week was a dead loss for me walking wise, I did none due to bad happenings here! We had an incident at home here whereby a burglar broke in while I was in the bathroom, must have thought the house was empty, I heard the doorbell and then the breaking glass, so I quickly washed my hands and as I got to the doorway to the hallway I heard big footsteps coming up the stairs 3 at a time. My mind was thinking why is my husband home? simultaneously big foot got to the top of the stairs and it wasn't hubby of course. His head turned towards me, he was about 2 of his giant strides away, five of my steps, and I just said as forcefully as I could, just go, just go now, quickly - and he paused, turned around and left, thank heavens. So then I dialled the emergency number and it was police cars and police dogs and helicopter tracking, but they didn't catch him, school was due out and we have one down the road a bit, so roads were busy, forensics came too but no finger prints of note.
Hubby and I went into security lock down mode, and of course the glass people came to replace the broken glass with super tough glass, but we are upgrading our alarm and installing a "Ring" doorbell, american made I believe, whereby you can answer the door bell from the smart phone where ever you are, out to dinner, on the boat, and in the bathroom as well. So we got a bit of a shake up and I hardly left the house last week thinking the bad guy might come back and take the stuff he was after the first time, luckily I work from home so was still doing my job, but it has taken a few days to lose the inner shakiness and we are still a bit wary. To be fair we have lived in this house for 24 years and never had any problem, so we had been a bit complacent with updating security, just thought we were safe, everything is getting a security scrutiny now!
Anyway, that was the reason I wasn't walking last week, too busy and too shook up, and I wonder if not walking all week is what made the longer walk more difficult this weekend, I just couldn't get my rhythym going and my muscles hurt and then my back hurt too, just not happy at all. Today I just did 2.5 km up to the vegetable shop and library and back, legs were fine, so might try for a 5 or 6 km walk mid week, weather forecast is awful so it will be weather dependent.
That's all from here, happy walking for both of us. Lynda.
 
Oh My! I'm sorry to hear about your break in, but so glad that he left with no harm done and nothing taken. That had to be so scary and likely will have you shaken for a bit. I know that when I'm shaken on some other level, I am not as strong physically too. I bet you will be back on schedule with your widening radius soon. Yes, I am inspired by you to keep widening mine as well, but also to continue respecting when it is too much. Sometimes, it is hard to figure the ups and downs of it isn't it?

Hope you have a more peaceful week:).
 
Thanks Rhonda, thank you for your kind words, just a little shaken up and yes, kindred spirits following a path to renewed vigour, thinking positive all the way.
Have a lovely day in the sun :) :-) (:.
 
Sending sunshine and peace your way on a lovely day here in Nevada. Never underestimate the strength of kindred spirits holding positive thoughts! We are getting stronger every day.
 
Those are lovely thoughts Rhonda, thank you, and yes the forecast is for sun today.
I didn't realise you are from Nevada, we visited there August 2016, loved it, amazing place, very peaceful and spiritual, I can see why you like the camping now, the photos are good but you don't get that 'feel' of the place from a photo. Pearl the camper looks good too, just like a little home on wheels. Funny question, but you don't worry about snakes out there? We don't have them so are always a little worried when out in the 'bush' overseas.
So that is amazing, as you have been to my little corner of the world and I have been to yours :). Not many Americans have been over here so you are a very intrepid traveller indeed. I must confess we have not seen very much of the south island, we are saving that one up for when we have had enough of air travel and will do a big road trip down there. It is hard when you have family overseas, the pull is always to see some more countries and pop in to see them as part of the holiday. Nice day here, good for a long walk!
 
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