THR teenager hip replacement after SUFE

[Josephine]

Depends what revision you're talking about. There's no point in 'revising' the fixation as it will only involve leaving yet more hardware in her bone. And the hip replacement is not on for a while yet.

I also said this about the hardware.

However, the screws in the plate do as they make a weakening of the shaft and also provide holes for the cement to ooze out of during surgery! All in all, I would recommend the staging and get those screws out so the hip surgeon has a solid femur to work with.

 

[Maya'sdad]

thanks Josephine, the current surgeon recommends a revision as I stated in a previous post. He still feels the best option is to remove all the hardware and revise new screws through the fracture site while leaving out the plate and screws in Maya's femur. If the plate and screws have to come out before a THR can be accomplished, would it make sense to revise the fracture site in hopes that we may (emphasis on may) not end up needing the THR?

 

[Josephine]

If the plate and screws have to come out before a THR can be accomplished, would it make sense to revise the fracture site

Yes, you're right, actually - there needs to be something that will provide some stability to the fracture site.

in hopes that we may not end up needing the THR

I think you should resign yourself to the fact that the THR will be inevitable as the damage in the acetabulum is excessive and will not improve.

 

[Maya'sdad]

Agreed. I realize that a THR is inevitable. However, If the hardware has to removed regardless, a revision might at least buy us a couple of years to allow Maya's skeletal growth to take place? The question is, what state would Maya be in for those two years? Would she be able to walk relatively pain free? Again, I profess my ignorance on this matter, but simply trying to make the best decision possible for Maya with as few surgeries as possible.
You've been so very helpful Josephine. Thank you kindly.
God Bless!

 

[Josephine]

If the hardware has to removed regardless, a revision might at least buy us a couple of years to allow Maya's skeletal growth to take place?

Absolutely!

The question is, what state would Maya be in for those two years? Would she be able to walk relatively pain free?

Well, that's the $20,000 question, my friend! No-one can tell you that. She might and she might not. I'm afraid you'll only know that when the time comes.

Again, I profess my ignorance on this matter, but simply trying to make the best decision possible for Maya with as few surgeries as possible.

I understand completely and that this must be a real nightmare. The responsibility for all this must weigh heavily on you. Obviously you want the best for your dear daughter. I wish I could be more explicit and positive about it all but it really is unknown territory. The only statement of certainty about trauma cases is that each one is totally unique.

However, for what it's worth and were it my daughter, I'd go for having the existing metalware removed and an attempt made to stabilise the fracture with another screw and see how things pan out. If she can get about relatively pain free, that will be great but if not - and this depends how well she can get about - you will just have to take it a period at a time and keep an open mind about what to do next and when.

I'd also expect the surgery to remove said metalware to be relatively uncomplicated with a reasonable recovery.
(notice how I'm treading on eggshells here!) But do keep me posted and if you have any more questions, concerns or puzzling things, I'll be more than delighted to do what I can. God bless you both.

 

[Maya'sdad]

Thank you Josephine. This does help a lot.
We have the appt with the hip replacement specialist a week from today and should have a clearer picture at that point.
Updates to follow.
Much obliged to all.
God Bless.

 

[Maya'sdad]

We just got a reply from Maya's surgeon. Here's what he had to say...

..."Hello everyone.

Dr. XXXXX and I were able to discuss and review Maya's case.

First, Dr XXXXXX would be happy to meet Maya and everyone. I know though that his January schedule is quite full as he was away from some time.
We will continue to see what we can do about moving up an appointment.

He agreed with the different treatment options at this point:
- removal of existing hardware
- consideration for revision screw fixation to stabilize femoral neck fracture
- consideration for total hip replacement

He did not think that a total hip replacement would have to be staged and thought it would be possible to perform a total hip replacement after the plate and screws hardware were removed (in the same surgery).

I would be happy to see Maya soon - especially if her condition is deteriorating. And can let you know if we've made any progress moving up Maya's appointment with Dr XXXXXX."

Guess we will learn more when we meet Dr XXX next week.

 

[Josephine]

That's fantastic! Thank you so much for sharing it. You must be one relieved daddy!

 

[Maya'sdad]

Yes, we will know more on Wednesday. I would be truly happy if she did not need another surgery at all, but is spite of our situation, it appears to be positive news. I will keep you posted on developments.
Thank you very much Josephine : ]

 

[Maya'sdad]

Hi Josephine,
Update!
We met last Wednesday with Maya's previous surgeon (osteotomy) and the hip replacement specialist. The recommendation was to go ahead and do a THR. The replacement specialist pointed out that the cartilage in her affected hip is already compromised and the fact that the two previous surgeries have failed. They can do the removal of the plate/screws and THR in the same surgery. Obviously there are a few risks and concerns. Mainly fracturing the femur while inserting the implant, dislocation and infection. All precautions will be taken, but these three things scare the bejeezus out of me. We were told that the risk of infection is somewhere between .5-1%. Although rare, I am still really concerned about this. We are planning to have blood tests done prior to the surgery and start antibiotics.
Despite my fears, the prospect of seeing Maya back on her feet and walking appears to be worth the risk. The surgery is scheduled for February 26. Most likely Maya will need to wear a brace to minimize dislocation and will be non weight bearing for 4-6 weeks if all goes well.
Any suggestions or recommendations in the meantime?
This poor child has not been able to walk for nearly 9 months so we're hopeful and looking forward to having this entire ordeal behind us. At least, for 10 years!
Thank you in advance.
God Bless!

 

[Josephine]

Well, my initial reaction is !!

Obviously there are a few risks and concerns. Mainly fracturing the femur while inserting the implant, dislocation and infection. All precautions will be taken, but these three things scare the bejeezus out of me.

Don't get too bent out of shape about this. These are the risks that apply to absolutely everyone who has any kind of surgery and the surgeons are legally obliged to tell you about them as part of the consent procedure. But it doesn't mean they are particularly worried about them because they face these issues with every patient they bring to the table. If Maya was 350lbs and 70yrs old, yes I'd say there was a bit of a higher risk but she's such a tiny thing, she'll breeze through it, of that I have no doubt!. And being the age she is, where they take out the screws, she'll create new bone in there in no time.

Have you got a surgery date yet?

 

[Shazzstars]

@Maya'sdad I know you are going through such an ordeal with your daughter and at such a young age.

I thought I would say I had screws and plate removed and THR done at the same time. Your daughter will get through this well, I have had a longer recovery than most Hippies here as the holes from the old parts in my hip need to repair naturally so I'm still getting around on crutches, basically I'm on crutches for 3mths. The movement is improving and no limping, I really wish you and your daughter all the best.

 

[Maya'sdad]

Thank you so very much Josephine and Shazzstars! I truly appreciate the vote of confidence. I realize it's just me being a worried dad, but at this point having gone through everything we've gone through, I suppose I'm a bit jaded.
It means a lot to get some positive feedback. Thank you. Maya's surgery is scheduled for February 26th. In the meantime I will be saying a lot of prayers!
Thank you all for sharing your experiences and passing along such useful information.
Best of luck with your recovery Shazzstars! I will include you in my prayers!

 

[HipSurprise]

I have insulin dependent Diabetes and didn't have any trouble with infection - and I wasn't put on antibiotics at all!! I'm glad Maya will be getting the screws and such taken out and getting a THR. Blessings to Maya for a successful surgery and to you for calming your nerves.

 

[Maya'sdad]

Thank you HipSurprise!
Glad to hear all went well for you.
God Bless!

 

[Josephine]

Maya's surgery is scheduled for February 26th. In the meantime I will be saying a lot of prayers!

So will I and, I would imagine, so will several others!

 

[Maya'sdad]

Thank you kindly. We appreciate any and all prayers for Maya. The hip replacement specialist, Dr Allison suggested a titanium/alloy/ceramic implant. From what I have read, these are very reliable?

 

[Josephine]

All materials are reliable as are all mixes of them because they've all been around for decades, tried and tested.
You've no cause for concern on that score, my friend.

 

[Toddlermom]

Maya's dad....so glad to have you guys in the February crew! Mine is in a week, and I will be watching out for you both.....my toddler's name is Maya.

 

[Maya'sdad]

Hello again Josephine, we are inching closer to Maya's THR on Feb 26.
The surgeon has recommended the following implants and was wondering if you are familiar with any of them or have a recommendation as to alloy on polyethelene, metal on metal, ceramic on ceramic or a combination?
" I am still finalizing the final implant, but the Biomet Echo Bimetric or Arcos modular femoral stem are at the top of the list. Both implants have been on the market for over a decade and have excellent survivorship. Using the Ortho Development Tribute femoral stem is also a possibility, it is a relatively new implant (a slight modification of a very proven design), but fits pediatric bone vey well. I will likely have all options available."
As always, thank you in advance.
You have been so helpful. God Bless!!