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how long after hip pin removal

 

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Roadndirt

Jul 2, 10 15:33

Post #1 of 26 (6605 views)
how long after hip pin removal Quote | Reply

Want to see about getting 3 pins removed from 8 year old hip fracture.
MD said maybe 6 weeks to be able to run again, but could bike sooner.
Anyone have an firsthand info on this sort of timeframe?

I want to know so as I can fit it into competition schedule going forward.

Thanks.


SeattleTK

Jul 2, 10 15:55

Post #2 of 26 (6598 views)
Re: how long after hip pin removal [Roadndirt] [In reply to] Quote | Reply

I'm just curious why your having them removed. I have three myself from a femoral neck fracture that are a little over three years old. I'm hoping that I don't have future problems with them but wondering what your story that's resulting in removal is.


Thanks,
Travis


RCope

Jul 2, 10 15:56

Post #3 of 26 (6597 views)
Re: how long after hip pin removal [Roadndirt] [In reply to] Quote | Reply

I've been the remover many times but not the removee. 6 weeks is an accepted time frame for impact exercise after screw removal. And even then I would start very slowly to increase mileage and/or intensity. Don't underestimate the stress riser formed by removal of three screws placed close together at the subtrochanteric region.

Most hardware does not need to be removed, but there are a few cases where it may be helpful. For example, prominent screwheads after a femoral neck fracture settles can cause a bursa to form and subsequent irritation with exercise. Good luck, and be sure you have a good reason to consider screw removal. It is not always as easy and as minor as it sounds.


psycholist

Jul 2, 10 16:51

Post #4 of 26 (6582 views)
Re: how long after hip pin removal [Roadndirt] [In reply to] Quote | Reply

Yikes! I hope you don't really have to go that route. I've got three in the left hip. Been there since '02. No issues whatsoever, but my doc advised me not to run unless I wanted a hip replacement, so I've been just a cyclist.

Good luck. I'd be interested to hear what symptoms you're having that have brought you to this point and, if you go through with it, how it goes for you.

All the best,
Bob


johnpostmd

Jul 2, 10 17:26

Post #5 of 26 (6581 views)
Re: how long after hip pin removal [Roadndirt] [In reply to] Quote | Reply

When you talk about "pins" we're assuming the possibilities include cannulated screws, Knowles Pins, etc. They were like placed to stabilize the fracture, and for whatever reason, you and your physician have decided that this is the appropriate time for removal. You'll want to think about the wound and any potential healing or infection issues, and that once removed, the path where the screws were. Now, as noted by RCope, this part of the femur is a place where stress is handled in an uneven fashion. You'll want these holes to fill in with bone before really pushing it. We use 6 weeks as sort of a standard understanding that some might take less time, some more. Follow up xrays will not be helpful in making this determination. Follow your docs recommendations, don't be in a hurry, and you'll have a great outcome.

John Post, MD
Medical Director, Training Bible Coaching
@johnpostmd
http://www.johnpostmd.com
Dr. Post's Blog is a medical/injury resource for triathletes.


Roadndirt

Jul 3, 10 8:38

Post #6 of 26 (6556 views)
Re: how long after hip pin removal [SeattleTK] [In reply to] Quote | Reply

First I want to thank all who answered this post as it is good to have such informed and caring people on this forum. To the MDs especialy thankful as their opinion is much appreciated


to SeattleTK --


My pins have been in since 2002. Three cannulated Osteonics titanium pins. Although I cannot overtly feel them by touch, the XRs show the heads are above the bone. Recent XRs do not show anything amiss with the pins and no arthritis in the hip joint. I am 59, if that matters.
I have stopped sleeping on that hip that side to decrease aggravation of that area and subsequent pains. The hip pain is intermittent and may arrive/depart without reason, and suddenly. The most aggravating thing is pain now along the side of my right tibia just lateral to the bone at the mid portion of the tibialis anterior muscle. But it does not feel lke the muscle so much as a nerve. This also can result in a weakness of my lower leg. This was the main reason I recently saw ortho and am considering pin removal.
I was hoping the pin removal might eliminate the pain in the IT band where it rides over the pin heads and thus eliminate pain lower down also.
The entire right leg is a pain, what with lateral hip pain, the lower leg pan, and occasional groin and sub patella pain. All occurring on and off without explicit reason.
This past weekend I hiked about 3 hours on a trail and my leg hurt mildly the entire time. I tossed and turned half that night trying to be comfortable and then it went totally away.
The next morning I hiked a 14er here in Colorado with 5600 feet of elevation gain (and loss) 8:37 RT and no pain at all until I hit the last 1/2 mile on a more or less level trail, when my leg began to hurt. However, it only lasted for 5 minutes and then was gone.
It is this intermittent nature of the pain, especialy in the lower leg that makes me think it is aggravation of a nerve.
My ortho guy thinks the lower leg pain is R/T my back, but I have no back problems. I think it may be FAI (femoral acetabular impingment) but maybe not.

The intermittent nature of the pain can be illustrated by my runs in the 8 hrs of triathlon where on a different runs (6 total) it hurt and on others it did not. Pain on. Pain off. Reflects in my times on these runs.
It is this capricious nature of the pain that vexes me.
The funny thing is that there is NEVER any pain with biking.

I do not know if pin removal is the solution but since this has been going on for several years now and inhibits my lifestyle, I am willing to consider it.
I am even willing to consider hip resurfacing and have read forum posts here regarding that.

Yikes!


ncgirl

Jul 24, 12 20:46

Post #7 of 26 (5591 views)
Re: how long after hip pin removal [Roadndirt] [In reply to] Quote | Reply

I really enjoyed reading all of your posts! Here's why: I fell and suffered a mildly impacted right femoral neck fracture 3 years ago. I have been an amateur runner at best, never attempting to compete in a marathon. Luckily was in Boston when I had my accident so I was surrounded by the absolute best in medical care. Joint replacement specialist inserted 3 parallel cannulated stainless steel screws [Knowles pins]. It took me 4 1/2 months before the fracture was healed --- my surgeon kept me out of work for that length of time. Bursitis reared it's ugly head 1/2 way into that recovery. At one point, nurses and surgeon suggested pins may need to be removed. Quite honestly I was horrified of the thought because the recovery was taking so long, and I insisted on treatments for the bursitis. I fully recovered my range of motion, and seemed to have limited pain for about 1 year. I resumed exercising and a healthy lifestyle. A year ago, the bursitis became much worse and a regular problem despite a 3-5 day workout. New surgeon immediately recommended removal of pins. I opted for cortisone/steroid shots directly into joint and surrounding bursa -- receiving these over a period of one year. They only worked for about 2 weeks maximum and the pain of receiving the shots negated the relatively short benefits. I finally agreed to pin removal procedure on June 29th. I am now starting my 4th week of recovery -- I am on crutches at 1/3rd weight bearing, no driving. Pin removal was outpatient surgery and surgeon used the exact same scar location. At minimum, surgeon has put me on crutches for 6 weeks. I swam 20 laps in my pool today since I read that water exercise was good -- doing just 20 leg lifts doesn't seem like enough. I can tell that the majority of my pain is coming from surrounding tissue trauma. My hope is for a full recovery within 3 months and that I can "turn back the clock" to prior to hip fracture! Good luck to you all, I will come back here to happily read your updates and also post mine :-)


type 1 cyclist

Jun 9, 14 11:25

Post #8 of 26 (2102 views)
Re: how long after hip pin removal [psycholist] [In reply to] Quote | Reply

This forum has been a real encouragement for me. I am a type 1 diabetic. Have been from the age of 2 years old. I am now 51 years old and until April 28th 2014, I was still going strong. On that date, I struck a dog at 28 mph. I had just looked at my speedo. prior to the dog cutting me off. I went airborne and hit the pavement hard. 4 hoers later I was in surgery for a fractured femoral neck. The ball of the hip had been snapped off and was slightly displaced. I had 3 cannulated screws installed. I was concerned when I read that athletes having suffered displaced femoral neck fractures can almost never return to athletic level activity. I am still worried about this. I know that in this case, there is a 20% or so chance of bone mortality if blood flow can't be restored. Normally, the bone mortality rate is higher than that, but my surgeon feels that given my physical conditioning and "young age", hahaha, that my chances of restoring blood flow may be better. I understand that only time will tell.

I'm no 6 weeks post op. and hope to make a full recovery. I'd love to come back even stronger like some do after injuries. Has anyone on this forum suffered the same injury and returned to full athletic activity? If not, does anyone on this forum know of any cases where athletes suffering a displaced femoral neck fracture were able to return to full athletic activity? Road cycling is my sport of choice. I sure hope to be able to return to a sport I am passionate about.

Thanks in advance.


BionicMan

Jun 9, 14 12:23

Post #9 of 26 (2082 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

I'm sorry to hear of your troubles. Sounds like a brutal crash not to mention the lifetime of diabetes.

At 14 yo (1986) I was in a scaffolding accident. Snapped my right femoral neck, crushed one elbow and broke the other. Three 5.5 inch screws in the hip and six pins and screws in the crushed elbow. These were all subsequently removed within 10 years or so. I don't actually recall the reasons. Just surgeon's recommendations.

After the hip screw removal I played a lot of basketball, competitive racquetball, raced motocross and finally got into running. Got serious with running in 2008. Did a half marathon and full marathon. In early 2009 I had pain in my hip that wouldn't go away. X-rays showed no cartilage. Eventually a hip replacement was was done. I was 39 and was very young on the "elderly" floor in the hospital :) .

15 months off running but was able to bike and swim during that time. Eventually was able to run again using pain as guidance, as recommended by my OS.

2011 I did two HIMs and my first IM in 2012 at Louisville. I have had some setbacks from time to time with the hip but a few weeks of rest and strength focus always has fixed it.

In 2013 I did New Orleans 70.3 in 5:19. I've also done two half marathons in 1:30 and 1:31 in the last 10 months. Not fast times but not horrible for someone at 42 with an artificial hip.

I can't swim worth a damn or I'd be faster but that's not hip related.

My point is you are plenty young to recover and be competitive. Just listen to your body and pay attention when it hurts.


(This post was edited by BionicMan on Jun 9, 14 12:28)


type 1 cyclist

Jun 9, 14 14:06

Post #10 of 26 (2067 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

Thanks for the words of encouragement. It sure sounds like you are not one to let difficult situations hold you back. I like to think of myself as one who shares that willingness to deal with pain and follow instructions with someone like you.
You have done well, post op. I know many would be happy with the times you displayed even without having suffered your injuries. In 2005, I took a spill while on a 97 mile solo ride. I was on target to complete my solo ride in 4 hoers 45 minutes. That may sound slow but with my scoliosis, I can't ride in a tuck position, so I only use the drops in descents. The ride also had some very tough climbs. Long story short, while checking my heart rate and speed... I failed to notice a softball sized rock and struck it at about 25 mph. This threw me into the air and I hit the pavement hard in that situation as well.

I ended up with a compound fracture of the clavicle, a clean fracture of the scapula, and a broken rotator cup. When the surgeon saw the x-rays, he was positive that my injuries were caused by a motor cycle accident. He told me he had never seen that type of injury resulting from anything other than motorcycle accidents. He told me that the way my rotator cup had been fractured would have required a very hard impact. He then asked me how fast I was going, to which I replied. Only about 25 mph. To bring my long story to a close. I broke every bone that held the arm in place. My arm was dangling, so for that reason, I was unable to ride my bike back into town. Hahaha!

I ended up on the trainer in 1 1/2 weeks and after giving the bones 6 weeks to heal and after another month or so to bring my legs back into shape, I was back to nearly where I left off. I still had about 2 months of physical therapy remaining for the broken shoulder when I got back on my road bike, so reaching out to the brake levers was hard for a while.

I may have missed it in your reply so I would like to ask you this question. Was your femoral neck fracture a displaced fracture? Those are the ones that according to what I read, that very few can recover to a point allowing them return to full athletic ability. That displacement is the issue.


BionicMan

Jun 9, 14 15:56

Post #11 of 26 (2059 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

Mine was a displaced fracture. Complete separation.


type 1 cyclist

Jun 9, 14 16:07

Post #12 of 26 (2056 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

Thanks, Now I feel confident that I should make a complete comeback, so to speak.


type 1 cyclist

Jun 9, 14 16:10

Post #13 of 26 (2054 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

By the way. I love your user name.


type 1 cyclist

Jun 9, 14 16:32

Post #14 of 26 (2051 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

I sure hope they don't have to remove my screws. The ones in my hip that is. The ones in my head are already loose. At least that's what my family tells me. Hahaha. I guess removing the screws isn't usually required.

Did you ever find out if the blood flow had been restored to your femoral ball? If blood flow was not restored, that could be the reason for the cartilage having eroded away. I sure hope to be able to avoid a total hip replacement or even a ball replacement.

Anyway. Let's be positive. I am impressed with your recovery. I would consider it a real blessing to be able to recover as well as you have. I also would be proud to have been able to accomplish what you did after hip surgery. Thanks again for telling the story of your recovery. That was exactly what I needed to hear since we are both in the same boat when it comes to our injuries and desired activity level.


BionicMan

Jun 9, 14 17:45

Post #15 of 26 (2045 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

It's been 20 years since I had the screws removed and I don't remember all the details. I do remember that the outside ends were covered with bone that had to be removed before the screws could be backed out, so there was good bone activity at some point.

Arthritis had developed from the accident and that's what was responsible for the cartilage degeneration, as I understand it. I don't think there was a blood flow problem for the head. I wasn't to the point of AVN, though I think I was well on my way had I not got it looked at. I may not have the facts entirely correct but these are my understandings. Maybe an OS could comment.

A resurfacing (cup insert and resurface and cap the ball) is a good option if available. It's way less invasive than a full replacement. If you have good bone structure a resurfacing is a nice option.

Because of how young I was when I had my accident I had a leg length discrepancy, so a full replacement was done since they could effectively lengthen my leg with a longer stake into the femur. Now that I think about it, with screws it may be difficult for a resurfacing, because the cap has to be inserted into the neck and would need room that might be interfered with the screws. Depends on placement, I suppose.

If you want to be totally disturbed go to youtube and look for hip replacement. It is crazy what they do. <shudder>

Whatever happens, I wish you the best of luck. If you're patient with recovery you can definitely get back to a full active lifestyle.


type 1 cyclist

Jun 10, 14 7:37

Post #16 of 26 (2003 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

I know what you are saying about the youtube videos. I have viewed some of them. Thanks for your help and I hope you are still doing well.


type 1 cyclist

Jun 10, 14 7:44

Post #17 of 26 (2002 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

Say, do you recall feeling pinching sensations in the hip during your recovery?


BionicMan

Jun 10, 14 7:50

Post #18 of 26 (1999 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

I don't think so but I'm not totally following what you mean. Where exactly and what does it feel like?


type 1 cyclist

Jun 10, 14 8:13

Post #19 of 26 (1993 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

Kind of like pin pricks when I move it sometimes.


BionicMan

Jun 10, 14 8:17

Post #20 of 26 (1989 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

Hmmm. No, nothing like that. Most of my pain was more like a deep ache and that was mainly due to the muscles that were cut during the surgery. Yours almost sounds like a nerve getting pinched.


type 1 cyclist

Jun 10, 14 8:24

Post #21 of 26 (1987 views)
Re: how long after hip pin removal [BionicMan] [In reply to] Quote | Reply

It may be when I try to over extend it. I hope it isn't a pinched nerve, or worse.


(This post was edited by type 1 cyclist on Jun 10, 14 8:25)


postrom

Aug 27, 14 10:09

Post #22 of 26 (1040 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

I am (lucky?) enough to have broken both hips at the femoral head in two separate incidents 3 years apart, one on a group ride fall and one in a cross bike race fall (no comments, please on my riding ability!). The first one on the right (which happened in late August 2010) had three cannulated screws installed within 12 hours of the fall (less chance of avascular necrosis if the surgery is done within 12 hours). The recovery was excellent with 10 weeks of toe touch on crutches and lots of stationary biking until the snow came. The doc said I have borderline osteoporosis (I am now 60). I was able to train for and ski the Canadian Ski Marathon the following February (carried camping gear, slept out overnight and skied 160 kms in two days). The hip was not a problem. The screws on the right cause me no discomfort. The second happened on the left in September 2013. Same as the first, 3 cannulated screws. Recovery took longer (flexibility), but I am now fully biking again, average 300kms/week (with groovy hips pads). Just participated in the D2R2 in Massachusetts last weekend. In the xray, the screw heads on the left do protrude and cause me discomfort when sitting and driving (not cycling!). I assume they are irritating the illio-tibial band. So I am having the left screws removed in the shoulder season in late October (between cycling an nordic skiing). The doc says 5 weeks recovery. I do not run, so I am not concerned about impact. So to answer your question, you can fully get back to training, exercise and competition. Thanks to Canadian health care, the only cost I had was $45 for the ambulance in each case. Hope this helps and gives you hope!


(This post was edited by postrom on Aug 27, 14 10:10)


Andrew Coggan

Aug 27, 14 10:20

Post #23 of 26 (1033 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

type 1 cyclist wrote:
Has anyone on this forum suffered the same injury and returned to full athletic activity?

I crashed in a criterium and suffered a non-displaced femoral neck fracture when I was 30 y old (I'm now 55). I returned to competition after I had the hardware removed 1-1.5 y later, and had some of my best years after that. I also dabbled in duathlons for a couple of years, and was able to work up to running 6-7 h/wk and completed a 30 km race w/o any real problems (although some hints of hip joint pain suggested I shouldn't do more).

In short, all I really have to show for the experience are some bad memories, a nasty scar, a ~5% strength/power deficit on one side, and stories to tell. Here's hoping your long-term outcomes are comparable.


type 1 cyclist

Aug 27, 14 12:17

Post #24 of 26 (1019 views)
Re: how long after hip pin removal [Andrew Coggan] [In reply to] Quote | Reply

Thanks Andrew. I have been back on the trainer now for 5 weeks and my left thigh and calf (on the side where I fractured my hip), have grown back to nearly the same size as my other leg. my left thigh had atrophied down to 18" and I'm amazed that in a mere 5 weeks I've managed to gain most of my strength and circumference back in that leg. After 5 weeks on the trainer, my left thigh now measures 21" and the musculature has returned. Incidentally, my good leg measures 22" so I may have a little ways to go yet. My right thigh has always been a tad bigger than my left one anyway so I'm real close. Plenty of hill intervals and simulated fast group rides on my trainer may explain this. My surgeon told me that as a diabetic, the healing process should take longer and the prognosis may not be as good as with non diabetics with the same injury. He was speaking of a displaced femoral neck fracture such as mine. He and the nurses keep telling me that I'm doing extremely well considering the type of injury I had, even for a non diabetic. I can't help but think that being a cyclist for as long as I have and keeping my diabetes in check has a lot to do with that. The main reason I haven't gotten back on my real road bike thus far, is I need to replace the helmet which got cracked in my accident and my break levers which were ground down to where they are not safe. $50,000 in hospital bills... has put a damper on that for now.

I feel my first goal has been accomplished. I'm able to ride at 90% of my max hr. for several minutes at a time. I am also able to ride at a low cadence of 75 rpm. at 85% + of my max hr. for 12 to 15 minute intervals. If I'm able to get my heart working that hard at such a low cadence, it seems to me that that would require both legs to be in good working order. Those are the same heart rates I was experiencing prior to my accident. I'm still having a real hard time putting my left sock on however as I haven't regained my full flexibility in my left hip yet. That being said leads me to believe that regaining my flexibility should be my next goal.


As far as I know, there is no reason to remove the screws in my hip unless they cause pain. They do cause some discomfort but as a cyclist, if I can't put up with that, I wouldn't be a cyclist. The only possible future surgery regarding my fractured hip would only be necessary if down the road the femoral head dies due to a lack of blood flow. I'm told that there is always a risk of this taking place with this particular injury. It may never be a problem if the blood flow has been restored. Unfortunately, there is now way of knowing unless the worse case scenario takes place. If this does eventually end up being the case, I would have to have a total hip replacement. I guess that is the same uncertainty you have to live with as well. I guess we must remain positive and hope for the best, but be prepared for the worst. For now, I'm just glad that you and I are able to continue our athletic activity.

Thanks again Andrew.


Andrew Coggan

Aug 27, 14 12:34

Post #25 of 26 (1015 views)
Re: how long after hip pin removal [type 1 cyclist] [In reply to] Quote | Reply

First, glad to hear you're well on the road to recovery.

The orthopedic surgeons I consulted fell into two camps regarding hardware removal, which possibly reflected when they originally trained. Specifically, the older docs generally said take it out only if it bothers you, whereas the younger dogs favored removal regardless (arguing that the long-term effects of metal implants was not really known). Another consideration (since I wanted to return to racing) was what might happen in event of another hard crash...with the hardware in place, the bone could very well fragment into numerous pieces/in odd ways that would be difficult to reassemble. I therefore opted for the 2nd surgery, and decided w/in just a day or two that it was the right move (because I had been in chronic, low-grade pain that was now gone).

Two other tid-bits I picked up along the way:

1) loss of flexibility (due to impingement) in the hip joint is pretty common (e.g., I can't cross my injured leg across my non-injured one w/o having my knee well up in the air); and

2) low back problems are also not uncommon (esp. if your leg is now shorter and/or your gait doesn't return to normal...fortunately, I had a friend who was a PT who would eyeball how I walked whenever we crossed paths at a confrerence).

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