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Slowtwitch Forums: Triathlon Forum:
how long after hip pin removal

 

   


Roadndirt

Jul 2, 10 15:33

Post #1 of 21 (5507 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 21 (5501 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 21 (5500 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 21 (5485 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 21 (5484 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 21 (5459 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 21 (4494 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 21 (1005 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 21 (985 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 21 (970 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 21 (962 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 21 (959 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 21 (957 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 21 (954 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 21 (948 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 21 (906 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 21 (905 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 21 (902 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 21 (896 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 21 (892 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 21 (890 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)

   
 
 
 



Ironman run shoe weight
When you race an Ironman, what weight class do you think is most appropriate for you? A sub-6-ounce shoe is a pure racing flat. A 7.5 - 8oz shoe would be a Saucony Kinvara or Hoka Clifton. A 10-11oz shoe is a lightweight trainer.
5.5-6.0oz
7.5-8.0oz
9.5-11.0oz
12oz+
I never thought about it
I don't do 140.6
I'm boycotting this poll