Broken Hip Chronicle
This chronicle is being written and kept current for anyone who has or is supporting someone who has a broken hip. I learned some key lessons at a price higher that I hope you will pay. If you get just one thing out of reading this my writing has been worthwhile. For reference I am male, 59 years old, 6' 2" tall and about 250 pounds. Young and big in the general populace of hip patients.
Day 1 Gravity - Broken Hip
Craaack! That sound of a well-struck baseball headed out of the park told me my life was in for change. There had been no sense of falling, only the jarring collision of my hip and the ice covered stone step at 4:20 PM on December 15, 2005. Rolling onto the driveway I took inventory hoping to brush it off and move on but the sickening sound had said it all. My left side hurt, I couldn’t move my leg and realized quickly that I didn’t want to. Fortunately it seemed that the nerves and blood vessels that route through the hip and groin were intact. I'd heard of people dying quickly from hip injuries. As the cold sleet filled my left ear I wondered how long it would take for someone to find me.
The next half hour gave me a chance to take stock. I certainly wasn’t moving to the nearby back door to let people know I was hurt. My shouts seemed faint even to me. The constant patter of falling water and ice on ice was louder at ground level. I had time to decide that I was going to have a good attitude. I knew even then that my new job was one of recovery and it was probably going to be a long hard task that could only benefit from my looking at it in a positive way. I didn’t yet know how right I was on my journey to learning how to walk again.
I’ll have to admit that I have scoffed when hearing stories of public figures explaining away their drug addictions as having started with treatment for a bad back or some other painful condition. Just quit when the pain’s gone. Right? Right!
By the time the rescue crew slid me onto a backboard some 40 minutes later (still on my side because I refused to move my leg), loaded me onto the ambulance and made the seemingly never-ending journey to the hospital, I was hurting. The ER was busy not in the least due to the ice storm but the staff took good care of me and, thank God, my wife Kate was already there. “On a scale of 1 to 10 with 10 being the most unbearable pain you can imagine how do you feel?” the nurse asked. “Seven or eight,” I said. The morphine went straight into my IV line and I felt better.
The doctor said that they would be taking me to X-ray shortly to make the diagnosis. Kate and I spent the next half hour slowly rolling me from my side to flat on my back. I knew they’d need me flat to get their pictures. We had just finished when the X-ray technicians came to get me. “I think my hip is broken,” I said. “We need a chest x-ray. Can you stand over here?” he asked pointing to a machine on the wall. “I think my hip is broken,” I said. “Well. Can you sit up straight?” he asked. I’ll save the rest of the story for another time but just let me say that I did not accept their offer to refuse the diagnostic exam but, for the record while I did cry out in pain as they shoved me around like a slab of meat, I did not cry even at level 9.
“Your hip is broken,” the ER doctor said “They are probably going to have to do a total hip replacement. You’ll be recovered in six to nine months and will probably walk with a limp.”
When the orthopedic surgeon that my personal physician referred arrived and reviewed the X-rays he said they could put in a six inch pin through a small incision and everything would be okay. The diagnosis was an unstable intertrochanteric hip fracture (the head of the femur was broken off and the large bone area between it and the shaft of the femur was in several pieces). Most fractures involve only a single break at the head. Surgery would only take about half an hour tomorrow at about 4:20 PM. I would probably walk with a limp and have arthritis in the joint.
Day 2 Broken Hip Repair Surgery
The doctors told Kate that the procedure went well but the break was far more extensive than previously thought. Surgery lasted almost 2 hours. The fracture was about as bad as they get so to stabilize it they put a rod in from just above my knee to the top of my femur and threaded a screw through a hole in the top of the pin into the ball. This worked to lock most of the pieces together. The six inch pin that had been planned turned out to be closer to 17.3 inches.
They held me in recovery until about 8:30 PM trying to find the right combination of narcotics to manage my pain. Then it was off to the hospital room and my morphine pump to moderate the pain on my own.
The x-ray to the right is not mine but it is an example of the repair hardware. My break had about 5 major pieces. The example in this x-ray has two pieces…a typical simple break in the intertrochanteric region.
Days 3-4 First Steps to Recovery from my broken hip
Every, and I do mean every, part of my groin and left leg were swollen and/or black and blue. I was quite concerned when I discovered this. I know I’m past child bearing age but 59 years of being male still leaves one with some sense of ownership. The nurses and doctors told me that significant hemorrhaging was an expected part of this procedure and that I would be okay.
Most of this time went by in a blur. I think that was one side-effect of the pain killers. Thank goodness for family and friends who visited and called. But I must say I was not a good visit. I was so out of it I couldn’t even watch TV. Reading was out of the question. It was a matter of getting by. A physical therapist came by twice to evaluate my condition and show me how to use a walker. I made it 12 feet from the bed and back. I was quite proud of the feat. I was prohibited from putting weight on my left leg (“Imagine a raw egg under the tips of your toes, I was told. Now, don’t break it.”). They sat me up in a chair once a day trying to prevent pneumonia and reduce clotting. I was okay for about an hour until the drugs no longer held the pain in check.
I have a hint for you. If/when they take a urinary catheter out, be absolutely sure to take a deep breath in before and then breathe out steadily during the withdrawal. I asked the nurse what to do and that was some great advice. I hesitate to think what would have happened if I hadn’t asked.
On the evening of day 4 I was transferred to an in-residence rehabilitation facility. It was a wing of a care facility I had evaluated for long term care for my father who was there for a short time, five years ago, before he died. I considered it a good choice.
Days 5-9 Residential Rehab for my broken hip
I arrived at the facility about 7PM some 5 hours after the scheduled time. My pain medications had worn off twice. Once while waiting for the wheelchair transport van and then again in transit. I was not a happy camper when the intake nurses asked me to stand up and step up onto a sc
Then I had to start the negotiations with the staff because the staff doctor had prescribed only one pain medication for me. I described what my pain control regimen had been in the hospital but they said that they couldn’t (wouldn’t?) give me morphine and the other IV drug (?) I was on. To make a long story short, I finally was given a four hour alternating regimen of hydromorphone (Dilaudid®) and oxycodone (Percocet®) because neither alone would suffice. Despite one dose of something every two hours I was still hurting about half the time. They couldn’t give me any more because I was on the maximum doses. Yes, that meant that I was “awake” to have medications every 2 hours for the duration.
I didn’t know what was going on but I went into morphine withdrawal that night and it continued for several days. Cold sweats, anxiousness, and dry mouth were my constant companions. The only saving grace was that the replacement narcotics helped dim the discomfort somewhat.
This pain management allowed me to lie on my back with my legs slightly raised for 21 to 22 hours a day. I timed my medications as best I could so I could tolerate rehab twice a day for about an hour each session. The nurses would bring the pills down to rehab for me when needed. The doctors and therapists told me that pain management was critical to my recovery. I needed to be able to tolerate physical therapy. I didn’t need much encouragement; I just wanted a bearable level of pain. Little did I know that I would not be pain free for many more months.
Physical therapy was great. The therapists were professional and I could actually see that I was making progress. I must say that those one pound weights they kept adding were missing a decimal point or two. Lying flat on my back I could not lift my left leg even after two weeks. I asked a therapist to check to see what was going on and was relieved to hear that she at least detected that the muscles were trying to work. I couldn’t tell. It weighed a million pounds to me.
We did take Christmas day off from rehab. My regular nurses took the day off too and the replacement couldn’t be bothered to give me my medications on time. I missed timing on two doses and was in agony (up to level 8
My wife and son joined me for a "hospital" dinner in my room and that was my Christmas. It actually was as pleasant as it could be since the meds had finally started to work again and I was back down to my usual level 3 to 7 range.
If Christmas was the low point of rehab, the high point came on my discharge day when one of the patient care assistants came to work early that morning to give me a shower…my first in 14 days. The staples had been removed a couple of days before after the wounds had healed. I was no longer leaking fluids so I was now cleared to get cleaned up. I’m sure it was not a pretty site. Images of naked bodies, fire hoses and tiled rooms came to mind. I had checked my modesty at the emergency room door and had to laugh rather than cry. The shower was marvelous. I knew it would be and I woke up at 4AM so I’d be ready at 6.
Days 14-25 Going Home
On day 14 (December 29th), nine days after entering rehab, they decided I was well enough to go home. I could “walk” almost 100 feet round trip with the walker and could “stand” for up to 16 minutes using my arms for balance and some support. I was ready.
They wheeled me out the front door and I slid straight-legged across the back seat of the car on a plastic garbage bag under my butt. I was heading home.
A rental hospital bed had been delivered and set up in the downstairs TV room of our tri-level home. An elevated commode seat had been set up and I could actually make it the 20 feet or so to the bathroom with my walker. The three steps up to the first floor seemed insurmountable and the additional nine to the top floor made Everest look wimpy. Those summits would come later.
A few days after getting home a physical therapist came to evaluate and give me some exercises. She gave me a routine of isometric exercises, leg movement exercises and weight bearing exercises to do twice a day. I did them faithfully.
A few days later another therapist came to follow up and told me I was doing everything great. He did correct my “walk.” He suggested that I stop tip-toeing with my left leg as I had been shown in rehab and that I use the proper heal to toe movement even though I was not putting much weight on it. That move to a proper walking gait saved me much trouble in later therapy as I did not have to correct a “bad habit.” He also showed me how to crawl up stairs. You have no idea how thrilled I was to crawl up stairs for the glory of taking a four minute shower (January 4th at 1 PM I reached the summit.). It was great even though I was exhausted and covered in sweat by the time I made it out of the bathroom to collapse onto the bed.
I didn’t have as many narcotics available to me now so I applied ice packs often and just lay there on my back gritting my teeth through level 3 to 6 pain. Someone had jabbed a big screwdriver into my hip and was twisting it 24 hours a day. I measured time all day and all night in two to three hour increments as I waited for the last pill to kick in or the next pill to come.
I had been sent home from rehab with what remained of my Percocet (oxycodone 5/325mg) and Dilaudid (hydromorphone 2mg) pain medication prescriptions. The rehab staff told me I was now in the hands of my surgeon and to contact him for medications to carry me through when these ran out. My surgeon told me that he would not refill either of those prescriptions and told me to get off them and transition to Lortab® (hydrocodone 10/500mg). I started that on day 25.
Day 25-33 Withdrawal
I ran out of Percocet on day 25 and Dilaudid on day 30. The doctor told me that the Lortab® replacement would help manage the discomfort of withdrawal. I suppose it helped but I spent these 8 days and nights saturated in cold sweats and with a mouth so dry it would sometimes crack to move it. I was anxious and agitated. I had a whole new set of symptoms to go along with those of my fractured hip.
On a good day I’d do my exercises 3 times to try to make up for those zero days.
I still could not read with much comprehension. Between the side effects of the narcotics, the lack of sleep, and my general discomfort the best I could do was some mindless TV and a scan of the newspaper headlines. I normally read 2 books and 5 or more magazines a week in addition to the newspaper so I was in “literary withdrawal” as well.
Day 34-45 Marking Time
I saw my surgeon for the first post-surgery follow-up on day 35. He said that things were progressing okay and said that I could combine Ibuprofen with the Lortab® to help manage the pain. He would not give me anything else. He released me for out-patient physical therapy to start in a couple of weeks. I was to keep the toe-touch weight-bearing limitation until I started therapy and then I was released for full weight bearing. This seemed optimistic to me but it sounded good. I was emotionally ready to get off the walker.
At this point the x-rays looked fuzzy and I saw the four inch splinter (the entire lesser trochanter) hanging free on the inside of my thigh about a half inch away from the mass held together by all the titanium hardware. That, the doctor said, would take care of itself. It would have been too much trouble to lasso (his word) it with cables and draw it into the rest of the bone structure. The risk/reward equation did not warrant the effort. He checked my leg length and said that they were both about the same. He would prescribe shoe lifts after recovery if needed. This struck me as odd but I didn’t ask why. I was just relieved to know that my bones had been “fixed” to the proper length.
I asked if there was anything I should know and if there was anything I could do to assist in my recovery. The doctor’s advice was to continue with the home exercises and engage in the out-patient therapy. He had confidence that the therapist could guide me along the recovery process.
What you need to know if you have a repair similar to mine: What I didn’t learn until two months later was how my hip hardware worked and that really cost me a lot of pain. My mistake was that I hadn’t asked the right question to get my doctor to divulge the secret. Here are some better questions: “What happens if I put too much weight on my leg? Or How does this repair hardware work? Show me.” The secret is that the screw that is fixed into the ball of the bone (that shorter downward angled piece) slides through a hole near the top of the pin in the shaft of the bone (the longer vertical rod). That screw and pin are free to move. Every time you put weight on your leg they can shift to some degree. In my case the bone was is so many pieces and so unstable that any weight bearing shifted the bone and the metal and led to pain. A couple of times when I pushed the limits in therapy I was in absolute agony. The challenge is to find the right balance of weight bearing and healing progress. Weight bearing is absolutely essential to the healing process not just for the bone structure but also for the muscles, the cartilage, and the overall system. Talk to your doctors and therapists about this. Ultimately my recovery was lengthened because I was afraid to do the weight bearing exercises to the level that I probably should have earlier on in the process.
When I did discuss this with the doctor, he told me that often patients will end up with the affected leg being significantly shorter because of bone collapse with movement of the hardware. Geriatric patients who lack the arm strength to support themselves on the walkers can lose an inch and a half of leg length. This obviously can lead to issues for the rest of one’s life.
Day 46 - 70 Therapy – From walker to crutches
On day 46 (Monday, January 30th) I started out-patient physical therapy. I was absolutely thrilled to be there. I now had some hope that I might be able to walk again.
My primary therapist turned out to be excellent. He did a thorough evaluation and explained everything that he found. He told me what exercises to do, exactly how to do them and what they would do for me. Further he told me what reaction I might expect after this new exertion. I complimented him on his professional skills and his ability (and willingness) to communicate so thoroughly.
As might be expected after almost 7 weeks of very little physical activity I was pretty weak overall. My left leg was extremely weak. I could barely lift its weight alone. The exercises were designed to build strength and increase weight bearing tolerance. The weight bearing exercises started with about 14% of my total body weight.
At session three on day 50 I felt great and put a little extra weight on my left leg. Big mistake! The pin and rod shifted and I spent the next four days lying down trying to diminish the pain. You see I didn’t know yet how the repair hardware worked. I was not aware that the metal and bones could shift. I thought the hardware was locking the bone into position. I’ll admit that I took an extra Lortab® each day for 8 days to get through it. Yes, I exceeded the prescribed dose by a little but I could not tolerate the pain otherwise. When I stopped the extra pill I went into withdrawal again for a couple of days.
My therapist told me that such setbacks were to be expected and he encouraged me to work through it. I did.
On day 60 after three sessions of therapy we took out the raised commode. I could actually tolerate the lower seat and had enough strength to raise and lower myself with the aid of the walker. I started reading again and devoured one book every two days. I had a lot of time and it was a great distraction from the discomfort.
I could now actually sit upright in a chair for 20 to 30 minutes at a time up to twice a day. Until now it was mostly the hospital bed all day and a bit of time in the Lazy Boy® recliner after about 60 days. Kate and I played cards when I could sit up. It took days to complete a single game. She clobbered me in Rook game after game but I won a few games of Crowns that took less brainpower.
On day 70 after nine sessions of therapy over three weeks, I graduated from the walker to two crutches. I was never so happy in my life to be on crutches as I was that Thursday, February 23rd. I could now navigate the stairs upright (no more crawling) and didn’t need someone to carry my walker. It was thrilling.
Therapy had increased my weight tolerance to the point where I could momentarily handle up to 66% of my body weight on my left leg. I determined that by standing with my left leg on a scale and my right on a phone book next to the scale. I let it balance out and read the weight. One hundred sixty five pounds out of a total weight of 250 equals 66%. I thought this was great progress.
My second follow up with my surgeon came on day 63 (9 weeks). The bones were healing but they were far from being fused. He told me to come back in another 4 weeks.
Day 70 - 98 Detox!
It was time to get the monkey off my back. I decided that graduating to crutches would be the sign that my recovery had reached a point where the underlying pain was sufficiently diminished that non-narcotic medications would work. Well, you don’t know until you try. I was tired of being mentally impaired by the narcotics (Lortab® - hydrocodone). My favorite hobby is thinking and I was being denied that fun.
The details of my detoxification process are covered elsewhere on the website. The process was difficult enough that I really feel that my experience is worth sharing in detail. I had been stunned when my physical therapist told me that he thought that up to three quarters of his patients were “dependent” on narcotics to one extent or another. He agreed that there was little support available for getting off the drugs.
Using my personal doctor’s advice and support I worked up a plan to wean myself off the drugs over a two week period. In the end it took 24 days because I had to plateau twice to manage the pain. I continued physical therapy as best I could by stretching out the time between sessions as necessary.
I was in withdrawal to some extent for the full 24 days that it took to go from 40 milligrams per day of Lortab® to zero and then another 5 days of significant discomfort. Imagine having a full-time hangover and the flu for 5 weeks straight and you will approximate how I felt for much of the time during withdrawal. This said, the withdrawal (detox) was absolutely the right thing to do. While these drugs were a vital part of my healing process and recovery, I could not tolerate the negative impact of the drugs any more. It was a full 14 days after my last dose that I felt whole again. It’s no wonder that both doctors and patients are scared to death of narcotics. They are truly an absolute blessing and a terrible bane. Drugs: 69 days on and 38 days to get off!
Day 99 – 111 New Normal
The night of day 99 (Friday, February 24th) I slept upstairs in the master bedroom for the first time in 99 days. I could navigate the stairs. I could sleep without needing the elevations of the hospital
I did my best to carry on a normal life. Kate and I went to a nearby restaurant for a quick lunch and I actually lasted the 45 minutes of sitting upright. I had been driving on my own for a few weeks since I started getting off the narcotics so I’d drive the 4 miles to the Lowes or Home Depot and make a circuit of the store with my crutches (two and then one) to get some exercise. There’s nothing like the smell of new hardware to make a man feel better.
I had my 16th outpatient physical therapy session on day 102. For the first time I did weight bearing exercises at 29% of full body weight on my left leg. It felt great until I got home. It was very had not to reach for the narcotics but I had too much invested in getting off them to go back.
Day 112 – Light at the end of the tunnel?
I put my crutches in the corner and took my cane for a spin. Freedom on a stick. My first excursion was to a local gym where I signed on for a 3 month test run. The trainer accommodated my limitations and helped me design a program to strengthen my mid-section (core) and upper body. I have been going to the gym twice a week and continuing physical therapy once a week. I can tolerate about 80% of my body weight on my left leg for short periods so the cane is carrying the difference. I try to walk unassisted but it is very painful and ungainly for even one step.
I stopped keeping a detailed log of my every pill and symptom on the 115th day. I stopped measuring time all day and all night in increments as I waited for the last pill to kick in or the next pill to come.
That was a sign of recovery for me. Now I just make a note on the calendar when I have therapy, gym sessions, and doctors’ appointments.
My third post-operative follow up with my surgeon came on May 1st (Day 137). Finally the bone was substantially healed. Even that errant 4 inch splinter was starting to fuse with the rest of the femur. Six weeks before the doctor had told me to start walking at home with no crutches or cane. I challenged him saying that I was still not able to do that without real pain. He told me that every person’s recovery is different. My hard bones had taken longer to heal than the softer bones of a typical hip patient (typically geriatric). We were both pleased with the progress to date. Whether it was fast or slow, it was still great progress. He did diagnose that the ongoing pain on the outside of my thigh was bursitis. He recommended anti-inflammatory drugs like Ibuprofen or Motrin but I reminded him that I was still under treatment for the stomach problems caused by the Ibuprofen I had taken while on Lortab®. The narcotic had masked the pain of the irritation while it developed into an ulceration. So I am still treating with Tylenol and have added ice packs two to four times a day. The ice is helping.
Day 136 + Getting better
I have felt well enough to have confidence that my hip joint is going to heal. My weight tolerance is up to 90% with my cane taking on 25 pounds or so. Stairs are still pretty much one slow step at a time but that's improving.
I’ve been to the gym for 5 weeks and I can actually fit into some of my old pants now. There are a few muscles showing again after having been on “vacation” for four months. It’s amazing how much strength can be lost so quickly with disuse. I’m relieved and gratified to have it coming back. The major muscle groups in my left leg can now lift about 40% in comparison to my right. When I started at the gym they could do only 10 to 20%. And that’s after months of physical therapy.
What’s more I’ve even been able to sit here at the computer and write this at day 147 (4+ months). Yes, I reach for the acetaminophen and ice after each limited session but this is a start.
I don’t do anything for a long time…sitting, standing, traveling or whatever. I find myself still gravitating to the recliner and ice packs for relief. I regretfully cancelled a planned trip to Montana this summer and Kate and I missed her Mother's 85th birthday celebration in Virginia in May. Most of my trips these days are to the gym and therapy. Twenty minutes in a car is a long time.
Recovery continues. My therapist thinks I’ll ditch the cane at month 5 or 6. My surgeon thinks I’ll be fully recovered in a year. Only time will tell but I intend to do what I can to make that happen. It's my job.
Day 155 - Graduation
After 26 sessions of out-patient therapy over 4.5 months I hobbled into the entryway of my physical therapists office, waved my cane and said that I thought I was ready to graduate. Paul agreed, gave me his usual thorough workout and said that he felt that I knew what to do at the gym to succeed. He and his staff were a wonderful part of my recovery.
I'm still using the cane but one of these days I going to forget where I put it.
Day 179 - Six-month checkup with the surgeon
Here I am two days short of the six month anniversary of my observations in the effects of gravity. I've come a long way. On day 164 I used no Tylenol and haven't had a pain pill of any kind since then. Seven days ago I took my last dose of acid reducer and my stomach seems to be okay now. I'm now hopeful of a full recovery from the NSAID induced ulceration. I have tallied up 48 sessions of physical therapy including the hospital and rehab center, 18 sessions at the gym (so far) and home exercises almost every day.
The doctor said that my ongoing pain and pronounced limp are probably due to two factors. One factor is a marked weakness in the muscles on the outside of the upper leg. Only time and exercise will bring them back. The other factor is bursitis which is an inflammation of the small fluid filled sack near the top of the femur. This may be due to irritation by my new hardware. I'll discuss anti-inflammatory drugs with my personal physician. We'll track the symptoms. I go back in two months for another follow up.
I estimated 80% of full recovery at this point and the doctor was pleased that I was not plateauing. He said that his little-old-lady patients recover more quickly because they have less of a recovery to make. I try not to use my cane at home but it's still my friend when I walk more than a few tens of feet at a time.
I raised the question of blood circulation in the fracture area. The doctor said that I was fortunate that my highest break was outside the capsular region of the neck. We will, however, have to keep an eye out for avascular necrosis (AVN - bone death due to a loss of circulation) for the long term. He mentioned one patient who experienced AVN 13 years after the break. The solution is a hip replacement. The symptoms are pain in the joint itself (groin region).
When I first met the surgeon he estimated a 6 - 9 month recovery cycle. At about the 4 month mark he estimated 9 months to a year. Today was the first time he mentioned 2 years.
I gave the doctor a personalized copy of "A Patient's Prayer" in thanks for his excellent work. I also gave him a printout of my Drug Withdrawal pages. He was quite pleased to have the information as he knows that bone pain is serious and that opiates can be hard to deal with. I told him I would be happy to provide him with the tables and charts and to make any improvements he might suggest.
Life is good.
Day 206 - 7 months
I've been going to the gym at least once a week and my strength is coming back. My surgeon said that I shouldn't worry about the elliptical machine aggravating my bursitis but it sure has been a lot better since I stopped a month ago. I guess the patient knows best sometimes. The cane has been gathering dust most of the time but a sojourn through the wholesale club and a couple of other stores gave it and me a workout last week. My hip is just sore now. More like a bruise than the sharp pain that has been a constant companion to one degree or another for so long. The NSAID induced ulceration appears to be healing but my cast iron stomach is not back yet. No more NSAID's. No other anti-inflammatory drugs. My personal physician and I decided that the benefits did not outweigh the risks. I can deal with "sore" and manage my physical activities while building strength. I'm going to give myself a grade of 90% today. My gait is still antalgic as I try to avoid pain associated with walking by using quick, short and soft foot steps.
A closing note
I started recovery lying on the ice with my ear filling with sleet. The very first step was the decision I made to do my best to keep a positive attitude no matter what happened. I realized that, for a time, my attitude would be the only thing in my life that I had any real control over.
I must add that all this experience is nothing in comparison to what so many others endure. In the grand scheme of things my broken hip was merely an inconvenience. I am lucky. This injury is healing. The long-term side effects can be managed. I will live. My heart goes out the the multitude of people and their families who are suffering with the devastating impact of severe injury and illness.
Day 182 - Just 1 day short of 8 months
I saw my orthopedic surgeon today. The x-rays look great. That dangling piece of lesser trochanter is now part of the bony mass that now makes up the head of my femur. We talked about my ongoing soft tissue pain. Zero days without pain or discomfort so far on this journey. It still wakes me up at night. He suggested a cortisone shot to relieve what appears to be bursitis. I told him I'd hold off. I want to be fully aware of my recovery so I can make better decisions. I'm still working out at the gym and walking more and more. At little time release acetaminophen now and then and the heating pad help.
New bone has covered the ends of the rod and lag screw. That appears to be part of the irritation. The long term fix if I can't deal with the bursitis or it doesn't clear up is to operate. He would open me up, dig down to the screw, extract it, replace it with a shorter one, shave down the bone and sew me back up. Major surgery. I really can't countenance that option.
I'm walking much better but I now have what the doctor called a Trendelenberg Gait which is caused by by weakness of the abductor muscles of the lower limb leading to a pelvic tilt when walking. More exercise is the prescription and in any case it's a great improvement in walking so far.
Day 364 - December 14, 2006
"Happy anniversary," my orthopedic surgeon cheerfully greeted me this morning. Actually it's tomorrow but who's counting?
I have been taking Tai Chi lessons two times a week for the past three months and I think that they and time have had a significant impact on my recovery. I indicated that I am up to about 80-90% of pre-fracture status. I can walk a half mile most days and take Tylenol time release tablets as needed rather than 24/7.
There is still some soft tissue pain which he attributes to the probability of scarring the the muscles he had to cut through to install the hardware. The only option he offered for potential relief is the removal of the screw running into the head of the joint. But that has a 3-4 month recovery and means operation on the muscles that may already be aggravated. That's not to mention the big hole left in the bone that takes a long time to fill in and strengthen. We concurred that we will not be taking that route at this time.
The surgeon said that he rarely sees this problem but he thinks it is due to the fact that most broken hip patients are geriatric and their mobility is greatly reduced even before the break. I'm too young to be that old, I think and will continue to hold greater expectations.
He would have me on NSAIDS (non-steroidal anti-inflammatory) for the soft tissue pain but there is no way I can tolerate those after they caused an ulceration earlier this year when I took Ibuprofen when tapering off the narcotic pain killers.
We talked about glucosamine chondroitin supplements. He said that there is hope (not scientific proof) that they have some beneficial impact on slowing the progression of arthritis. So I'm going to start them and see if they make any difference.
I'll go back in 6 months for a full pelvic x-ray exam and we'll talk then. If the soft tissue issues are still there I'll ask for referrals for the appropriate experts and tests.
I've signed up for the next term of Tai Chi twice a week and will continue those through the winter and spring.
January 30, 2007
I'm still sore but the Tai Chi continues to help. The slow movement with bending and twisting seem to be just what the old hip needs.
I'll next update at the 18 month anniversary in June, 2007 unless something noteworthy happens.
June 14, 2007 (one day short of a year and a half from my break with gravity)
I've been continuing Tai Chi twice a week and walking. Two to three miles at a time on good days. My pace is improved but still slower than before the break (20 minutes per mile on a good day versus 15 minutes per mile before). I'm still sore all the time (Acetaminophen 16 to 24 hours a day) and the hip wakes me up several times a night. Rolling onto my left side is a guaranteed alarm clock.
I had an intense visit with my surgeon this morning as we discussed the diagnosis and treatment possibilities for my ongoing soft tissue pain. I indicated that I felt I have been on a plateau in recovery (in terms of pain) for the past six months. I asked for aggressive diagnosis short of doing surgery as a diagnostic procedure.
The X-ray images look good. The bone is healed and there is "no evidence of hardware failure" to quote the radiology report.
The doctor suspects that the pain is primarily caused by inflammation of the bursa (bursitis) due to the injury and aggravation by the hardware (lag screw) running through the outside of the femur into the ball. Surgical removal of the hardware might be both diagnostic and corrective. He indicated that MRI imaging would probably not be useful because of distortion of the image due to the large amounts of metal. We settled on a corticosteroid injection (dexamethasone) into the bursa. If it reduces the pain that will be indicative of bursitis. We'll discuss the outcome and next steps in six weeks at the end of July.
The doctor reminded me that my body will never be the same and that some level of problems are inevitable. I replied that I still have another 30 years or so of required use so I need to minimize those problems. He agreed.
As usual, I did my research in advance of the office visit and was well prepared with a list of my symptoms (including anatomical charts). I had my questions prepared and predicted the options that were presented. I was then able to make a choice of trying the corticosteroid injection before trying surgery. Note that the surgeon has been recommending the injections for nine months now but I purposefully held off because I felt that it was important to see what my body would do on its own. I do not want to sign up for a lifetime of steroid injections as the only option for symptomatic treatment. Steroid injections are not without risk and work in only about 70% of the cases anyway...for some period of time. I want a cure to the extent that it might be possible. But this is my thinking and you should not substitute it for your own! Talk with your doctor about your situation and treatment options.
It's a matter of scheduling to set up for hardware removal and a possible bursectomy. A couple of years of therapy, tai chi, swimming and the gym still leave me with discomfort that limit my lifestyle more than I want. Recovery from a broken hip, I see, can take a long time.
August 2008 2.5 year anniversary
On August first I finally had my surgery to remove the hardware and the bursa and do an iliotibial band release. I am writing this on the 14th and will update later as appropriate. The surgery went well. I used Lortab from the 1st though the 10th and I am now relying on Tylenol. It is still sore but I am feeling better each day. I did use my drug withdrawal regime to taper off the Lortab (hydrocodone) over four days. I am including the details of the surgery on the hardware removal page.
Broken Hip 3 year anniversary
December 15, 2008 marked the third anniversary of my broken hip. The bone pain from the removal and the replacement graft was significant for a couple of months and has slowly tapered off so by this date (3.5 months later) I finally feel better than I did before the surgery. I have been exercising twice a week at the gym since the end of the first month post-op and have been gradually able to add leg exercises and increase intensity. The orthopedic doctor indicated that the bone pain could last six months and that full healing could take a year.
Broken Hip 3 1/2 years of recovery
I can now walk a mile fairly easily and occasionally up to two miles. I lift weights two days a week at the gym with little discomfort. I am still aware of the surgical area from the hardware removal last August but I feel much better than before the surgery.
Broken Hip 4 years later
Today is December 15, 2009 which is exactly four years to the day since the injury. Four years ago at this hour, I was in the emergency room groggy with drugs and trying to figure out what was next. The doctors were talking to me about things from hip replacement to arthritis. The bottom line today is that I am still about where I was six months ago. I'm not sure that my recovery is going to be much greater than it is now. I'm afraid my days of skiing, ice skating, mountain climbing and similar activities are long gone. But, that said, I am grateful for what I have; especially a loving family.
5 years later
I'm still in recovery, working out at the gym twice a week to build and maintain mobility. I must be satisfied if this is as good as it gets. Some people recover in 6 to 8 weeks after the break. I'm guessing that I'll still be in recovery after 6 to 8 years.
I am so very, very grateful to all my family, friends, medical professionals and even strangers who supported me through this all with both actions and prayers. That support has been treasured and invaluable.
Please also read A Patient's Prayer and pass it on to your healthcare team.
Also use the Patient Survival Tips and Questions to Ask your doctor about your healthcare to help manage your care. They may help you save your life and improve your recovery.
Thanks to those of you who have written about this site and your situation. I am pleased that you are finding it to be helpful. Good luck to you all.
Here are some more hip stories from visitors who have been willing to share with all of us.
Thank you all,
Steven C. Martin
A broken hip story and chronicle of events. Fractured hip.
(c) 2006 - 2011 Steven C. Martin www.positive-way.com/recovery All rights reserved.