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Hardware Removal From a Broken Hip

Here is the abstract for one recent medical article on the subject of the removal of implant hardware.  It certainly appears that the decision should not be taken lightly.

Hardware Removal: Indications and Expectations

Matthew L. Busam, MD, Robert J. Esther, MD, MSc and William T. Obremskey, MD, MPH

Reprint requests: Dr. Obremskey, Division of Orthopaedic Trauma, Vanderbilt University, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774.

Although hardware removal is commonly done, it should not be considered a routine procedure. The decision to remove hardware has significant economic implications, including the costs of the procedure as well as possible work time lost for postoperative recovery. The clinical indications for implant removal are not well established. There are few definitive data to guide whether implant removal is appropriate. Implant removal may be challenging and lead to complications, such as neurovascular injury, refracture, or recurrence of deformity. When implants are removed for pain relief alone, the results are unpredictable and depend on both the implant type and its anatomic location. Current literature does not support the routine removal of implants to protect against allergy, carcinogenesis, or metal detection. Surgeons and patients should be aware of appropriate indications and have realistic expectations of the risks and benefits of implant removal.

J Am Acad Orthop Surg, Vol 14, No 2, February 2006, 113-120.
2006 the American Academy of Orthopaedic Surgeons

My Broken Hip Hardware Removal Experience - August 1, 2008

Ever since my very serious fracture on December 15, 2005 I have experienced pain.  After the bone healed the pain was centered in my soft tissues.  I had muscle pain and finally bursitis that did not respond to any form of exercise, physical therapy or steroid injections.  In addition, my iliotibial band (IT band - a ligament that runs from the top of the hip to below the knee to hold the leg together), was quite painful for a long time.  The surgeon and I finally agreed that surgical removal of the lag screw in my hip, a bursectomy and an IT band release was the only course of action left.  I have had few good nights sleep in the past 2.5 years because of the ongoing discomfort.

The image to the left  is the pre-surgical x-ray showing how the lag screw protrudes from the side of my femur.  It is about 4 and 3/4 inches long and about 7/16ths of an inch in diameter.  That is what has been causing the ongoing pain.  The long pin that runs the length of my femur is called a gamma nail and is about 17" long.

 

The picture below is the actual lag screw that was taken out with the palm of my hand and a dime for scale.

If you look really closely at the head of the gamma nail in the top photo you can see the faint impressions of threads.  That is actually a set screw that locked the lag screw into place.  That was a good thing because it helped to keep my leg from shortening during the healing.  Current designs do not include the set screw.
 
I did not include the images of the incision that stared below the pin and traveled up to the top of my hip.  He had to open up the top of the gamma nail and chisel out the bone to release the set screw.  That took considerably more chiseling than the screw.  Yes, I could hear it all but rejected the offer of more sedation.  The good news was that the sedation made time fly and I had no sensation of the fact that it actually took over 2 hours to get the job done.

Intermediate update

I was on crutches for about two weeks post-op and in significant pain for two months.  Both soft tissue and the bone pain added up but after a couple of months the bone pain was the greater factor.  I started exercising after four weeks.

My Broken Hip Hardware Removal - 4 month update

January 1, 2009 marks four months since the screw was removed from 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 I finally feel much 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.

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2 year update of my hip hardware removal - August 1, 2010

I'd like to tell you that I am fully back to normal but that is not the case.  I still have muscle and tendon pain that I moderate with consistent but low-level exercise and regular stretching.  My leg is far better than it was before the removal but it is unlikely, at this pace, to ever return to pre-broken-hip normal.  Make sure you ask your doctors and therapists about your muscles, tendons and nerves - recovery is far more than just bone growth.

Vital resources for managing your healthcare and recovering from a broken hip

Home Up drug withdrawal broken hip Survival Tips a patient's prayer

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Disclaimer: Please note that everything here is personal opinion that is not intended as a substitute for medical advice.  It is highly recommended that you review your case with a medical doctor who is familiar with your medical history before you start any narcotic or drug withdrawal process or obtain treatment for any illness or injury.

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