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Post op femur fracture after hip replacement

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What should I expect after having a femur bone fracture 8 weeks post op after hip replacement surgery? I was told I would not be able to put any weight on my leg for 6 weeks. Any tips on how to function daily with these limitations?
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First Helper User Profile Gaelic
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replied July 2nd, 2012
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cheewa,

First you need to know why the bone fractures. If it was due to trauma, that is pretty obvious. But, if not, you need to find out why the largest bone in the body broke, and will it affect healing (i.e. was it mechanical which will not affect healing, or was it biological, which can affect healing).

But, since you did not have to have another surgery to stabilize the fracture, it sounds like it was not a complete fracture, or it was totally nondisplaced. Which is good, since you do not want to have to have another surgery so soon.


But, you will have to be very careful in your activities. You should really never move the leg unsupported. When you do a straight leg raise, as when you just lift the heel off the bed, that puts a tremendous amount of bending moment (stress) on the femur. You can visualize this - if you have a long thin strip of wood, it will bend if you lift it by just one end. There is a bending moment on the wood. Your limb is the same way. If you have a weak spot, such as a "hairline" fracture, then the bending moment can cause enough stress to complete the fracture and displace it.

So, if you have someone to help you, that person should support under the calf and knee while you are moving.

If you do not have anyone around, then you should use your good leg to help. Slip the good leg foot under the back of the injured leg's ankle. Then when you move, the good leg helps to support the injured leg.

You can do the same when getting into bed. You sit on the edge of the bed with the heel of the injured leg resting on the floor. Slip the good leg foot behind the ankle and then lift with the good leg, while swinging both up and into bed.

If you have trouble visualizing or doing this, ask a physical therapist to show you. This is a very common technique used by knee surgery patients. But, it will work here too.


When you are up and about, you cannot put your foot down. If you are relatively young and fit, this should not be a problem (except that your upper extremities are going to get tired, until you build them up). But, it also takes quite a bit of overall fitness to go a distance. You will have to build up your upper body strength quite a bit.

Young patients may find it easier to be nonweight bearing on one leg by using crutches, instead of a walker. But, if you do not have the strength or balance to use crutches, then you will have to use a walker.

Again, it takes a lot of upper body strength to be nonweight bearing on one leg. But, it helps if the walker is adjusted properly. It has to be low enough so that you can lock out your elbows when swinging/hopping through with the good leg. You cannot do this if the walker is so high that your elbows are always bent. That position is fine for balance, but not for nonweight bearing movement.


Some things for around home that may help. You may want a bedside commode to use. Make sure all throw rugs have been taken up around the house. Have everything you need placed close to where you will be spending most of your time (TV remotes, books, magazines, arts/crafts, drinks, etc, etc). If you live in a multistory house (where the bedroom is upstairs), make up a bed on the first floor, and live basically on only one floor.


But, again, you are going to have to be very careful not to displace the fracture. If the fracture displaces, then surgery will probably have to be preformed. Support the weight of the leg when moving and do not put weight on the leg when walking. Make sure your walker/crutches are appropriately adjusted. Gather things around where you will be. Get a bedside commode.


Good luck. Wishing you the best.
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replied December 29th, 2012
I had THR in Aug 2012, during surgery the fractured my femur then had to do revision the following day. I was on crutches for 6 weeks with no weight bear on fractured leg at all. It set me back a fair bit on my recovery for walking etc. I have found since I am unable to bend right knee (operated leg) as I used to before. I am feeling a grinding feeling and can feel the patella is not in correct position. Has anyone else had this happen with the knee and what treatment was advised etc?
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replied December 30th, 2012
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Deeeeb,

Sorry you had problems with your total hip.


As to the knee, the treatment would depend upon what exactly is causing the decreased range of motion.

Often, patients with femur fractures develop scarring of the quadriceps muscle, in the thigh. If the quad muscle is scarred down, it can be quite difficult to fix, to regain the patient the range of motion they had before. It is not really possible to go in and release the scar which has formed within the muscle. That is why it is usually best to try to prevent this problem with early knee range of motion, even if the patient is not weight bearing.

If the problem is in the knee itself, it is sometimes possible to do a lysis of adhesions to regain motion. But, if you have at least 90 degrees, most surgeons will not do surgery, as the risk of causing further adhesions is high and that could result in even less motion.


You really need to discuss this with your surgeon. You need to fing out what is causing the problem and then ask your surgeon what your options are.

Good luck.
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replied December 30th, 2012
Gaelic,

Thanks for your response. I have mentioned this to my surgeon, he told me he has no idea o
As to what is the problem with my knee. He kept insinuating that the problem was there prior to the hip replacement. I am still unable to walk freely up steps when attempting this on the operated side, I am unable to kneel on the operated leg as the knee is unable to withstand
The bending of it and the weight, ( I am only 65kilos). Physio has tried to tape the patella in the right position, but sine being able to weight bear they have only wanted me there fortnightly. Note, I was not to attend Physio until I was given the all clear to put weight on the leg.
I last seen my surgeon at 12 weeks post op and he said all was great and to see him 12 months time.
Do you think that Yoga or Pilates might help with the knee and muscle stretching/building exercises?

Thanks Smile
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replied December 30th, 2012
Oh sorry, after surgery on the hip the knee was very swollen for many weeks. When swelling started to subside I started doing some flexing of the knee etc as I had a pulmonary embolism in the lung after first surgery and before second surgery the following day. I made sure I kept my legs and feet moving to avoid clotting due to inability to walk on both legs. The knee was sore as soon as I tried to bend.
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replied December 30th, 2012
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Deeeeb,

Yes, it is a great idea to work in physical therapy. That is the place to really work on your rehab. Yoga will help with flexibility and balance/agility. Pilates will help with the strengthening some, and also with the same things as yoga.

You will still probably have to work with the therapist on getting more range of motion. It may need some passive range of motion (where the therapist pushes on the leg to try to get more motion). But, this has to be done gently, because in patients who have been nonweight bearing for a while, the bone can be soft, and too much pressure can actually cause of fracture.


If you know that the knee problem was not there before the total hip replacement, your surgeon needs to know this. Do not be afraid of the surgeon, he/she is there to take care of you, and needs to know all of the information. Most actually want to know this type of information. Sure, all orthopedic surgeons want every procedure to go smoothly and have the patient do wonderfully, so that they do not have to be seen in the clinic often. But, if a patient is not doing wonderfully, the surgeon has to know this and do something about it. That is his/her job.


Again, physical therapy can help a lot. Not being able to walk up stairs is probably due to weak quadriceps muscles (anterior thigh muscles). They have to be able to lift almost your body weight (you can use the hand railing and also push off a little with your gastrocs - the calf muscles, this will reduce the amount the quads have to lift). So, if you cannot lift, say at least 2/3 of your body weight with your quads in a knee extension machine, you are probably going to have trouble walking up stairs.

It is very common for patients to have quad weakness. The muscles atrophy very quickly. If you were nonweight bearing for quite a while, you are going to have a lot of muscle atrophy. And, it takes a lot more time to rebuild that muscle than it took to lose it.

Recovery does not “just happen”. It takes a lot of hard work, diligence, and sweat to get the range of motion and strength back.


So, yes, do as much rehab exercises you can with your therapist. But, have your therapist outline a program that you can do on your own, at home. There are a lot of exercises you can do at home.


If you have access to a pool, you might look into water exercises. In a pool, the warmth of the water makes the tissues more pliable and stretchable. So you can work on range of motion. The buoyancy of the water makes exercises essentially nonweight bearing (in chest deep water). Thus, you can work on gait mechanics (walking) without putting a lot of weight on the limb. Also, you cannot fall in the water, so it is a very safe way to rehab. It is something that you might want to look into.


If your knee is just not responding to what the therapists are doing for you, then you really need to make another appointment with your surgeon and bring these problems to his/her attention. Your therapist can even write up a narrative summary or medical note for you to take to your surgeon, outlining what has been tried and what has been gained (if anything). And, also what problems have been encountered.


Keep working on your therapy. Lift a lot of weights. Walk as much as possible, building up those muscles. Work on flexibility and balance. Work on your range of motion.

But, if you are just not getting better, make an appointment with the surgeon.

Good luck. Wishing you the best in the new year.
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replied December 30th, 2012
Gaelic,
thanks for the information, it is much appreciated.
My therapist gave me exercises to do at home and I do have a routine to get them done a minimum of twice per day, if not 3 times. They gave me squats to do while leaning against a wall, and also lunges to work on building the quads. The problem I am having is when I lower my self and the knee bends, this is where the pain catches and I feel the knee click and a grinding sensation. Therefore, even though I feel this limits me in doing more to build the muscle, (which I feel the muscle could easily do as it doesn't feel like it has worked at all),
I will join a Pilates class and make sure I advise them of my surgery so any modification can be made for me,
I don't have any pain at all when walking and I don't have a limp, no longer take pain meds and sleep comfortably.
I am also thinking of doing some bike riding which could possibly build the quads and all other muscles effected and also use continuous motion in the knee and hopefully improve the ability to flex.

I will also continue with the exercises from Physio and hopefully the combination will improve strength and range of motion.
I have determination to work on this as I do not want pain or weakness now the surgery has been done. For the first time in years I am able to walk totally pain free and not limp, and it does feel sooo good Smile

Have a great New Year and stay safe Smile
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replied December 31st, 2012
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Deeeeb,

Stationary cycling is a great idea.

It sounds like, from your description, that you make have either some problems with your extensor mechanism (the patella in its femoral groove) or the menisci (the cartilages). Without an exam it is not really possible to tell exactly what is going on.

It is great that you can walk without a limp. That is the first big hurdle.

If you are still having problems getting up stairs, work on those quad muscles. It may be difficult if you do have an extensor mechanism problem, as that often causes pain when doing the extensor exercises. But, try them and see how it goes.


If the problem in your knee just does not get better, do see your surgeon.

Good luck.
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replied May 29th, 2014
the surgery was early sept.2013. most of the pain(which is quite severe) is after sitting. when i get up, walking is very difficult. am i overdoing exercises? does walking with a cane exacerbate the problem? xrays, so far have been normal. i have good upper body and "core" strength. without,which, i couldn't easily walk. any thoughts? i am 80 and a former long distance runner. thank you for any advice. bob
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