Medical Questions > Conditions and Diseases > Orthopedics Forum

Broke my Acetabulum – Any recommendations for the future?

Hi to all,

I had a skiing accident in 2000 and broke my right hip socket (Acetabulum) at age 20. During the surgery, the orthopedic surgeon (Prof. Thierry Judet) fixed me up by inserting 10 x 3.5cm screws with two metal plates (see attached xrays). During the next 6 months, I would spend my days in physical re-education to strengthen my leg muscles and relearn to walk. In my bad luck, I had been lucky as I was able to walk again and continue to have a normal life.

Xrays:
http://xarj.com/images/100211-xray-1.jpg
http://xarj.com/images/100211-xray-2.jpg

Twelve years later in 2012, my accident hasn't really negatively impacted my life but I'm starting to feel pain and it's worrying me. The doctor has prescribed Clonac 50mg tablets. It relieves pain and reduces inflammation and I think it works as the pain disappears for at least 15 hours.

The surgeon hasn't really explained much about what physical activities were recommended or not after my surgery. Prof. Thierry Judet told me “You can continue your life same as before”. From what I read, the worst would be jumping or running. Walking, swimming or bicycling would not worsen my condition but I would appreciate if someone could confirm that. Could I really do one hour of bicycling every day (I ride to work) without it having an impact on my hip socket? In my situation, isn't all movement and friction bad in some way? The more the femoral head rubs against the acetabulum, the more damage is created to the cartilage in between?

I am quite an active guy and must often decline to go hiking in the mountains because I'm afraid to accelerate the deterioration of my hip socket. Should I be worried by doing intensive efforts such as hiking or walking long distances?

I understand I will need a hip replacement in my lifetime and it is a major surgery. How much mobility will I regain after? Walking should be ok but will I have to completely give up activities such as hiking? In terms of pain, when would I know it’s time to get the hip replacement surgery?

I'm currently traveling in Australia for a year but when I return to Montreal, Canada, I will get an MRI and see what the orthopedic specialist says. Xrays do not give you the full picture. There's not much they can do except prescribe stronger anti-inflammatory medicine, right?

What should be my strategy for the future? My objective is to delay as much as possible the hip replacement surgery.

Thank you so much for your help & responses!
Arnaud
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First Helper User Profile sierraskier
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replied October 24th, 2012
Experienced User
Hi Arnaud42:

I am new to this, only about 10 weeks into it. I crashed on my bicycle and cracked my acetabulum. My fracture had a minimal lateral displacement of about 1mm. I have been reading about some other stories here and started my own story here as well.

You have just given me the longest followup I have read and your 12 year hiatus sounds rather promising for long term usage before arthritis sets in. Due to the fact your injury was repaired with screws sounds like your injury was more serious than mine as mine was stable and required no surgery.

It sounds to me like you may be at the point where arthritis may be setting in, your cartilage has gotten thin and you may be nearing the time for a hip replacement. Your MRI will give a much better determination of this possibility. However once arthritis does set in, often it progresses rapidly to the point where a necessary resolution should be addressed in short order. I am just a layman who has shown a recent interest of this subject through my own desire to learn the most I can about my injury and future outlook.

A resident poster who has been of great help and very informative for me, Gaelin will most likely drop by this thread with much information and expertise. I wish the best for you and hope for the best results from whatever direction your condition demands.

Here are as couple of links to 2 other acetabulum threads:

http://ehealthforum.com/health/topic16972. html

My story:

http://ehealthforum.com/health/acetabulum- and-clavicle-crashed-on-my-bicycle-t364496 .html
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replied October 24th, 2012
Especially eHealthy
Arnaud42,

You should listen to sierraskier, he has had a great recovery from a pretty significant set of injuries. And, he can give you personal experience.


You do not say when the x-rays were taken, but if they are recent ones, you have had an excellent result from the fixation of the acetabular fracture. Of course, you were treated by the "Father of the Acetabulum", Dr. Judet. There are even a set of x-rays of the acetabulum named after him, which are taken of trauma patients who have suspected acetabular/pelvic fractures - the Judet views.

Your “joint space”, the thickness of the articular cartilage, is excellent. The head of the femur has remained round and congruent with your acetabulum. You cannot get much better than that.


As to the activities which would put the most stress on the hip joint, these are mainly the impact activities. Running and jumping, and sports which include these activities, are the worst. The nonweight bearing activities, such as swimming and bicycling are the most recommended for acetabular fracture patients.


You should basically let pain be your guide. Anything which causes discomfort should probably be avoid as much as possible. As long as you do not have any significant discomfort, you should be able to do just about anything you wish. Keeping the muscles as strong as possible and maintaining balance and agility will do more to protect the joint than anything else.

You can get the MRI, but it may not be of too good a quality. With that much hardware in place, the artifacts created and the scatter effect are going to be significant. You may not be able to get very good images, if you can get any at all. But, if the radiologist thinks it’s worth a try, then go for it. Some radiologists will not do an MRI if you have stainless steel or chrome/cobalt implants, as they are ferrous and can be attracted by the magnet in the MRI. Titanium plates do not react to the magnet. But, they were not in much use twelve years ago.


Of course, you have had a very significant injury to this joint, and as such, you are at a much higher risk of developing traumatic arthritis in the future. But, you have done very well so far. Try to keep your impact activities to a minimum, but remain as strong as you can around the joint, is probably the best strategy to delaying a total joint.

Good luck.
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Users who thank Gaelic for this post: sierraskier 

replied October 29th, 2012
Hi sierraskier & Gaelic,

Thanks for your responses.

Sierraskier, I’m glad to hear you didn’t require surgery after your accident. Did your doctors talk about how your fracture would evolve in time? Will you require surgery one day?

I couldn’t find info which mentions your point: “once arthritis does set in, often it progresses rapidly…”. Any idea what could be an average duration before it really becomes a problem? Months? Years?
I was hoping to hear the opposite and that I still had another 10+ years before needing a hip replacement. I’m only 31 and my life would change quite dramatically if I started feeling strong constant pain, if I lost mobility or if I needed major surgery which would handicap me at least temporarily. I not ready for that.

I take Clonac 5 times a month and when I do, I would rate the pain as 1 on a scale of 10. The pain has never been more than a discomfort, not yet. 2 years ago, after doing quite a bit of exercises, the pain kicked in for the first time and after a couple months it disappeared for a year and a half until recently. I’m hoping the same will happen now and the pain will just disappear.

Gaelic, yes, I heard that I had been lucky to have Dr. Judet operate me at the Tenon hospital in Paris. He has contributed quite a lot to the cause and is a reference in the orthopedic world. When I need a hip surgery, I wouldn’t mind if he operated on me!

Thank you for your analysis of my Xrays! It’s good to hear it’s looking “excellent”! Smile The Xrays were taken 1 year and a half ago in 2010.

Also, thanks for the tips on which activities are recommended or not. I’m 90kg for 1m82 so I could lose some weight and I do regular exercises so that’ll help strength the muscles around my hip.

I did not know that metal implants could distort the MRI image. So the doctors could only use XRays to determine whether or not I need a hip replacement? And my level of pain?

“Some metal implants typically do not cause problems. These include hip and knee replacements; plates, screws, and rods used to treat fractures; and cavity fillings. All of these metal implants can distort the MRI image if near the part of the body being scanned”
http://orthopedics.about.com/od/hipkneerep lacement/f/mri.htm

The orthopedic surgeon in Montreal, Canada had prescribed the MRI for me which I didn’t get because I left to Melbourne, Australia. The hospital did tell me there was a 10 month waiting list! WHAT!!! Or I can pay around $1500 and go to a private clinic. Canada’s health care system is totally overloaded and I’m scared I won’t get a proper medical service there. I got my original surgery in France.

I found some interesting facts about Arthritis on http://en.wikipedia.org/wiki/Arthritis. Osteoarthritis would be the kind of Arthritis applicable to me?
-“Physical therapy to strengthen muscles and joints is very helpful.” So I should definitely continue to work out and do physical activities.
-“Medications can help reduce inflammation in the joint which decreases pain. Moreover, by decreasing inflammation, the joint damage may be slowed.” So when I feel pain, I shouldn’t just try to ignore it but take a Clonac tablet. Pain = inflammation = accelerate damage.

Any idea if the hardware in my hip would be removed when I get a hip replacement?

Thanks again to both of you for your replies and support!
Arnaud
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replied October 30th, 2012
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HI Arnaud;

No surgery needed for my acetabulum, but yes for my clavicle so I could get out of the wheel chair sooner. My hip socket had a 1mm lateral displacement with no step so there should be no issues with accelerated arthritis and my cartilage appears to be in good shape via the x-rays.

The doctor did say they could not determine if the cartilage has impact damage which could possibly lead towards the damaged cartilage deteriorating over several years and causing arthritis as the body removes the damaged tissue.

I do participate in a lot of athletic endeavors but most are of low impact so that is a plus for not needing any hip work down the line, but I am also over 60 and have been involved actively for most of those years so that may be a negative in regards to future hip needs.

Best of luck with your discomfort and pain and I wish for the best results in whatever you need to do to resolve it. As far as how fast arthritis develops it is not so much how fast it happens, but your notice of the discomfort/pain. Once you begin to feel the pain it means you are possibly feeling the beginning of bone on bone, and from that point the pain accelerates rapidly as the cartilage further wears out from those who I know and have had hip or knee replacements.

My wife had a double knee replacement early this year and I have numerous friends who have hip or knee replacements and I base my statements on their experiences.
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replied October 31st, 2012
Especially eHealthy
Arnaud,

Actually, the type of "arthritis" you would develop, if you do (it not a given that it will happen) would be considered traumatic arthropathy. It is a degenerative process due to the joint surface not being smooth and congruent, thus causing uneven wearing of the cartilage.

It also depends a lot of genetics. If your patents/grandparents had Osteoarthritis (also referred to as DJD - degenerative joint disease), then you are more likely to develop it also.


It is interesting that the word arthritis actually means inflammation (-itis) of a joint (artho). Thus, osteoarthritis is a misnomer. That is why orthopedics prefers to use the term DJD, because there really isn’t any inflammation in OA or DJD. Many physicians feel that medical personnel overuse the -itis terms. That most patients really do not have tendonitis or arthritis, that they actually have a tendonopathy or an arthropathy. That there is no inflammatory component of many of the overuse and wear/tear conditions.

There are some physicians who feel that NSAIDs are overused, that their use is basically for the money made by pharmaceutical companies. These physicians basically feel that patients should be advised that their bodies will take care of most overuse problems, if they give it enough time (weeks to months). Problem is that most patients want a quick fix pill, and do not want to wait months for their body to heal itself. And, we do not have very many analgesics to use. There is aspirin (which is an anti-inflammatory itself) and acetaminophen. Then, you have the opioids (which have a lot of problem in long term usage).


In terms of using antiinflammatories to reduce joint damage from arthritis this is for the inflammatory arthropathies, such as rheumatoid arthritis. The joint damage in OA or DJD is from abnormal wear and tear, not inflammation.

So, what do you do?


But, back to your hip. You have a great result as it stands right now. It is not a given that you will develop degenerative changes in the hip. You are at a higher risk, than if you had not injured your acetabulum.

As to when to decide if you need a total hip or not, how do you figure that out? Well, it is actually NOT from the x-rays. It is when you have significant pain in your hip that cannot be controlled by any other methods; when all nonoperative methods have failed.

It does not matter, really, what the x-rays look like. There are some patients out there that have horrible looking x-rays, but do not really have much pain at all. And the reverse, there are some patients who have x-rays that do not look very bad, but they have tremendous pain. So, as they say in medical school, you treat the patient, not the x-rays.


When you can no longer get around, when you have significant pain that cannot be controlled, and it is affecting your life, then you talk to your surgeon about a hip replacement. Who knows when that is going to be???? It could be next year, a couple decades from now, or never.


As to the hardware you currently have in, that would be up to the surgeon. You will be a complex revision case. Some surgeons prefer to stage it so that the hardware is removed and the bone allowed to consolidate in, before the total hip prosthesis is put in. However, others, just do it all in one setting. Again, that is up to the surgeon.


So, continue to be as active as your hip will allow. Of course, if you limit the impact activities on the hip, by common sense, that will slow the wear and tear on the hip. But, you do need to stay as strong as possible around the hip. Strong muscles , balance, and agility will protect the joint more than anything else.


Good luck. Hope you are doing well.
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