Discussions By Condition: Hip conditions

Acetabular fracture recovery?

Posted In: Hip conditions 45 Replies
  • Posted By: Aptos Gimp
  • November 16, 2008
  • 09:12 PM

In January of this year, I fractured my right acetabulum falling on ice. I underwent "open reduction with internal fixation" surgery in Reno within a couple of days of my accident. I now have eight pins in my hip. After the operation, the doctor said my socket, which was broken in four or five places, had fit back together just right and that he didn't think I would have to worry about arthritis. But he also said he couldn't predict how the cartilage in the hip socket would heal.

I did not begin walking until April 1. Well before I was cleared for weight bearing, back in mid February, I began feeling as if I had a "brick" in my right hip. It was not painful at that time, but once I started walking again it did become painful. Initially, my physical therapists and my local orthopedist (not the same doctor as the one who operated on me) diagnosed my condition as trochanteric bursitis. When a couple of months or more of physical therapy for this presumed condition failed to yield results, the doctor here referred me to an orthopedist at Stanford. He ordred an MRI, which failed to reveal any anatomical problems, and told me I that the source of my pain was my iliotibial band. I returned to physical therapy for more exercises, this time aimed at stretching my "IT band." Again, therapy failed to result in any improvement. Meanwhile, my hip pain was getting worse.

I returned to the Stanford orthopedist, who suggested that maybe the pain I was feeling on the outside of my hip was actually referred from the hip socket itself. To test this hypothesis, he sent me for an arthrogram, during which Ripivocaine, a numbing solution, was injected directly into the hip socket. Prior to this procedure, I was experiencing a burning sensation both on the outside of my hip and in my groin. Immediately after the injection, the burning went away, although I continued to feel pressure in my hip.

Based on this result, I am now scheduled for an arthroscopy at Stanford in December. My hope is that once the doctor actually gets into the socket and can see what's happening in there, (1) he'll be able to "clean up" loose cartilage, if that's the problem, or (2) tell if the socket is so far gone that what I really need is a total hip replacement.

I would really appreciate it if anyone who has also suffered an acetabular fracture and undergone open reduction and internal fixation surgery as I did could share their post-operative/recovery experiences with me.

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45 Replies:

  • Hello,I am going in this monday ( 3/16) to have an impingement, tear and loose bodies among other things repaired. I took a bad fall a few years back -and now many OS later I have been finally referred to Bellino from an impressive OS who had 1st thought I needed a THR until he saw the tear and impingement. My bone and bone space is still too good he felt for a THR and thouht this arthroscopic repair might buy me more time before a THR. I am told it will be a long recovery - 3-4 months ( best scenario) and that there will be weight restrictions on crutches. I will be on them for 12 weeks min. He wants to me to severely reduce my range of motion and not to even think of driving , returning to work etc. ( I am a primary school teacher) I am seeing Dr Bellino at Stanford. I have had 2 other hip surgeries as a young teen ( I am 53).I have been reading boards and I am confused as my Dr said NO PT for awhile as I am to reduce my range of motion- I had hoped to swim - Has anyone been told this?Thanks,Debbie
    Anonymous 42,789 Replies Flag this Response
  • My orthopedist is Dr. Mark Safran, also at Stanford, but in sports medicine. I see that Dr. Bellino is in a different department -- trauma. When Dr. Safran got into my hip socket on Dec. 8, 2008, he found that I had a torn labrum and torn ligaments, which he debrided. After surgery, I was told that I could bear weight "as tolerated." I was able to ditch my crutches and walker by the end of the week. I was also advised to begin physical therapy ASAP, which I did. I resumed swimming a couple of weeks post-op, as soon as my stitches were removed. A few weeks after that -- I forget how long -- I worked out on an elliptical trainer for the first time in more than a year. I didn't feel any worse after 30 minutes than I did at the start, so I've kept it up.I am now nearly 14-weeks post-op and I'm finally starting to feel like my hip is improving. I still have pressure and pain in my hip, but the pain is not as bad as it was a couple of weeks ago. I swim 1,500 yards three days a week and work out on the elliptical trainer three or four days. I also do strenghtening exercises prescribed by Dr. Safran the last time I saw him, at the end of January. I went to physical therapy from about mid-December until Jan. 21.I go back to see Dr. Safran next on March 26. They'll do x-rays at that time to see if my hip socket still looks OK as far as separation between the ball and the socket goes. After the surgery, Safran said that my cartilage was still in good shape, although "thin" in one spot. He said he saw very little evidence of arthritis and also that the surgeon who pinned my hip socket back together in Reno last January did an excellent job. At age 63, I'm hopeful that I won't need a total hip replacement.Your situation sounds more complicated than mine, which may be why you've been advised that you'll have to avoid PT and stay on crutches for 12 weeks.Is Dr. Bellino doing your arthroscopy? My understanding was that Dr. Safran is the go-to guy for that procedure at Stanford. I "Googled" Dr. Bellino and I see that he specializes in acetabular fractures like the one I had. Dr. Safran told he that he doesn't do those.By the way, the outpatient surgery facility at Stanford is excellent. Good luck!
    Aptos Gimp 11 Replies Flag this Response
  • Yup Dr Bellino is doing my arthroscopic surgery in less than 48 hours. Any words of wisdom? I am glad that you recommend Stanford's outpatient center. I need all the positive I can hear right now- I am unsure what to expect. Thanks, Debbie :(
    dezool 4 Replies Flag this Response
  • No words of wisdom here, since I don't have any to impart. I'm hoping that the pain and pressure I'm still feeling is part of my recovery and not a symptom of the dreaded "FAI" (femoral acetabular impingement). If I still feel the way I do this afternoon when I see Dr. Safran next on March 26, and if the x-ray doesn't show anything, I think I'll just demand an MRI to make sure that there's really nothing else going on. If I do need more surgery, I would like to find out now and take care of it, rather than waiting for another couple of months. In the meantime, best of luck to you! :o
    Aptos Gimp 11 Replies Flag this Response
  • Just got back from seeing Dr. Mark Safran at Stanford and I have concluded that he has totally wasted my time -- for nearly six months! When I first went to see him late last September or so, he ordered an MRI, which didn't show anything and then diagnosed my problem as a tight IT band and sent me to PT for that. When I went back to see him at the end of October because I wasn't making any progress, he sent me to Stanford radiology for a fluoroscopically guided injection to see if a pain killer injected directly into the socket would get rid of the pain I was feeling on the outside of my hip. It did, somewhat, so we went ahead with the arthroscopy in December, when he found I had a slight labral tear and torn ligaments.When I last saw him at the end of January, he said it takes "four to eight months" to recover to 80 percent of normal after arthroscopic surgery, and he mentioned that he didn't "do" (repair) acetabular fractures like mine -- which was the source of all my subsequent problems.Today, after an x-ray, he insisted that despite all the pain I'm having -- now just about as bad as it was BEFORE he operated on me -- he didn't think it was coming from the joint itself. He said there's nothing wrong with my articular cartilage. He said he thinks the pain is "traumatic", meaning it's a sort of hangover from the original fracture.I asked him, "You don't do acetabular fractures and you don't see many patients like me do you?" He said he didn't and he didn't. He said he would refer me to Dr. Michael Bellino, another Stanford OS who's a trauma guy (not a sports medicine guy like Safran) and who DOES "do" acetabular fractures. Then he shook my hand and said, "Good luck."Basically, Safran washed his hands of me today. As of now, the soonest I can get in to see Bellino is May 4. Safran's medical assistant, who's very nice, said she would try to get me in to see him sooner if possible. I'm hoping that Dr. Bellino can figure out if there's anything more to be done to correct my problem surgically or if -- as Safran insists -- there's nothing wrong with the joint itself and that my pain is "traumatic." If that's truly the case, then the answer is probably drugs -- maybe for life. (My primary care doc is pushing narcotics.)But what really and truly has me hopping mad right now is the fact that Dr. Safran, who doesn't do acetabular fractures and doesn't see many if any patients in recovery from them, didn't send me over to see Dr. Bellino when I first went to see him last fall. If you were a Chevy mechanic and only knew GM cars and somebody came to you with a Jaguar wouldn't you send them down the street to the Jaguar mechanic instead of trying to fix it yourself? Dr. Safran did not serve me well by treating me despite the fact that he is not really familiar with the ramifications of acetabular fractures and outlooks for acetabular patients like me, and I am steamed.:mad:
    Aptos Gimp 11 Replies Flag this Response
  • Hello,I finally found these posts again. How did it go ? You sounded so frustrated at your last post at Safran. I don't blame you. Have you seen Bellino? I am now about 15 weeks post op with Bellino and my hip was a mess and he did an incrediable job. The surgery was very long and I struggled for several days afterwards but after 72 hours- pain free.. and amazed at what he accomplished. I am improving S l o w l y but am free of pain for the most part if I folllow the rules. I still have restrictions and go back and see him in a few weeks...But I am on my stationary bike, walking alot more and sleeping on my bad side now! It has been a long recovery, Bellino has been very conservative with me - there was a great deal of damage...FAI, Torn Labrum, microfracture, debride, bone spurs , lose bodies and lesions etc.... He is an interesting OS- I am curious on your opinion and how you are doing.Debbie
    dezool 4 Replies Flag this Response
  • I did see Dr. Bellino. He ordered an arthrogram (MRI with contrast), followed up immediately by an ultrasound-guided injection of a steroid into my bursas (shallow and deep). The injection did nothing for me. Subsequently, he said that the arthrogram showed no indication of bursitis and diagnosed my problem as "abductor insertion tendonitis." He sent me back to physical therapy with a prescription for "modalities" -- iontophoresis (or however you spell it), etc. That didn't help. So Bellino sent me over to Dr. Michael Fredrickson, another orthopod up there who is also a physical medicine specialist. He sent me back to PT with a prescription for deep-tissue massage. That doesn't seem to be helping either. I go back to see Fredrickson on Wednesday of this week. I continue to be very frustrated with this, and in a lot of pain.Thanks for your concern, Debbie.Steve
    Aptos Gimp 11 Replies Flag this Response
  • Steve,I am so sorry you are still in pain. I had hoped Bellino would shed some light on things for you. He did amazing work for me and while I am still recovering ( Long ordeal) I am thrilled with my slow progress after all the mess he had to repair. ( torn /shredded labrum, loose bodies, debridement, reattaching labrun and flapping cartilage, microfracture and more- all thru a scope!) . I was referred to Bellino by a OS named Dr Hartford in Palo Alto who did an excellent job of diagnosing me ( the ONLY one who got it right after numerous Orthopedic Drs missed the marked BIG time) - Maybe he can help? Anyway, Have you at least been enjoying the weather in Aptos? I live in Boulder Creek and it has been lovely.Debbie
    Anonymous 42,789 Replies Flag this Response
  • Debbie,I saw Dr. Fredricson, the orthopod/physical medicine guy at Stanford, yesterday. He has referred me to the pain-management people. He says that my continuing pain may be the result of nerve damage, stemming from my original fracture and repair surgery. In any case, I hope to finally find a doctor who will actually listen to me. I started feeling pressure in my hip about six weeks after the fracture, while I was still non-weight bearing. All I was doing at that point was sitting in a wheel chair or lying down with my right foot elevated to alleviate temporary edema. (I was navigating our small house on a walker, on my left foot only.) I woke up one morning in mid-February '08 and remarked to my wife, "I feel like I have a brick in my hip." I reported this to Dr. Christopherson, the local orthopod who was following up with me, the first time I saw him on Feb. 28. He looked at the x-ray and said he didn't see anything out of the ordinary. I've told every orthopod I've seen since about this pressure and how it started BEFORE I resumed weight bearing, but it never seems to register with them. I continue to believe that the fact that it started when I was still laid up is significant. The pain only came after I started walking again.Meanwhile, all the subsequent imaging, including an $8,000-plus arthrogram this spring (Cigna paid it), has indicated that there's nothing wrong with my hip socket. Both Bellino and Fredricson say there's nothing more they can do for me "mechanically." Now I'm waiting for the pain-management people to call so I can set up my next appointment. Stretching seems to provide some small relief and lap swimming makes me feel better for part of the day. But the pressure never really lets up and I continue to have pain on the outside of my hip and burning in my right groin.As for our weather, other than the usual morning fog, it's been great.Steve
    Aptos Gimp 11 Replies Flag this Response
  • Steve,Why is no one dealing with the Labrum tear you mentioned awhile back? What happend with that?Debbie
    Anonymous 42,789 Replies Flag this Response
  • Hi Steve, Has any of the doctors you've been seeing talked about the labral tear you mentioned below? "It did, somewhat, so we went ahead with the arthroscopy in December, when he found I had a slight labral tear and torn ligaments." Why was this labral tear ignored? Having gone thru a labral tear that only worsened for me and was ignored /misdiagnosed etc. for years I am concerned about this being ignored for you too- Debbie
    dezool 4 Replies Flag this Response
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  • Debbie,Dr. Safran fixed the labral tear back in December. Per the arthrogram (the gold-standard of imaging) I had this spring, I have no other problems mechanically speaking. At this point, I'm "hoping" for a diagnosis of nerve damage, which can be addressed through medication. It's not looking good for getting in to see the pain management docs at Stanford any time soon, however. So I made an appointment to see Dr. Marcus in Santa Cruz. He's the pain-management guru around here. I'll see him on Aug. 7, if not sooner. I'll take Dr. Fredericson's notes with me.Steve
    Aptos Gimp 11 Replies Flag this Response
  • Hi Steve, I misunderstood- I thought the tear was discovered after your surgery when the pain started ( the brick). I haven't heard of Dr Marcus. I hope he is helpful - What does a pain dr do/. Do they help develope pain management techniques or help determine the cause of the pain? I wonder if we were in the xray waiting room at Bellino's place one time. I was there and a man was talking about how they suspected he had nerve damage and why he was experiencing pain. I was there for my 1st post op xray and appointment with Bellino and wondered if that was a common concern for these surgeries. Debbie
    dezool 4 Replies Flag this Response
  • Hi Debbie,I don't know if you saw me at Stanford or not. I'm an older, balding guy with a beard and glasses. I generally don't get into many conversations when I go up there, however.As for what a pain doctor does, I'm not sure. I think they try to figure out what kinds of medications/injections will help quiet the nerves, after doing whatever they do to confirm that nerve damage is indeed the source of one's pain.Steve
    Aptos Gimp 11 Replies Flag this Response
  • Steve -I just googled "pain management acetabular fracture" and found your post. It sounds so very familar. My 21-yr-old fiancee was in a car accident last summer (I over-corrected and hit a tree) and suffered a posterior acetabular fracture when his hip dislocated. The fracture was repaired with a plate and screws. Fast forward, months later, he's walking and trying to function normally but keeps telling me that it HURTS. He too describes the pain as a type of "pressure." The original dr. reviewed x-rays and insisted that there was nothing wrong with his hip now, and that the persistant pain must be "muscle weakness." He gave me the distinct impression that he didn't believe Chris was actually in pain. Finally (a year later) we have gotten to see a second orthopaedist, who ordered a CT scan and identified a non-union of the original fracture. He recommended total revision of the surgery, complete with a bone graft, to give Chris a chance at an approximation of his previously high-impact (skater) life. But the surgeon we were referred to was more conservative - said that the hip was "stable" (it's not going to dislocate) and that choosing to undergo major surgery again was a big risk. And might not even reduce the pain significantly. And Chris would have to quit smoking (the dr didn't seem to think that would happen - but this is a great motivation for him!). He sent us away with a referral to a pain specialist and said Chris should just deal with the pain - through medication, some more physical therapy, and severely restricting his activity. No more skating, no basketball, no football, no snowboarding... he might be able to play GOLF. :-/ ANYWAY, Chris called the Pain Spec. office to get an appt today and it's going to be a hassle, getting the authorizations in place. I'm interested to learn how your quest is proceeding!
    Anonymous 42,789 Replies Flag this Response
  • I had a car accident on 4-21 and fractured my acetabulum. I was released from the hospital the next day to see a surgeon on an outpatient basis. The fracture did not shift or move fro the first 3 weeks. I had an MRI done on the 4th week and it shifted, so I was referred to a hip specialist for surgery. I was instructed to stay off that leg for 12 weeks following the surgery. I am still waiting for my 12 week follow up so I can start physical therapy. What should I expect with physical therapy? Any advice? Sometimes when I move my leg now it feels like I can feel the bone in my hip? Does that make any since?
    Anonymous 42,789 Replies Flag this Response
  • Hisadvocate and "unregistered",I saw a doctor at the Stanford Pain Management clinic yesterday and he prescribed Gabapentin, otherwise known as Neurontin, to relieve the pain in my hip (it's on the outside, in the vicinity of the greater trochanter). At this point, the assumption is that the pain is the result of nerve damage, which I presume occurred during my open-reduction, internal-fixation surgery on Jan. 10, 2008. If you do a search on YouTube, you will find graphic videos of this procedure. It's pretty ugly and frankly, I don't understand how the surgeons can figure out what's what in there with all the goo they have to deal with. How can they even see the nerves to avoid damaging them? I am permanently numb on the outside of my right thigh because the doctor could not avoid cutting at least one nerve there to get down the fractured bone."Unregistered," I also had to stay off my right foot for 12 weeks following surgery. I was hospitalized for a couple of weeks afterwards, because of complications, and then I spent another 8 days in an inpatient rehab facility. I never had any pain in my hip during all that time. In mid-February of '08, after I had been home a couple of weeks, I woke up one morning feeling like I had a "brick" in my hip. I was feeling a lot of pressure there, but still no pain, as I was spending most of my day in a wheel chair or on my back with my right leg up because of edema in my right foot. I was getting around the house on a walker, hopping on my left foot. The pain didn't start until I began walking again on April 1, '08. It was initially diagnosed as bursitis; later as IT band syndrome; still later as abductor insertion tendinitis. I was prescribed various physical therapy regimens, none of which seemed to help with my pain. In the middle of all this, I had arthroscopic surgery on Dec. 8, '08 and the surgeon found that I had a partial labral tear and torn ligaments, which he debrided. Otherwise, he said, my hip socket looked good. The surgery didn't relieve the pain either.I've had a lot of expensive, fancy imaging and the consensus of three Stanford orthopedists is that there is nothing mechanically wrong with me. So that leaves nerve damage as the remaining likely cause of my ongoing pain. What can I say? It sucks. At this point I'll be glad if I can get the worst of the pain down to a "3" on a scale of 0-10.Hisadvocate: My pain is also primarily pressure, although it has often felt like being poked in the hip with a sharp stick. Based on my experience with my original surgery, I would agree that having another operation like that is probably not a great idea. Acetabular fractures are about the worst thing that can happen to you in the way of broken bones and the surgery is pretty radical. As I indicated, I had serious complications -- including significant blood loss, severe edema in both legs, and an intestinal blockage (ileus) that had me on a nasal gastric tube for a week; also venous clots in both legs. I wouldn't want to risk going through any of that stuff again!Basically, I've concluded that you have to accept that a fracture of this severity will probably change your life. I broke my hip falling on ice at South Lake Tahoe after a day of skiing. Odds are, unless I become pain-free at some point, I won't be able to ski again. I am able to swim laps (1,500 yards five days a week), and the swimming seems to help relieve the pain for a few hours. I'll be happy if -- through medication or whatever -- it can be dialed back enough so that my wife and I can walk on the beach again and I can resume working out on an elliptical trainer.By the way, this kind of hip fracture is relatively rare. According to one Web site I came across, there are only about 10,000 a year nationwide. And the orthopedists who repair them are few and far between. My surgeon in Reno told me there were only 50 orthopedists in the whole country who perform this operation. There may be more than that, but it's not a large number of doctors. To me that means that most orthopedists and other specialists don't see many patients like us. My physical therapists have all said that I'm the only patient they've seen with this kind of injury. So I think that when it comes to dealing with the problems we're experiencing, most practicioners are groping in the dark. There just don't seem to be any easy or clearcut answers.Me, I'm hoping that this latest medication will bring some relief. Next step would be an injection to block the nerve pain. In the meantime, I just keep muddling through.Good luck to all of us.Steve
    Aptos Gimp 11 Replies Flag this Response
  • Steve,I was wondering about your physical therapy. It sounds like the complications you had after surgery were a lot more severe than mine. I was in the hospital for a total of 5 days with my surgery. The only complication that put me back in the hospital was a blood clot in my right leg. Everyone I talked to told me it would happen so I was prepared and knew what to look for. I'm still on medicine for the blood clot and a restricted diet due to the medicine I'm on interacting with certain foods. Is there any advice you could give that would help me prepare for rehab? Did you experience muscle spasms around your tail bone? I live so far away from where I had my surgery that another ortho surgeon is doing my follow up. He is a great doctor but does not perform these surgeries. I have asked him about the muscle spasms and he kind of just looks at me like I'm crazy. I know I'm not crazy because I can feel them but I thought it was odd if I'm the only one experiencing them. I've tried doing research on the matter, but sitting in my wheelchair is very uncomfortable so I can;t sit at my computer too long. I have tried laying on my side but that seems to hurt worse than the muscle spasms. Have you been able to return to work and how long did it take? A friend of mine tells me this injury will affect everything I do for the rest of my life and that I should file for disability. I didn't think disability was an option, however, I don't know how I'm going to be able to return to work with the restrictions they have already given me, not to mention trying to manage the pain. I'm already worrying about how I'm going to care for three year old once my live in help has to go home. I wanted someone who has been through this situation to give me their opinion on what I have to look forward to; good or bad. Thanks
    Anonymous 42,789 Replies Flag this Response
  • Unregistered: No muscle spasms here. Just the "brick" in my hip starting about 5 weeks post-op. I had no problems sitting in a wheelchair. I'm retired, so going back to work was never an issue. As far as "getting ready" for rehab, there's not much to do. Just show up and do what they tell you. I don't know what to say as far as what you can expect long-term, since everybody is different, but you may have to anticipate enduring some or many months of pain. I've been in pain for 16 months now, ever since I started "weight-bearing" again on April 1, 2008. It has been variously diagnosed as bursitis, IT band syndrome and tendinitis. I have tried all kinds of physical therapies -- stretching, strengthening, "modalities" -- without much improvement. I've undergone arthroscopic surgery to repair a labral tear and torn ligaments in the socket (collateral damage from the original fracture and surgery). Three Stanford orthopedists have told me that there is "nothing mechanically wrong" with my hip. However, the fracture did leave my right hip higher than my left and I have to wear a thick Dr. Scholl's insert in my left shoes to even myself out. My latest physical therapists say that my right hip is also "out of alignment," angled inward, compared to my left hip.We have a trip to Europe coming up at the end of the month, and it will involve a lot of walking. The latest directive from my latest physical therapist is to get ready for it by walking in the swimming pool for 30 minutes for a week or so, and then on soft sand (the beach is a couple miles from our house), and also by spending time on a stationary bike.As I may have said before, my understanding is that this is one of the worst fractures you can have and I believe it when someone says you'll never be the same again. Right now, I certainly don't feel like I will.Good luck,Steve
    Aptos Gimp 11 Replies Flag this Response
  • Thanks for the advice. I have my 12 week appointment on 8-12 and then I'll start physical therapy. I'll keep you updated on my progress. Maybe something I hear or do could benefit you and help with your pain. Enjoy your trip if I don't talk to you before then.
    Anonymous 42,789 Replies Flag this Response
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