Resurfacing an option post femoral neck fracture w/pinning and AVN?

[hippycyclist]

Hi folks! I'm a 33yr old male and avid road cyclist. I've completed a number of high level endurance events and amateur competitive road racing.

About a year ago I had a high speed bicycle collision and sustained a displaced femoral neck fracture. I was immediately taken to Swedish hospital in Seattle and ~6hrs later had emergency surgery to repair the fracture with pinning. After 10wks of no weight bearing, the fracture completely healed and I spent several months in rehab learning to walk again. It was incredibly difficult but I had an awesome PT and worked religiously at getting my ROM/strength back.

Unfortunately, I've had two complications since the fracture:

1) Severe hip flexion ROM deficit and pain from pinning. I found out after the fracture that I had pre-existing asymptomatic FAI. It became symptomatic after the fracture and now causes severe pain with any hip flexion past 90 degrees. My surgical pins also backed out as the fracture healed and I have pretty bad IT band pain.

After exhausting all other options with my PT, I decided to explore hip arthroscopy with a specialist at Swedish and I'm scheduled to have it done next month to address these issues. The surgeon will attempt to reshape the femoral neck to allow for additional ROM and remove some or all of the surgical pins.

2) AVN. In anticipation of arthroscopy, I had an MRI completed a month ago. Unfortunately, it shows early stage AVN in my hip. Despite this, my surgeon says it's fine to go ahead with arthroscopy as it's unclear if the AVN will continue to progress or if the bone with re-vasculaize and remain stable without collapse of the femoral head.

My questions for y'all are two-fold:

1) If the AVN progresses, can one have hip resurfacing done to preserve the hip joint and avoid total hip replacement?

2) If hip resurfacing is an option, would it be jepordized by arthroscopy? E.g. if I have bone reshaped, would it impact potential/eligibility of future resurfacing?

I'm going to ask my arthroscopy surgeon these two questions as well, but thought I'd ask the question here as well.

[catfriend]

If you're in Seattle and already seeing someone at Swedish, then my recommendation is to go see Dr. James Pritchett. He is one of the top resurfacing (and joint) surgeons around. He is part (head at one point; may still be) of the Swedish Orthopedic Institute, and that's where he performs his surgery. He has an office in the Cabrini Tower as well another in Kirkland. He not only does resurfacings, but replacements, revisions, and other joint surgeries. He has resurfaced a number of the hips of forum members, including myself.

[chuckm]

1) AVN patients do very well. Many have developed new supplies of blood to the femoral head through the bone instead of all the blood supply coming through the soft tissue on the outside of the neck.
2) probably not a problem to have arthroscopic surgery to help with FAI.

Chuckm

[imgetinold]

Also, you can email Dr. Gross in South Carolina.  He takes on a lot of difficult cases, and can consult over the phone.  It's a hike, but he's the best.  He also performs the surgery outpatient (saving TONS of $$), and leaves a roughly 4" scar. 


He's the best.


Good luck!

[John C]

I have two friends, male and female, who were in a car accident about 7 years ago resulting in fractures and eventual AVN. Both are avid cyclist and skiers. Within the past couple of years they have both had their damaged hips resurfaced by Dr Gross and are back to all of their sports. The male cyclist has commented that he is still challenged to get full strength back on that leg, and the lady who is deeply into yoga still has some flexibility issues at extreme ranges, both of which are still true for me as well at 10 years out. However, we are all basically pain free with very active sports lifestyles.

[karlos.bell]

Hi Hippycyclist.
Question.
1 Not sure do some home more home work on it. Ask the best in the world.

2 FAI will never get better and the bone taken away is much needed in the resurfacing operation. Take that from my experience.

Cheers K