Hardware Removal- Tibial Plateau Fracture

[canchaser]

I would like to know what to expect when my hardware is removed. I had surgery June 1 of this year to put in a plate, pins, and screws for TPF. I am doing pretty good, but at my last doctors visit he said that after about a year or so the hardware needs to come out. What will happen, recovery time, will it be as bad as my last surgery, will i have to go through the stiff knee and physical therapy again? Very scared

[MeTazDvl]

Canchaser...Rest easy!  Removal is a SNAP compared to your first surgery!  I had mine removed at the 6 month mark because the placement of the plate was rubbing on tendons and it would have been dangerous to leave it in.  I had a pretty bad break (3 seperate ones actually) and had to take it easy for a few weeks after the removal not just for the holes to heal but to also continue the originally breaks healing process.  I had the surgery to remove everything on a Wed. morning, used a walker for that afternoon, was up and around the house unaided with minimal DISCOMFORT....not really pain...by the next day.  Went back to work the next Monday and have never looked back.  I could actually feel the hardware gone as soon as I woke up from the surgery!  It immediately felt better!  My discomfort came from having stitches and not from the bone.  Very slight muscle soreness...equated it to the soreness you feel after heavy exercise.  It was gone within a day or two. 

Don't worry about removal....concentrate on healing now.  Work on your strength in that leg as much as you can.  That is the best advice that I was given and it was SO true.

Best wishes!

Juli

[vichall]

Thanks for that encouragement on the hardware removal, Juli! I had surgery on April 8, and I'm having some issues that may be hardware related. When I saw the surgeon a couple of weeks ago, he suggested we'd give it another couple of months to get past the 6 month mark, and then it could come out if necessary. I'm a bit concerned about the idea, because I have foot drop from one of the original incisions, and I worry that I'd have to fight back from that again. At least the hardware removal itself is not so big an issue.

[TaniaSki]

Thanks so much Juli - that is so helpful.  My hardware removal is coming up in the fall, and I am already worrying about it!

Tania

[pattyb]

Hi Everyone,

I have a love/hate relationship with my hardware. 
It took me ~weeks~ before I could bring myself to even touch it!
I was very fired up about getting it removed ASAP because it symbolized all that was wrong with my leg.  But now, after some though, I have come to appreciate how important hardware is for me to get back to a normal life.  So I don't hate it as much but still look forward to getting it out, if the doc says okay.

Patty

P.S.  I also wear braces (orthodontia at age 52) and have a love/hate relationship with them, too.  Braces and a broken leg within 5 months...life isn't fair! 

[Grandhoux]

I'm seeing my original (French) surgeon on Monday and hope he's going to come up with some plan to get me walking properly again. My original tpf (plate and 7 screws) was December 2008 but I slipped and fell 11 months later and broke my femur on the same leg. That really hurt! There's a difference of opinion on why it broke so easy; the insurance doctors say demineralisation from lack of use but my physiotherapists says weaknesses and fracture lines from the original accident, which was a bad one! I tend to go with the physiotherapists view.

The hardware for the femur fracture (plate and 10 screws) is really painful and is impeding my flexion by about 20 degrees. I had to have one huge screw removed after about 5 months as it was coming out on it's own but I'd like to have the rest of the femoral hardware out now, too. The tpf hardware is fine (even though one of those screws had to be removed after about 8 months for the same reason) and doesn't seem to impinge at all. I've been told that I'll probably need a replacement knee sooner rather than later and they may wait to see about that and not remove the hardware; hopefully I'll find out on Monday.

Whatever, hardware removal is a bit painful but nothing like your original operation. I've had two very big screws out now under local anaesthetic and it was fine. I'm not looking forward to a full knee replacement, though, even though it should get rid of most of the pain I get from arthritis, now.

Dave

[KartBoy]

Hardware removal is nothing to worry about, I had mine out a year after accident, I ended up spending two nights in hospital but that was mostly because the wound was still bleeding a bit too much. It was painful but for a fairly short period and although I came out of hospital on crutches I ditched them within two days. I was full weight bearing the whole time and did need physio as ROM suffered a bit temporarily.

Andrew

[Grandhoux]

Looks like I'm about to find out. I saw my original French surgeon today. He has definitely decided I need a new knee within 2 or 3 years but recommended a two-stage approach: all the hardware out now and then the new knee when it's stabilised. He then gave me a date for the hardware to come out allowing a year since my second lot of hardware was 'installed' after the femur break. So I now have a hospital appointment with an overnight stay booked for the 16th November. Xray to hospital appointment in an hour ... try that in Britain! 

I'm not exactly worried but there is rather a lot of hardware to come out and some pretty big screws, 2 plates and 15 screws at the last count, but I'll be glad to get rid of them!

[pattyb]

Oh Grandhoux, that is a whole lot of hardware.  I'm so sorry for you.

I cried like a baby the first time I saw my xray at the doctor's office. 
I wasn't prepared for it and it was the first time I saw a xray with pins and a plate--and the worst part it was MY leg!
Best wishes for you--I know from past posts that you've had quite a journey!

Hugs,

Patty

[KartBoy]

Dave

I can fully understand the removal of the Femur hardware but are you also taking the TPF hardware out at the same time because that's got to be a huge operation, do you really need the tpf hardware out now or is it harder to get it out in 2 - 4 years time closer to when you get knee replacement, or is it the case that once hardware comes out the holes will get a chance to fill in before the knee replacement happens.

Andrew

[TaniaSki]

Did any of you TPF'ers have audible clicking caused by the hardware?  Whenever I bend my knee in a certain way, there's a click that I can hear and feel.  It doesn't hurt, but it's uncomfortable.  I am hoping it's the metal and will stop when hardware is removed.  Anyone else have this?  Thanks!

[Grandhoux]

Dave

I can fully understand the removal of the Femur hardware but are you also taking the TPF hardware out at the same time because that's got to be a huge operation, do you really need the tpf hardware out now or is it harder to get it out in 2 - 4 years time closer to when you get knee replacement, or is it the case that once hardware comes out the holes will get a chance to fill in before the knee replacement happens.

Andrew

Hi, Andrew, it's the femur hardware that seems to be causing the pain and loss of movement but I think he wants to do the lot to be ready for the tkr. My tpf set wrong due to a bad decision without an Xray by a locum in Britain and the bottom part of my leg is out by a couple of degrees. The only way he can do this, he says, is with tkr. I'm not looking forward to the 'hole filling' period, I'll have to be careful, maybe they'll use some more French cow grafts? 

It certainly seems a better idea that was put to me before by the insurance doctors of the removal and tkr in one operation. I'd rather have the holes healed before they saw the bones off! 

[Valinla]

It's been a long time since I've posted.  I joined the bad-knee club back in January of 2008.  A skiing accident left me with a medial TPF.  I am scheduled for hardware removal in an hour and a half:  A plate and five screws.  It's been in there now for two years, seven months.  My doc told me it is harder to take out the longer it is in there, but I don't expect there to be any problems. 

I will post again after surgery to let those anticipating hardware removal know what they can expect.

[Valinla]

Hardware removal is truly a walk in the park compared to the original procedure.  Less than 48 hours after surgery and I am already able to bear full weight on the leg.  The calf muscle is rather painful, though, and doesn't tolerate regular walking movement, so I'm using crutches.  I will probably dig out the cane later today or tomorrow.   Foot is rather swollen.  I am able to (carefully) sleep on my side without causing pain to the incision.

They did keep me overnight because of an anesthesia complication.  I haven't looked at the incision yet, but the doc told me it would be about the same size as the original scar.

Happy to respond to any questions.  And best wishes to all my TPF brothers and sisters.

[pattyb]

Thanks for the update, Valinla.  I am scheduled to see my OS tomorrow (only my second visit with her--almost 4 months post -op) and one of the few questions I have for her is when/if hardware removal is in the cards. 

My question for you (after a few weeks anyway) is does your leg move freely instead of feeling like you are wearing a brace on it all the time?  I swear it feels if I have rubber bands in my leg that restrict my movement.  I hope that makes sense...

Glad you are doing well!  Please post again, if you can just for an update or two.

Patty

[TaniaSki]

Thanks all for the info - my hardware removal is scheduled for this Friday.  I am very excited to get it out - it feels like the beginning of the end of this whole TPF ordeal.  Any recommendations/tips for what to do pre or post-surgery would be appreciated! 

[Valinla]

Hi Tania,

I think the best advice I can give is to stay relaxed.  Sounds as though you're in a good state of mind approaching surgery, and you should be.  This procedure is nothing like the first one.  I shared your view going into surgery, hoping this step would be the beginning of the end to this long TPF road. 

My hardware was in for a long time, two and a half years.  One of the screws was stubborn, didn't want to come out (I was warned about this), and my doctor had to partially core the surrounding bone to remove it.  Even with that, my leg is feeling pretty good.  I am shuffling around the house unassisted and expect I'll have a decent gait back in no time.

I changed my bandages yesterday.  My new incision appears to be about an inch to two inches shorter than the original one.  The swelling in my foot has all but disappeared.   I've taken no pain medication in the last 12 hours . . . just don't feel the need.

Don't forget to take a stool softener for a while after the surgery.  I don't know if that is something your doctor will mention or not, but you will need it if you are taking certain pain medications, specifically Vicodin. 

Good luck on Friday.  You will do great !!

[pattyb]

Hey Valinla--great news about your HWR progress.  I'm glad it wasn't that bad for you!

Tania--best of luck in your HWR on Friday, if I don't get back on the boards.  I'm sure you will be happy once it's all over. 

And ladies, I found while I was on the vicodins I drank a glass of Sunsweet Plum Juice with extra fiber--it worked 100% of the time.  Just don't do like I did and drink a pint at once...try running to the toilet with a broken leg. A smallish glass will work nicely.  And it tastes good too. 

As far as my own HWR, my OS told me yesterday at my visit that since it doesn't hurt now, there is a good chance it will stay in.  She said if I had hardware issues, I should have known by now.  She did promise to talk to me at the one year mark if I was adamant about removal. Other than that, things are going well for me, and hope for all of you too!

[rainbowonthefly]

Hello Canchaser,
I had the hardware removed from my TPF last week, with no ill side affects. I walked out of the recovery room, only concern was the leaking of blood for a couple of hours. This settled over time, by following morning.
I had the hardware in for just over 30 months, biggest delay was that I work in the woods and Dr. commented I would need about 3 weeks for wound to heal, so surgery had to be scheduled in early winter.
I was full weight bearing and currently walking up and down stairs at one week unaided, little or no pain, the pain is from the steri-strips and pinching. The steri-strips will be out at ten days. I have been using ice to control the swelling but other than this all is well.
Sleeping at night is okay if you don't mind sleeping on your back, with knee elevated with a pillow, my partner can't wait to have roll over onto my side to quell the snoring.
You will be surprised at the size of the hardware as the larger of the 6 screws was 8 centimeters, and smaller was 5 centimeters, with a 10 centimeter plate, together these titanium trinkets, made for a very nice tree ornament.
You should be up to normal in no time, I hope to be walking 30-40 minutes once the s/strips are out.
Regards,

[KartBoy]

I specifically asked the surgeon to see my hardware after it came out but wasn't allowed to, I understand it was incinerated after the operation so all I have is the xrays but glad it has gone.

[rode1981]

I just got home from the OS.  I have a non union tbf.  I have another appointment in a month to x-ray it again and I am being scheduled for a scan. The hardware will be coming out as soon as the bone is healed completely.  As of now, the bone behind my knee is still not healed.  Then, he recommends a total knee replacement.  The best scenario would be to do it all at once but he is leaning towards the conservative side and doing the hardware removal, letting it heal and then do the knee replacement. I am so over this injury.  Any advice from anyone?  He told me to continue with PT to keep strenghtening the knee and surrounding muscles and soft tissue.  RIght now, my knee feels so constricted, actually I should say from my knee to my shin. I have had enough.

[KartBoy]

Depending on your age are you a MACI/ ACI candidate like me. I am now 48 and way to young for a knee replacement and so far at nearly five months its doing the job. I'm still in a bit of pain and need a cane to get around if out and about too long but its still healing and its way better than before the operation.

Its a good idea to get hardware out first as any metal in the leg makes things like MRI's very tricky. The hardware op is no big thing and gettign it out and seeing if that helps is a good step forward.

[rode1981]

Hi!
Thanks for writing back.  I can't wait to get this hardware out.  I can feel it and as you can see on my x-rays the location makes it even mor constricting.  It's still not healed compeletely though and since my bones are so soft it's going to take a bit longer I think.  I've taken a lot of Prednisone over the years and it's done on a job on my bones.  What are MACI/ ACI?   I'm 56 and so far we going with the removal and then when that heals we are doing the TNR.  I honestly can't wait. My PT and surgeon said I will be much better off and feel better quicker.  The whole process is still going to be a year when all is said and done.

[Grandhoux]

Hi, Rode, (?)

I'm 56 as well and hoping for a tkr later this year. I had my hardware (2 plates and 15 screws) ut in November last year (2010) and i's far better for bending and overall movement with less pain. The downside is my knee now has all the weight and I can walk a half mile but my limp gets progressively worse and I can feel the bone-on-bone until it just gets too much and I have to stop. More fatigue than pain but it hurts, too. Unfortunately it's getting worse so the cartilage is shot and not recovering.

I've also had problems with the scar: one part wouldn't heal and got infected, then still wouldn't heal. Last week I went into the A&E epartment and was seen by my surgeon who dug around in the wound (without anaesthetic), told me to 'tais toi' (shut up!) and eventually dug out 3 undissolved stitches as well as assorted bits of meat! Hopefully it'll heal OK now!

I'm hoping for a tkr later this year (same surgeon!) as not only is my cartilage shot but my knee is set in a bend and my left leg is now at least an inch shorter than my right. I'm told the surgeon is the best around here (in this part of France). Lucky I don't live where the surgeon is really bad, eh! 

[KartBoy]

MACI/ ACI is cartilage transplant. They do keyhole surgery to remove a  small bit from a part of the knee that isn't load bearing, send it off to a lab and grow a few million new cells (on a matrix scaffold if its MACI) then in a second operation 6 - 8 weeks after the first they patch the damaged cartilage. They have been doing extended research at Stanmore for almost ten years with 400 + patients, I had mine last August. The recovery is very long and not guaranteed, anywhere between 50 - 80% depending on how much damage you have and where in the knee the damage is. They carefully evaluate every patient and not everyone is suitable as its still experimental and probably will be for a few years yet.

[djjaydee4883]

I had 6 screws and a plate inserted on Sept 20,2011 as of January 2012 my fractrure is fully healed and range of motion is 131 degrees, my strength is great. my doctor told me that the hardware should be removed in Sept of 2012, and I will eventualy need a full knee replacement. I would like to know how the surgery is comparied to the first one, and is the recovery time the same as the orginal surgery.

[KartBoy]

The hardware removal is nothing to worry about, it doesn't involve any period of non weight bearing and although it might be a bit painful your only talking about a couple of days and some physio after to restore ROM if the knee tightens up which is common to any knee surgery but again relatively short term.

Don't be too quick going down the TKR route, my ACI surgery at Stanmore was done to test out the limits of ACI to correct traumatic damage to the cartilage, it helped and while I'm still having plenty of trouble with the knee and ongoing pain we are still buying time and delaying my TKR, a good thing if your only 49 (45 when hit by car).

[morgana]

Hi Gang
     I'm looking for who had their hardware removed after it had been in the longest.  As of May my hardware will have been in 4 years.  My biggest issue is & has been the same all along - the screw on the inside (there's only 1 there) hurts at pressure.  It wakes me up repeatedly thru the night.
     At this point the only thing I can't do is a prolonged unsupported catcher's squat - I still need something to do a light touch balancing.  And I truly believe that I am within weeks/months of being able to do that again.
     But, I haven't slept longer than 2 hours without being awakened by the inside screw.  My guess, although I haven't confirmed with the dr, is that if we're removing 1 then remove the whole thing.  At the last dr appt (Nov 2009) he indicated that removal is optional, contact him when/if I wanted it done.   Since it has taken so long to get to teaching full time again, I really haven't wanted tp push it.  But after reading & rereading - I'm thinking...