Hardware removal 10+ years after TBF ORIF-- what to expect? (plus a novel about my experience)

[Lozilla]

Hi all,

I'm new here, I've been reading around and boy I wish I'd known about this forum when I had my accident!

Lots of details below (this became a bit of a therapy session, whew) but you don't need to read it all unless you're interested. Basic info is I had ORIF for tibial plateau fracture in spring 2012. Was in a cast then a brace and worked hard on physio and had a good 10 years. 2.5 years ago it started bothering me, and after having been round the houses with the NHS (which I love, but it really has been ridiculous), I've got day surgery booked in late June.

I had under five minutes to ask questions, and don't feel like the answers line up with what I'm seeing online. He was 100% only concerned with wound care, said I would be fully weight bearing straight away, no crutches or canes, didn't need to modify activity unless it damaged the wound.

When I look online, I see lots of reputable sources saying recovery is slower than that. Another NHS trust (https://www.rjah.nhs.uk/media/5dihvwkj/ ... eaflet.pdf) says "For the first week or two you should rest and elevate your leg(s) as much
as possible" and that it can take months to regain capacity.

I'm trying to figure out what is realistic. I am really convinced that this won't be anything like as bad as the original surgery. I have read several ORIF removal posts here, which are helpful, although the oldest hardware I've read about is two years old, so don't know if it will be harder having been in so long.

I work an office job that is very flexible. If I tell my boss I should WFH for two weeks or even a month, he will be fine with that. But is that sensible? We currently have a train trip to visit family about 10 days after the surgery, it will be a 2 hour train and then an overnight stay in a hotel and a 3 hour train the next day. I'm imagining that will be uncomfortable but hopefully not unbearable or damaging for recovery?

And we had possibly planned a trip to Paris about a month after the surgery, which would typically include lots of walking around. Is that a stupid idea now?

Any words of wisdom would be most appreciated!


Further details if it's useful, like I said, this was a little bit of therapy typing it all out, so thank you to this forum for being here:
I fell off my bike in 2012, inital x-rays said nothing was wrong so A&E sent me home. After increasing pain while walking on it for 6 weeks or so, I went back to A&E after seeing my GP, A&E sent me to lower-leg clinic who said I was going into surgery that day for tibial-plateau fracture ORIF. I was in a hip to toe cast for several weeks (which I think is not the done thing these days?) and then in a brace for many weeks more. I did physio and got acceptable ROM back, and got back to a very active life full of lots of walking and bike riding, with only the occasional tinge. I would say I could easily average 5-8 miles a day of casual commuting walking around the city with no problem.

Roll forward to 2022. I went on holiday in Lake Como and something about lots and lots of very steep cobblestone stairs (I think lateral movement plus lots of stairs did it), my knee was really swollen and painful more than it had been in years. I iced and elevated and it went down, but if I walked much at all, it was really painful. That autumn my husband noticed I was limping and I was in pain if I walked anything more than a half mile or a few flights of stairs (we live on the third floor, no lift, so getting in and out of the flat is six flights of stairs even if I don't go any further). Saw the GP, who referred me for an x-ray, they couldn't see anything so referred me to get an MRI and then see the MSK team, MRI happened in Dec and MSK in Feb 23, MSK couldn't tell what was going on and referred me to ortho.

Finally saw an ortho June last year, he said looking at the MRI he thought it could well be the screws irritating things, and said he could either put me on the waiting list to take them out or give me a steroid injection to see if that helps. He'd bring me back in a month to decide on surgery. Two life lessons for me: if it's a waiting list, just say YES! PUT ME ON THE LIST! and you can change your mind if you don't actually want surgery. Also, steriod injection was super painful for me, actually made my knee hurt worse in the injection site, and gave no relief at all.

I waited three weeks and emailed about the follow up appointment, kept being put off, gave an appointment which was cancelled, rinse repeat until I finally was seen mid October. By a different ortho registrar. When I came in, she said I would have the surgery to remove the screws, there were three variations and she would check with her consultant to see what he thought. She prodded my knee a little. But she couldn't see the MRI on file, had I had one? I said yes, at another NHS hospital, and the guy in June had been able to see it. Hmm, can't see it, but she would see what the consultant thinks. She came back in less that 4 minutes (I had noted the time) and consultant had decided it was just patellofemoral pain syndrome, that surgery was unlikely to help, and I just needed physio. When I said that I had been paying for private physio for a year, which had helped steady my gait but not got me to where I was before, she just sighed and said some platitude about not being what I wanted to hear, but it was what it was. She said she would bring me back when they found the MRI, in less than a month.

Reader, you may have guessed that it was not a month. After being very persistent (in a respectful way) with the admin team, I got an appointment for early January this year. I took my husband this time as I honestly felt I'd been a bit gaslit the previous appointment. It was the same registrar, and she started off by saying again it was unlikely surgery would be relevant for me. But as I was there, she probably should just look at the knee again before checking with consultant again. She poked at my knee, and when I flinched when she poked where the screws are, she seemed surprised. "Does that hurt?!" "yes" "but...in my letter, I say that the screws aren't palpable...and that they're on the other side of your knee." I responded that as far as I knew, they hadn't moved in the last 12 years. She actually apologised and said she'd got it wrong and felt around a bit more. She said it wasn't good that there was swelling over the screw heads and that inflammation could be causing my problems (what I'd been saying for 18 months at that point) and I would be on the waiting list for surgery.

Have done the interim assessment stuff, and finally got the call yesterday that my surgery is in a month.

[Bella_Gamba]

Hello Lozilla,

I am not sure I can be helpful as I got the hardware removed almost a year after my TPF ORIF surgery. The recovery is much faster but I could not walk without aids or be full weight bearing for the first month (or two?). I think you really should take it easy and follow the advice of your physical therapist but would not go to Paris (or any city that requires a lot of walking) a month after the surgery if I were you.

If interested, I have written a post on my recovery in 2018:
viewtopic.php?p=679641#p679641

Best of luck on a speedy recovery,
Bella

[Lozilla]

thanks so much for your response! Yes, your post was one that I found really helpful, thanks for all the detail, it's really good to know.

I'm in the frustrating place where I'm more inclined to believe strangers off the internet than the surgical team. I emailed asking about the trip, as I would need a letter advising against travel to claim on travel insurance. They say " Yes, this patient with implant removal she is ok to travel, however her wound need to be looked at by GP/ district nurse at 2 weeks. Apart from that no such restrictions he can wait fully mobilise full weight bearing as tolerated. Yes prolonged standing might causes excess swelling but should be major issues as we are just removing screws."

So they are saying no crutch or cane will be given as I'm weightbearing straight away, and am fine to travel right away.

I guess I'll see how it goes but I just can't quite imagine it's going to be that easy and quick!

[Bella_Gamba]

It may be possible that since your hardware has been in for so long, your bone is completely healed. This was not the case for me, as the holes left from the screws were visible on the X-Rays. Maybe there is some truth on what they are telling you. What do I know, after all? Take care!

[Lozilla]

thanks! from what I can tell, the bone still will have holes where the screws are, plus there's a chance the screws are more embedded/calcified in the bone, potentially making a more difficult removal (which is why they usually do it earlier). We'll see I guess!

[Bella_Gamba]

Sure, makes sense that the holes will be there too, but you had 10 years to heal and your muscles are probably stronger than any of us who got the metal out in one year or so. Keep us posted with your experience. I am sure we will benefit from learning about this! Take care, Bella G.

[listlesslab]

Removing this hardware years later can present both benefits and challenges.drift hunters