April 2018 Update and new article
My Hip Journey So Far – An osteopath recently hypothesised that the osteoarthritis (OA) in my left hip was probably caused by a leg length discrepancy from birth – my left jamming down first would have taken its toll and eventually caught-up with me over the course of my 50+ years! Whether or not this theory is correct, it is true to say that I started to notice persistent groin (adductor) tightness from 2008. From much further back to 1991 when I started running, I had noticed that niggles and injuries nearly always occurred in my left leg. I have found it very interesting that different professions rarely cross-reference to consider all the evidence … so you inevitably get conflicting diagnoses and therefore often contradictory treatment plans.
From 1991 to 1996 I went from scratch to training for and racing in 4 big city marathons (New York, London, Berlin & Chicago). I ran 2:57 in September 1995 in Berlin at the age of 31, but then started to get problems and full-blown injuries which meant I ended-up walking the second half of the Chicago marathon in October 1996.
For the next 13 years I kept getting injured and so failed to train consistently to race to my potential – this was incredibly frustrating as my big passion in life was to train hard for and compete in marathon races around the world. I became a walking directory of physios and wider therapists – none of whom were able to offer a diagnosis and treatment plan to get me training and racing consistently.
More through persistence on my part and good luck rather than good management, I finally managed to get myself into shape to race another marathon.
In 2009 I placed 222nd finisher of over 6,000 runners at the Rotterdam marathon in a time of 2:55:45. I had actually managed to improve my PB despite being 13 years older. An improvement I mainly attribute to lifestyle changes impacting on work, sleep, nutrition and smarter training. All this despite what I later knew to be a rapidly deteriorating hip!
In 2012 I came within 52 seconds of this time at the same event in Rotterdam. After the race I had to lie down on a bed for hours with a strong aching pain from what I perceived to be my adductors. I knew something was wrong and needed an explanation. Knowing the problem is such an important step forward … you become empowered to investigate what best to do, you can plan your rehabilitation!
I was finally diagnosed with OA in my left hip in February 2013.
The diagnosis was a shock and devastating for me and led to a period of readjustment as well as research into the impact of OA as a long-term condition on quality of life for athletes wishing to continue to compete.
My research led me to try and self-manage to offset surgery. I tried all sorts of things including glucosamine and chondroitin supplements, copper heels, acupuncture, steroid injections, prolozone injections & intensive therapy and massage – all ultimately to no avail. If you were to ask me what made the biggest difference, I would say acupuncture actually got me significantly better for 9 months or so!
I stopped running in April 2014. I remember my last run was on Easter Sunday 2014 – the run itself was OK but I was in pain for about a week afterwards and just knew I had to stop. That same month I decided to learn to swim and so started lessons just before my 50th birthday. I progressed to completing open water swim races – a mile in 28:49 in July 2016 and a 4K in 1:29 in August 2016 – not fast but a benchmark from which to improve! Interestingly I noticed that swimming long distance in open water really made my hip hurt – it felt like it ‘froze’ / locked-up and ached increasingly over time spent in the water. This did not happen in the pool, I think because the act of kicking of the side every 25 metres actually tractions the hip and so stops the ‘freezing’ / locking / aching that I would get in open water.
With a definitive diagnosis and growing awareness the OA was only going one way, I got a referral to the care of an orthopaedic surgeon at Addenbrooke’s hospital in Cambridge, UK. I attended as an outpatient in January 2015 and was told I would need surgery any time from 6 months to 5 years depending on the progression of the OA in my hip. Options for surgery were explained including a total hip replacement (THR) and a Birmingham Hip Resurface (BHR) – the latter offered by Addenbrooke’s for younger, active hip OA patients. In May 2015 I had experienced sufficient deterioration and daily discomfort to take the decision to go onto a list for a BHR procedure due October 2015.
I had done extensive research about the relative merits and risks of BHR over THR and came to the conclusion that for my personal priorities and lifestyle, a BHR procedure offered the best outcome for me. Performed by a skilled, well-practised surgeon, the weight of evidence shows that patients rehabilitate back to near 100% mobility and functionality in the hip. This outcome would enable me to continue to do what I love to do – train and compete in endurance sports – realistically perhaps not as a marathon runner, but potentially competing in shorter road races, open water swim races as well as aquathlon events.
In the summer of 2015 Smith & Nephew, the manufacturer of the BHR implant, took the decision to recall all kit for procedures for small hips (femoral head of diameter less than 50mm). Following an MRI scan at Addenbrooke’s in December 2015 my left hip was estimated to be around 46mm. This meant I could not have a BHR procedure – I was once again devastated by this latest news. I decided I was not ready for a THR as this would likely outcome in reduced hip mobility and functionality – something I was not prepared to accept at my age and levels of activity. My research showed that there continue to be a range of different implants designed and manufactured for hip resurface procedures that were available, some on the NHS.
I was becoming desperate to proceed as soon as is possible with an alternative resurface procedure option. I was recommended Professor Justin Cobb at Charing Cross hospital (Imperial College London) as an expert proponent of resurface procedures. What is more, Professor Cobb was about to start a clinical trial of a new ceramic resurface implant device which was reputed to avoid the risk of toxicity from metal-on-metal implants such as the BHR device. What is more this new H1 ceramic implant is designed with a contour to avoid psoas impingement and has a special coating to encourage bonding to bone.
What finally convinced me that this was absolutely the right option for me was the extent of preoperative planning undertaken by Professor Cobb and his team at the MSK lab at Imperial – they 3-D print the instruments bespoke just for your surgery! The precision of their work is outstanding and is what I believe will deliver amazing outcomes for patients.
I was on the very first list of the safety group for the clinical trial – I had my operation on 26 September 2017. The procedure took just 90 mins and I had a spinal block (epidural) plus a sedative. My new hip feels superb. I was walking 5k in well under 50 mins just 2-3 weeks post surgery. I have since been working on strength and conditioning for the operated leg and am now back swimming and on my elliptical cross-trainer 6 weeks postop.
I feel incredibly positive about the future and look forward to training and racing competitively in the not too distant future. I predict that the new H1 hip resurface implant will prove to be a big success and radically improve the lives of many – thank you Professor Cobb!
David Brewer – 10 November 2017
December 19, 2017
No problems at all at 3 months postop – I am completely satisfied with progress.
My strength & conditioning routine seems to be paying dividends and I am back to full on training in the pool.
I have decided to wait until 6 months postop (Easter) to start running – I will follow the Dr Su PT programme and make sure I run on grass.
I’m impressed with your ultras and can certainly appreciate how small biomechanical inefficiencies can magnify through performance. I would certainly go for surgery in your case.
I would love to know what the surgeon perceives the risk to be? Prof Cobb and his team are a class act and inspire confidence.
I’ll try to post regular updates – 2018 will be a big year – I have entered aquathlon races in May and July.