New study released about cycling after hip surgery

[dougmint]

Thought some of you might like to see this:

http://www.ejbjs.org/cgi/content/abstract/92/4/814

Background The optimal treatment strategy following primary total hip or knee replacement remains unknown. The purpose of this study was to evaluate the effect of ergometer cycling after hip or knee replacement surgery on health-related quality of life and patient satisfaction.

Methods Three hundred and sixty-two patients were randomly assigned to either perform or not perform ergometer cycling beginning two weeks after total hip or knee replacement. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at three, six, twelve, and twenty-four months postoperatively. Results were compared with published thresholds for minimal clinically important improvements.

Results The baseline characteristics of the two groups were similar. After the hip arthroplasties, all of the outcome parameters were superior in the ergometer cycling group at all follow-up intervals, and the primary outcome, physical function as measured with the WOMAC, was significantly better at three months (21.6 compared with 16.4 points, effect size = 0.33, p = 0.046) and twenty-four months (14.7 compared with 9.0 points, effect size = 0.37, p = 0.019). After the hip arthroplasties, a higher percentage of the ergometer cycling group was "very satisfied" at all follow-up intervals (for example, 92% compared with 80% at three months; p = 0.027). The significant differences in the primary outcome exceeded the absolute minimal clinically important improvement threshold by a factor of 2.0. No significant differences between the study groups were seen after the knee arthroplasties.

Conclusions Ergometer cycling after total hip arthroplasty is an effective means of achieving significant and clinically important improvement in patients’ early and late health-related quality of life and satisfaction. However, this study does not support the use of ergometer cycling after knee arthroplasty.

[Pat Walter]

Hi Doug

Thanks for posting the information about the interesting medical study.  We can learn a lot from the studies.

Pat

[LOGAN13]

Since the syudy you mention was done in Ontario Canada...I have to ask. Have you yourself had a hip resurfacing? If so..was it done in Ontario & by whom.

Thanks

[dougmint]

I believe the study was done in Germany.  But regardless, I had my right hip resurfaced 2 weeks ago, and I live in Michigan.  My surgeon was Creg Carpenter from Chelsea, MI.

[PaulUK]

I contacted the lead author of this report for details (Dr Liebs in Germany). He tells me that the amount of cycling needed for benefit was minimal.

Patients started the cycling two weeks after their operations. The ergometer (static) cycle was on the minimum setting (about 30 watts), with the saddle set so that the forefoot reached the pedal with the knee in extension. Each session lasted about 15-20 minutes and were done three times a week. The patients were instructed to perform ergometer cycling for at least three weeks.  Some patients may have gone on cycling for a longer period of time, but that was not analyzed.

The paper states that the aim is not about building strength or cardiovascular performance, but to 'improve muscular coordination, proprioception and range of motion'. The results were quite impressive for a small effort!

[dw]

The first thing my PT did was put me on a bike - they had a special one with moveable pedals, to increase or decrease the range of motion so as to not break any 90 degree rules (also had a tension adjuster). I think it helped allot.

On another note, recently rented bikes and rode probably 15 miles - hip felt great after (my "sit bones" not so much).

[ByTor]

DW,

   You might want to consider a recumbent bike or trike if you're going to do some road riding. They're fantastic for "getting a load off" and allowing you to ride more comfortably. For example, I have had a Catrike Road for several years due to some neck problems, and it's a great ride. You can check out a bunch of different 'bent types at www.bentrider.com - they have reviews, all kinds of stuff. You can also find different 'bents on youtube.

I haven't been able to ride mine for the last year+ due to RoM issues w/ my left hip, so I'm looking forward to getting back on & using it as a big piece of my therapy after surgery this Friday (LBHR 6/11, RBHR 8/13/10 planned).

[tricky]

I tried the real bike this afternoon after working out a couple of times on the stationary bike.  It went pretty well but felt some pain on hills and inclines.  Does anybody have any thoughts about doing hills and riding real bikes as opposed to stationary ones?  I'm 5 weeks post op and have just been cleared to commence weight bearing rehab.

[Pat Walter]

Tricky

Has your surgeon given you permission to ride a real bike yet?  I held off for quite awhile since it takes time for the bone to grow into and around the new hip components.  If you fall off and jar that hip hard - it could cause problems.  I would be careful and check with your doctor. It isn't the riding - it's the falling that could cause the problems.  Be careful for now and let the hip get healed well.

Pat

[resurface]

Tricky

Hi.  I am 6 weeks out and was just cleared by my surgeon to ride on the street.  I had been doing stationary riding for the past 3 weeks and my wind trainer.  This morning was the first time that I felt great on the bike.  I also had somewhat of a change in condition.  This past week seems to have seen significant "healing" progress as I have no limp and I feel stronger.  My early riding was limited to 10 - 20 minutes session as my inner thigh became sore.  I did stop as soon as I felt this.  It was just getting tired. 

I am going to a local Wed night hill session this week, but I do not plan to get out of the saddle just yet.   I am worried about falling.  On the other hand, I had never fallen until 3 weeks before my hip surgery.  My shoulder took a beating!  It is always something.  Take it slow.  Be safe but enjoy.  As was said, make sure your doc is ok with this as well.

Good luck...

[dw]

I tried the real bike this afternoon after working out a couple of times on the stationary bike.  It went pretty well but felt some pain on hills and inclines.  Does anybody have any thoughts about doing hills and riding real bikes as opposed to stationary ones?  I'm 5 weeks post op and have just been cleared to commence weight bearing rehab.

Well, it's kinda like running outdoors vs. a treadmill - not a controlled environment. Your body was probably in different positions than it was indoors, as to be expected. As long as you're not breaking your doc's after surgery directions, and restrictions, let your body dictate activity level.

[tricky]

Thanks for the inputs....the Dr. did clear me do ride outdoors but the fall possibility is definitely a factor.  I think I will stick to the stationary bike for the time being.....it's just a lot more fun being outdoors!

[DirkV]

I had good fortune/ bad fortune when it came to cycling PT. As background, when diagnosed with arthritis, I had recurring cycling problems with isochial tuberosity (sp?) muscle pulls - probably from rom limitations to step over the pedal stroke. Eventually I had to stop riding, but a friend who is a way more serious cyclist, suggested that I see his coach. His wife is an MD in PT and that year had a US national championship (on tandem)! They were able to get me re-fitted on bike to ride a year or so longer on with arthritic hips.
So I saw her again after surgery, and as somebody who really knows cycling, it was good that she had all kinds of good PT exercises. But she was extra cautious, and she didn't want me going on the road until she was satisfied that balance and strength were sufficient. She would have liked to have me riding no handed on rollers while getting knocked with a pool noodle :-) before going back on the road. I don't recall if it was 9 weeks or 12 weeks or whatever when I took my bike off the training stand and went out into the real world, but I kind of split the difference when it came to getting back on the road. The advice sounds trite, but listen to your body.
Sometime during the first couple months, while riding on the training stand, I recall trying to get out of saddle, and the muscles just were not willing. I'm not sure if I would have fallen had I not been attached to the stand, but it certainly would have required a catch of balance.
Even after 1 yr, I was still feeling some effects from the surgeries. I could slog up a long climb with no problems, but a couple times, I got some significant soft tissue pain from all-out sprints. So I laid out of the group-ride sprints for a few months, and gradually worked up intensity of output, and sometime during that 2nd year, the problem went away. Oh, another thing from the first year, that you may or may not find, I'd get a clue from my back when I had worked too hard. The good news is that all those symptoms went away.
Good luck,
-Dirk