Joint Movement question

[Alan B]

I had a resurface on July 20th.  I am very happy with the results and am already feeling better in many respects than before the surgery.  My question is that the joint has a little bit of movement "klunking around". It is not terribly significant, but enough to notice. I am interested in learning from anyones experience if this was typical and if it goes away as part of the healing/strenghening process. Thanks Alan B

[ScubaDuck]

Alan-

There are a lot of postings on this topic.  Just search for the term in the forum.

It is practically a given that everyone will experience some clunking.  This is more a function of the muscles than the implant from what I have read.  It should become more infrequent as you stretch and strengthen the muscles.

Dan

PS  I had clunking in my hip prior to surgery while stretching in certain positions.

[hernanu]

Like Dan said, this is a very common experience and attributable to the muscle strengthening. I still have some every now and then about a year later. I was very nervous about it at first until other posters and most importantly, my surgeon reassured me.

I am doing what I can to make sure the supporting muscles are stronger, but like with everything else, patience and exercise will get you through.

[Luann]

Hi Alan, Congrats!!

Search the topics on this discussion site and you will find an entire section on this and related topics. It is nothing to worry about in most cases. I still have a little after 14 months. It never is painful, you just kind of feel it and "hear" it in your head!  Good luck and heappy healing, Lu

[John C]

I wanted to post one more testimonial that early clunking happened to a lot of us, and almost always evolves away into a non issue. I had a lot of clunking during the first month, and it really worried me at first. I still had a little over the next few months, and occasionally for a year or so. I believe that it is all just a matter of the muscles healing and strengthening. At three years, it is no longer an issue at all.

I also wanted to throw out an idea that may not be popular, but it is worth considering. There have been studies done with cadavers showing that with resurfacing, there can be impingement when taken into extreme flexion, particularly with internal rotation. Some of these studies took the position that this impingement is the norm with resurfacing. This may not be a huge problem, but the argument is that in deep flexion, this impingement levers the ball slightly out of the socket; not enough to come close to dislocation, but enough to unnaturally stretch the muscles and ligaments that hold the joint together. This may lead to a clunk when the ball settles back in place as the person comes out of the stretch, and may arguably lead to more occasional clunking later, since the integrity of the ball being held tightly in the socket may be compromised each time the ball is leveraged slightly from its seated position in the socket. I had a resurfacing friend who, a year or two after surgery, started working with people who believed in extreme flexibility. He started experiencing clunking for the first time during some of the stretches, and sometimes afterwards. In a worst case scenario, some studies expressed theoretical concerns that pushing through this impingement could lead to notching or fracture of the femoral neck, or levering the cup loose. As I understand it, the lower coverage angle in the ASR cups was an attempt to minimize this impingement issue, but we all know that it came with undesired side affects.
So my own non-medical takeaway from all of this as far as clunking is concerned, is that strengthening is good, regaining a "natural" range of motion is good, and pushing for extreme ranges of motion with a resurfacing device may be questionable.

[Lopsided]

I also wanted to throw out an idea that may not be popular, but it is worth considering. There have been studies done with cadavers showing that with resurfacing, there can be impingement when taken into extreme flexion, particularly with internal rotation. Some of these studies took the position that this impingement is the norm with resurfacing.

I am glad you have brought this up, and I have considered there can be impingement with resurfacing too. Not just with flexing, but with abduction.

It is well known now that the acetabular cup should be placed at a relatively shallow angle to prevent edge loading. When I look at x-rays, mine and others, it seems apparent that extreme abduction (doing the splits) would be difficult. In fact, in order to place the cup at a shallow angle, the top of the cup protrudes and is not flush with the acetabulum.

I had also understand that the ASR was designed to minimise this. Maybe those patients that had the ASR placed well will end up with the best range of movement.

D.

[FlbrkMike]

I'm going to have to keep reminding myself, then, not to do the splits.
:(

[Lopsided]

I'm going to have to keep reminding myself, then, not to do the splits.

Double pike back somersaults are okay.

[lori.36]

Alan,

I had clunking when walking in the pool or stretching.  I am now three months out and rarely get the clunking.  I think it is different for each person based of their muscles and strenth prior to surgery, also their ROM.  It seems to fade like the other things, the IT band pain was the worst!

[hernanu]

Lori, did you try a roller for the IT band? It really helped me with my second, after having real issues with the first.

[lori.36]

Hernanu~  My IT band issues where really bad at the 2-4 weeks portion.  I was going to PT and he did deep tissue, which relieved it.  I did a little foam roller, but I had the PostLateral approach and at that time rolling it was a little painful.  I have very few issues to report now.  I am feeling very strong and flexible.  I can even cross my leg over.   :D

[hernanu]

That's excellent - I started with the roller at about four weeks, since the IT band was complaining for a few months on my left. I can also cross my leg over now, just doesnt look as good on a guy  :o.

[hipnhop]

5 months and the clunking stopped around the 3 month mark.