running and jumping. Why the differences?

[teaching tennis]

Hi all, new guy.  I have been the luckiest BHR patient ever.  I have been pain free since about a week after surgery.  By riding a stationary bike and doing the home rehab that Dr. Brooks (cleveland clinic) ordered, I have had complete range of motion for the last two weeks, same time that I threw the sticks out the window,  and have been able to cross my legs "man style" for the first time in 7-8 years.  As a tennis teaching pro, I have decided to go back to work with young kids only, because that requires no running or jumping.  I FEEL GREAT!!!!
My topic is the variance of Doctor recommendations on when to start running, jumping and weight use.  I have been told by Dr. Brooks that all of that must wait a year from surgery.  The posts on this site vary from 4 months to a year.  I have noticed that most breaks or dislocations seem to occur in the first 3-4 months.  Help me please.  I'm chopping at the bit.  My son is a 3rd year otho resident and his view is,  your doctor did a great job in the OR, now you need to do a great job out of OR by listening to him.  I want to.  I just feel so good that I want to keep pushing my body.  Advice/ Comments

[Spanielsal]

Hi Teacher, why take the risk? 

[hernanu]

Hey, welcome to the site! great that your HR is going so well.

I think you can see based on the posts by runners here what the prospects for returning to serious running and about when. I'm not sure I've seen one that went back to running at 4 months, I know there's several who began training for it later than six months. I was told to start running at one year after my surgeon tested my three steps jogging at my six month checkup. I both looked bad running and it felt really awkward. I actually began walking / running on the treadmill at about 9-12 months, but it really was mostly walking. There are several good triathletes who have had the procedure and are either in the process of training to get back to the sport, or have begun to compete again; you can look at their posts and get an idea of how they felt and what they did to train.

My own view is that you listen to your surgeon. I understand that we are all type A's here and are not the type to be held down, but look at what you're able to do already. You're crossing the legs like a guy, already teaching, no pain, all good.

The main reasons for a revision are not necessarily femoral breaks, rather slippage of the cup or femoral component, issues with the junction of the bone with the devices; all of those are helped by patience - the bone is growing into each of the components at a rate determined by nature and the almighty (or just nature, to be tolerant of all viewpoints), and the bone growth is not hurrried or aided along by anything you do other than nutrition and your acts of protection towards your hip.

The growth of the bone seems to take about two years, with it reaching a level where it is really strong by one year. I'd listen to Dr. Brooks; right now it seems like forever, but you want to go back to running / jumping when you're strong enough that the results will be a great rest of your life, not chancing a revision.

It's a bone race, not a muscular race; the muscles are important, but the bone itself is critical.

[stephen1254]

Hern is spot on. The issue is not muscle recovery but implant healing. The recommendations ARE all over the map, but the longer you wait to run and jump the more likely you have adequate bone growth into the implant.

And believe me, I know all about chomping at the bit.....

[Woodstock Hippy]

Best advice is it listen to your doctor.  The doctor knows what's going with you better than anyone else. My doc allowed me to start at 6 months, telling me to start easy and use my head.  I think that court sports like tennis, basketball and volleyball are harder on the joints than straight ahead running.  Your doctor is being wise to restrict you.  Go with it.  Patience is the hardest thing to learn with our recoveries, be patient and it will all work out.

[David]

My Doc (Su) did say I could gradually introduce running at 4 months.  That just meant a couple of pick-ups here and there between walking and hiking, which I did.  The key after 4 months "IS" muscle recovery, because that is what will protect the hip capsule from taking too much impact.  You must become in tune with your body and progress slowly.  Your recovery completely depends on your individual situation.  The better you know your body and listen to it, when to push a bit and when to rest, the easier you will progress without any hitches.  Someone who has been an athlete and in shape right up to surgery, will surely or should recover a bit more easily than someone who is very overweight and sedentary.  No majic pill here, we are all guinea pigs in a way.  Ask questions as you go and don't push through any sort of noticed pain.
Best to you...
David

[teaching tennis]

thanks all.
I will be holding back while on the court, no doubt, but I still don't get the surgeon variances on when to start running etc.
I understand this is a new surgery and Dr's are still gaining info themselves on post op issues.  But one Dr. having success at 6 months and another at 12, almost seems that we are test cases at some level.
O well. 
I will continue to push (as much as a father can push a 29yr. old son, who is very strong willed) into a fellowship on the BHR. 
Feeling like a run, but going for a walk.

[Dannywayoflife]

Personally I would listen to the surgeons who pioneered the proceedure McMinn and Treacy they advocate waiting 12 months they have done over 10,000 between them and are world authorities on resurfacing so personally I'd take there word over surgeons who were not involved in development and have only been doing the proceedure a short time. 

[bilateralbliss]

Personally I would listen to the surgeons who pioneered the proceedure McMinn and Treacy they advocate waiting 12 months they have done over 10,000 between them and are world authorities on resurfacing so personally I'd take there word over surgeons who were not involved in development and have only been doing the proceedure a short time. 

100% agree with Danny- err on the side of caution!! Medical facts ie bone strength and muscles are proven. Don`t risk it :)

[JerryD]

I fully agree with the advice of Dannywayoflife -- take the advice of the experts that invented the procedure.  Here's what McMinn had to say on the topic in an interview back in 2007:

"The evidence from a DEXA study on BHR patients published from Japan is that the bone density in the proximal femur returns to normal 1 year after operation. The at-risk period for femoral neck fracture following the BHR is in the 6 months after surgery. I advise patients not to return to impact sport for 1 year after surgery. For those patients who want to road run, I get them running on a treadmill at 10 months post-op and they resume road running at 12 months post-op. My unit published on activity level after resurfacing some years ago in a group of patients who followed those rules. In young men with a single osteoarthritic hip resurfaced, 92 % played sport and 62 % played impact sport. The ladies were not quite as active, but you can see from the publication that they still had an impressive activity level. In the total group their 10 year implant survival is 99.8 % showing that high activity introduced at a sensible time does not deteriorate the results."

Personally, I haven't been able to run for 5 years and am keen to get back to it.  I had my BHR 2 months ago.  I figure that having had to wait 5 years, I can certainly wait another 10 months (8 for the treadmill).  I'm going to have "high activity introduced at a sensible time" so that I can hope to be part of that 99.8% implant survival group after 10 years (and counting).

[Tin Soldier]

Chomping at the bit is what causes some of the problems.  It's very easy to find yourself thinking "its ok, I can do a little running, it's only kids"   I can understand that perspective, and I even pushed it a little early and probably should have waited a few more months.  Anyway, heed everyone's advice, wait the 6 months ot a year, or better yet closer to a year.  I don't there are many surgeons who will tell you to that its ok earlier than 6 months.  Also, when you look back, the year is actually pretty quick (I'm coming up on my first annual post-op appointmen) looking forward to bending the doc's ear.

Along the lines of Jerry's post regarding bone growth, if you take a look at a series of consecutive x-rays, post-up to a year or more, and hone in on the femoral neck, you'll see some pretty dramatic changes to the shape of the femoral neck over that period.  It actually thins a bit, which seems counterintuitive, still strong, but the forces are slightly different and there was bone loss during surgery, so it's all reworking itself to become strong again.  All I'm getting at is that even after one year, you'll still see slight changes in the shape of the femoral neck meaning that the femur is still adjusting.  I haven't looked closely at the acetabular side, but I think the same thing happens there.  In short, bone growth is slow.

Also, there is quite a bit of info on the subject here.  I remember seing a pretty good interview Pat had with Brooks, or Mont (can't quite rememeber), talked a lot about bone growth post surgery. 

[Dannywayoflife]

Tin I think the neck thinning is a contentious issue. I asked Treacy about it and he thought it was down to the surgeon really treating the soft tissues with kit gloves. Ive measured my xrays with callipers and there's no thinning. The bone density has defiantly gone back to the pre op level as the films are bright White.