So is running REALLY ok with an HR?

[Marco Polo]

ChuckM:

I think you raise a very good point.  While these longitudinal studies may be able to identify correlations between high impact activities and failure rates, there may be other variables (such as poor cup placement) that are not being measured that are the underlying reason for the failures. 

[Pat Walter]

Sorry, I missed the intro info for the study I posted above.  Here is the information as posted:

Public release date: 8-Feb-2012
American Academy of Orthopaedic Surgeons

Excessive sporting activity may impair long-term success of hip resurfacing

Original News Release:

http://www.abstractsonline.com/Plan/ViewAbstract.aspx?mID=2841&sKey=8f07675f-aadf-4b0b-baed-e7aabc4b0f69&cKey=7c32b727-acd9-44a7-bb88-909c43baf3c5&mKey=BA8AA154-A9B9-41F9-91A7-F4A4CB050945

Classification: Adult Reconstruction Hip
Keywords: Outcomes; Complications; Hip

Author(s):
Harlan C. Amstutz, MD, Pacific Palisades, California, United States
Michel J. Le Duff, Glendale, California, United States
Regina Woon, Los Angeles, California, United States
Alicia J. Johnson, BA, Los Angeles, California, United States

Patients should limit activities to maintain hip prosthesis

SAN FRANCISCO â€" In hip resurfacing the femoral ball in the hip joint is not removed, but instead is trimmed and capped with a smooth metal covering. Young and active patients with arthritis often choose hip resurfacing over total hip replacement to minimize the risk of hip dislocation, and to preserve the bone for a revision surgery should the primary resurfacing fail. However, the long-term effects of sports on a resurfaced hip were unknown.

In new research presented today at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), investigators surveyed 445 patients between one and five years after hip resurfacing. The type of activity, frequency and duration of the sessions, and intensity of participation were documented. Over the next 10 years, each patient's hip status was monitored. The mean age of the patients was 48.7 years, and 74 percent were male. There was a correlation between higher activity scores and risk for surgical revision. Other independent risk factors for revision included small component size, low body mass index, and 1st generation surgical technique. Patients with an Impact Score (IS) lower than 50 had a revision risk rate 3.8 times lower than the patients with an IS of 50 or greater. Survivorship for patients with a lower IS score at eight years was 96.4 percent versus 88.8 percent.

Large amounts of high impact sporting activities â€" such as daily running or tennisâ€" can be detrimental to the long-term success of hip resurfacing arthroplasty. Surgeons should advise patients to limit their physical activity to levels that the device can sustain.

[Canadian-Ice]

In my humble opinion, that study by Amstutz is about the ASR.

[Dannywayoflife]

I dont think it is an asr study mate.

[Pat Walter]

I asked Dr. Amstutz to tell us more about the study and any more recent information.  He was kind to answer with the following information:


Pat:

Our study (lead author Le Duff - see attached) showed some deterioration after impact post 10 years post implantation but that was with our earliest Conserve Plus technique. However with good bone quality and improved technique the results show no deterioration at ten years. Do not have the 15 year results on those as yet but included are runners, lots of tennis players and others with high impact. I do however  believe that our new porous ingrowth femoral and biofoam sockets will perform better over the long term. They are approved everywhere in the world but in  the US but I use under physicians indication. The performance is spectacular at 3+ years and I expect that impact will have no adverse effect on durability (based on our earlier versions anthem 1980's)

Regards
Dr. Amstutz
4/2/2013

[Marco Polo]

FYI, Dr. Gross is now giving his patients the option of installing either the uncemented Wright C+ device that Dr. Amstutz is referring to or the Biomet Recap.  It will be interesting to see how it performs over time.

[chuckm]

Now I know of at least three top surgeons who have implied that impact sports are having no detrimental effects on good devices that were properly inserted on well selected patients. Those surgeons are Mr. McMinn, Dr. Amstutz, and Dr. Schmalzried.

[stevel]

Mr. McMinn has also published studies about patients under age 55 participating in impact sports or heavy occupational work (55 % participation).  These studies are "Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis"  and "Five to eleven year follow-up of modern hip resurfacing:  In patients under the age of 55 years with osteoarthritis."  The study is limited to the BHR device or it predecessor and Mr. McMinn as the surgeon.  Needless to say, the medium term results are outstanding.

Pat:  Do you have any updates to this study?  Does Mr. McMinn have any comments about the study and runners?

[chuckm]

Pat thank you for finding this information so quickly.

On your site you help surface hippies forward copies of their x-rays to other surgeons for review when they have problems with their new resurfacings.

But what about patients who are not having problems? Do you think those same surgeons would be willing to review and assess if the x-rays are indicating a good surgery or not?

Even if one uses a really experienced surgeon, does the surgeon ever explain that the components didn't quite go in right? My surgeon told me that my LBHR was installed perfectly but the only review on this was from a radiology report from an x-ray taken while I was in the recovery room. The report said was "the alignment of the components is satisfactory".

I guess it would be great if one could get another review from another doctor.

Chuckm

[Dannywayoflife]

Chuck I think most of the surgeons only give opinions for people who are having problems (but I may be wrong) but if your surgeon said its fine and your having no problems then why worry?

[Pat Walter]

chuckm

I wanted to correct your statement that I will send patient's x-rays to surgeons for review.  I am not medically trained or a doctor, so I never handle a patient's medical information.  I can suggest surgeons that a patient can email to get opinons.  Vicky use to send patients personal medical information to doctors, that is not something I feel I should be doing since I have no medical training.

I doubt you would want to ask the very busy, top experienced surgeons for information about your well placed hip resurfacing component if you are not having problems. If you are active and without pain or problems, why would you not trust the surgeon who placed your component?  Most of the surgeons who are kind enough to answer emails are very busy and most perspective patients wait weeks and months to see them in person.  I don't even bother them much for information unless I feel it is very important.  Most of them work hard and have long surgery days, so when they have some spare time I feel they need time away from hip resurfacing.

I can also tell you that surgeons don't like to criticize other surgeon's work.  Even at the hip resurfacing courses, they are very polite in any topics they disagree on.  Most of the surgeons we work with are the top, most experienced surgeons and even they have different ideas on what they feel is the best way to do things or place components.  As I have said many times, hip resurfacing surgery is much more than a highly skilled surgery - as far as I am concerned, these surgeons are artists from their experience and techniques.

Pat

[stephen1254]

I think I can accurately answer the OP's original post by saying the answer is definitely.....maybe.

There is another aspect to this discussion to consider. When I was facing surgery the thought crossed my mind that if I hadn't run for 35 years maybe I wouldn't have to replace my hip. If I had known then what I know now would I have never run? Of course not, because running has been such a big part of my life.

So, if 5 years from now or 10 years from now I need a revision because running wore out my new hip at an accelerated rate, would I regret the decision to run again? I don't think so. We only get one shot at life and running is too important to me to give it up. If a THR meant I could never run again I figure I got another 5 - 10 years in.

I'm not trying to be melodramatic and I do think that moderation is probably best after an HR, but I intend to be as physically active as I possibly can until I can't do it anymore.

Oh, and I never second guess a decision.

[Arrojo]

I think I can accurately answer the OP's original post by saying the answer is definitely.....maybe.

There is another aspect to this discussion to consider. When I was facing surgery the thought crossed my mind that if I hadn't run for 35 years maybe I wouldn't have to replace my hip. If I had known then what I know now would I have never run? Of course not, because running has been such a big part of my life.

So, if 5 years from now or 10 years from now I need a revision because running wore out my new hip at an accelerated rate, would I regret the decision to run again? I don't think so. We only get one shot at life and running is too important to me to give it up. If a THR meant I could never run again I figure I got another 5 - 10 years in.

I'm not trying to be melodramatic and I do think that moderation is probably best after an HR, but I intend to be as physically active as I possibly can until I can't do it anymore.

Oh, and I never second guess a decision.

Thank you for this.  Fyi, in six weeks or so, I plan to sprint at the Connecticut Masters Games (think 50 meter dash, 100 and 200).  I know many surface hippes have sprinted while playing soccer, baseball, tennis and other sports, but I dont believe anyone has ever sprinted comepetetively at the masters level after a hip resurfacing. If not, then I will be the first. 

The whole point of this surgery, at least for me as I understand it, is to be able to continue to live our active lifestyles.  I had three respected orthopedic surgeons tell me that I needed a Total Hip Replacement and that I would never run again and even now, after this surgery, there are doubters who claim it is impossible to run fast after this surgery or who question the wisdom of running after resurfacing.  Keep doubting, people, I love the motivation!

PS Pat - thank you for all you have done with this site; I understand you only care what's best for all of us surface hippes and I certainly appreciate that!   And if running really is bad for my new hip, then I 100% agree with what stephen said above :)  Peace to all.

[hernanu]

Arrojo, that is awesome (just wanted to tell you, and good luck).

I understand the advice to take things as moderately as is possible and believe that it is a good way to go, but as with runners, I am taking a calculated slow approach to my impact sport.

I was also given the choice and selected HR because it would let me get back to martial arts and other sports. I do accept as a possibility that it can wear out the joint earlier than it would if I were more static, but it allows me to do what I'm passionate about and I'm grateful for that.

My hope is that it wears fine and holds up well. I also understand Pat's care for us and her untiring work in getting the word out and getting us fully informed.

In the end, it's a personal choice, but it is made in full knowledge aided and abetted by the exact kind of discussion we're having here. I value the ability to get information like what's in the article and the followon comments that Pat was able to get from Dr. Amstutz.

[chuckm]

Sorry Pat, I certainly didn't intend to say you actually forward medical information to other surgeons but I did mean to say your website helps Surface Hippies learn how to forward x-rays to other surgeons. I was so careful to try and word it that way. Guess not :-\

As far as my own case, I totally trust my surgeon so I am not worried. But I've seen lots of x-rays of bad surgeries from this site. Obviously those are the very few that get revised. Some of those probably returned to impact sports and then had early failures.

I just wonder if those patients knew they had poor surgeries before they became active. I'm sure there are plenty of patients with poor surgeries who are active and will be failing soon.

But there was a time when did I worry during the first three weeks post op. It wasn't until my follow up visit with my surgeon that I was able to discuss my surgery, how the components turned out, and what my prognosis was. That's when I saw the x-ray after walking on it for three weeks and it was still perfect. Had it not been perfect, I doubt I would have been so decisive to return to impact sports.

Chuckm

[obxpelican]

Ok, so I email Lee Webb Dr. Gross's surgical ass't.

She said that Dr. Gross said that article was probably referring to cemented hips, he further said uncemented hips have NO RESTRICTIONS.

So guess what?  I'm going to go workout and play some racquetball without any worries.



Chuck

[stevel]

I found the answer to allowable activities after a resurfacing, including running at both Dr. Su's and Dr. McMinn's websites.  They both say running is OK.  See the FAQ's section at www.hipresurfacingnewyork.com/hip-resurfacing-faq.html (What kind of activity can I do after resurfacing?) and www.mcminncentre.co.uk/faq.html#hobbies (When can I get back to hobbies and sporting activities?).

Meanwhile, I went over the results of the MRI for my right shoulder with my local OS.  I have severe arthritis at the acromioclavicular joint and Grade 2 to Grade 4 cartilage loss at the humeral head.
Grade 2 is defined as minor tears visible in the cartilage and for Grade 4, the carlilage is torn exposing the underlying (subchronal bone).
Surgery is not warranted, the next step is cortisone injection.
When we discussed limiting an activity such as racquetball to extend the life of the natural shoulder maybe 5 years, he replied that I might be dead in 5 years (I am currently 59) and not playing racquetball would be a personal choice.  So with that, I will be going to the Alaska State Racquetball Championships in two weeks!