Smith & Nephew BHR Brimingham Hip Resurfacing

Author Topic: Is Tennis possible/advisable after HR? (I'm a newbie)  (Read 21788 times)

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suncag

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Is Tennis possible/advisable after HR? (I'm a newbie)
« on: May 28, 2014, 07:56:15 PM »
Hi Everyone,

I'm new to this site & forum.  I was encouraged to read some of the posts here in the tennis section.   I'd like to share my story and ask for your feedback, opinion, advice, shared experiences, etc.  Starting with the bottom line up front:  I'm trying to decide among several options (or a combination of these options): Hip Arthroscopy, THR, HR, some regenerative methods: (Stem Cell injections, PRP injections, chondrocyte grafting, collagen type-2 supplements, glucosamin/chontroiton supplements, etc.) and have even considered just waiting a few years to do anything in the chance that better options emerge within the next 5 years.

My story:     

My name is Chris and I'm a 48-year old male who is (was) a very active recreational tennis player.  Since I was 21, I've played mostly mens singles but also some doubles and mixed doubles with my wife.  I'm a 3.5 - 4.0 player.  So not a great player, not a professional player, but a fanatical player who loved the process of improving my game.  For the past 25 years, I've spent many hours at the baseline practicing my serve and being run all over the court by my ball machine.  And loving every minute of it.  I was usually enrolled in 2-3 leagues per season -translating into 2-4 hours on the court per day 5 days a week. 

     Two years ago my left knee started getting cranky but I persisted in playing on it anyway (used cortisone injections once or twice over two years).   At first, I was told the knee uneven wear and mild arthritis in the knee was due to muscular imbalance (tight IT band, weak VMO muscles).  So I did VMO physical therapy.  That helped after 6 weeks. Then - last September (2013), I developed the classic symptoms of cam-type FAI in my left hip (groin pain, hip pain, and referred pain down to the left knee).  My last two matches it became painfully obvious that moving laterally or doing any kind of start/stop was too painful.  So off to the doctors I went. After comprehensive diagnostic tests (xrays, 3D CT Scans, MRIs with dye/arthrogram), I was told I have mild to moderate osteoarthritis in the left knee and hip (I'm a righty and I strongly suspect that serving 600 serves a day for 25 years just may have something to do with why my left leg has so much more wear and tear than my right leg - imagine my left leg as a piston repeatedly collapsing and explosively expanding over and over again).  To sum up what my three orthopaedic surgeons told me: the first two told me that I should quit tennis, take up swimming, and take 2 advil a day until I'm 65 at which point I should have a THR.  I asked them about hip arthroscopy for FAI (hip impingement) - they both said at my stage of articular cartilage degeneration, arthroscopy would be like closing the barn door after the cows got out - useless since the damage to the articular cartilage is too extensive and irreversible at this point.  The third believes there is a 70% chance that hip arthroscopy will buy me a few more years until either a THR or a HR is needed.  The third also believes it's better to take advantage of what is available now in order to keep doing what I love - play tennis - rather than sit on the side lines for the rest of my days.  Which I see the logic in but am not sure I agree with for the following drawbacks which worry me about each surgical solution:

1) Hip Arthroscopy - I don't mind being on crutches for a month and having to rehab for another 5 months because I've been doing constant physical therapy for the past 7 months.  And I like the idea of preserving my natural hip as long as possible.  BUT - it sounds like there is a large possibility (based on other hip scope patients) that for my condition, the scope will not provide any benefit (other than removing the cam lesion which tore up my cartilage to begin with and repairing some labral damage).  I am also worried that having the scope might take the HR option off the table.  Does anyone know if having a scope removes or delays the possibility of having a HR? 

2) THR - frankly - this "procedure" seems barbaric and straight out of the Middle Ages to me.  And despite all the risks (dislocation, blood clot, infection, uneven leg length) - the real problem with this "solution" is that it does not solve the problem because I was told by my surgeons not to play tennis on a THR because I'll wear through it in 5 years, only be able to have one more after that, and then they'll have to amputate my leg when I wear through that one.  just great.  So this "solution" which leaves me with one leg by the time I'm 58 (unless I am happy to put it off until I am 65) does not appeal to me.   Please correct me if I am wrong in this assumption - does anyone know someone who has successfully maintained an active tennis life with a THR?

3) When I learned about resurfacing I was thrilled - finally the perfect solution for me: "appropriate for the adult under age 60 who wants to remain active."  Then I started to read about some nasty potential outcomes: "necrosis, metalosis, femoral head fracture, every step you take creates millions of ions as debris which poison your surrounding bone, tissue, and blood."  So I am now leery about what I thought was going to be my savior. 

4) Regenerative techniques - supposedly they are growing cartilage in the labs at Duke University, in France, and in Sweden from stem cells, fat tissue, and healthy cartilage pieces using chondrocyte grafting.  And they can even form these cartilages in the shape and size needed - much like you would use a jello mold. 

5) What about artificial cartilage?  Don't laugh - I had a vertebral disk fusion in my neck due to a bad disc herniation (also caused by excessive tennis and having been born with a vertebral fusion to begin with).  While that operation was very successful back in 1997 - I remember asking my dr. "can't they replace the bad disc with an artificial one?" No was his answer.  No such thing.  Guess what - some very clever scientists in Germany created an artificial disk back and "artificial disk replacement" is available in the US as of 2007.  Experimental but available.    My point being - if they can create an artificial disc and implant it, why can't we do the same with cartilage?  If not today, why not someday within the next 10 years?  Doesn't it seem that either an artificial or regenerated cartilage are possibilities.

So my current plan is to possibly try to buy more time with the arthroscopy, keep an eye on regenerative breakthroughs, and fall back on a hip resurfacing if/when my hip becomes too painful or dysfunctional to get through my day. 

Regarding hip resurfacing - I've been told everything from "you can play tennis 2 months after" to "you have to wait a year for the femoral head bone to fuse to the the metal covering" to "you don't have to wait because they cement the metal covering on to the femoral head and you're good to go."   What's the truth on this matter?  does anyone know?

And to finish with the question I started with - do these BHRs really last 17 years?  And can I really (at some point post-op) play tennis on a resurfaced hip?  Or am I just asking for serious problems if I do? 

Thanks so much for enduring this walk through my confused mind with me.  Any advice, experience, opinions, insights are greatly appreciated and welcome.  I'd really like to stop limping around and to even be able to play tennis again.  It is one of things my wife & I really enjoyed doing together.  But there is so much conflicting information out there - I find it hard to feel confident about going forward with any currently-available surgical options. 

Sincerely,
Chris


Granton

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #1 on: May 28, 2014, 08:12:51 PM »
Hi Chris,

Welcome.

I am a keen tennis player. Not perhaps QUITE as keen as you, by the sound of it!

I had my first BHR at age 51, having been told that I would soon wear through a THR (though THRs have improved since then). I had given up tennis a couple of years beforehand because it was not worth the pain.

I went back to tennis after the op and have never had a moment's problems with it. I played doubles mainly but a fair amount of singles. It felt exactly like a natural hip. It has now been implanted for over fourteen years and apparently shows no signs of wear on X-Ray.

The second hip failed last year and I did not delay in getting the same procedure done by the same surgeon. I am back to playing tennis.

My surgeon's advice is to wait a year before returning to a really serious level of tennis. For "gentle double", he says six months.

It's not all down to the prosthesis. My sister's BHR failed catastrophically within a few years. The acetabular component needs to be set at just the right angle and not everyone gets it right. You have to go to a very experienced surgeon with a very good record.

If you are in the UK, I recommend Mr Derek McMinn. He developed the BHR along with Mr Ronan Treacy. Mr Treacy is another surgeon I would have been happy to go to.
David
Rt BHR Nov 1999
Lt BHR Oct 2013
Mr D McMinn

chuckm

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #2 on: May 28, 2014, 08:41:19 PM »
Hello Chris, you have lots of information spinning in your head. Go back to the home page for surface Hippy and search the left side for doctors. Then find Mr. McMinn. Visit his page and listen to his interviews about his thousands for patients and the device he invented - the Birmingham Hip Resurfacing System. It is the same one that I have. He has done over 3,000 resurfacings and of his male patients that have reached 15 years, 98% are still working - regardless of the activity level they returned to.   

I had FAI at 46 and went through all the stuff you are going  through with the questions and doubts about what to do. I was a very active soccer player all my life and finally had to stop. I went to the best hospital I could find (Hospital for Special Surgery in NYC) to have my resurfacing done.

Now, a year and a half later, it is amazing how it not only made me pain free, but it restored all the function that FAI had been taking away slowly and undetected.

I think you should just consider resurfacing and fix yourself for good...BUT...you must use a very experienced surgeon to be absolutely sure the device is aligned correctly and that optimal surgical technique is used. Surgeon choice is the number one variable in resurfacing. If you choose a good one, none of those bad stories you hear apply. It is mostly the inexperienced who have problems and even then it is very few.

Chuckm

Chuckm
LBHR 11/30/12 Dr. Boettner HSS 60mm cup 54mm head

einreb

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #3 on: May 28, 2014, 08:41:54 PM »

And to finish with the question I started with - do these BHRs really last 17 years?

They sure can.  Nothing is guaranteed though.  A good experienced surgeon can increase those odds.


 And can I really (at some point post-op) play tennis on a resurfaced hip?

Absolutely.  At 6 months out, I got the go-ahead to run... I played 90 minutes of basketball that night.  I've never hurt that much before from a work out, but none of the pain was hip related.  It will take a bit of time to get back the flexibility, speed and strength... but the one year point for me was like magic.  Stronger than I had been in years.



 Or am I just asking for serious problems if I do? 


Not at all.  Just follow the doctor's advice (typical thought is no running till after 6 months, others say one year).  In fact... the impact from tennis is likely good for bone density.
40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

suncag

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #4 on: May 28, 2014, 10:03:11 PM »
I just wanted to say thank you to the folks that took the time to respond with their experiences and advice!

Very kind of you.  I value your shared experiences very much.

Sincerely,
Chris

Pat Walter

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #5 on: May 29, 2014, 12:01:22 AM »
Welcome to Hip Talk

Here is some of the McMinn videos and info:

http://www.surfacehippy.info/mcminnnegativepr.php

http://www.surfacehippy.info/doctorinterviews/mcminninterview.php

and many of the top surgeons information about the positive aspects of hip resurfacing:

http://www.surfacehippy.info/positive-results-hip-resurfacing-2012.php

Many people have tried the various treatments you mentioned, but none have been successful long term.  Many wished they had just had a hip resurfacing.  You can do a search for the various treatments on this group and read some of the info.

Good Luck.

Pat
Webmaster/Owner of Surface Hippy
3/15/06 LBHR De Smet

tennisgirl

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #6 on: May 29, 2014, 04:03:23 PM »
As you can see by my name, I play tennis..alot.  I am a 4.0 and was able to go back to playing at about 10 months competitively.

I can't run quite as fast as I used to (the left hip is complaining now), but I say go for it if you are hurting and want to get back to the game.

I love playing and the thought of not playing was unthinkable.

Mindi
R Biomet Uncemented Dr. Gross 11/9/2011

John C

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #7 on: May 30, 2014, 07:38:18 PM »
Hi Chris. You asked a lot of good questions, so here are some thoughts from one patients point of view.
Though skiing all day every day in the winter and windsurfing everyday in the summer are my main sports, I do play tennis four or five days a week during the summer. I went through all of your thoughts, and tried most of them, before having my left hip resurfaced 6 years ago at the age of 56. Here are my thoughts and experiences relating to your questions.
I had to give up tennis for almost ten years because of my bad hip. I got back into tennis one year after my resurfacing, and have been loving it. My doc okayed starting back into easy tennis at six months, but because of the time of year, it ended up being one year for me. You mentioned tennis at two months, and I do not believe that any of the top surgeons would consider that to be safe or reasonable. Though my hip is not 100% (nor is the rest of me at almost 63), it is a solid 95% for most activities, and I seldom think of it when I am active in my sports.
No one knows how long these will last, but in the hands of a top resurfacing surgeon, I think your odds are over 90% for the 17+ years that you asked about.
The grandfather of resurfacing, Dr Harlan Amstutz, published a study a couple of years ago on the effects of impact activities on resurfacings. It concluded that high impact sports do increase the risks (though resurfacings hold up way better than THRs). If I remember correctly, his study showed that regular high impact activities could drop the long term survival rate from around 98% down to around 90%, so each person must weigh the risks versus what they love to do.
Before my resurfacing, I tried arthroscopy. I had about at 30% improvement that lasted about three years.
I tried a stem cell injection that really crippled me and made it clear that I needed a resurfacing.
I am currently trying viscosupplements and PRP on my other hip to try and get another couple of years out of it, with mixed results.
Other things you asked about:
Necrosis- possible but highly unlikely (probably less than 1/10 of 1%) in the hands of a top resurfacing surgeon.
Femoral neck fracture- This was a concern in the early days, but it is extremely rare now for the top surgeons (way less than 1%), unless you try and play tennis at two months. Some say that six months is the safe time to be past the risk for femoral neck fracture.
Metal ions- All artificial joints produce wear debris, so this needs to be considered. However the amount of wear in a resurfacing is largely determined by how well the surgeon places the device, and the design (brand) of the device. Even with my very active life, my ion numbers are very low and thought to be no cause for concern; but they do exist and some people can have reactions.
The key thing right now is exactly what you are doing; do a lot of research, and if you decide to proceed, go with one of the top resurfacing surgeons no matter the inconvenience of travel etc.
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08

Arrojo

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #8 on: May 31, 2014, 01:51:49 AM »
Not sure why you would consider hip resurfacing as a "fallback". Find a great surgeon and it should be your first option. Breakthroughs in regeneration? You'll be waiting a long time.

Hip resurfacing is awesome. Heck, if I can run the Boston Marathon, you can play tennis all you want.
« Last Edit: June 02, 2014, 06:17:46 PM by Arrojo »
Dr. Su
RBHR 4/9/12

suncag

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #9 on: July 11, 2014, 02:40:09 AM »
John C - thank you so much for your post.  I have reread it a few times over the past few weeks while I have continued with my research.  Your experience has been very helpful to me.

Arrojo - good point you make.  That is amazing you can run the Boston Marathon!

Tennis Girl - thanks.  I am seriously considering Dr. Gross for my surgery.

My general question to everyone is:  what do you do, if anything, to monitor the metal build up in your system - if there is any?  Also - do you have yearly xrays to make sure the resurfaced joint is still doing ok?

Thanks to all of you for kindly sharing your experiences and insight!
Chris

Dannywayoflife

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #10 on: July 11, 2014, 08:15:24 PM »
I know Mr Treacy's feeling on the subject are checks at 1,5,10 &20 years. He doesn't do metal ion checks unless there's symptoms
Train hard fight easy
LBHR 10/11/2011 Mr Ronan Treacy Birmingham England
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Rbhr 54mm head 60mm cup 12/02/15 Ronan Treacy ROH Birmingham England
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John C

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #11 on: July 12, 2014, 04:20:25 AM »
Hey Chris,
You mentioned Dr Gross, who is the surgeon that I chose and have the highest respect for. In answer to your question, he, like most surgeons, has a standard followup protocol. I don't have it in front of me at the moment, but my memory is that Dr Gross has follow up x-rays at six months, one year, and then every two years thereafter. He asks for a blood test for metal ions at I think two years, which is after the initial wear-in period. If that test is good (meaning low ion numbers), then he does not ask for future metal ion tests unless there are symptoms that would indicate a problem. If a person has concerns, he is great about evaluating X-rays and metal ion blood test anytime that he feels that it is important to the patients mental or physical well being. He prefers that the one year and then every two year check-ups be at his office, but if you live a long way away as I do, you can send in the x-rays and blood test, along with a thorough questionnaire, with no charge.
Hope this answers your questions.
John
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08

Paul_D

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #12 on: April 04, 2016, 01:11:09 PM »
Yes, the answer is an amazing yes as on last weekend I felt that i was ready to give it ago after 5 years absence and it felt great. The only issue I had was fitness as although I walk between 7 to 10km each day with some short running along the way, tennis requires a bit more that was I was used to in terms of fitness. But, I hit the ball well and I was able to get to the ones I was unable to earlier and I believe in a few more weeks as long as I can get the match fitness I need, I will be back in black!!!
L BHR (52 mm) 28/7/2015, R BHR (52 mm) 23/7/2015

Paul_D

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #13 on: April 18, 2016, 06:50:11 AM »
Its now third week in a row of playing tennis on Saturdays and finally my serve is back and confidence rising. This last game I think I over did the day as I had a 1km run in the morning followed by a 12km walk then 1.5 hours of tennis. In the last game I felt a twinge in the right buttock hip region and hoping its just a muscle. Seems a bit better today after a good rest on the Sunday.
L BHR (52 mm) 28/7/2015, R BHR (52 mm) 23/7/2015

Paul_D

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #14 on: May 23, 2016, 09:56:07 AM »
Just had a game with an ex pro player and I was so happy with my hips after our 2 hour session. No pain, no restrictions and my shots were nearly back to the good ole days! So YES, tennis is possible 9 months after double hip resurfacing!
L BHR (52 mm) 28/7/2015, R BHR (52 mm) 23/7/2015

tricky

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Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #15 on: July 06, 2016, 12:30:25 AM »
Just logged back onto the site because a friend was asking about resurfacing vs THR and i wanted to refer him to this site.  In the process I ran across your post, and since it hit close to home, let me chime in.  The reason I did the resurfacing rather than THR was because tennis is part of my life, I play competitively and this is why I wanted the procedure.  I was playing 3 months after surgery, played my first tournament 6 months after and was back to "tournament shape" about a year later.  The physical recovery was easier than getting the timing and competitive skills back.  5 years later, I have played a lot of tennis and everything is still good, knock on wood.  So yes, tennis is not only possible, it is why I had the procedure!  How long will it last?  Who knows.  But I'm going for it for as long as things stay good.

Hip Talk About Hip Resurfacing

Re: Is Tennis possible/advisable after HR? (I'm a newbie)
« Reply #15 on: July 06, 2016, 12:30:25 AM »

 

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