I know that many Hippys on this site return to active running. I myself was an avid runner until my HR with Dr. Su five years ago. Since then, I haven't run a mile (although I do a lot of other non-impact exercise). My fear is that it will shorten the life span of the device. I'm especially worried about the effect all that impact will have on the bone cement in particular.
Truthfully, I miss running terribly. And if I got a definitive "all clear" from someone, based on specific evidence, I'd be out buying new running shoes tomorrow. But it still feels like the jury's out.
Can anyone shed any further light on the issue? What have your doctor's told you? What does the evidence say?
Todd:
How are you five years out?
With respect to the running question, I have been sniffing around this issue for the last several months. We are definitely hearing from a handful of people who have jumped right back in and are meeting with good results. We have also heard from some people way back who jumped back into long distance running and who were also reporting good results.
What I do not see much of yet is data/input from people who have been running a long time since their surgeries and who continue to report much at all, good or bad, quite frankly. I would love to hear more.
My post-op result is great so far and I have started to run, with a fair degree of comfort. I remain a little skeptical, however, that upping the mileage and doing so over a longer period will be that good for me. I have a lot of years of marathoning on me and I landed on the operating table mostly because of it. Right now I'm feeling really well and I don't have much interest in testing my luck.
Any/all input from others greatly valued...
Jon
I'll let you know in 20 years?
Dr. Gross seems completely ok with the running or other impact after 6 months. I tried to get right back into it at that time and had to back off due to weakness in some flexors/stabilizers. Would get sloppy and lacked firm control of my gait.
18 months and happy doing 10K distance for now, with no hip anxiety or pain (other joints maybe but not the HR). If it lasts another 20 years it was worth it. I'm hoping it lasts forever with or without the running.
As for the decision to keep running, well, its part of why I went with the HR in the first place in lieu of the total hip.
Curt
McMinn and Treacy have patients at 16+ years who have run long distance with zero signs of any problems. I think you worry needlessly about the cement issue mate. The cement technique used in the bhr is unique to the bhr no other device uses the same method. Having seen sectioned components they really are going nowhere. Also the bhr has the longest track record of any device so if anything the cement less devices are the ones unproven. I have yet to run again (well I've run after people) properly but I'm back boxing and doing judo and I'm not really concerned about the device. Treacy told me that he's had guys back in his clinic for 16 year check ups who have done in his words UNBELIEVABKE things and they are still fine.
Danny
You should really get in contact with Dr. Su. The Birmingham hip resurfacing system was fairly new back then and there is so much more clinical evidence on the device now. I had my hip done at the same hospital (Hospital for Special Surgery) in 2012 and have the "all clear" to do whatever I want including impact sports. It seems reasonable to me that running could shorten the life span of a resurfaced hip but running can shorten the life span of a native hip too.
Chuckm
If in doubt watch the interviews Vicky Marlow did with Mr McMinn he address this very question.
Most HR surgeons support their patients going back to running, and this is one reason that I chose and continue to support HR. However, I can only remember reading two formal studies or presentations addressing running. One was done in Europe a few years ago (Sweden I think), and showed little ill effects. More recently at the February 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons, Dr Amstutz who is one of the godfathers of resurfacing presented a study which specifically correlated impact scores with an increased risk of revision, and suggested that surgeons caution their patients against excessive impact activities. For those that are interested in reading the study, here is a link. It is listed as "Paper No. 216" on page 529.
http://www.aaos.org/Education/anmeet/education/AdultHip_Abstracts.pdf (http://www.aaos.org/Education/anmeet/education/AdultHip_Abstracts.pdf)
Though one of the reports on this study (you can find this report here on Pat's site in the "What's new" section in 2012) lists running and tennis as potential problems, I continue to play tennis every day during the summer and ski every day during the winter. As always, we each need to make our own priorities and decisions. Dr Amstutz felt that his study should be considered in making these decisions, so I pass it along.
I am scheduled for bilateral with Dr. Su in mid-April. I asked Dr. Su's PA about running. He said that they have people that run marathons and such, but they really don't recommend it, because of the amount of impact - especially training for it. He seemed okay with doing a couple of 5K's though.
I should say, that personally, I wouldn't expect any of the doctors to actually say that it is okay to run marathons on a implant. Too many lawsuits around these days to go that far. That being said, we know that many marathons have been run on HRs. Heck, there are lots of marathons being run on THRs too. (Yes, most of us here cringe when we think of running on a THR.)
Let me also clarify that I am 6'5" and 230 lbs, so it's not like I've been running regularly up to this point (high school and college cross country was a long time and many pounds ago.) The first orthopedic surgeon I saw told me to forget about running with the torn meniscus in my knee as well.
So, it seems like it depends a lot on the individual circumstances. Your size, general condition, and how much of a blessing you're looking for from your doctor. First thing to do is ask him.
Todd, I hope I'm in a similar predicament in a little over a year from now.
This is some good stuff.
John, thanks for the link and the additional info.
I hope we hear from others on this...
Of course, what is clear is that at the end of the day this becomes a very personal decision -- as it should be...
Jon
The ONLY reason I got a resurfacing was to run. Running is, and has been, a huge part of my life since I was 1 year old. Dr. Su says I can run on it and that is good enough for me. I will run and run until I die or wear out the device, whichever comes first.
That said, I am (or will be once the snow melts) more into trail running than ever before. And I will avoid running on concrete (sidewalks mostly). But the roads beckon....
My opinion (and a non-medical one at that) is that after having waited the proper amount of time recommended by your surgeon, HR gives you a very good opportunity to go back to your activities.
Bone mineral density is the measure used to evaluate bone density. There is a theory proposed by German surgeon Julius Wolff (1836-1902), which is well accepted. It says that bone density is increased by the proper amount of pressure being applied to the bone.
If pressure is applied over time, the bone will grow denser and stronger. If loading decreases, then the bone will become less dense.
Tennis players, for example are apt to have much more dense bone in their racket arm versus their non racket arm. It also explains the loss of bone density by astronauts if they are in space for an extended amount of time.
So this is an accepted theory, that the more controlled impact is bound to improve your bone density. Martial artists (hitting close to home) have much more dense bones in areas where high impact happens.
I imagine (expanding this to runners) the same theory applies here, since you are dealing with repetitive pressure being applied to a limb. As long as it's controlled and gradual, my uneducated thinking is that it will make the bones denser.
The only thing that's up in the air to me would be the actual connection between the bone and the device. The connection is made when the bone anneals itself to the roughened and beaded surface of the device and grabs on. The real question is whether, after the connection is made and the bone has wrapped itself around the device protrusions, adding pressure to it makes the bone that is now holding on to the device stronger.
My hope is that it is and does, so that if you are applying non-catastrophic pressure, you are making that joining stronger. It is a hope, but seems to follow Wolff's law.
From an article comparing bone density between HRs and THRs, and the effect of Wolff's Law:
"The mean BMD in the calcar region increased after one year to 105.2% of baseline levels in the resurfaced group compared with a significant decrease to 82.1% in the total hip replacement group (p < 0.001) by 12 months. For the resurfaced group, there was a decrease in bone density in all four regions of the femoral neck at three months which did not reach statistical significance and was followed by recovery to baseline levels after 12 months.
Hip resurfacing did indeed preserve BMD in the inferior femoral neck. In contrast, a decrease in the mean BMD in Gruen zone 7 followed uncemented distally fixed total hip replacement. Long term follow-up studies are necessary to see whether this benefit in preservation of BMD will be clinically relevant at future revision surgery. "
Reference:
http://www.bjj.boneandjoint.org.uk/content/92-B/11/1509.abstract (http://www.bjj.boneandjoint.org.uk/content/92-B/11/1509.abstract)
To me this shows that after HR, the bone density returned fully to baseline or better than baseline levels taken before the HR (105.2%). It also shows the dip in femoral neck density at three months which is recovered later, backing the advice given by surgeons to be careful for the first six to twelve months.
Again - not a medical person, but it's what I got from the article and to me shows why surgeons are Ok with running and other activities, so long as it's done with some restraint, at least initially.
Excellent thread and I really like John's and Hern's responses. There are certainly a good number of hippies here that are running with HRs but have relatively "young" HRs less than 5 years. I think one of the problems we might get with existing data (registry and different surgeon's centers) is that they probably are not capturing the amount of running or the types of activities folks are doing whith their HRs'. So when we see failure rate of 2 to 4% in a dataset of 15 or so years, is the failure due to high abduction angle, excessive running, or some other factor? The high angle has been shown in a number of studies, but running, or impact sports and how it relates to revisions? The Amstutz study that Johns referenced, might be the only study that gets close to trying to answer this question. This is why I think these data should try to be captured in registries or other large groups.
I run occasionally and I play soccer once a week, ski a little. Generally I don't do a lot of running and I don't plan to, even though I like to run. So maybe just being a bit moderate without worrying about it, is the best approach.
Wow, what great info on this topic.
Hern, that's some answer! Thank you.
I remember McMinn telling me something about making sure to work the joint/bone post-op in order to promote strength and health. I intend to call his office in the next few days to follow up on this specific aspect and the general topic as well.
I agree with Tin's assessment on data too...
Jon
ps: Four smooth miles in Central Park tonight! Beautiful day and lovin' it!
really good post there hern thanks for that I know that must of taken some time to reference!
I've said it before to me it's not possible to actually wear these things oh per se. The reason they may fail over time will be due to loosening(my opinion I'm no doc!) and the main factor in this I believe will be longterm bone quality. As hern has so brilliantly shown we need some impact for bone quality and density!
I for one will run again maybe not the 40 miles a week I once did but I'd rather spend that time in the ring or on the mats:-)
I have been running around the racquetball court, downhill skiing and packing elk out from mountainous terrain. I had the resurfacing installed so I could do all of these activities without restrictions. I have bumped into fellow skiers who have traditional hip, knee and shoulder replacements who shouldn't be aggressively skiing (skiing the black diamonds) as the device will wear out prematurely or they may fall and dislocate the device, but they do it anyway. As Dr. Su says about my resurfacing "Enjoy it!" and I have been enjoying it for the past 4 1/2 years.
Meanwhile, I just had an x-ray and an MRI of my right shoulder to determine the cause of pain after playing racquetball for 4 or 5 games. The x-ray was negative but I need to wait a couple weeks for an interpretation of the MRI as my local OS in on vacation. He suspects a labral tear or maybe a rotator cuff tear.
I was also told by Dr Sparling the running and tennis were not recommended after HR. Funny but I feel that running. ( going on three years post op) is still the one thing that feels awkward to me. Because of that, I don't really try it much. I have sprinted lightly from the barn to the house and back (probably about 400 yards ) and felt kind of weak in the HR leg still. I am super active and often quit aggressive with my activities, so this always surprises me. Hiking or walking give me no trouble. Maybe if I liked to run and worked up to it better I'd notice a difference. Or, maybe this is why the Drs don't often want their patients to partake in it. Anyway, do any other hippies only notice their limitations during attempts to run? I sometimes feel that my cadence is a little off, too, when I run, and that my HR leg cannot keep up and I might trip if I continued ( especially if I tried to run fast). Thanks, not really complaining, love my HR!! Lu
I just recently noticed that after 2 and 1.5 years, I don't seem to notice any limitations in the hips when I play soccer or when I do a short run or short sprint. I think it's just the body getting used to it. If you never did much running then maybe it will seem more awkward. I used to play a lot of soccer and run here and there, and ran quite a bit in high school long ago, so maybe it's just easier for the body to adjust if those muscles were already being used a lot. Although the other day I stubbed my big toe in soccer and I think I either rebroke it, or majorly sprained it, so I've been limping again. It will go away a in a couple weeks, but the other day I went for a short run and the whole leg up to the hip on the bum toe side, was cramping. Odd huh.
Thanks Tin, interesting. Used to run and jog a bit in when I reduced for race riding. Other than that don't much care for it. Still feel like if I ran too long I might fall. Oh well. Long as I can ride!! 😊
I'm the original poster. Many thanks for all the informative replies.
After reading about the Amstutz study, I'm starting to think that running isn't really the best idea, as much as I love (and miss) it.
Frankly, it figures from a common sense point of view. As sturdy as the BHR might be, and as effectively as it might be implanted, you'd think that repeated pounding would eventually lead to a shortened lifespan, with the weak points being the bone cement on the femoral side and, to a lesser extent, the press-fit on the acetabular side.
I guess the question is, how much is too much? Could you get away with, say, 10-15 miles a week with no reduction in device lifespan? It'd be nice to know.
Only time will tell on this but I'm confident in my BHR. The stats from Birmingham @16 years show no sign of anything untoward even under incredible stress levels. I think there is a bit of a downer on cement with no real cause. McMinn Treacy etc have never had a femoral loosening with cement even at nearly 20 years. Don't forget the cement technique used with the bhr is unique to it. If you look at sectioned components then you will see just how securely placed they are. I personally think the key is waiting for FULL recovery and then a gradual return and listening to your body.
I read the report, and what catches my attention is the time frame. I don't know the date of the study, but the mean age of the implant is 10 years. From what I've read (someone correct me if I'm wrong), they have only known about proper cup angle placement - and the correlation between that and revisions - for about 5 years. Unless you factor that into that study, I'm not sure how we can know what is truly impact-based, and not high-cup-angle related.
This video of Vicky Marlow interviewing Dr. McMinn might be a re post but it is very convincing about the durability of the BHR in athletic men. Are there any hippies out there where running, or any sporting for that matter, was the reason for their BHR to fail? I'm mostly interested in those whose implants were put in correctly, had a good recovery, and then had a failure.
http://vimeo.com/12462399
Chuckm
Great question from my perspective. I hope that we don't get too many affirmative responses though...!
I recently had an email about BHR and running. I am going to weigh in on this subject of running and post my reply:
I can’t give you an answer since I am not medically trained or a doctor. I don’t know specific studies which show why a runners BHR failed.
It just comes down to this â€" you decide if you want to run or not. Do you want to take the chance of a problem. Most athletes decide to be as active as they can. I do have a story or two where runners wished they had just enjoyed their new BHRs and not run since they required revisions to THRs.
Mr. McMinn’s info is good, but I don’t know at what time frame he is looking at. 5, 10 years, etc. It is difficult enough to just get general information about BHR retention rates, failure rates and reason beside going into just failure rates for runners and why they failed. I don’t know of any studies.
I do know almost all the top surgeons have said they would prefer their patients don’t do high impact sports. I sat in hip resurfacing courses at least 4 different times and listened to them. They did say that they know patients won’t listen to them, so they OK high impact sports. The BHR is basically a mechanical device and after a time, can wear out. No bearing lasts forever and the BHR is a bearing. The body joints don’t last forever, so how hard to you want to push it. Normally the rest of the body and it's joints are not far behind the hip in a person with an arthritic hip joint. So do you want to push your whole body?
If you are younger, you say it won’t happen to me and push, push, push. If you are older, you decide you can live your life in moderation. That’s been my choice since I have been given a great pain free life back with my BHR.
You need to listen to your inner voice â€" it is usually right. Obviously it is concerned and you should listen to it if you spend hours researching specific studies about running and hip device failure. You are trying to prove high impact sports are fine to return to. No one can give you a guarantee. Make your choice and live with it.
Pat
So now, its my time to weigh in. It most certainly IS a personal decision on whether to run or not. I would venture to say that most of the people visiting this site that ask the question were at least recreational runners prior to injury...that's why they ask right? The same questions arise about every activity or sport, depending on one's former addiction, because we all want to return to the things that we loved prior to our injury.
Looking back on my earliest inner debates about whether to get an HR or not, it really came down to what, if any, procedure would allow me to achieve the highest return to activity. I also contemplated the life-span of the device and my age at the time of the procedure. I was one of the many patients that were advised to get a THR, and lacking an alternative would have gladly gotten one in order to be nearly pain free. The chance of being q
(apoligize for fat finger submission!)...
I finally had to decide that an HR is the best opportunity for me to fix my hip pain and regain a higher level of activity. In short the surgery by Dr. Gross was intended to help put me back in charge of my life. I do not now wish for the life of my device to become the one in charge, otherwise what was the point in the first place?
Curt
I'm running again. Not as far and not as often but I'm running.
One suggestion that I'll throw into the conversation - Hoka One One running shoes. They have been talked about many times in many threads but they are absolutely the real deal. I ran from the middle of September - my 6 month point - to the middle of December, then stopped when the snow on the ground got too deep. I just started again about 10 days ago with my first 3 runs on the street, as opposed to the trails. First run was 2 miles, then 2.5 miles, then 3 miles. Not even the slightest amount of stiffness or soreness. I will never run again in anything else.
The concern with running is with the impact and these shoes lessen the impact.
Todd,
Reviewing your prior posts, I see that you are also a patient of Dr. Su and a Dr. and received a left hip resurfacing less than a year before I did. When I asked Dr. Su if it was OK to run, he replied, "You are an Engineer, you figure it out!" He did say it was OK to ski and play racquetball. Pat is also an Engineer and she gave you her response. I see that you other hip is nearing a resurfacing so obviously it has been prudent not to run until you receive the second resurfacing. Vicky Marlow once advised, if you really want to run (esp. in competition) then go to a Dr. who will unequivocally give his blessing that it it Ok to run, such as Dr. Bose in India. Dr. Rogerson has stated that the heel strike of running imposes a tremendous load on your hip. I suppose the larger the stride, or faster the pace, then the greatest load will be imposed when landing on single foot. Good luck with your resolution!
I personally think that some common sense need to be applied. I do lots of stuff(when not at dam work!:-() no real running but other high end activity. This was the reason I went for a HR per thr. Any device could probably last a lifetime if you just sit around and do nothing! What's the point in that? Now I do risk ascess everything I do and I've yet to start running again but I'm sure that I will start at some point. If your an avid runner I would advise as much cross training as possible to lessen the impact but I'd still do some running if guys what you love as that's why most of us got bhr's.
I agree with Danny's point of view to use good judgement. Some hippies have posted that their sugeons told them staight out - no running ever. And in those cases, maybe there was somehing else going on besides having a resurfacing, like soft bone or small components, etc.
But, when a surgeon "advises" against running, I think that is different than being told not to run. And with that advice, it seems some hippies have decided to become idle after resurfacing without further conversation. And that is the personal choice part. I made sure my surgeon knew exactly what activity level I wanted to acheive after the surgery and I also made sure he was clear with me about how he felt with regard to my intended activity levels. No offense, but that way I wouldn't have to ask you hippies advice on what activities are acceptable for my new hip.
Chuckm
That's the thing chuck I was told to crack on and do anything I wanted. Although preferably no bunjee jumping
I have the same approval to return to whatever activity I want. But, I continue to research what to expect from my new hip. Everything I find indicates that if you are a select patient with a properly implanted resurfacing device, that your hip will be quite durable.
We all assume risks when we participate in impact sports when we use our native hips. I haven't seen any studies that compare the durability of native hips compared with resurfaced hips.
While I doubt anyone can truly answer my curiosity, I do wonder if it is any riskier for me to do impact sports now with BHR than before with my native hip? Am I more fragile now or not? Unlike my other hip, my new hip isn't likely to develop OA ;)
Chuckm
I would have thought that a bhr is more susceptible to injury than a natural but for what it is a mechanical device they are amazing!!
I'm about to have my 4 year post HR anniversary. I started back to running as soon as I was allowed and have been running regularly ever since. I run about 30 miles a week. I'm not fast (9-10 minute/pace). I have not experienced any pain. Its been a wonderful 4 years and the best decision I ever made. I continue to ski, bike ride and do just about whatever I can. I am super careful about ice when running. Good luck out there!
Since we have so little data, I was woundering, Pat, exactly what details you can recall about those couple of BHR recipeints who reported regreting running prior to revision to BHR? What evidence did they have that running influenced the need for revision? Did any of them have surgeons considered top surgeons on this site?
Thanks, Stephen, for your comment on Hoka One One shoes, as also responded to my similar post earlier. I've bookmarked that and contacted a retailer. Can't wait to try them out in the spring.
I just posted this study. Thought it interesting since there are so few studies about sports and hip resurfacing.
http://www.surfacehippy.info/excessive-sports-longivity-hip-resurfacing-study-2012.php (http://www.surfacehippy.info/excessive-sports-longivity-hip-resurfacing-study-2012.php)
Original Release http://www.eurekalert.org/pub_releases/2012-02/aaoo-esa020812.php (http://www.eurekalert.org/pub_releases/2012-02/aaoo-esa020812.php)
Public release date: 8-Feb-2012
American Academy of Orthopaedic Surgeons
Excessive sporting activity may impair long-term success of hip resurfacing
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.
Well, I'll be 5 years post-op this August, I just started back to racquetball and basketball, now I am re-thinking all of this, I do not want to destroy my hip and go through the surgery again.
I am just wondering if cementless would be more durable than cemented when it comes to the pounding that I am putting on my hip. Dr. Gross cleared me to do whatever I wished but I am wondering if he's changed his opinion?
Chuck
I don't think any of the surgeons have changed their minds and written new articles or studies about running. I would not worry about normal sports and moderate running. Most patients are going to do it anyways.
I had this study and forgot to post it. I just thought it would be interesting for this particular discussion. There are not many studies about sports and resurfacing that I know of.
As I stated before, I think moderation is a good thing, but that doesn't mean everyone needs to only walk and rock in their rocking chair :o
I zipped an email to Lee anyhow, just to see if Dr. Gross has had any change in his mind.
Chuck
I think what is frustrating us former impact athletes is that these impact studies (unlike most other studies) have no specifics regarding the causes for the revisions. I've only seen a few studies on impact sports and they just say the chances of needing reivision is higher.
Are impact athletes having failures due to the same reasons as the non-impact resurfacing population? Notched femoral necks, poor cup placement, femoral cap place in varus, etc.
Are impact sports ruining perfectly good surgeries or are impact sports just amplifying the poor surgeries?
Chuckm
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.
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 (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.
In my humble opinion, that study by Amstutz is about the ASR.
I dont think it is an asr study mate.
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
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.
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.
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?
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
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?
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
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.
Quote from: stephen1254 on April 03, 2013, 01:29:55 PM
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.
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.
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
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
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!