Recovery time discrepancies

[chuckm]

Does anyone understand why different hip resurfacing surgeons have such a large difference in recommended recovery times - especially the time to return to impact sports? Dr. Bose says 3 months, Dr. Su 6 months, and the master Mr. McMinn 12 months. My surgeon told me 6 months and I will adhere to that. But I do want to better understand so that when I get to those six months I am better prepared to see if I should wait longer. At least Dr. Su states from studies that the blood supply to the head is at max by six months and may explain his reasons. Mr. McMinn says that the bone density in the neck continues to gain strength for two years and he says to wait a year for impact sports. Dr. Bose just says you are good to go at three. Still other surgeons say be your own barometer and suddenly you have people skiing at 3 months and runners even sooner. I suppose overall health, age, and presurgical fitness level would play a large role in how soon the hip gains strength but I have never heard of a surgeon giving a personal time table to recover. They seem to give the same one they give their all their patients whether young or old.

Chuckm

[hernanu]

Hey chuck, welcome.

I was told impact sports at one year. It was really one year + 3 months for me, since I got the second done three months later.

In my case, I have high bone density, having put in decades in martial arts, weight lifting, etc. I think you'll find many here who have been highly active and benefited the same way.  My muscles would not have allowed me back at six months anyways, since I may have waited longer and muscles may have atrophied, so that may have caused longer recoveries.

I still felt good about waiting for a year before getting back to martial arts. Being able to move the way I wanted, with confidence that I had waited long enough, so that when I felt the inevitable tweaks and little pains, I didn't think that it was my hip having problems, just the gradual rebuilding of my muscles.

I have to say that after two years it feels much better than at one. Just my own take.

[stephen1254]

I have concluded that the discrepancies are due to the fact that nobody really knows when any particular person is ready, and they give their best guesstimates. I've speculated on this forum myself as to what factors we have to be concerned with and I've boiled it down to two areas:

1. Femoral neck strength. I've read that failures are not seen after 6 months, and that is the time frame I used to start gentle, limited running - my Doctor actually gave me the OK at 3 months. I would suggest that both Su and McMinn are correct; maximum blood supply to the head at 6 months, but the neck continues to get stronger until perhaps 24 months.

2. Loosening of the cup. You need adequate bone growth into the cup but I doubt anyone can absolutely determine the strength of the bone - cup connection without anything short of an autopsy. Again bone growth is observed by 3 months, but continues to grow for some time. I began doing squats with a 50# dumbbell at 6 months, and I am limiting myself to 50# until my one year check-up in another 6 weeks or so.

I timed my surgery to give me maximum recovery time before ski season and I started skiing at 8 months with no issues. I am still being careful with all my impact activities and I'm guessing it will be 24 months before I simply forget the new hip is there.

[Tin Soldier]

Pritchett says 6 months, at least for me he did, but he also emphasized gradual increase in the types of activities from there and to not go too hard.  I wonder if a surgeon might have a rough idea of someone's bone density/bone growth by simply cutting into bone during surgery?  With that in mind, barring an actual dexa scan or other anlalytical methods, maybe surgeons suggest a range depending on what they see in a patient?  I don't know but, I would say the vast majority of HR surgeons say 6 to 12 months, more landing on the 12 side, probably because of McMinn's work/book and the BHR training.  I suspect the other manufacturers probabaly suggest similar timeframes.  I think Gross also says 12 months. 

The femoral neck is the main issue as Stephen and Hern pointed out.  There might be some other soft-tissue stuff they concern themselves with too, like the capsule, very slow cell turnover. 

[chuckm]

Thanks for all your input. My participation in impact sports was down at least 90% but not completely gone before surgery so I'm thinking my femoral neck strength will be better than someone who was sedentary prior to surgery. I a 46 year old male with large bones and my components were large (54mm head and 60mm cup). Sugeon is experienced and told me component positioning is perfect. If my muscles are feeling good and strong as I approach the six month mark it doesn't sound like I have too many risks that will be much less if I wait a year.

Chuckm

[John C]

My understanding from Dr Gross was that he had seen some femoral neck fractures up to six months, but never any after that, so that is why he allows impact sports to start building gradually at six months.