What is the best hip for BJJ?

[Zaga]

Hi I have been training in BJJ, Judo and wrestling for most my life. I am 46 years old and would still a like to compete. I need to have both hips done.  Some Dr.s have said it will dislocate to easily.. Should I consider the mini hips or resurfacing.  Is there a difference in flexibility?  Is dislocation a real problem or are the Dr's to conservative?  It is very confusing to go through all the info out there. Any suggestions will be greatly appreciated.

Dave

[Dannywayoflife]

Hi Dave,
           Great to have a fellow martial artist join the group. Well in terms of a best device for martial arts you have to go for the device with the longest and best proven track record. That is the BHR. There is the same risk of dislocation with a BHR as with a natural hip so 1 in 1000. The mini hips seem to be tauted by some surgeons as better than HR but they are still a THR and therefore still have the drawbacks of a THR such as stress shielding. I am 5 and a bit months post op now and dont intend to get back on the mat untill January next year as i believe as do my surgeon and Derrick Mcminn that a conservative rehab for the first 12 months will pay dividends as far as longevity is concerned. There are plenty of guys who go back to training after a HR the most important thing to do is go find the best surgeon that you can possibly get to. The surgeon is THE most important factor in a good outcome with this surgery. As ive said a patient 12 month recovery is also imprtant in the eyes of most of the top surgeons.
In terms of flexability between a mini him and a HR theres no contest as the head neck ratio is the key to this and with a mini hip this is reduced even further than with a HR so your less flexable and as the femoral head is smaller the risk of dislocation is a real concern.
Where abouts are you? I take it your on the other side of the pond to me?
Danny

[Zaga]

Hi Danny,
   Thanks for the info. I am looking for a good surgeon now.  This board has lots of good referrals unfortunately none are close to me.    When you say 1 in 1000 do you mean 1 in 1000 surgeries will dislocate?  do we increase that because of what we do? 

I am in the San Francisco Bay Area.
Dave

[Dannywayoflife]

I believe that it means every 1 in 1000 HR will dislocate. Thats the same rate as a natural hip. I think though the chances are it wont dislocate once all the muscles are strengthend up and tight again. I live in the UK so dont really know much abpout your health system but do know Derrick Mcminn takes US insurance and i believe its cheaper for the insurance company too so that might be an option. You have found a great place for support and info here its full of great members.
Welcome mate
Danny

[hernanu]

Hi I have been training in BJJ, Judo and wrestling for most my life. I am 46 years old and would still a like to compete. I need to have both hips done.  Some Dr.s have said it will dislocate to easily.. Should I consider the mini hips or resurfacing.  Is there a difference in flexibility?  Is dislocation a real problem or are the Dr's to conservative?  It is very confusing to go through all the info out there. Any suggestions will be greatly appreciated.

Dave

Hi Dave,

Danny has given you some really good advice.

The best thing to do is to find a good surgeon who does the procedure often and has done many. That may leave out some good up and coming doctors, but for the patient it does increase your expectations of success. Overall, with the more and the less successful HR (hip replacement) doctors, the average success rate - as in a well functioning hip with few issues or none at all is about 96.4%. The more experienced or skilled doctors have a higher success rate than that, this has just been found to be the average.

I don't know that much about the mini-hip. My brother in law had it implanted by the same doctor that did both of my HRs. It may be that the hip was too far gone to do the HR, or my brother in law may have preferred it, as he had been talked to by two other doctors who were adamant he do a total hip replacement (THR).

I think one of the benefits of the HR implants is that not much bone matter is lost in the procedure. This allows the thigh bone to remain mainly intact to provide its main function, which is to support the hip and allow good movement. I think it is one of the reasons that so many of us can return to more challenging sports / working out, since although we do have an implant in place (in my case two), outside of the metal cap on the femur and the metal cup on the hip socket, everything else is in place. The mechanics of motion, running, the way that the body was meant to handle impact is still as architected originally.

The minihip has some of the strengths of the HR in that it is less invasive than a THR. It requires that less of the femoral bone be taken out than with a THR, but it still requires much more to be excised than the minimal amount that the HR requires.

The stem that a THR uses is inserted deeply into a cavity carved into the thigh bone. Because the head at the top of the stem is inserted into the hip cup at an angle, the downward force is not distributed in only one direction (down), but rather has a sideways component defined by the direction of your movement. This sideways component over time can compromise the bone that encloses the THR stem, causing issues if it loosens within the cavity or presses against the side of the bone cavity.

To me, it seems that the stem that is implanted within the bone for a minihip is also subject to the same stresses that a longer THR stem is, it is not as long, so the stress may not be as problematic as it can be on a THR, but the issue is still there in the long run to my point of view. The minihip is very new, so the extent of the problem may not be severe, I don't know.

This stress is not there as a problem for the HR devices, since no long stem is used. So to me, the more active you are, the better off you'll be with an HR implant than with a THR or with the mini hip, which seems like a lower impact version of a THR. Just my opinion, based on looking at all three with an engineer's eye.

As a martial artist (TKD for 35 years), I can tell you that at 17 months on my left and 14 months on my right, I am really beginning to push my hips with both punching and kicking. The movements feel smooth, my range of motion is really coming back and I feel strong. There is room for improvement, and I will probably feel back to snuff in due time, but I'm patient about it. I don't feel any limitations, but will be aware of anything that may tell me to back off. So far I haven't really felt that in the last 5 months or so.

I was also leery of dislocation, but again, as an engineer, I look at it like this - the HR approximates to a minute level the way your hip was originally shaped. It is still an implant, but it is as close to the original as is possible with a mechanical product. The THR and to a lesser extent, the minihip are not able to do that, so they are lesser approximations. Dislocations are a problem with smaller head THRs and not enough is known about the minihip now to document its characteristics.

I chose the HRs because I wanted to be as active as I was before, or to be able to take up something new and challenging. The story that I got when told that THR was the best way to go was that I would need to significantly tone down what I do. Now there are plenty of stories of very active martial artists with THRs, but for me, I'd rather take my chances on what seem like a better design that would let me be active for longer.  To me, I was lucky to be able to choose an HR device; the THR and the mini hip are good devices for their purposes, all of them allow us to get back to life, I just wanted something that would let me be as active as possible.

Sorry for the length, hope that helps.

[johnd_emd]

Zaga,

There are good surgeons close to you if you live in S.F.  I chose Dr. Rector in Boulder and chose to fly there from Calif.  But, there is a Dr. Callander in the Bay area and supposedly he's had very good results.  He is on this web sites referral list.  You can find his contact information there.

[Zaga]

Thank you very much this is great info.  I had never considered the UK for surgery.  I am going to look into it as a possibility.  It sounds like HR is the way I should go, some of the Dr's dont useBirmingham they use Conserve or other products it seems like Birmingham has been around the longest.  Would there be any reason to go to other caps ? For Example Flexibility, Range of motion, or longevity?

[Zaga]

Hi Johnd_emd,
I have seen Dr Callender and he suggested only THR when I asked him about HR and continuing Jiu Jitsu he said I would dislocate.  He has been one of the best hip Dr's I have seen but he was not excited about the resurfacing.  I also have some complications with a herniated disk and other spine issues which he helped me better identify.  I will look into Dr Rector
Thanks
Dave

[hernanu]

Thank you very much this is great info.  I had never considered the UK for surgery.  I am going to look into it as a possibility.  It sounds like HR is the way I should go, some of the Dr's dont useBirmingham they use Conserve or other products it seems like Birmingham has been around the longest.  Would there be any reason to go to other caps ? For Example Flexibility, Range of motion, or longevity?

Hey Dave, as you can see by my signature, I don't have Birmingham devices, and am pretty happy with them. The BHRs (Birmingham) have a great record, but others also perform well. A good argument for the BHR is that it does have the best record of survival from the known data. Some excellent doctors use other devices (see Dr. Gross) and have great success. I would rate the success rate of the device as very important, only outranked by the quality of the surgeon him / her self.

All in all, except for the devices that were recalled, the success rate for most is very high.

[Dannywayoflife]

Dave, drop the Mcminn centre an email and see what they say. As hern says other devices have good track records but I would have thought that your insurance would want you to have the device with the most proven track record. I know Mcminn does a fixed price of around £12500 that's a lot less than any US surgeon I heard of. And he's certainly one of the best surgeons in the world as well as being the developer of the bhr. 

[Zaga]

Thanks for the info I am going to dropp the Mcminn institute an email and I am going to contact some more local Dr.s on the board. Thanks for all of your help. I will look you up when I get on that side of the pond.
Dave

[Dannywayoflife]

Dave please do mate. I hope that you find a decent doc and get back to rolling! I can't wait to get back on the mat!