Hip Talk Forum About Hip Resurfacing

Hi all.

I am a few months out from having a LBHR.

I am almost 40 and have been highly active all my life. About 3 years ago I noticed all the usual first symptoms of an arthritic left hip. 6 months later I get the confirmation but carried on with my activities. They slowly tailed off but not completely - mainly stopped running.

Things became a little uncomfortable like moving around at work (as it’s physical) and soreness would happen but wasn’t unbearable. I noticed I was walking on the better leg more often and was getting a sore knee. My lower back was also taking the load.

I spoke with many people about the operation and kept hearing they wish they did it sooner. I also hear of people returning to activities pain free. Based on this information I decided I would have surgery before it became worse.

So almost 2 months out here is what I’ve noticed about my body and myself. I feel I need to share this information for people who were in a similar situation as me.

So again bear in mind I wasnt always in agony but I would have episodes of sharp unpredictable pain from time to time and general soreness that would disappear. The more active I was the more it would hurt but I would say I was very active in the gym still.

So since surgery just over 2 months ago I have probably been active about 20 percent of how active I was before surgery. I have followed post -op protocols (little walks, gentle strength exercises, gentle mobility etc). I can stand straight with both legs feeling equal without the bone restriction feeling and my lower back feels like it’s freed up a lot. My ROM in certain positions is better but a few are not (knee to chest mainly). I think that my body has relaxed because I’ve not been weight training, jumping etc and now think if I had just stopped a bit of activity my body would even out a bit and relax.

However, here comes the negatives and I’m sorry for letting them out but I’m being honest. So some common problems I have read time and time again on here are - (groin pain/ soreness, tight hip flexors,) and I have these issues. When I extended my leg out behind me it catches and is sore, when I stand straight it catches and is sore. Also there’s a lot of clicking and clunking from what I believe is the Psoas attachments and the components. Also I underestimated the massive hit to the glute muscles which will take a long time and may never return to the strength as before.

When I increase walking theres a warm sensation and it seems sore after. Now I’ve read  quite a few people never return to running as they have this soreness in the groin area and I already think I could be heading that way from the symptoms I’m showing.

I’m going to be honest again with how I feel about what I’m going through. I knew that I was not in the worse shape before surgery and was still very fit and strong. The arthritic hip was always on my mind and was painful at times but I was still very active. I had surgery to mitigate that annoyance and have my ROM pain free and would help my training and mitigate the future pain I will experience. However 2 months out I’m noticing problems others have experienced and now I’ve realised that if I had more of a conservative approach to my injury I could of, and maybe had years of my natural hip without jumping into surgery and causing problems. I feel the trade off for what I had going into surgery was not worth it. I should have waited unitl I was in more pain and it was necessary.

There’s no one else to blame but myself but I did think going into surgery maybe I should wait because the trade off is too much of a risk. I know people say “I wish I done it sooner” and I understand that because they got to the point where is was really bad. I don’t want to put anyone off surgery but make those aware I who are a similar age and symptoms that it’s a big risk if you’re not too symptomatic as you may not feel much has changed after. I know it’s only been a few months and I’ll have to see how it is in another few months time but the issues I’m already facing seems to linger for some many others.

The other side of this is the emotional side. If you’re in chronic pain, wake up from surgery and it’s gone it’ll be a miracle. I woke up from surgery and realised at that point I definitely wasn’t in that pain all the time. I have really struggled being inactive for two months as before I was in good shape. And this is another point, is it worth the trade off for your current situation in life?

The big test will be later on in the rehab when I start trying to be the same as before and how pain free and how the movement feels.

I’ve realised that I needed to let my body relax and slow down on the training and I would have found a good place in my life without the annoyance of a 3 year arthritic hip. It’s made me realise that I was being selfish for my own physical actives and not my family by giving up things and slowing down.

However I know people want to return or carry out their activities pain free which is where I was just before surgery. So I guess I need to keep telling myself that’s why I did it and make peace with myself rather than beat myself up.

I kept saying before surgery I wish I was in more pain so that the benefits would always outweigh the risks because “it was time”.

I feel this quite a bit but maybe in a different way than you, but what you are experiencing is completely valid. My right side was very bad and I went into that surgery with the feeling that it didn’t matter what the pain was it would be less than what I had been experiencing.  So I was able to do that mental rationalization of the trade off.  I had gone from running 4 miles a day to no jogging whatsoever for nearly two years, and that lack of physical activity was weighing on me mentally.

I was at the 4.5 month mark and had really started to feel very good in my right side when the left hip was scheduled.  Though it also had the highest severity of OA it never really bothered me as bad and it made me think about this one completely different.  Getting the left one done made me completely start over again on my right as well as you can understand and that means another year before I’m completely cleared. 

I’ve had many of your same thoughts around how hard / next to impossible it’s going to be to recover from three years of reduced or limited activity. I’ve just really had to focus on two things - first my “good hip” was never going to magically fix itself and no matter my pain level it would continue to degrade, and second I have tried to be focused on how good my recovery started to feel at the 10-12 week mark even when I was worried that some of these lingering things would last forever. 

For really active people, a 6-12 month recovery feels like forever, but most of us chose this path because we knew we had a degenerative condition and we wanted to return to an active lifestyle. Hang in there, what you are feeling is for sure shared by me at least, as I lay here four days from my second BHR. 

Second, BSarchet!  Well said!  IRONMAN, you are only 8 weeks post-op.  You’ve just taken a mighty step towards getting back your active life by going through a VERY traumatic surgery.  Until 3 months, you are still healing and susceptible to femoral neck fracture.  Give yourself a break.  There will be plenty of time for training after your full restrictions are removed at 6 months and you are FULLY healed at 12.  Eyes on the prize!  Think about Andy Murray competing at Wimbledon after his hip resurfacing.  I’ve had a few moments myself after both my right 3.5 years ago and my left 4 weeks ago where second thoughts and regrets start seeping in.  I keep reminding myself that it’s a marathon, not a sprint.  You’ll get there.  Be patient, do your exercises, and buy yourself some new running gear for motivation.   ;)

Thanks for the replies.

Marvin I fully understand the process that is required for healing and know it all could still work out. What I’m trying to say is if you jump very soon into surgery the results are tighter than say someone who could not walk or climb stairs etc.

Mine was a some ROM restrictions, on and off pain and not being able to kick a football well with the bad hip. I could still run, jump, skip, box….. all with some restrictions and pain.

It’s a big ask for someone before 40 and high expectations to achieve.

I will test it out at the appropriate stages which will confirm if I’ve made the right choice. I just didn’t wake up thinking “ all the pain has gone” because it was tolerable at times.

I don’t want to come across negative but I’m just making people aware who are younger and lost some of their athletic capability that it’s huge operation and you could feel worse than before the op which I do.

If your job requires you to be physical that’s another consideration also.

Understand.  It is very much a weighing-of-options, but there is also the possibility of waiting too long.  In most cases, it’s a wear-and-tear problem, even for folks younger than 40.  Wait too long and there may not be much left for the surgeon to work with.  BHR is still a much better option for younger, active people than total hip.  Too many restrictions.  I’m quite active - love hiking, biking, kayaking, skiing…though nothing competitive, other than competing with myself.  Hopefully your recovery will be swift and you’ll be back to running in no time!

I really hope so. 8 weeks out and I feel groin pain mainly and feel it’s more constant pain than before surgery. It’s not 10/10 pain more like 3/10 but it’s always there and is mentally draining mainly because I’m beating myself up for jumping  in too soon. Is this normal? Of course if I was in that chronic pain all the time before it wouldn’t matter right now.

My x-ray confirmed it was severe osteoarthritis and bone on bone in some places which were giving restrictions. I am having episodes of thinking I’m I in denial about the whole thing but I knew even when I was about to have cannula put into me I was still thinking I didn’t want to do it.

I think the mental side of having a condition like this is harder than the physical now!

“Normal” is subjective.  I thought after I had my right hip done and the pain was gone for a few days that I had DEFINITELY done the right thing, even though I dealt with 4 years of pain from deteriorating, bone-on-bone osteoarthritis.  A month into recovery, I was wondering why I did it, as the pain and sleepless nights took their toll.  After 6 months, I wondered why I took so long to pull the trigger and get it done.  This time around, more pain than last time and more sleepless nights, I’m wondering again, but keep telling myself that it's gonna be better here shortly.  And it truly IS shortly.  Feels like forever right now.  But 4 months from now, I can almost guarantee you’ll be saying “WOW!  I really feel like IRONMAN!”  Just for giggles after my first surgery, I added a “Spider-Man Pose” to my yoga routine.  Impressed my 8 year old great nephew!

I love your positivity for sure!

What I believe to be a good trait for me is I have high expectations but equally it can be my downfall if things I set out to do are not achieved. If I’m left with lingering pain, not return to running or be able to kick the ball again without pain it’ll kill me for the trade off of major surgery at 38.

I know it wasn’t going to get any better but I could have modified my life and not been selfish.

I appreciate your positivity in this time of deep regret for me. I thank you for that Marvin.

We have something in common: high expectations and finding the way to make them happen.  I have another challenge for you, since you’ve already met this one head on.  Let's meet back here on November 1 and compare notes.  I have a feeling you’ll be training for a marathon by then.  I’ll be coming back from my first trip to Washington, DC, where my wife and I intend to enjoy a long walking tour of the town including the Mall from one end to the other.

I just went back and re-read your original post.  You said:  “ My ROM in certain positions is better but a few are not (knee to chest mainly).”. Did you mean your op leg knee to chest?  If so, did your surgeon or PT clear you for that this early?

Yes operated knee to chest whilst lying down. Yes it was cleared at 6 weeks.

The other that is restricted - lie on your back, bring unoperated leg as tight as possible to your chest. The operated leg will love off the floor and feel tight. This is basically the Thomas test. If your leg has been made slightly longer it’ll be very hard to ever remain the same.

Interesting.  Dr. Gross’s guidance is flexing past 90 degrees, but not as extreme as knee to chest until 6 months.  Wondering if that may be the cause of your extra pain?

I wonder why so many surgeons advise and restrictions vary. Makes me think they don’t really know the exact answers.

I don’t do it often and won’t push it to the point of pain.

How does is your previous operated side fair with getting the knee towards your chin/chest whilst lying on the floor?

I suppose it depends on the muscles they cut and what approach they use.  Have you watched any of the surgery videos on YouTube?  Dr. Gross has an 8 part series.  Personally, surgery vids used to make me nauseous, but I figured I’d like to see what this guy is going to do to me.  My wife says I’ve watched them so many times, I could perform the surgery myself!   :)

Actually, I’ve never been able to get my knees to my chest.  I had a few structural abnormalities from birth, like femeroacetabular impingement.  After the right side was done, I could get to within a few inches, which was an improvement since my youth.  I was working on it when the left started giving me grief.  Starting over!

Yeah I’ve watch the surgery a good few times prior to mine - good or not I don’t know!

My flexibility in some ranges is already better than before but just as tight in others.

The last day or so my groin/hip feels like it’s burning constantly and seems to be so easily aggravated it’s getting me down. Can’t stop worried about it being the psoas as my leg is ever so slightly longer also (half confirmed by physio)

Have you checked in with your surgeon or someone on the surgical staff?  They may offer an alternative recovery path.  Do you feel like if you slow down, you’re going to stop?  Maybe you should give three days to resting and icing.  Think of it as a part of your training regimen.  See if your pain subsides.  I still think you’re pushing too hard too soon.  Sometimes, good things take time.  Try to stay positive, Mate! 

I only walk a mile at a time 2-3 times a day from week 6.

Very basic exercises - ankle pumps, add/abduction raises, flextion and extension (body weight) half squats, glute squeezes.

At that point could you do glute bridges, single leg squats and clamshells? Piriformis was cut and is weak, its needed for running later on. I started squatting with extra weight from week 7. Now at five months can run 9km easy runs but piriformis (clamshells) still need daily work. Things take time, patience and work is needed a lot.

Yes but I haven’t tried single leg squats. I haven’t added any weight yet and won’t unitl week 12.

You have a COC?

I’ve heard it’s better for running as it does not heat up as much? Haven’t seen any literature on this?

Yes, CoC. Studies are coming when time goes by as its relatively new invention, started 6 years ago.

Here is one: 45% of patients doing high impact sports. It does not say how many did them before hips got too bad. Or how many many wants to do them (everyone are not runners). High impact for me was possible 3 months post OP.

https://www.arthroplastyjournal.org/article/S0883-5403(24)00514-X/fulltext

I am sure they will release bigger study later..

Thanks for sharing.  Here is my post on the website:  https://surfacehippy.info/two-year-results-of-ceramic-study-2024/ (https://surfacehippy.info/two-year-results-of-ceramic-study-2024/)

hi Ironman,
I am in a very simular situation to you. 43, extremely active (rode 24 hours straight on my 40th birthday a week beofre the accident that led eventually to my BHR on May 1 of this year.

i am also dealing with big time  hip flexor and groin issues every time I do anything beyond 8000 steps (any kind of hip hinge and flexion)

I don't have much to offer except i am right there with you and have my fingers crossed for both of us.

Hi Tobyskier. Yes so you’re about a week ahead of me.

Yes at the moment any fair amount of steps flares it up - it’s not too painful but it’s there! And yes any flextion really aggravates it.

I think hinging or flextion causes some type of impingement of the soft tissues because the implants are bigger than the natural stuff that was in there before! Hence why sooooo many can’t get their leg to their chest, feel a pinch and struggle bending deep into the operated side. Extension (leg straight out behind me) is super tight too.

A surgeon said to me also that the metal debris early doors can cause irritation in the groin and this settles over time….. I found that a little concerning.

Here we are, IRONMAN!  November 1st already!!  How are you doing?  Ready to start training for that marathon?  How are you doing with the emotional issues these days?

Wow you actually did come back on November the 1st!

I won’t try any impact for 12 months and to be honest I have been thinking about the risk vs benefit - is it actually worth it?

I’ve still be doing body weight exercises mainly and LOTS of walking. Sometimes I think is it too much?!? 

Pain at rest is pretty much zero but flexing can cause some pain and balancing on one leg - mainly when putting a pit of boxers on. It feels like painful pressure and then just eases off a few seconds later.

Loads of clunking - mainly when bending over, shifting around the house, balancing. When I’m bare foot on my wooden floor I seem the feel the implant more - I don’t have this really with trainers on only when bending over again etc.

It feels very wobbly in comparison but I know it can only get stronger right.

Emotionally I’m still struggling if I’m being honest. I’m only 39 and feel I could have put it off longer but I do understand it was on my mind a lot so it was a rock and a hard place. I worry about the future, revisions, my work etc.

I feel like maybe the implant is not set in the correct angle causing all the clunking and being MOM does make me paranoid. I am fully aware I have an artificial hip whilst other completely forget it’s there - good for them I say.

However when I walk there is no pain and I don’t have a limp when I have trainers on. I have an ever so slight limp bare foot around the house and a physio thinks the leg is slightly longer causing this. Measurements have been taken but at the 12 month review it will be confirmed by an x-ray.

I also have better flexibility in certain angles than before but knee to chest isn’t quite there and bringing my leg up and across my body can cause sharp pain which I think is some sort of impingement of soft tissue or my neck bone rubbing the cup. That seems to have stayed the same.

I don’t train no where near the same as I did pre-surgery because alot of my activities we high impact and as I said before the risk vs benefit just doesn’t seem worth it at the moment.

That being said an Ironman has crossed my mind but I feel I need to see where I am at 12 months.

How are you getting on? 5 months now?

5 months coming up November 10.  ROM actually a little better on the newer left than on the 3-year-old right!  Back to normal activity except bike riding and kayaking.  Long walks no problem - did 10 miles on our first afternoon in Washington DC, including the 57 steps of the Lincoln Memorial.  Feet were tired… hip wanted more!  Had some serious up-and-down workouts renovating our guest room last week.  The op side on those laminate floors was quite uncomfortable, but not unbearable.  Color of the scar has started to fade in the middle, but it’ll take about a year or more to fade completely.

The clunk will fade as your body adapts.  Takes a while.  Also, and I hope other Hippies will weigh in on this, I felt like my leg length was a little longer, a mil or two when walking, both for the first hip and now this one.  Took almost a year for me to feel like the right leg was actually the same length.  This time, it’s just starting to feel the same length around the 5 month mark.  Doc assured me that even though they don’t use the K-wire to mark leg length anymore and use the x-ray, leg length is the same.  I was wondering if there’s a “run-in period” for leg length?

Other than that weirdness, strength is getting better every day.  Haven’t been to the gym in several weeks, between Helene cleanup and room reno, I haven’t felt the need.

You’re doing well! Any niggles at rest?

I will have a 12 month review with an x-ray and that’ll be when they are measured. As you say it takes time for things and the body to settle so at 12 months that’ll be enough.

Not really.  I was always crossing my legs at the knee to stretch pre-op.  Can’t tolerate not being able to do that.  Still watching out for the nocturnal leg cross and sleeping with a knee pillow.  On occasion, it happens accidentally, but the lingering pain from doing that seems to be disappearing faster and faster.  Something else to look forward to at 6 months besides bike riding, deep squats, and more extreme stretching.  I need to make a checklist!   :D

I do find it interesting as one surgeon can give advice on rehab that can be completely different to others. Conservative will always be the best approach and it seems Dr Gross’ is pretty much that.

So you get any pain when balancing on one leg to get socks or pants on? I have no bud but it disappears quickly after I put the other leg down.

Just to throw a data point in, because I know clunking is a concern for Ironman; I'm about 6.5 weeks out, just started walking without crutches 3 or 4 days ago.  I had a pretty bad limp the first day from weak control muscles, still limping but it's improving pretty quick.  Odd feeling when walking without crutches, it's the weak muscles but kind of feels like that pressure feeling you get with a joint injury, but not pain.  It's improving daily.  My lower back hurts since ditching the crutches, I think from the limp.  I still get some clunking, but I think it's improving.  Initially I was getting occasional clunking mid-step while walking without crutches, when the stabilizer muscles got tired, but that seems to be going away.  I definitely still get some clunking/moving feeling (no audible sound) when doing things other than walking.  My first post-surgery appointment is in 2 days.  I'm 6', 160#, 32" inseam, no idea what size ball and cup they used but it was the Smith & Nephew BHR.  No pain other than my lower back, which I also had before surgery.  Oddly it was gone when walking with crutches, so it must be related to my limp, which I had both before surgery and now.  Anyway, still clunking/movement feeling here and there, but I do think it's improving. Right now I think trying to balance on the new leg to put pants on is a bad idea, there's no stabilization really and feels like bad things might happen.  But if I hold on to something like the counter or a shelf with my opposite hand then I can stand on the new leg to put pants on OK.  I'll report back after the Dr. Apt on Tuesday.

Hi Matt.

Yeah at 6.5 weeks you’re so early into rehab at the moment - there’s loads of new gains to still happen!

I didn’t realise you were clunking at bit but if it’s getting better that’s good.

Mine seems to have stayed relatively the same. Some days I’ll do some certain movements and think oh it’s going. Then the next day I’m clunking like the tin man again!

I think I’d it’s like this at 2 years I’d be concerned of bad placement or something else.

Really wish it didn’t feel artificial - However I’m aware over time it’ll feel just normal as part of my life.

Just keep strenghtening those closest muscles next to artificial parts and they will support parts better and less clunking etc. Do exercises every day..

What do you suggest or have been told to strengthen those areas? Seems like I’m doing alot and it stays the same.

@Ironman, yeah at first I wasn't clunking at all really but in hindsight I think it's because I was being so careful with my movements, and walking with crutches makes a big difference.  But as I started moving around and doing more, it started happening more.  But is now starting to go away I think, it definitely comes and goes. 

If you're far enough in that you're allowed to do exercises, check out the squat university channel on youtube.  Ignore his thumbnails, he's got really good info on things to stabilize the core and hips.  I'm going to try some of his exercises when I'm allowed.  Also I'm expecting the doctor to give me some exercises when I see him tomorrow, I'll share whatever they suggest. 

Thanks Matt I’ll look into it.

Did you have a BHR device? What size head? I’m 52mm and 5ft 8.5

Quote from: IRONMAN on November 04, 2024, 07:47:36 AM
What do you suggest or have been told to strengthen those areas? Seems like I’m doing alot and it stays the same.

- Single leg deadlift has lately been my favourite and have progressed holding 12kg kettlebell in that. But otherwise all these: https://surfacehippy.info/hiptalk/index.php?topic=7141.0

How’re you getting on bilateralrecerf?

Quote from: IRONMAN on November 05, 2024, 04:05:43 AM
Thanks Matt I’ll look into it.

Did you have a BHR device? What size head? I’m 52mm and 5ft 8.5

Yes to the BHR.  52mm head 58mm socket.  I'm 6' and about 160#, 32" inseam. 

I think at 5ft 8.5 my 52mm is quite big and usually those my height are 50mm or less. Could explain why my leg is probably longer!

Quote from: IRONMAN on November 05, 2024, 05:59:22 PM
How’re you getting on bilateralrecerf?

Quite nice but still work to do. Now at 9 months. I think the progress will continue for 1.5 years at least. I am following some professional athletes who had bilateral and for them they could still improve a lot after one year post op.

@bilateral - What makes you think it’ll keep improving 1.5 years out?

Any pain?

Its the performance, what you can do in sports. Everything gets better all the time. Rapid movements, flexibility, nerve things (how you control your moves). I play football, played few matches this season and it was still quite difficult though could do almost everything but now gets easier all the time. Maybe in everyday life you dont notice it that much, but as I am training every day towards the next full season, cant wait how good this will be.

Did or do you get clunking? Does it feel stable?

Supporting muscles are getting strong after all the hard work so quite stable.

Clunking rarely only in few extreme positions but no pain associated with that so nothing to worry about, its normal behaviour.

Pain only when running too much or fast, still limited to shorter distance or lower speed in long distance running. Fast sprints are fine tough. Not planning any marathons, but enjoying 40min jogs 3 times a week.

Sounds very positive and a lot of long running already! - fair play!

I think ceramic will be superior for ruining than MOM - I just have a feeling.

Could be, if does not get loosen  :D. Who knows how it goes. Now only concern is that hips feel bit different. It might be too early to make any conclusions at this point. But these kind of things - that every recovery and hips are different - are easy to spot when both sides are operated  ;D

Its actually weird that weaker side is painless in running, then stronger side gives some pain. I have no idea why, so just continuing exercises and hoping the best.

I promised to share the exercises my Dr. gave me at my 6 week checkup.  The only thing he gave me is abductor exercises; lifting my leg to the side while standing, then eventually while laying on my side when the muscles are strong enough.  Other than that, just live life (just not fun stuff for 1 year). 

Just for a data point, I'm off of crutches now for just over a week.  Initially it was really hard to walk without crutches, the stability just wasn't there and it felt really odd.  But the situation improved very rapidly, and now I can walk really well a couple miles at a time. 

Is anyone else still sore and stiff for the first 5 or 10 steps after sitting for a while?  I thought that would be gone since the joint is new, but apparently it's the muscles and things that get stiff lol. 

Yes I was really stiff after sitting for a while when getting up for about 4 months. It’s getting better but still there. I do think it could take a very long time to completely disappear.

One thing I’ve noticed in the last month that has got much better is extending my leg out behind me…. Seems pain and tightness is disappearing there also.

Still overall the glutes are weaker than the other side I and do think will it ever be the same as the muscles were cut and had so much trauma…. Time will tell.

Probably not or atleast takes more time if rehab is too conservative. Extra weights, rubber bands etc needed to get the muscle strength back. Two muscles, piriformis and quadratus femoris were cut and sewed back. Others need work too. My scars in both glutes are 16cm long so damages were enormous.

I think I have now quite the same strength than before OP. Yesterday squatting 4x10 with 70kg. Difference to old gym life is that now can squat much deeper.

Remember that pro athletes have made their way back to atp tennis, Nhl etc after same surgery (and have done lot of work)