Best resurfacing device for runners?

[Dayton96]

In the opinion of the runners reading this forum, is one particular hip resurfacing device (i.e. Biomet, BHR, etc) better for runners with our particular needs?  Would cemented or uncemented be a preferred choice for runners?   

I am a 55-year-old male and I like to run three to five miles a day at a nine minute pace with a ten mile run on weekends.  The runs are usually on bike trails and the back streets of my small town.  The last eight months though I've been having severe left knee problems and stiff hips.  My doctor tells me I have bone on bone on my left hip and my right hip is probably about two years behind the left hip.  He tells me I'm a candidate for a hip replacement.  Luckily he suggested I look into a hip resurface.  He thinks my knee pain is a result of the bad hip, although he admitted there may also be a small tear in my knee that doesn't show up on the x-rays.  So now I'm looking for a surgeon and trying to decide on the type of hip replacement device to go for.  The goal is to return to running within 12 months of the hip resurfacing.  It seems to me, based on what I've been reading on this site, that getting back into running could be questionable and/or difficult, even with a resurface.  Any comments would be appreciated.   

[resurface]

I don't know about a best device.  There are no studies published looking at this level of detail.  My money is with the surgeon who is implanting a device that they know and have predictable results.  I might first suggest that you look after your knee.  An MRI will definitively allow for a tear to be diagnosed [or not].  Depending on the location of a meniscal tear, it may be treatable.  Good luck...

[Dayton96]

Thanks for the response.  I have had an MRI done on my knee and it did not show anything.  So I'm working on stretching each morning and taking it easy on the knee.

[Tommy]

My Dr. gave me a choice between BHR and ASR. In his was opinion that in time the ASR would show to be a better implant but it didn't have the history that the BHR had. He did say they were both good and it's more about getting it put in right. In the end I went with the BHR because of the history behind it. As far as running again he ask me to wait 3 months before running, 6 before running hard. He said walking was good for it so I walked 2 weeks post op I walk 10 miles. I would walk fast when I could, then slow when I had to. At 5 months post op I run a 5k, at 7 I run a half marathon  at 11 months I run a marathon. It can be done If you want it bad enough.
                 
                                                          Tommy

[resurface]

The ASR is no longer available in the US!  Just google "DePuy ASR"

[Tommy]

At the time of my surgery it was!

[Dayton96]

What about Dr. Gross' Biomet device?  I'm considering Dr. Gross (Biomet, cementless) and Dr. Brooks (BHR, cemented).  Then there is also the issue of the type of incision.  Dr. Gross uses a 4" posterior cut and I'm not sure, but I seem to remember that Dr. Peters uses an anterior approach (I will need to double check that).  So is the incision a factor in a runner's recovery too?  Which cuts the most muscle and after being cut, can the muscle ever, truly recover completely?

[moe]

Do a search for Cory Foulk, he is an ultrarunner, double ironman participant with a BHR. IMO he has pushed the envelope for running and cycling more than anyone alive. moe

[bothdone]

For the question "which device is better for runners" my answer is that there are so many variables that we will probably never know the answer.    Variables include:

running style and efficiency
mileage
weight
speed
age
other health factors
how well the device has been fitted
and so on.

Perhaps the answer will be found when some of those factors can be collated and linked to the length of time the device survives.

If that sounds at all negative or depressing, it is not meant to be.   As someone who is enjoying a limited amount of running (maximum 5 miles in one go so far) I'm pleased with what I've got - a BHR coming up to its sixth anniversary and a BHR just over two years old.
Ed

[stevel]

The BHR device has the longest, most successfull case history exceeding 10 years for impact sports.  I am not aware of a select study of runners exceeding 10 years of running on a BHR device.  Other devices will have a shorter case history.  In a interview with Vicky Marlow, Dr. Su stated "I would ideally like the hip resurfacing implant to last as long as possible, and I feel that repetitive running on hard surfaces may be detrimental to the implant and it's connection to bone.  If a patient feels strongly about running, I would prefer it be done on a softer surface."

No doctor would recommend running on a conventional THR with a small ball femoral stem and a plastic socket liner, as the device will wear out due to plastic debris, requiring a revision in about 10 years.  I know a couple of downhill skiers in their 70's (one is also a squash player), who had conventional THR's in their 40-50's, who required revisions because they were active in sports and wore out the device.

The jury is still out for the longevity of hip resurfacing devices, but so far they are much improved over conventional THR's.
Basically patients return to sport anyway, regardless of the device.  The worst that can happen is a premature revision.

As Dr. Su stated in the interview "After 6 months postoperative, I remove all activity restrictions - its your hip!"

In other words, "If you make your bed, then sleep in it!"

[Pat Walter]

I wanted to make a couple comments.

In my opinon it is always best to go with the hip resurfacing device and surgeon with the best track record.  The most used and most reliable device according to the National Registries is the BHR.  It is said that many people knew the ASR had problems, but it took awhile for it to be removed.  Meanwhile, many people had that device.  Hopefully, if they used a really expeirnced surgeon, their ASR will do fine.  It was very important to have the acetabular cup placed correctly.  Of course, it is just as important in any device to have it placed properly or there can be excessive wear causing high metal ions. 

So stick with the BHR which most of the top surgeons use or with the Biomet with Dr. Gross uses.  If you are going to run, there are no medical studies to show either the cemented or cementless devices are better.  Every surgeon would prefer their patients not do a lot of high impact sports - but realize they will anyways.  So as someone said - it is your hip and your mileage may vary if you beat the heck out of it.  Doubtful you will destroy the metal bearings - but you need to keep the bone around the cup and cap healthy to keep the device soundly in place.  So it is always a gamble on any patient's part to do a lot of hard running or extreme impact sports.  Many do, but none of them are 10, 15 or 10 years out yet.  It will take time to get medical studies about the impact sports.  In a way, we are all experiements since resurfacing is still not very well accepted.  I wanted to be part of it and help develop the procedure. I feel is you get a second chance with a new hip replacement, you have a second chance in life and perhaps need to evaluate what is really important to you.  If you don't make a living at running and extreme sports - maybe you need to find some other activities that are not so hard on your body. Remember if your hip has problems, then the rest of your body is not far behind.  Joints can only take so much beating and repetition.  We are human!

Choose an experinced surgeons and let them decide what device is best for you.

Pat

[Lopsided]

I feel is you get a second chance with a new hip replacement, you have a second chance in life and perhaps need to evaluate what is really important to you.  If you don't make a living at running and extreme sports - maybe you need to find some other activities that are not so hard on your body. Remember if your hip has problems, then the rest of your body is not far behind.

Pat, I know your comments were directed to Dayton96, but they seem to mean something to me. I have already decided what is important, and much as I enjoyed sport, extreme in some ways, in the past, I have no ambition for it now, and would be happy if I could remain active.

I am seeing the quack this weekend to see if there are any issues with my spine, and if not I am going to book a resurfacing operation in Europe.

Dan

[Dayton96]

Good luck Dan.  I appreciate your input.  Like you, I'm struggling to decide when to do the surgery.  My hips are stiff and I limp a lot, but I have pain in my knee that may be completely or partially blamed on my hip.  I could put this off for a year or two, but I'm afraid that will only allow the cysts to become larger and weaken the bone.  I'm leaning toward Gr. Gross right now, principally because of the information posted on this web site and by the quick and personal replies I've received from his office.  When I emailed my x-rays to him, I had a response within 24 hours.  There does not seem to be anything negative about the man and his work anywhere on the internet - just the opposite.  I have an appointment with a doctor at the Cleveland Clinic in a few weeks, but I suspect in the end I will go with Dr. Gross.

Addressing the issue of giving up running.  I just can't do that.  Running is my way of easing tension.  I can spend an hour a day inside myself and feel refreshed the rest of the day.  If a resurfaced hip will allow me to run for another 10 or 15 years, then I will gladly accept that THR down the road and count myself lucky to have had the extra years.  I know runners can be passionate about their sport and therefore if there were one resurfacing device out there that runners particularly liked, it might be brought up on this particular forum.  That hasn't happened yet though.

By the way Dan, I spent three weeks in Thailand about 15 years ago and I loved the country.  The people, the food, the religions, the landscapes, were all incredible.  I'm hoping to take my wife and son to Thailand when my son is at least 12-years-old.  It hurts my heart to watch the news and see what is going on in the capital.  What is going on in the rest of the country?

Take care and good luck with your trip to Europe. 
     

[Lopsided]

Thank you Dayton96. I am glad to speak to people on this board who are before their operation.

'Like you, I'm struggling to decide when to do the surgery.' Well I think I have had enough putting it off.

'I'm leaning toward Gr. Gross' It seems as though he is one of the best choices. I would be interested in him, as he does the Biomet, and I want cementless, but he is too far from me. I did write to many surgeons and hospitals in England, and as an off chance wrote to Dr. De Smet in Belgium as well. I am sorely disappointed with the response, or lack of it, from England. But like your experience with Dr. Gross, similarly I got a personal and encouraging reply from Dr. De Smet, who said he could do the Biomet too.

'giving up running.  I just can't do that' It is not so simple as either give it up or continue. I used to love running in the heat, running in thunderstorms, had great friends while running, and even met my wife while running. And if I run some more after the operation I will be happy. I am aware that the road running I did contributed to my arthritis, and also, as with your knee, it is not just my hips that are degenerating, my spine is a bit mashed up.

'I spent three weeks in Thailand about 15 years ago' I appreciate that you remembered from my previous posts where I am. 'What is going on in the rest of the country?' The provinces, and in fact, most of Bangkok too, carries on as usual.

I will continue to look out for your posts Dayton96, and hope you make the decision too.

Dan

[Tommy]

 

I used to love running in the heat, running in thunderstorms, had great friends while running, and even met my wife while running. And if I run some more after the operation I will be happy

Spoken like a true runner go luck in your journey.
                   Tommy