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Author Topic: Bone Healing by Dr. Michael Broder  (Read 1174 times)

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Pat Walter

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Bone Healing by Dr. Michael Broder
« on: August 18, 2011, 12:10:26 AM »
Introduction by Patricia Walter:
Occasionally people have hip device failures due to pushing too hard right after surgery or doing hard impact sports or activities too soon.  There are stories of people with hip resurfacings that required revisions to THRs.  Dr. Broder, a hip resurfacing patient and radiologist, explains why patients should be conservative during their post op recoveries.  Most surgeons want patients to wait until at least 6 months to return to normal sports and one year to high impact sports like running. Using common sense, listening to your surgeon's protocols and giving your body time to heal is always the best approach to returning to a normal activity level.

Dr. Broder explains:
I am a Radiologist, and have been a member of Yahoo surfacehippy discussion group since 2002. Over the years we have had numerous members, especially young active athletes, who have accidentally injured their prosthetic hip.
Nuclear Medicine bone scans reveal metabolic activity (new bone growth) persisting for up to 2 years in adults over 30 who sustain fractures, or have had joint prosthetics. The reason is simple. As the bone heals, new bone is produced by special cells, and tiny new blood vessels (neovasculature) which very slowly grow into the older bone, and the special surfaces of the prosthetic parts designed for that purpose. Over time, other special cells reshape the new bone, and eventually it is replaced with thicker stronger bone tissue. In fact, over time, ALL the bone in our body is being replaced slowly in response to various stress factors, and maintenance. This is true of many tissues in the body.

If we return to certain activities too soon, we will apply forces that will produce microscopic fractures in the new bone, and it may fail to completely heal. The complex process of bone healing is delayed or completely fails. This is a well known problem in treating fractures of any bone. That is why cast material is applied, or other methods of internal fixation (screws, plates, rods), or EXTERNAL FIXATION methods are used to hold fractured bones in place. Even slight mobility will result in mal-union, incomplete union, or even complete NON-UNION which is a very serious problem. Each person will heal at an individual rate controlled by complex factors.

Every surface hippy has already arrived at the point where the NATIVE HIP has failed.
 
New Hippys to be:
Don't put your new artificial hip at risk. Follow instructions. Exercising too forcefully, too soon can lead to failure of union of the new bone to the hip. This is especially true of the uncemented portion(s). There is no magic involved here. Once you have micro-fractured the new bone, it may never heal properly.

I waited 11 months at age 58 before returning to skiing.

Best wishes,
Michael (MD in NC) (L) C+ 3/31/03

   
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3/15/06 LBHR De Smet

futbalfan

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Re: Bone Healing by Dr. Michael Broder
« Reply #1 on: August 18, 2011, 12:33:37 AM »
Just a quick question but I see the comment that people talk about doing to much or returning too early to impact activities.  What exactly is doing too much too early.  I see where it says to walk walk walk but is there a point where a person can walk to much.  It appears that walking promotes healing and bone growth but then I see where people are hardly allowed to walk at all.  Anyone want to shed some light on this topic?  Can a person actually walk too much?  Thanks gang looking forward to how everyone progressed.  Right now i have seen everything from limited walking at three weeks on crutches to walking with no aids an climbing hills at three weeks. 


Thanks

Pat Walter

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Re: Bone Healing by Dr. Michael Broder
« Reply #2 on: August 18, 2011, 12:43:15 AM »
Most surgeons do recommend a lot of walking.  Usually if you walk too much, your hip will complain and swell up with a lot of pain.  So your body is usually a good guide if you get too carried away.  Dr. Broder was talking about people that start running, lifting weights, pushing cars, picking up heavy loads, etc.  Not the normal walking and doing stairs. Many people feel so good that they go out and start doing sports, etc again.  That can cause problems as he indicates.  Common sense and being conservative is the best approach.  Walking is great, but there is no way to force your body to heal faster.  It will heal at it's own rate no matter what you try to make it do.  Some athletes heal slower than us regular older folks!  Every body is different.

Pat
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3/15/06 LBHR De Smet

hipnhop

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Re: Bone Healing by Dr. Michael Broder
« Reply #3 on: August 18, 2011, 12:52:08 AM »
uh ohhhhh
3/2011 and 2/2012 HR Dr. Craig Thomas

Tin Soldier

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Re: Bone Healing by Dr. Michael Broder
« Reply #4 on: August 18, 2011, 05:15:07 AM »
HnH - you been pushing cars, or something?

In all serisousness, that's great info.  I think the problem is that we feel so good and then we don't take it easy.  It might be akin to taking antibiotics, after the first few you feel great, and then you stop (but you're not supposed to).  Stick with the doc's orders.

Thanks Pat.   
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

Anniee

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Re: Bone Healing by Dr. Michael Broder
« Reply #5 on: August 18, 2011, 04:18:48 PM »
Tin, I think you are exactly right.  It has been quite difficult for me at times to remember what I am not supposed to do, because I feel like I can do most anything!  My main limitation is my left hip, which is hurting quite a bit.  I figure it will be even more difficult not to do too much after I have that one resurfaced.  However, I am determined to follow my doctor's orders exactly because I do not want to do anything to jeopardize the healing process. 

Pat, I appreciate the information from Dr. Broder - it is always helpful to understand the reasoning behind the post-op restrictions!
Annie/ Right Uncemented Biomet 4-20-11/Left Uncemented Biomet 10-12-11/Dr. Gross

futbalfan

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Re: Bone Healing by Dr. Michael Broder
« Reply #6 on: August 18, 2011, 06:15:30 PM »
I am not disagreeing with this but there are just so many people all over the map and perhaps that is personal, your surgeons choice or something else.  I just wanted to know when people say they overdid it exactly what the over did it was so we can all dodge that pot hole?  Others are going into week six and are barely walking at all.  Did the research say anything about people who were not doing enough and the detrimental effects that has on recovery?  It is fascinating how the body repairs itself.  Thaks everyone for your feedback it is great hearing other's stories.

Tin Soldier

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Re: Bone Healing by Dr. Michael Broder
« Reply #7 on: August 18, 2011, 11:29:23 PM »
I think recovery depends a lot on the person's age and generally how well the body repairs itself.  I don't think being on crutches at 6 weeks will significantly decrease bone growth, that's a long term deal.  I think when folks "overdo it", I think they are generally referring to sore muscles, maybe sore capsule, and simply going a little fast in the recovery phase.   

I think you can't go wrong with Dr Broder's advice, taking it easy with regards to bone growth.  That is different than the soft tissue repair that you will hear the PT's talk about.  I could see where one might worry that they are not doing enough, because a PT and a surgeon said you need to get off the crutches and move quicker through recovery.  They are concerned about slow recovery causing a long term unsymmetrical gait.  It's easy for the body and brain to accept a limp and then stick with it even after muscles and bones have repaired.  Although muscle building supports healthy bones, so I could see if you sat in your easy chair for a year, you might want to wait another year before playing soccer or pushing cars. 

My PT actually told me early on that he is the regulator and that I should not do more than what he is recommending each week, which was supported indirectly by my surgeon's advice also.  I think you need to be moving to keep you blood flowing, build muscle to aid in bone growth, but you also need to stick to the PT and surgeon's recommended rate and all should be fine.
LBHR 2/22/11, RBHR 8/23/11 - Pritchett.

 

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