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.