Questions about knee pain, scars, exercise...

[Rosie90]

Hi,
I'm from Hamilton, Ontario.  My right hip was resurfaced in '09 when I was 55. The scar is about 5" long.  I was told not to run, ever, after the operation.  I had quite a bit of clunking after the operation.  It has only disappeared this past year, so about 3 years after surgery.  Now my left hip is starting to hurt.  I was told by my surgeon that they are no longer doing resurfacings, only replacements, though I don't know why.  My questions are:
1. what is a general scar length for hip resurfacing?
2. why are some patients allowed to run after surgery and others aren't?
3. even though I have pain in my left hip joint, I think I should continue to exercise the joint in order to keep the muscles strong.  Is that the right approach?
4. with both hip problems, I have had a lot of pain in my knee. Some people who have had hip resurfacings or replacements didn't have this pain.  I am wondering why I have so much pain on the outside of my knees.
I will have an appointment with my surgeon in 3 weeks and I can ask questions then, but I was hoping to meet her with more knowledge of my situation.
Thank you for any help you can provide.

[hernanu]

Hi Rosie and welcome!

I don't know why they told you not to run, I was never told that and there are many hippies on here who are committed runners. Your scar sounds about the same length as both of mine, so I guess it's average.

I've done a lot of different exercises, but walking / running was definitely one component of it once I got to where my surgeon approved of it (at about 9-11 months) for me. He did that by seeing how I was doing at six months, saw me try to run and set that limit for me.

I think it depends on the surgeon whether and when you can do different exercises, but to me the whole point of an HR is to get back to your activities, so I don't see the point of telling you not to run ever.

I'd keep exercising so long as you enjoy it. The better shape you're in before the surgery, the better it will be afterwards, IMO.

If you haven't exercised as much, the pain in the knee may be referred from the IT band of muscles / tendons on the outside of the thigh. Exercise, stretching and using the infamous foam roller on it to loosen the muscles might help. The clunking seems to be a sign of insufficiently strong stabilizing muscles, so that may have been what impacted you.

Some surgeons have stepped away from HRs due to some bad press for implants with bad designs. I know we just had one person from Canada who got a resurfacing, and several others who have done so as well. You may need to research places both in Canada and in other countries (Belgium?, Birmingham?) where you can get an HR going.

Good luck, and let us know what happens.

[imgetinold]

Rosie,

Ditto what Hernan said.  Some surgeons are very conservative and therefore recommend never running.  My scar is about 4 inches long, but that varies completely with the surgeon and their approach.  Check out the poll on this:  http://surfacehippy.info/hiptalk/polls-about-hip-resurfacing/poll-size-of-your-incision-after-surgery/

Prior to surgery, I had a lot of knee pain....also on the outside of the knee.  When my hip didn't hurt, my knee was fine.  When my hip hurt, my knee often hurt worse than my knee.  Post surgery, I have no knee pain.

Good luck.  Don't let your surgeon talk you into a THR unless that's what you want.  I originally picked a surgeon in the Atlanta area because he did them.  Then, when he suggested that a THR was an equivalent option, I found Dr. Gross.  Very glad I did.

Andy

[Dannywayoflife]

My scar is a lot bigger mines around 11" but then my legs are on the large side.
As for the running some surgeons will always errr on the side of caution and say don't do it. McMinn says you can run but wait 12 months my surgeon Mr Treacy also says the same. If your surgeon no longer does resurfacing then did he use the ASR? If your a candidate for HR why would you choose to have thr?!

[Tin Soldier]

There is very little reason to go with a THR other than having some other complication like AVN, or something beyond the standard OA degeneration of the hip.  Although that doesn't exclude HR right out of the gates.  It's best to discuss with an experience HR surgeon.   

I think there has been a bit of a mini exodus for the partially experienced HR surgeons.  It's a more involved surgery and it requires more experience and so with a little bad press (unfounded, BTW), the less experienced leave HR and stick with THRs.

My scar is about 6 inches long.  The length of the scar has to partly to do with size of the patient, but also has to do with how much room the surgeon needs to do the work.  HR scars theoretically should be longer than THR scars, because you have to manipulate tools, drills, grinders, templates,... in an around a non-sawed off femur.  I don't think they gain much room when they dislocate, also.  Anyway, the more room the easier it is to work and the more likely the surgeon will get a good fit/angle, product.  I should say that there are some really experienced surgeons who are known for shorter scars and they have excellent results.   

Running with HR - popular topic.  I get the feeling (from reading so many posts here) that the less experienced surgeons are more likely to be the ones that recommend no running with a HR.  None of the common name surgeons tell you no running other than during the 6 to 12 month recovery period.  I suppose there could be some unusual circumstances, but again, like Hern and Imgetin said, the point of HR is so you can run.   

I agree with what the others said on knees and staying in shape. 

Welcome and ask the surgeon lots of questions, and consider second or third opinions.   

[Woodstock Hippy]

Hi Rosie.  I'd say it's time to find another surgeon.  My doctor, Scott Marwin from NYU Hospital for Joint Disease told me that the doctors who turned away from resurfacing never took enough time to do the work and learn the procedure properly.  If you look on this sight, you will be able to find a new doctor to take care of your left side.
 If your current doctor told you that you can never run again, he's not really up on what's going on with hip resurfacing.

[Rosie90]

Thank you for all of those comments.  Unfortunately I won't have an appointment with my surgeon until mid-October and will have to wait until then to find out why the surgeons here are no longer doing hip resurfacing.  I'm hoping that my surgeon won't feel defensive when I ask questions.  The first surgeon that I had was planning on giving me knee surgery because I had so much knee pain.  That was before it was discovered that my hip was the culprit.  And then he insisted that hip surgery was inadvisable because of my relative youth (55 years) and became very annoyed when I mentioned items I had read on the internet, "Who are you going to believe, your doctor or the internet?".  I didn't see him again.

Question:  I have pain from the unoperated hip.  Do I continue exercises involving hip flexors in order to keep the muscles strong, even though the joint gives me pain?  Is there still a net gain when those muscles are cut during surgery?

[Woodstock Hippy]

While most doctors use the posterior approach and cut the muscles and then reattach them, some surgeons are using other techniques where they go in between the muscles.  Dr Marwin calls this "direct lateral with a posterior dislocation".  You should be able to ask the doctor anything.  When I first met Dr Marwin he sat down and explained everything about hip resurfacing.  He almost seemed disappointed when I ran out of questions. If the doctor doesn't like questions, it's time for a new doctor.

[hernanu]

Rosie, just to be better informed and feel like you've covered all of your bases, I would get a second opinion. There are surgeons listed on this site by Pat who will review your XRays and other information and give you their perspective on whether you are a good candidate for resurfacing on your other hip and also answer some questions about running, etc.

My surgeon is very much for being active after the HR. He prescribed both in home and outpatient physical therapy, both worked on strengthening the hip and the core, as well as increasing range of motion within safe limits. I was very pleased with the results, then continued their exercises. I am now doing what I wanted to resume (martial arts), and am doing things like kicking a heavy bag with abandon.

It may be that you need to get your muscles better in tune, both in stretching and general strength. I would recommend talking to a physical therapist who has worked with HRs or THRs and is willing to listen to you and your concerns.

[Tin Soldier]

I'm with Woody on this and I'll take it a step further.  If the surgeon gets defensive or the suregon appears to believe in the anti-HR rhetoric that's so common today, then you should find another surgeon.  A THR surgeon should have a well-balanced perspectiveon the variety of options, even if they don't perform HR, they should accept HR as a valid option. 

I would keep doing as much exercsie as you can without too much discomfort or the need to take a bunch of extraneous pain meds.  Exercise is a vital piece of our total health.     

[hipnhop]

I would like to add - find a surgeon who is a runner. He/She would never tell you not to run or try like hell to find the best option so you can.