BHR 3.5 Years Post Operation

[benf]

I had my LH done some 3.5 years ago with a Burmingham Hip resurfacing.  The original bone on bone pain is completely gone.  There is however still a dull ache all of the time (hard to describe, it is like a feeling that I have something foreign in my body - is this to be expected or should I almost not feel and difference between my resurfaced hip and my normal hip?).  The thing is it is worse when I do not exercise.  If I exercise including stretching, weight bearing gym (squats, leg raises,etc) and swimming it feels much better (should it feel better with exercise?).  My hip clunks when in certain positions also and I do not have any better range of motion than I did before the operation (which was very little in both hips).  I am 46 years of age and want to maximize the longevity of my hip so need a good plan to do this?  I do not run (I would like to but am willing to sacrifice this for longevity so long as I can do plenty of other activities).  Anyone who can shed light on their experiences of similar or have answers it would be much appreciated.  Also, does anyone know the latest research figures?  Whats the chance of getting 20 years our of a BHResurfacing?

[Dannywayoflife]

Ben welcome and congrats!
I'm only around 10-11 months post op myself. I'm currently 29 I was 28 at the time of operation so I do share your thoughts on longevity. I think that this is effected by many many things. To me one of the most important is surgeon skill. How it's implanted in the first place.
I am highly optimistic about my BHR lasting way more than 20 years. The data from the developing surgeons here in the UK also back this up.
I think the clunking in some positions will be due to some catching of tissues on the implant. I asked Mr Treacy about component positioning and he basically stated that is where the true surgeon skill comes in. He said it's impossible to implant a device where it will never catch the skill is to implant where 99% of the time it won't while still remaining within the design peramiters of how the device was designed to be place.
As for rom the head neck ratio is reduced when the op is performed so the rom will never be as good as a natural hip but my rom is already the same as when my hip was "normal" and it's getting better.
I think that the long term survivorship of the HR will be down to skill of the surgeon and the longterm bone quality so keep your nutrition right and take exercise that will help.

[hernanu]

Hi Ben, I'm at two years and still get a bit of soreness in my right hip when I sit too much.

Exercise definitely keeps me loose and overall makes me feel better. I can tell the difference since I work on a computer all day; when things get intense at work, I can be sitting in one spot for hours. I don't really get startup pain anymore, but do get a bit sore when I've sat in one position for way too long.

Have your X-Rays been pretty good since the operation? If so, I notice you don't run, but maybe, since you get good results from exercise, going to a physical therapist to strengthen the area may help.

I think for me, I need to keep up the exercise to recover correctly, even then. In my case, I had seven years of OA, with possible atrophy of muscles, back body mechanics building up, etc. so I would expect some issues to last a while, something that needs work long term.

I would also talk to your surgeon, tell them how you feel and eliminate the device as an issue - then you can take care of muscular issues if they are there.

As to longevity, we are at the first (statistical) wave of adopters, so we are setting the standards. There are plenty of people who are successful at 10 years (see the national registries), and stories here about some really early HRs who are doing fine with theirs in 20 years.

My own opinion (and hope) is that I'll actually be able to take my metal HRs with me when I go and trip the metal detectors at the pearly gates.

[imgetinold]

Hey Ben.  Welcome.

I think that it totally makes sense that it aches less when you exercise.  Even though it was over three years ago, the ache you describe is similar to one I get.  It is usually when I am balancing on the leg of my operated hip.  When all those not-fully-recovered stabilizing muscles are called into action, I feel an "ache".  Granted, it goes away in a few seconds, but perhaps what you're describing are not-yet-fully-strong hip muscles.  I know that, for me, the clunking I experienced has been in direct proportion to the strength of the hip.  I had tons of clunking at 4 months, almost none now.

Like Hernan said, talk to your surgeon, but consider some quality PT. 

[Tin Soldier]

I don't have any discomfort in either hip, unless I over exercise, like playing an intense game of soccer.  I commute by bike everyday, it's only 3 miles in, but I think that helps keep the muscles strong and tight and probably keeps some of the more low grade dull achiness from coming in, as you have mentioned.  The discomfort I get from hard sprinting/cutting in soccer is soft-tissue and goes away the by next morning.

ROM is certainly decreased from when I was 30 years old or younger, but its much better than it was just before surgery and I think it's still continuing to improve.  I know that there is a mechanical ROM extent with the device, but I don't think I'm there yet.  I think the hip capsule could still be stretched further and provide more ROM, but that would take daily consistent stretching for several months to get much noticeable change.

I'm with the others on the topic of longevity.  I expect to take these babies to the crematoreum and be given them back to my wife for high-end scrap, or use in someone elses hips.     

[luann again]

Hi Ben, my experience is almost identical to Hernanu's. It is not usually something I would describe as pain, but if I really pay attention and think about my resurfaced hip, I can tell the implant is there. I am two years + out. I think most of the time when I'm not noticing it, it it because I have gotten used to this feeling, and my brain just blocks it out.
Just recently I had ankle surgery and literally sat on my bottom for a week recovering. By day 4 of no or very little walking, movement, or exercise, my hip was fairly "achey". I still had to sit, so I squirmed around a few more days trying to get relief. I am happy to say now I am up and moving and the hip is completely fine again. This goes along with Hernanu's comments, too.
I didg get a great ROM after HR, but your anatomy/arthritic complications may have limited yours.
Overall, I simply adore my new hip. I figured it may have literally saved my life and sanity.
Congrats on your 3+ years. Hope these comments ease your mind, and may your good hip moments outnumber any "not so good".  Lu

[benf]

Well thank you very much for all the great feedback.  I wish I had found this forum before my operation.   I really appreciate it.  I don't know if the dull ache that I am feeling is "normal" or not.  It has really always been there since the operation but it seems less when I am stretching and exercising (but this could be because I just feel better overall).  I can run on it but have never tried intensive running because if the soreness.   Maybe if I did get running on a regular basis it would feel much better???  One thing that I do do to test my hip is jump on one leg and on impact there is a sharp pain but as I continue to jump it goes away??? After reading the comments on the importance of the skill of the surgeon it makes me beg the question as to what was the quality of the surgery that I received?  Would it be beneficial to send my x-rays to a number of recommended surgeons for there opinion?  I have had these done recently and have today ordered blood and urine tests for chromium and cobalt.   If so do you have surgeons that you know and recommend who do give opinions on x-rays etc for a second opinion?  Or is the just paranoia?  At 46 I want to live an active and pain-free life but at the same time am pretty frightened of potentially receiving less than good news.  Again, thanks heaps.

[Woodstock Hippy]

Hi Ben,  I'm only 10 months out from Bilaterals so I'm Not an expert but I thInk that you just need to work tHat hip more.  I think that the clunking comes from the muscles not being developed enough and you need to build them Back up.  Get to the gym three times a week, swim three times a week, cycle, walk or run again, three times a week and I'll bet all you issues will go away.

I have a friend at the pool who has a steel on steel THR that is over twenty years old and going strong.  He says that if he doesn't swim every day, his hip would be killing him.  We will all find out, but I see no reason not to think that most of us will get the same twenty years or better that he is getting if we take care of our new hips and exercise them regularly.

[Tin Soldier]

I don't think its paranoia.  I think the fact that you have a dull ache commonly, and you also have a sharp pain when starting up activity (jumping), does beg the question of the device, it's placement, and hate to say it, but the potential for metallosis.  Your metals analysis will be pretty telling.  I'd recommend waiting for the results and then send the results along with your most recent images to a few of the surgeons that you hear about here on the forum that review images for free.  I think a lot of the well-known HR surgeons will do that, although, Gross is who folks here usually mention for this type of service.  I think Bose (India) does it, possibly Su (New York).  Pritchett does it.  He called me after I sent my images to him.   You might just find the closest well-known HR surgeon and call their office and see.  Take a look at the list of surgeons that Pat has here on the website. 

Also, you should discuss your concerns with the original surgeon and see what they say.

I'd like to think you just need to get the muscles going a little more around the hip and that your metals results come back below the screening values.  Keep in mind that revision rates are pretty darn low, even with less experienced surgeons.  I'm genaralizing but I'd say the range is usually 4% or less and thats for 10 to 15 year populations (basing this on McMinn's data set, some of the national regeistries, and common quotes that we see here on the forum).  In short, don't let the paranoia get to you, just get a little more info. 

Good Luck.   

[benf]

Thanks again for those great comments. I will certainly take all comments on board.  I have been neglecting my hip and body by not exercising enough and probably carrying 5kg too much weight.  It's amazing, I went for a swim yesterday, stretched the hip and played a bit of soccer and I reckon that it feels 75% better.

[Pat Walter]

Thanks for your update.  It is great when people take time to tell their stories. I am sure you will have many more years with your BHR.

I moved your story to the Hip Stories section.

Good Luck.

Pat