So is running REALLY ok with an HR?

[todd4e]

I know that many Hippys on this site return to active running. I myself was an avid runner until my HR with Dr. Su five years ago. Since then, I haven't run a mile (although I do a lot of other non-impact exercise). My fear is that it will shorten the life span of the device. I'm especially worried about the effect all that impact will have on the bone cement in particular.

Truthfully, I miss running terribly. And if I got a definitive "all clear" from someone, based on specific evidence, I'd be out buying new running shoes tomorrow. But it still feels like the jury's out.

Can anyone shed any further light on the issue? What have your doctor's told you? What does the evidence say?

[Jon]

Todd:

How are you five years out?

With respect to the running question, I have been sniffing around this issue for the last several months.  We are definitely hearing from a handful of people who have jumped right back in and are meeting with good results.  We have also heard from some people way back who jumped back into long distance running and who were also reporting good results.

What I do not see much of yet is data/input from people who have been running a long time since their surgeries and who continue to report much at all, good or bad, quite frankly.  I would love to hear more.

My post-op result is great so far and I have started to run, with a fair degree of comfort.  I remain a little skeptical, however, that upping the mileage and doing so over a longer period will be that good for me.  I have a lot of years of marathoning on me and I landed on the operating table mostly because of it.  Right now I'm feeling really well and I don't have much interest in testing my luck.

Any/all input from others greatly valued...

Jon

[curt]

I'll let you know in 20 years?
Dr. Gross seems completely ok with the running or other impact after 6 months.  I tried to get right back into it at that time and had to back off due to weakness in some flexors/stabilizers.  Would get sloppy and lacked firm control of my gait.
18 months and happy doing 10K distance for now, with no hip anxiety or pain (other joints maybe but not the HR).  If it lasts another 20 years it was worth it.  I'm hoping it lasts forever with or without the running.
As for the decision to keep running, well, its part of why I went with the HR in the first place in lieu of the total hip.

Curt

[Dannywayoflife]

McMinn and Treacy have patients at 16+ years who have run long distance with zero signs of any problems. I think you worry needlessly about the cement issue mate. The cement technique used in the bhr is unique to the bhr no other device uses the same method. Having seen sectioned components they really are going nowhere. Also the bhr has the longest track record of any device so if anything the cement less devices are the ones unproven. I have yet to run again (well I've run after people) properly but I'm back boxing and doing judo and I'm not really concerned about the device. Treacy told me that he's had guys back in his clinic for 16 year check ups who have done in his words UNBELIEVABKE things and they are still fine.

Danny

[chuckm]

You should really get in contact with Dr. Su. The Birmingham hip resurfacing system was fairly new back then and there is so much more clinical evidence on the device now. I had my hip done at the same hospital (Hospital for Special Surgery) in 2012 and have the "all clear" to do whatever I want including impact sports. It seems reasonable to me that running could shorten the life span of a resurfaced hip but running can shorten the life span of a native hip too.

Chuckm

[Dannywayoflife]

If in doubt watch the interviews Vicky Marlow did with Mr McMinn he address this very question.

[John C]

Most HR surgeons support their patients going back to running, and this is one reason that I chose and continue to support HR. However, I can only remember reading two formal studies or presentations addressing running. One was done in Europe a few years ago (Sweden I think), and showed little ill effects. More recently at the February 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons, Dr Amstutz who is one of the godfathers of resurfacing presented a study which specifically correlated impact scores with an increased risk of revision, and suggested that surgeons caution their patients against excessive impact activities. For those that are interested in reading the study, here is a link. It is listed as "Paper No. 216" on page 529.
http://www.aaos.org/Education/anmeet/education/AdultHip_Abstracts.pdf

Though one of the reports on this study (you can find this report here on Pat's site in the "What's new" section in 2012) lists running and tennis as potential problems, I continue to play tennis every day during the summer and ski every day during the winter. As always, we each need to make our own priorities and decisions. Dr Amstutz felt that his study should be considered in making these decisions, so I pass it along.

[hippy hippy shake]

I am scheduled for bilateral with Dr. Su in mid-April.  I asked Dr. Su's PA about running.  He said that they have people that run marathons and such, but they really don't recommend it, because of the amount of impact - especially training for it.  He seemed okay with doing a couple of 5K's though.   

I should say, that personally, I wouldn't expect any of the doctors to actually say that it is okay to run marathons on a implant.  Too many lawsuits around these days to go that far. That being said, we know that many marathons have been run on HRs.  Heck, there are lots of marathons being run on THRs too.  (Yes, most of us here cringe when we think of running on a THR.) 

Let me also clarify  that I am 6'5" and 230 lbs, so it's not like I've been running regularly up to this point (high school and college cross country was a long time and many pounds ago.)  The first orthopedic surgeon I saw told me to forget about running with the torn meniscus in my knee as well.   

So, it seems like it depends a lot on the individual circumstances.  Your size, general condition, and how much of a blessing you're looking for from your doctor.  First thing to do is ask him.

Todd, I hope I'm in a similar predicament in a little over a year from now.   

[Jon]

This is some good stuff.

John, thanks for the link and the additional info.

I hope we hear from others on this...

Of course, what is clear is that at the end of the day this becomes a very personal decision -- as it should be...

Jon

[Arrojo]

The ONLY reason I got a resurfacing was to run.  Running is, and has been, a huge part of my life since I was 1 year old.  Dr. Su says I can run on it and that is good enough for me.  I will run and run until I die or wear out the device, whichever comes first. 

That said, I am (or will be once the snow melts) more into trail running than ever before.  And I will avoid running on concrete (sidewalks mostly).  But the roads beckon....

[hernanu]

My opinion (and a non-medical one at that) is that after having waited the proper amount of time recommended by your surgeon, HR gives you a very good opportunity to go back to your activities.

Bone mineral density is the measure used to evaluate bone density. There is a theory proposed by German surgeon Julius Wolff (1836-1902), which is well accepted. It says that bone density is increased by the proper amount of pressure being applied to the bone.

If pressure is applied over time, the bone will grow denser and stronger. If loading decreases, then the bone will become less dense.

Tennis players, for example are apt to have much more dense bone in their racket arm versus their non racket arm. It also explains the loss of bone density by astronauts if they are in space for an extended amount of time.

So this is an accepted theory, that the more controlled impact is bound to improve your bone density. Martial artists (hitting close to home) have much more dense bones in areas where high impact happens. 

I imagine (expanding this to runners) the same theory applies here, since you are dealing with repetitive pressure being applied to a limb. As long as it's controlled and gradual, my uneducated thinking is that it will make the bones denser.

The only thing that's up in the air to me would be the actual connection between the bone and the device. The connection is made when the bone anneals itself to the roughened and beaded surface of the device and grabs on. The real question is whether, after the connection is made and the bone has wrapped itself around the device protrusions, adding pressure to it makes the bone that is now holding on to the device stronger.

My hope is that it is and does, so that if you are applying non-catastrophic pressure, you are making that joining stronger.  It is a hope, but seems to follow Wolff's law.

From an article comparing bone density between HRs and THRs, and the effect of Wolff's Law:

"The mean BMD in the calcar region increased after one year to 105.2% of baseline levels in the resurfaced group compared with a significant decrease to 82.1% in the total hip replacement group (p < 0.001) by 12 months. For the resurfaced group, there was a decrease in bone density in all four regions of the femoral neck at three months which did not reach statistical significance and was followed by recovery to baseline levels after 12 months.

Hip resurfacing did indeed preserve BMD in the inferior femoral neck. In contrast, a decrease in the mean BMD in Gruen zone 7 followed uncemented distally fixed total hip replacement. Long term follow-up studies are necessary to see whether this benefit in preservation of BMD will be clinically relevant at future revision surgery. "

Reference:

http://www.bjj.boneandjoint.org.uk/content/92-B/11/1509.abstract

To me this shows that after HR, the bone density returned fully to baseline or better than baseline levels taken before the HR (105.2%). It also shows the dip in femoral neck density at three months which is recovered later, backing the advice given by surgeons to be careful for the first six to twelve months.

Again - not a medical person, but it's what I got from the article and to me shows why surgeons are Ok with running and other activities, so long as it's done with some restraint, at least initially.

[Tin Soldier]

Excellent thread and I really like John's and Hern's responses.  There are certainly a good number of hippies here that are running with HRs but have relatively "young" HRs less than 5 years.  I think one of the problems we might get with existing data (registry and different surgeon's centers) is that they probably are not capturing the amount of running or the types of activities folks are doing whith their HRs'.   So when we see failure rate of 2 to 4% in a dataset of 15 or so years, is the failure due to high abduction angle, excessive running, or some other factor?  The high angle has been shown in a number of studies, but running, or impact sports and how it relates to revisions?   The Amstutz study that Johns referenced, might be the only study that gets close to trying to answer this question.  This is why I think these data should try to be captured in registries or other large groups.

I run occasionally and I play soccer once a week, ski a little.  Generally I don't do a lot of running and I don't plan to, even though I like to run.   So maybe just being a bit moderate without worrying about it, is the best approach. 

[Jon]

Wow, what great info on this topic.

Hern, that's some answer! Thank you.

I remember McMinn telling me something about making sure to work the joint/bone post-op in order to promote strength and health. I intend to call his office in the next few days to follow up on this specific aspect and the general topic as well.

I agree with Tin's assessment on data too...

Jon

ps: Four smooth miles in Central Park tonight! Beautiful day and lovin' it!

[Dannywayoflife]

really good post there hern thanks for that I know that must of taken some time to reference!

I've said it before to me it's not possible to actually wear these things oh per se. The reason they may fail over time will be due to loosening(my opinion I'm no doc!) and the main factor in this I believe will be longterm bone quality. As hern has so brilliantly shown we need some impact for bone quality and density!

I for one will run again maybe not the 40 miles a week I once did but I'd rather spend that time in the ring or on the mats:-)

[stevel]

I have been running around the racquetball court, downhill skiing and packing elk out from mountainous terrain.  I had the resurfacing installed so I could do all of these activities without restrictions.  I have bumped into fellow skiers who have traditional hip, knee and shoulder replacements who shouldn't be aggressively skiing (skiing the black diamonds) as the device will wear out prematurely or they may fall and dislocate the device, but they do it anyway.  As Dr. Su says about my resurfacing "Enjoy it!" and I have been enjoying it for the past 4 1/2 years.

Meanwhile, I just had an x-ray and an MRI of my right shoulder to determine the cause of pain after playing racquetball for 4 or 5 games.  The x-ray was negative but I need to wait a couple weeks for an interpretation of the MRI as my local OS in on vacation.  He suspects a labral tear or maybe a rotator cuff tear.   

[luann again]

I was also told by Dr Sparling the running and tennis were not recommended after HR. Funny but I feel that running. ( going on three years post op) is still the one thing that feels awkward to me. Because of that, I don't really try it much. I have sprinted lightly from the barn to the house and back (probably about 400 yards ) and felt kind of weak in the HR leg still. I am super active and often quit aggressive with my activities, so this always surprises me. Hiking or walking give me no trouble. Maybe if I liked to run and worked up to it better I'd notice a difference. Or, maybe this is why the Drs don't often want their patients to partake in it. Anyway, do any other hippies only notice their limitations during attempts to run? I sometimes feel that my cadence is a little off, too, when I run, and that my HR leg cannot keep up and I might trip if I continued ( especially if I tried to run fast). Thanks, not really complaining, love my HR!!  Lu

[Tin Soldier]

I just recently noticed that after 2 and 1.5 years, I don't seem to notice any limitations in the hips when I play soccer or when I do a short run or short sprint.  I think it's just the body getting used to it.  If you never did much running then maybe it will seem more awkward.  I used to play a lot of soccer and run here and there, and ran quite a bit in high school long ago, so maybe it's just easier for the body to adjust if those muscles were already being used a lot.   Although the other day I stubbed my big toe in soccer and I think I either rebroke it, or majorly sprained it, so I've been limping again.  It will go away a in a couple weeks, but the other day I went for a short run and the whole leg up to the hip on the bum toe side, was cramping.  Odd huh.



 

[luann again]

Thanks Tin, interesting. Used to run and jog a bit in when I reduced for race riding. Other than that don't much care for it. Still feel like if I ran too long I might fall. Oh well. Long as I can ride!! 😊

[todd4e]

I'm the original poster. Many thanks for all the informative replies.

After reading about the Amstutz study, I'm starting to think that running isn't really the best idea, as much as I love (and miss) it.

Frankly, it figures from a common sense point of view. As sturdy as the BHR might be, and as effectively as it might be implanted, you'd think that repeated pounding would eventually lead to a shortened lifespan, with the weak points being the bone cement on the femoral side and, to a lesser extent, the press-fit on the acetabular side.

I guess the question is, how much is too much? Could you get away with, say, 10-15 miles a week with no reduction in device lifespan? It'd be nice to know.

[Dannywayoflife]

Only time will tell on this but I'm confident in my BHR. The stats from Birmingham @16 years show no sign of anything untoward even under incredible stress levels. I think there is a bit of a downer on cement with no real cause. McMinn Treacy etc have never had a femoral loosening with cement even at nearly 20 years. Don't forget the cement technique used with the bhr is unique to it. If you look at sectioned components then you will see just how securely placed they are. I personally think the key is waiting for FULL recovery and then a gradual return and listening to your body.