Seven week review and comments about fracture risk following arthritis.

[Granton]

I saw Mr McMinn yesterday at the seven week mark. I feel great, am walking fast and without a limp for up to three miles plus, could go further.

He gave me the go ahead for the next stage. Mainly stretches (goodbye 90 degree rule) and swimming.

He said I could ride my bike, "but don't fall off". He is concerned about fracture risk, rather than dislocation. I asked him more about this and found this interesting.

I asked him if it was more bone ingrowth we were waiting for, but he said that arthritis patients are at high risk of fractures because the pain has meant that we do not walk or run on it and the lack of impact means that the bone becomes weak. Further, he says that this bone strength takes a long time to get back.

For example, I am looking forward to playing tennis at the six month mark, but I am talking about social doubles. He said that if you were going to start "throwing yourself about the court", he would advocate waiting as long as eighteen months. It takes that long to get better.

To reiterate, this is not about breaking the join between prosthesis and bone, it's simply breaking your leg.

[obxpelican]

Dr. Gross wants his patients to wait 12 months before any impact exercise is attempted, I think 18 months is probably not a bad idea.

And while we've had several fools on this forum posting about running at the 6-12 month mark don't try it, listen to the doctors that know and proceed with caution, you want to be sure that you are going to take your device to the grave after a long life full of painless walking.


Chuck

[Dannywayoflife]

I think that being conservative will pay dividends in the long run! I personally waited 12 months before attempting any high impact stuff. Even at over 2 years I'm still easing in!

[chuckm]

Following hip resurfacing every patient loses bone density in the femoral neck to varying degrees for about three months. By three months time the body has reconfigured how to restore the blood supply and so the bone density begins to increase again and continues for years. Surgeons agree that the density of the femoral neck at six months has recovered to a safe level based on statistics that show femoral neck fractures are rare after the six month mark.
Some patients lose very little density but the point is you don't know if you are the one with the weaker neck or the stronger early on. So if you want to be sure your hip won't break if you happen to fall off your bike you should wait.
Chuckm

[Granton]

What Mr McMinn was talking about was nothing to do with the surgery or the prosthesis. He was saying that arthritis increases your risk of fracture.

The surgery reduces the risk because you start to walk more and rebuild bone strength, but it takes time.

[obxpelican]

Check with McMinn again, it's been a long held belief by doctors that the surgery causes a temporary period where the femoral neck is subject to fracture, especially when you pound on it while running or landing hard.

Some docs will tell you a year, some longer, personally I think it's best to be conservative as you only get one shot at keeping the device usually.


Chuck

[oldsoccerplayer]

Dr. Gross wants his patients to wait 12 months before any impact exercise is attempted, I think 18 months is probably not a bad idea.

obexpelican ... Dr. Gross told me I could get back to soccer after 6 months and it takes 12 for a complete recovery. I guess I'll pick up the phone and ask before I get out there.

[Granton]

Chuck,

I am not suggesting you can do what you want as soon as you get out of hospital. We know that doctors advice varies and clearly depends on individual patients situation. I just thought it interesting that the arthritis itself makes you more vulnerable to fracture.

Some more evidence:

http://www.ncbi.nlm.nih.gov/m/pubmed/21572148/

CONCLUSION: The increase in fracture risk confirms the importance of fracture prevention in patients with RA and OA.

[Mike D]

I think we all feel that we have something we need to protect to some degree, be it THR or HR.
With my THR, there are some things I do that make me think twice such as motorcycling or climbing ladders at work.
When I first got back on my bike, I'd find myself thinking-"what if I fall off and land on my hip?"
Likewise, on the ladders. I wondered if I should continue, but then realised that even with my natural hips, I'd be likely to do some heavy damage so I reckon it's about how important the risk is and that really is a personal decision.
I know with a THR that a fracture is probably more likely than with a HR should a heavy fall occur, but I accept that as I consider it a risk worth taking.
I'll be eternally grateful for the hip Mr Treacy gave me and I hope I'm never laid on his table asking him to fix it for me, but I want to carry on with life and not let my hip have too much say in how I live it.
I've altered my riding style to suit such as not going fast in wet roads etc and I double check every set of steps I climb but that's enough.
Our surgeons give us the very best advice regarding the protection of our joints but I think many of us bend the rules a bit- if you're ok with that, go for it and enjoy it!

[whyme]

My surgeon (De Smet), with ~4000 HRs done told me I could ease into running at 3 months. So there is a wide variance between surgeons.
I guess this really depends on a lot of factors: gender, weight, physical condition, age, device implanted, surgical approach ...

I personally decided to give it a minimum of 9 months before I even think of running.
Regarding cycling outdoors, at 2 months he told me I could start. Again, I won't do it until 6 months or so.

[bosoxgordon]

Dr. Gross wants his patients to wait 12 months before any impact exercise is attempted, I think 18 months is probably not a bad idea.

obexpelican ... Dr. Gross told me I could get back to soccer after 6 months and it takes 12 for a complete recovery. I guess I'll pick up the phone and ask before I get out there.

Yea, I always thought Dr. Gross had a 1 year limit on running and other higher impact stuff. I just had my surgery three weeks ago and Lee Webb and Dr. Gross were both clear that I could start running again at 6 months. "no restrictions after six months" However, the total healing process does take a year. I would imagine waiting longer is always better. I will have to clear this up when I see him at my six week check up.

[chuckm]

Getting back to the topic about Mr. McMinn's comments. He simply implied that patients with OA generally do not participate in impact activities and their bones will be less dense if the inactivity has been for a long period. So if you suddenly get a new hip it and want to do impact you have to wait for your bone density to return which can take time, otherwise you could risk fracture, especially the femur neck which is traumatized during hip resurfacing.

And so his other comment about "throwing yourself about the court". This is the same thing. If a patient had not been playing aggressive tennis for years, he really should wait longer to regain the bone density needed to avoid fracture.

Chuckm

[Jason0411]

It is not just the femoral neck as I can testify. I crushed my femoral head by doing too much too soon. I agree entirely because I learnt the hard way. There was no break of the Neck of my femur but the Femoral component of my BHR shifted about a CM because I crushed the bone under it and continued to walk on it. Take it from me you don't want to do that. It took me a bloody long time and a lot of effort and discomfort to fix myself with the constant worry that my femoral head was likely just to collapse at any time and I would need a revision to THR.
If I had listned to McMinn and his team to start with it could have been avoided. So trust me when I say if McMinn and his team tell you what to do then you had better listen.
It took a lot of pain and fear to make me listen to McMinn but next time I will listen to everything he says. Thankfully he and his team made me behave and I think I am better but only time will tell.

[Staggerwing]

Jason,

What exactly do you believe you did that caused your femoral head problem?  What were you doing? 
Nathan

[Dannywayoflife]

Nathan from memory Jason had a kitchen accident.

[chuckm]

Granton, I followed the link you posted and read the article carefully. You just posted the conclusion but the result section tells a different story.
Below is the last line in the results. Apparently those with Osteoarthritis have no more risk of hip fracture than Non-arthritis patients. But, those with Rheumatoid arthritis have a large risk.
And for ANY fracture in the body the OA group is just barely more than non-arthritis which very well could be from less impact activity.

"The risk of sustaining a hip fracture was not statistically increased in the OA group (HR 1.11; 95% CI 0.98, 1.25; p = 0.122) compared to the nonarthritis group; however, the risk of hip fracture increased significantly (HR 3.03; 95% CI 2.03, 4.51; p < 0.001) in the RA group compared to the nonarthritis group."

Just want to make sure we are all accurate.

Chuckm