Pre-op conditioning

[Rn2md]

 Hey,

41yo male with left hip OA, CAM impingement, and mild Dysplasia scheduled for left hip resurfacing by Dr. Gross on 3/20.
Glad I found by all accounts what appears to be a superb surgeon. But still not too enthusiastic about having to do a major surgery in general. Trying to put myself in the best possible position for an optimal result.

I’ve seen some posts from people who felt that putting themselves in the best possible physical condition prior to surgery gave them an advantage for rehab and full recovery. I would think that specific exercises to develop the abductors, psoas, and internal/external rotators may also potentially be advantageous.  I suppose maybe we could term it as, “Pre-habilitation”? 

Anyway, I was curious to see if there was a consensus as to whether specific hip strengthening exercises help? Or could it potentially make the surgery more technically difficult, having to deal with hypertrophied periarticular musculature.

[John C]

I strongly believe that it makes a big difference to be in great overall condition, but also specifically around the hip area.
Here is my own experience: With my first hip 10 years ago, I was on crutches due to a failed stem cell injection for over six weeks prior to surgery. Though I am usually in very good shape, I entered that surgery way below my norm, especially since that leg had very little weight bearing for six weeks prior to surgery. With my second hip 8 months ago, I was in very good condition, and skied hard eight hours a day, every day, right up to the week before surgery, even though I could barely walk after skiing. I think that high level skiing is one of the best exercises there is for strengthening and toning all of the hip muscles, since there is a lot of powerful lateral moves, as well as a lot of internal and external rotating moves. The difference in the recovery was dramatic, with the second recovery going much faster and easier than the first, even though I was 67 the second time. By the way, both surgeries were with Dr Gross, so you are in excellent hands.

[Rn2md]

Thanks a lot. That’s really helpful. Although I don’t ski, I have incorporated a few hip focused exercises to my regular gym routine with the affected hip only, including side leg raises, mule kicks, and leg lifts with ankle weights, abduction/adduction machines, internal/external rotation, and body weight squats. Not necessarily all in one workout, but spread out between different days after the regular workouts. I still limp for a couple of days after any of those, but I hope that this version of hip pre-conditioning also pays dividends later.
I think Dr. Gross didn’t necessarily encourage the idea when I spoke with him, but didn’t recommend against it either.
I’m with you though. I can’t imagine it could hurt, and may very well help.

[John C]

I think another thing worth striving for is increasing the bone density in the hip area through loading it. Doing a Dexa scan for bone density is a big part of Dr Gross's pre-op testing right before surgery, and the results determine the speed of the rehab protocol he will put you on. On my first hip, after six weeks of very little weight bearing while hobbling around on crutches, my bone density just barely made the cut for the fast protocol. For my second surgery, my bone density was above the range for my 67 year old age group, and at the top of the range for a 25 year old which seemed to delight Dr Gross. Bone density increases in response to load, so I believe anything you can do to increase the load on the leg and hip bones will pay dividends in the recovery, both short term and long term. A lot of exercises that focus on muscles do not necessarily load the bones, especially if machines are used which isolate the muscles.

[Rn2md]

All great points.
It’s a good reminder to keep up as much weight bearing activity as possible right up until the surgery. Bone density is proven critical factor in preventing fractures after this procedure.
Admittedly, I’ve been doing progressively less intense leg workouts over the past couple years due to the discomfort that weight bearing activities cause, particularly traditional back squats and then over the past 9 months, 45 degree leg presses have been irritating too. Those have been the cornerstone of leg day in the past. So now I’m left with straight leg presses (where you sit upright), lunges, and bodyweight squats and leg extensions/curls.
I always used deadlifts as the cornerstone for my back workout, but anything beyond a light weight on those bothers the hip now too.
When I consulted with a local ortho on my path to eventually finding Dr. Gross, I was told that the bone density (as seen on a plain radiograph) on the affected side appeared to be slightly less than on the unaffected side. Given this natural history of gradual worsening of bone density on the affected side, I can imagine that the post op fracture risk might also increase, the longer I wait to have the surgery.
I wonder if one legged leg presses focused on the left would help boost the bone density, since the right has been compensating. I guess I could also just tough it out on the other exercises too, but the pain is a powerful deterrent to doing those.

[John C]

Both before and after surgery, I am a huge fan of all things one legged; one legged squats, step ups, eventually one legged hops to a squat, and one legged bosu ball work. After surgery, it is important to follow Dr Gross's protocol and build up gradually to some of these things, especially when adding weights to one legged squats.
It sounds like you are approaching this very wisely.

[Philbrd]

I just had bilateral with Dr. Gross and will add some.  I did a lot of preconditioning as best I could with pain and I think it will pay dividends.  I am just 5 day past second hip and feeling quite mobile.  One thing I could have probably better prep'ed was "training" for transitioning from seating to standing.  I am finding that this is the most difficult part and end up using something solid (arm of chair, end table, crutch) with one arm and then leg strength.  its pretty much like one legg'ed squat with tricep lift.  I would have done more prep of tricep dip stuff.  When you put your hands behind you on a bench and dip.  I am using that muscle a lot! 
Dr. Gross and staff are fantastic.
Dan

[Rn2md]

Thanks for the info.
That’s helpful.

I also plan to use Gross and am scheduled for March.

Incidentally, I’ve been putting a premium on one legged exercises of various types within my regular gym workouts.
My involved side is weaker, particularly with hip extension exercises like leg presses and formerly with weighted squats. I cannot really do squats anymore with weight due to pain and discomfort it causes.

I generally also do weighted dips, so I guess I’ll be good there. I could try bench dips too, to help more with the getting up from a chair.

Thanks again

[Joe_CA]

Rn2md,

I also encourage you to do keep fit in all of your muscle groups, especially those which will be impacted (glutes, psoas, hip flexors,...) as well as weight-bearing work in the gym for bone density as John C points out. As I have recommended here numerous times, pre-surgery squats and lunges can be yoru friend. I was a bilateral patient of  Dr Gross and my anecdotal (as well as a few others in this forum) experience *might* point to a better recovery.

I stayed active in the gym and sports right up to a few days before my surgeries. I recall having seen my bone-density numbers and they were through the roof. Perhaps this was partially due to hereditary factors, I don't know... I was walking unassisted 10-11 days post surgery, and had no real issues in my recovery (and still don't). So do what you can in the next two months. It should pay off in dividends. Good Luck!

[Rn2md]

Thanks for the feedback

I do occasionally do lunges with and without weights and have down both forward and reverse lunges. Just not every time.

Do you you find that forward lunges or reverse lunges are equally helpful or is one better than the other?

I do body weight squats for high reps but have generally avoided weighted squats.

I do them occasionally on the smith machine but pay for it in the subsequent days with increased limping and aching. I guess this is the home stretch now.  so I could try to do those after premedicating with Aleve or ibuprofen

[Joe_CA]

With respect to lunges, while both types are beneficial, I would give the nod to the front lunges. For me, while both types work the quadriceps muscles, the front lunges seem to utilize your glutes more. That is the muscle to focus on.

And in terms of squats, these really do hit the muscles that will be affected the most by your surgery. It was further confirmed to me post-surgery. I started to do light weighted squats about 4 months after surgery. It was the one exercise that really hit the muscle groups that were cut. I too was having trouble doing these before surgery. If you can't perform weighted squats now, then try and work them in after surgery. Dr. Gross will probably say wait until 6-months (I cheated a little bit).

Also, as others have recommended, getting all of your other muscle groups in shape will also help. I see some mentioned triceps via dips. These were very helpful in terms of having sufficient strength to get off a chair or out of bed.

You're going to a great surgeon. You're in good hands and should be very content with your decision. Feel free to ask as many questions to the group as you need. I know I certainly did.

[Rn2md]

Well, I did barbell squats with lighter weight for several sets last week and did one legged squats with the affected side this morning. It didn’t feel great on the hip during or after, but it was satisfying to know that at least I’m probably paving the way for a better outcome.
I’ve definitely been neglecting the hip extension exercises for a while. The hip pain it causes is such a strong deterrent. I’ve lost so much strength in the gluteus because of that. But I think I’ll have time enough to make some strides before surgery, with the help of some Aleve, muscle memory, motivation, and the pearls of wisdom from the support group.

So I’m definitely going to keep it up right up until the surgery, without going crazy or overdoing it of course

[Rn2md]

Increased weight on back Squats, then did leg extensions, leg curls, calf raises, then bodyweight lunges and reverse lunges on the affected hip.  💪
Predictably, the hip is definitely cussing me out right now.💩 But hopefully this helps buy me a few more pre-op bone density points and post op strength to get up and moving the sooner