TKD/Recovery After Hip Resurfacing

[Justa Bill]

Hello everyone.

I am a 46 year-old martial artist who was just informed by his Ortho that his hip joint is "Shot". My Doc told me that I have three two options available to me. The first is Cortizone injections and NSAIDS. The second is THR. And the third is Hip Resurfacing.
Because I am in very good shape (runner, Martial Artist, 6' tall, 185lbs) and due to my age, he HIGHLY recommends Resurfacing. He trained under some doc at the Cleveland Clinic under a surgeon who has performed more than 3500 of these procedures. But my Ortho (here in the Baltimore area), will not be performing the surgery, himself as he says he personally doesn't have the experience.
Now, for some history about me. I had FAI correction under Dr. Marc Hungerford 11 years ago. At the time, he said I would eventually need a new hip. But he said it would probably be in about 20-25 years. Unfortunately, reality is a little different. 

So my questions are these... Since I practice a kicking art (Taekwon-Do), I'm afraid of my new joint not being up to the task of kicking and stretching as I am accustomed. And since I am also a runner who is used to 5-13 mile runs, will the joint be able to handle that? And what kind of recovery time am I looking at before I'm kicking again?  With these factors in mind, will the joint hold up or would I wear it out quickly? Are there any other marital artists/runners out there with a similar situation?

Thank you for reading this rambling mess. As you may be able to tell, I'm very stressed over the situation. And any guidance would be appreciated.

[Rn2md]

Hey,
I’m post op day 4 from a resurfacing by Dr. Gross in South Carolina, who I would highly recommend by the way. I am a former martial artist, forced to early retirement by hip OA and FAI.
Although I am far out from the 6 month point where I could consider martial arts again, I’m glad that I took the big step up to doing the surgery. At least now I know I have an excellent shot at resuming that type of activity again, as well as running, obstacle racing and heavy lifting. But all in good time. If I didn’t take the step, then I know the chance would be zero and I would probably have to abandon those activities for good.
I’ve learned from reading the posts on this site and from my surgeon, that recovering and eventually getting back to ones favored activity can often be a game of persistence and patience, with progressive gains occurring even after the 6 month mark. I’m sure being a martial artist, that part would not be an issue for you whatsoever.

I think most on this site would probably agree that you could do martial arts, or basically anything else you want after fully recovering from a hip resurfacing done by an experienced surgeon.

There are several advertised and repeatedly mentioned on this site. So I think you would want to consult whichever one is most accessible to you and determine your candidacy for the procedure.

Being in Maryland, surgeons that are relatively closer to you may include Dr. Gross in South Carolina who pioneered a unique cementless resurfacing implant, Dr. Su at HSS in NYC, and Dr. Brooks at Cleveland Clinic. But there are a few others around the country, as well as overseas, including Dr. Mcminn in Birmingham, England, who pioneered the modern BHR implant.
So there are plenty of options. It just depends on who you like and where you want to go.

I’m sure others will also chime in.

Good luck with your decision.

[Justa Bill]

Thank you for your input. 
Unfortunately, travelling isn't really an option for me as I suffer from Travel-related anxiety. However, there is a surgeon here in the area (Dr. Jacobs) who is affiliated with Johns Hopkins and has performed more than 500 of these procedures and the reviews I've read have been all positive.  I will be contacting him for more info.
So you are 4 days post-op? How is the pain? How well are you able to get around? I remember when I had FAI correction, I was non weight-bearing for 6 weeks. Is it anything like that?

Regards,
Bill.

[Rn2md]

Cool. I’ve heard people say that it takes at least 200-300 to be proficient at the procedure, and skill continues to improve beyond that. Given that this is a complex procedure, it is wise to seek out the most experienced surgeon that you have access to. Most agree that the surgeons skill and experience are paramount in the result. At the end of the day, this is a procedure that will affect the rest of your life, and you just have to be very comfortable with your chosen surgeon.

My surgeon uses bone density to determine post op weight bearing, and mine was excellent. So I’m full weight bearing as tolerated.
I get around well with crutches, which im keeping up mainly to be ultra conservative with the fresh hip. But I’m cleared to transition to a cane and then unassisted walking as early as the end of the second week.
The pain is zero, with minimal pain upon too much flexion or pressure on the incision
The main challenge is the getting up and the letting oneself down, which is also getting a lot easier at this point.
I started from as high a fitness and strength level as possible prior to surgery, thanks to helpful advice of some on this site, which I think definitely is yielding dividends on the early recovery process.

[John C]

Hi Justa Bill. Glad to see that you are doing your research, an important first step in this process. In answer to your first questions about TKD and running, you will find a wealth of information on this site by scrolling down to those categories in the forum. In Martial Arts alone, there are almost 500 posts. The reason I suggest this approach, is that most of the people who made those posts are no longer on the forum because their new hips have allowed them to move on with their lives. Rather than asking the few who are more recent patients and therefore still active on the forum, go to that section and you will get testimonials to your hearts content. The same would be true with running, which also has its own section. Reading these forum posts covering many people over many years, you will hopefully get a balanced view of the successes, as well as the challenges along the way.
Happy researching.

[Justa Bill]

Thank you, John C.

[Saf57]

I would also recommend Dr. Marwin at NYU in NYC, in the event that Jacobs is no longer doing resurfacings.

[Justa Bill]

Thank you.

[Justa Bill]

Starting to get frustrated. Had a cortizone injection 3 days ago and relief has only been moderate. And I'm having a lot of trouble getting call-backs from doctors and their staff when I call for information.  Baltimore has some of the best doctors and hospitals in the world. Yet few of them do hip resurfacing.

[Rn2md]

Sorry that the injection didn’t help much.
I understand your frustration as I was in that position not long ago.
Did you return to kicking right away?
Mine seemed to last about 2 weeks-2months, but the duration of the effect was dependent on me remaining more sedentary than I would want to be.
As soon as I returned to kicking or running the effects would diminish quickly.

You may need to take it easier until you can find a surgeon.

Premature OA in a younger person is often predisposed by a mechanical problem such as FAI and/or acetabular dysplasia, which often needs a mechanical solution like surgery to definitively address the underlying problem.

Have you consulted a surgeon specializing in Hip resurfacing yet?

Dr Mont used to be in Baltimore, but now appears to be in New York. He does resurfacing in high volumes as do other surgeons mentioned on this site.

As you’re discovering, this is a highly specialized procedure. So not many regular orthopedic surgeons offer resurfacing or even mention it as an option to patients. It’s unfortunate, because many have had excellent results from a resurfacing.

I read the commentaries of many of those surgeons opposed to resurfacing as part of my own research. Just so you understand why it’s so difficult to find a resurfacing specialist, Here’s what I found out:
Most orthopedic surgeons in the community feel that total hip replacement generally has excellent results in most everyone with a much longer history. There have been some poor results/outcomes with resurfacing when performed incorrectly or with bad implants, with premature wear and resulting issues of metal ion elevations. Many surgeons are still hung up on those issues, and either ignore or are unaware of the advances in resurfacing.  Resurfacing is also more technically demanding and onerous to learn, easier to mess up, doesn’t generally pay more than a hip replacement, and also includes the additional follow up/management/questions related to metal ion levels, requiring even more time investment  for most surgeons. So since they feel the benefit doesn’t outweigh the risk, they don’t see the point of taking it all on.

So many patients end up not even hearing about resurfacing at all, unless they independently look into their options as you’re doing. Because orthopedic surgeons may not feel it is an option worth discussing for the above reasons. The ethics of not routinely mentioning every viable option to patients is probably questionable in my mind, but that’s a separate issue.

Reading their stories, I think many on this site saw one or more orthos who initially told them a THR was their only surgical option.

Since the relatively few specialist surgeons are spread around the country and globe, many also ended up having to travel to their chosen surgeons, myself included.

If you decide surgery is what you want to do, consulting with one of the specific high volume resurfacing specialists would be wise.

[Saf57]

I know that you mentioned that you had an aversion to travel, but it is critical with resurfacing to have it performed by a surgeon that not only believes in the surgery, but has a specialty in it. You are within a 3 hour or so drive to NYC, where you have doctors Su and Marwin, two of the best in the world.

[Mikek]

I'm about 10 years out from a left BHR, and not quite 5 months out on a right.  I'm not a martial artist, but a climber; I like steep, feet over the head style climbing quite a bit.  ROM in the hips would be similar to what you do.  A year after surgery I never thought about the left hip, and in fact my ROM was better than it had ever been on that side (I can usually do splits left foot forward, and kick above my head).  I was climbing within 3 months, and really felt normal within 6, with occasional new angles I got into while climbing stinging the first time but fine thereafter.  I've been able to play basketball with abandon (albeit not well) and boulder, taking 8 to 10 foot drops onto a mat repeatedly.  My limitations over the past few years had been all about the deteriorating right hip.
The recovery on the right is going better - climbing in 2 months, some light running in 3, flexibility is close to normal (although that last little bit is a bitch), I'm at normal in the weight room except for deadlift, and I just started dabbling with bouldering - a five to six foot drop is about all I wanna take at this point.  External rotators are still quite weak, and that'll be my new PT focus.  If I were into martial arts,  I could kick air right now at a near normal ROM, but kicking a bag hard would hurt.
I feel lucky that there is an excellent BHR surgeon near me, Joshua Hickman, and that his recovery protocol has allowed me to cautiously but constantly work on ROM and strength.   I had ROM restrictions 10 years ago, but not for this one.
So I am a very satisfied BHR customer.  Sounds like you're due. 

[Justa Bill]

Sorry that the injection didn’t help much.
I understand your frustration as I was in that position not long ago.
Did you return to kicking right away?
Mine seemed to last about 2 weeks-2months, but the duration of the effect was dependent on me remaining more sedentary than I would want to be.
As soon as I returned to kicking or running the effects would diminish quickly.

You may need to take it easier until you can find a surgeon.

Premature OA in a younger person is often predisposed by a mechanical problem such as FAI and/or acetabular dysplasia, which often needs a mechanical solution like surgery to definitively address the underlying problem.

Have you consulted a surgeon specializing in Hip resurfacing yet?

Dr Mont used to be in Baltimore, but now appears to be in New York. He does resurfacing in high volumes as do other surgeons mentioned on this site.

As you’re discovering, this is a highly specialized procedure. So not many regular orthopedic surgeons offer resurfacing or even mention it as an option to patients. It’s unfortunate, because many have had excellent results from a resurfacing.

I read the commentaries of many of those surgeons opposed to resurfacing as part of my own research. Just so you understand why it’s so difficult to find a resurfacing specialist, Here’s what I found out:
Most orthopedic surgeons in the community feel that total hip replacement generally has excellent results in most everyone with a much longer history. There have been some poor results/outcomes with resurfacing when performed incorrectly or with bad implants, with premature wear and resulting issues of metal ion elevations. Many surgeons are still hung up on those issues, and either ignore or are unaware of the advances in resurfacing.  Resurfacing is also more technically demanding and onerous to learn, easier to mess up, doesn’t generally pay more than a hip replacement, and also includes the additional follow up/management/questions related to metal ion levels, requiring even more time investment  for most surgeons. So since they feel the benefit doesn’t outweigh the risk, they don’t see the point of taking it all on.

So many patients end up not even hearing about resurfacing at all, unless they independently look into their options as you’re doing. Because orthopedic surgeons may not feel it is an option worth discussing for the above reasons. The ethics of not routinely mentioning every viable option to patients is probably questionable in my mind, but that’s a separate issue.

Reading their stories, I think many on this site saw one or more orthos who initially told them a THR was their only surgical option.

Since the relatively few specialist surgeons are spread around the country and globe, many also ended up having to travel to their chosen surgeons, myself included.

If you decide surgery is what you want to do, consulting with one of the specific high volume resurfacing specialists would be wise.

I haven't returned to any activity other than walking...when necessary and pedalling on the recumbent bike for 30 minutes a couple times a week..
The strange thing is, the pain is different every day. Sometimes it's lateral to the hip, sometimes it's in the groin.. Other times it's in front of the hip..
 I will HAVE to have surgery. I CANNOT live like this.

Edit: I spoke to Dr Jacobs' assistant on Friday and she said that he doesn't do "many" of them anymore but he looked at my MRI and is willing to take me on as a patient. I have an appointment to see him on April 12.
I'm waiting for a callback from another doctor today and have a line on another about 45 minutes to an hour from here (Arlington Va).

[Justa Bill]

I'm about 10 years out from a left BHR, and not quite 5 months out on a right.  I'm not a martial artist, but a climber; I like steep, feet over the head style climbing quite a bit.  ROM in the hips would be similar to what you do.  A year after surgery I never thought about the left hip, and in fact my ROM was better than it had ever been on that side (I can usually do splits left foot forward, and kick above my head).  I was climbing within 3 months, and really felt normal within 6, with occasional new angles I got into while climbing stinging the first time but fine thereafter.  I've been able to play basketball with abandon (albeit not well) and boulder, taking 8 to 10 foot drops onto a mat repeatedly.  My limitations over the past few years had been all about the deteriorating right hip.
The recovery on the right is going better - climbing in 2 months, some light running in 3, flexibility is close to normal (although that last little bit is a bitch), I'm at normal in the weight room except for deadlift, and I just started dabbling with bouldering - a five to six foot drop is about all I wanna take at this point.  External rotators are still quite weak, and that'll be my new PT focus.  If I were into martial arts,  I could kick air right now at a near normal ROM, but kicking a bag hard would hurt.
I feel lucky that there is an excellent BHR surgeon near me, Joshua Hickman, and that his recovery protocol has allowed me to cautiously but constantly work on ROM and strength.   I had ROM restrictions 10 years ago, but not for this one.
So I am a very satisfied BHR customer.  Sounds like you're due.

Thank you.. Your post gives me hope...

[Rn2md]

My symptoms were mostly at the anterior and lateral sides. Since my job can be sedentary at times, the symptoms had an intermittent course, and did not bother me constantly. But the minute I needed to stand or walk for significant periods, do any kind of weight bearing or running, or especially if I tried to stretch with my legs spread apart, my symptoms would return and linger for days. Sometimes there would be a limp too. Martial arts activities brought on the worst of the symptoms and a session of stretching/hard kicking would cause days of aching and limping.

It sounds you’re more resolute about the decision for surgery than I was, which is probably a good thing. Right up until the end, the intermittent nature of my symptoms made me constantly wonder about the best timing of when surgery should happen. Retrospectively, that probably made the process more stressful than it needed to be.
The actual experience of going through the surgery was easier than I thought it would be. You can read my evolving story under the Dr. Gross section if interested.
Now that it is behind me, I’m glad I got it out of the way.
Even in the unlikely event that I won’t be able to return to some or all the activities I’ve given up, at least I can look forward to no pain with other activities or at work.

Hope you soon find an experienced surgeon that you’re comfortable with.
Good luck

[jimbone]

Bill-
Considering the investment you're making in your health, future and well being it would be worth your time to research the top surgeons for this procedure as has been stated by others.  It is the single most critical decision going forward.  A rule of thumb some people pay attention to is a minimum of 500 previous successful surgeries for consideration and a continuing practice of improvements and dedication to HR demonstrating a commitment to its viability.  I would be very reticent to consider a surgeon that does not meet those basic qualifications at least and would only rely on someone with an onging high volume practice of HR.  As difficult as it might be to confront an aversion to travel, you have some extremely well qualified surgical options that have a longstanding proven track record and would be well served by consulting with them.

[Justa Bill]

Bill-
Considering the investment you're making in your health, future and well being it would be worth your time to research the top surgeons for this procedure as has been stated by others.  It is the single most critical decision going forward.  A rule of thumb some people pay attention to is a minimum of 500 previous successful surgeries for consideration and a continuing practice of improvements and dedication to HR demonstrating a commitment to its viability.  I would be very reticent to consider a surgeon that does not meet those basic qualifications at least and would only rely on someone with an onging high volume practice of HR.  As difficult as it might be to confront an aversion to travel, you have some extremely well qualified surgical options that have a longstanding proven track record and would be well served by consulting with them.

As I stated previously, Dr Jacobs has done more than 500 of these and I will be meeting with him in less than two weeks.  I'm waiting for callbacks from a couple others.
But here's the thing about travel.. My travel anxiety not withstanding, I CANNOT travel because nobody I know is willing to drive me 200-500 miles back and forth. Especially to or through NYC... And most especially for up to a 4 day stay.

[Justa Bill]

So it seems that there are two doctors in my area with similar levels of experience with BHR. Both say they have done 500+ procedures and I've made appointments to meet with them both.
SO how do I decide which one to go with? What should I use as my criteria?

[John C]

I feel that the best way, is to ask them for peer reviewed published results. These are hard success and failure statistics that have been published for everyone to see, including other surgeons who can read between the lines and understand the details. If you want to see what this might look like, go onto Dr Gross's site and look at his published results. If a surgeon has problems with infections, complications after surgery, or failures at various time frames, this is information you want to know as the basis for your decisions.
The problem for you might be that many surgeons do not go to the time and expense to collect or publish this critical data, which makes your job much harder., and in my opinion does not reflect well on the surgeon. You can always ask for verbal statistics which is better than nothing, but obviously not as good as published results. If a surgeon says that he does not know the specific data on his patients, that would be a huge red flag to me.
If the all important patient data is not available (bad), or inconclusive between the two, then I would ask detailed questions that give you insight into their surgical techniques and dedication, but asking these questions means that you have to do your homework to understand the answers. What sort of anesthetics do they use, what methods of soft tissue repair, what type of final closure and who does it? What acetabular angles do they shoot for, and what percentage are within a narrow range of that target?
All of the above require some fairly extensive research on your part, and the willingness to ask tough questions.
One thing that I would ignore is patient reviews on a surgeons web site. Any surgeon can cherry pick enough of those to paint a rosy picture, and any surgeon is bound to have a few unhappy customers. It is the total statistics that matter.
It sounds like you have been doing your homework so far. Keep at it, and best of luck with whoever you choose.

[jimbone]

Most of the top re-surfacing surgeons have websites that are meant to be as educational and informative for their patients.  It is to both the doctor and the patient's benefit for them to be making a truly informed decision.  Regardless of who you finally choose to do the surgery, you would be well served to visit the websites of these top doctors, locate interviews they've done available online, find and do some reading of any published studies they've been involved with and learn with who and where they studied.  Their CVs should be available from which you can make comparisons with other doctors to evaluate the depth of their experience.  I've found a lot of information that helped me form the questions I needed to ask.  Dr, Pritchett in Seattle has a comprehensive site as well as Doctors Gross, Su in NYC and McMinn in England.  Checking those out will give you a better idea of what your'e undertaking.  Most of these surgeons have done several thousand hip re-surfacing and continue to do a high volume practice in the procedure which keeps their skills sharp and up to date.