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Author Topic: Running and Biking Performance after Hip Resurface  (Read 970 times)

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bgoetke

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Running and Biking Performance after Hip Resurface
« on: May 09, 2019, 04:25:52 AM »
A little about me first...  I'm 58 years old and always lived an athletic lifestyle. I was an avid skier for about 30 years including ski instructing 3 days a week, GS ski racing, trips out West, etc.  I stopped skiing about 4 years ago.  I was also an avid runner, road biker and triathlete. I had to stop running and triathlons over 2.5 years ago.  My 5k time then was sub-23:00. My cycling FTP around 240W. I would regularly do very hilly (over 10k ft of climbing)  100+ mile rides.  While I can still bike, I am limited to a distance of no more than 40 miles. 

I have experience significant physical changes in the last 2.5 yrs.   My hip ROM (both sides) had become severely limited. I can barely swing my leg over the bike seat. I can no longer pull up hard on the pedals seated or out of the saddle.  My FTP has dropped about 10% in the last 2 years.  For the last 5 years or so my knees have been floating out.  I now walk like a cowboy. My knees flair out while riding the bike.  I can no longer squat down and can not tie my shoes the way most people do. 

I was diagnosed with some hip dysplasia about 4.5 years ago.  The wearing away of the cartilage has been progressive.  My femur is about 49mm... so the BHR device at 50mm is a 50/50 proposition.  I have put together an info packet to send to Dr Gross.  I seem to be limited to the Biomet with Dr Gross or perhaps Dr Pritchett device with cross-link poly lining.

I'm trying to figure out when to do this.  Its a matter of when.  I'm looking for feedback from people who ran, biked and perhaps skied at a reasonably high level.   I'm trying to set the proper expectations for what I should be able to do after the bi-lateral resurfacings.
--Were you able to match your pre-OA performance (adjusting for age of course)?   
      If yes, how long did it take to get there?
      If not,  what were the obstacles? 

My hope is to regain my ROM to the point where I can bring my knees close to my chest while lying on the ground.  I currently can get to about 90degrees.  Is this a reasonable expectation?

Did anyone experience their knees floating to the side (bow legged) over time due groin pain and lack of ROM?  After the resurface was there any straightening of the leg over time? 

I understand there are no guarantee that my results will be identical to yours.  I'm trying to figure out what is the "average" result. 

Thanks in advance,

Brian

SW27

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Re: Running and Biking Performance after Hip Resurface
« Reply #1 on: May 09, 2019, 06:33:26 PM »
 Hi Brian
 I'm the big 50 , can relate to the biking end and some running that I have done. I'm only a little more then 2 months post op on the 2nd side(left) , 4 months on the first one(right). My legs wanted to go out like urs as well. Alawyas walked cowboy style for a long time! It just eased a little pain that way I guess and on the bike my right knee was always out in the wind. FTP was around 235 , ran a 22.5 5k , 1:54 half marathon. Played lots of hockey both in the net and out.

 After surgery I have been on the trainer but with very little ressitance and I haven't thrown a new battery in the power meter yet to see anything. Doing 1 hour at easy pace. Dying to get out and pedal! Not sure if I plan on running much in the future but definitely wanna get on the bike.
 
 My girlfriend tells me I walk way more normal now then before . I had lots of lower back pain which was an added bonus cause I would say 75% of that pain is gone! I contemplated for 3 years when to do this surgery( I own a concrete place finish company). I got stuck 35 miles out from the truck and had to sit on the side of the road for about an hour for the pain to ease off. I may have been 2 years late on the first side and about a year early on the 2nd one! I can add you will be in good hands with the Gross gang. My size was 50/56 , 50 cap.
« Last Edit: May 09, 2019, 06:35:17 PM by SW27 »
right side Bio-Met Gross 1/4/19
  left side Bio-Met Gross 3/4/19

grants

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Re: Running and Biking Performance after Hip Resurface
« Reply #2 on: May 09, 2019, 08:10:56 PM »
Hi bgoetke, this site seems to be full of middle aged recreational and age category sport competitors.  Me being one, and do all the things you noted, in about the intensity you noted as well.  I too was looking for a performance hip solution.  Thus resurfacing vs THR.  I choose Dr. Pritchett as I'm in Vancouver and he is in Seattle, so good proximity and he, along with Dr. Gross and Dr. Su seems to be the leaders in the field in NA.  I went with his Buechell Pappas system with cross poly insert.  That system has been around for a long time (30 plus years i believe) with the new difference that the plastic insert in now cross-poly.  Also seems to have the name Synovo Preserve.  I'm 8 months out from surgery and am riding 100+ km's and playing tennis/hockey etc.  So far so good! :).  Some strong athletic outcomes from Dr. Su and Dr. Gross within the site.  John C (I believe that's right) being one who is very active with bilateral through Dr. Gross and is heli skiing within a year of the operation.  He will likely pipe in and give you some confidence on that option.

Cheers,
Grant
LHRS - Dr. Pritchett Aug 2018, bearing surface - cross-poly insert on ceramic coated titanium un-cemented femoral  component.

John C

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Re: Running and Biking Performance after Hip Resurface
« Reply #3 on: May 10, 2019, 06:55:44 AM »
Thanks for the intro grant ;). JohnC here as predicted.
Hi bgoetke. I can share my experience as a skier. Like you, I am an instructor, teaching high level skiing 8 hours a day, seven days a week, for the past 49 years in Sun Valley. Also, like you, a racing background before I started teaching full time. Had my first hip resurfaced by Dr Gross 11 years ago, and the second one a year ago. Like you, my femoral size was right around 50, so I have a 48 on one side and a 50 on the other. As a skier, the results have been great. At 68, I do not hit the bumps as hard as I used to when I was competing, but powder, crud, and high speed carving on groomers are all going better than it has in many years. With both hips, I started skiing at exactly 6 months. In both cases I was able to go right back to skiing all conditions by the first day, and skied every day. I did have some soreness for the first two months on skis if I pushed it too hard for a day or two, but it always came right back after taking it easy for a day. With my first hip, I went on our annual heli-skiing trip up to Canada at 10 months, and with the second hip I went up at 8 months. No problem at 10 months, but at 8 months I had to take one day off after skiing too hard and jumping off too many drop-offs one day. I am not sure why, but my second hip recovered overall much faster than the first. The first one still had small residual issues out to about 18 months, and the second passed that same barrier in about 11 months. In the summer I surf, windsurf, and play tennis pretty much every day, and both hips feel great. We just returned to Maui for the summer, and I had the shocking experience of walking along the beach here this afternoon without any limp on either side, for the first time in at least 20 years; sure feels good.
As far as range of motion; I have not been flexible since my hips caused me to give up aggressive martial arts 30 years ago. My new hips have given me a pain free range of motion, but I would not say that I have anywhere close to the degree of range of motion I had when I was younger, but I think that is more due to overall age than the new hips. I can force my knee up to my chest if I am sitting on the edge of something, but it does not come close if I am laying flat on my back, probably just past 90.
Swinging my leg up over a bike or motorcycle was a real struggle. Now it is much easier, plus I no longer have hip pain during motorcycle or bike rides.
Both resurfacings cured the problem of the knees floating out to the side during flexion. When I rode a bike before resurfacing, my bad hips would flop out to the side with each peddle stroke; that is now completely fixed.
I cannot say that my resurfacings gave me the flexibility I had 30 years ago, but I can say that they allow me to do all of my sports essentially pain free for the first time since I was 40, and I am not aware of any compromise in performance caused by the hips (at 68, everything has a little compromise here and there).
As far as overall timing, I think that Dr Gross predicts it pretty well. Take it really easy for the first six weeks, start building back with the goal of returning gradually to sports at 6 months, unpredictable aches and pains for 10 to 18 months, and after that you forget that you have a resurfaced hip. Lots of room in there for personal variation, but Dr Gross's timeline is as close to average as a person can guess.
John/ Left uncemented Biomet/ Dr Gross/ 6-16-08
Right uncemented Biomet/Dr Gross/ 4/25/18

bgoetke

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Re: Running and Biking Performance after Hip Resurface
« Reply #4 on: May 11, 2019, 02:12:50 AM »
Hey SW27!

Thanks for responding.  I never thought I'd ever hear myself say "oh to be 50 again!"  sigh.

I'm wondering what factors went into your decision to do both hips 2 months apart.  I have seen some that have them done two days apart.  You mentioned you might be 1 year early on the 2nd. Did you decide to just get it all done in a fairly short period time?   

I live in upstate NY.  So, for me, Columbia, SC is quite a trek.  My right leg seems to be the one that will need to be done first. Like you, my right knee sticks out the most while on the bike.  Strangely thought, I still produce a bit more power with the right leg (4%) than the left.  As this condition has progressed over the last couple of years my ability to ride with a decent cadence (90+ rpm) has degraded.  I'm lucky if I can maintain 80rpm for 1-2 hours. 

Anyway, while the left isn't quite as bad, I still have limited ROM.  My thought is that it might be better to get both done together, or fairly close together,so I can rehab both hips more or less together.   Is that the way you and Dr Gross viewed your situation?

I know it's early - 4 months or so, while on the trainer can you see that your right knee appears to be over the pedal more now than before?    Have you adjusted your seat height up in order to not break the 90 degree rule?  Only two months on the left knee,  you're swinging your right leg over the seat? 

I know its a lot.. but when you get a chance, maybe add a detailed description of your hip resurfacing surgery to the Dr Gross section of this site.  I'd love to read about it.

Thanks again!

Brian


bgoetke

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Re: Running and Biking Performance after Hip Resurface
« Reply #5 on: May 11, 2019, 02:31:06 AM »
Hey Grant,

I was very interested in Dr Pritchett's Sinovo device with the cross-linked poly.  My only reservation about it was losing the extra 4mm of bone placing the cup.   The plus is the negation of the MOM concerns.  If he was as close to me as he was to you, I'd probably would go to him.

It's very encouraging to hear that you are doing 100km at 8 months. I'd be happy to be at 60km at 90% of current power at 8 months.   How close is your pace to your pre-op pace?

Brian

bgoetke

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Re: Running and Biking Performance after Hip Resurface
« Reply #6 on: May 11, 2019, 02:58:05 AM »
Great stuff John!

I'm encouraged by what I'm hearing about the progressive bow-leggedness potentially reversing somewhat, if not completely.  Before thirty years ago I had a near perfect stride and hip/knee/foot alignment.  I started noticing a slight bowing of the knee when I tried certain drills while skis.   Or if I got surprised by a hard bump I'd feel it harshly in my groin or hip.   I just thought I had inflexible hips. 

John,   You certainly have provided a great testament of the durability of the BioMet.    You've given me hope that I'll be enjoying skiing again!  It's been 10 years since I've had the joy of skiing the chutes at Breckenridge. 

I appreciate the thoroughness of your response. It was a great read. 

Brian

moe

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Re: Running and Biking Performance after Hip Resurface
« Reply #7 on: May 11, 2019, 12:36:05 PM »
Hi Brian, I am in my mid 60's, an experienced road, gravel, and mountain biker. Do about 4000 miles a year in the northeast. I had bi-lateral BHR about 10 years ago. I had the same symptoms as you, knees all over the place, barely able to get on and off the bike, lot of limping and pain. I had both my hips done the same day which is quite unusual, not many surgeons will do that, mine suggested it, one surgery, one recovery. No regrets ever. I don't use a power meter, I mostly ride for health and fitness now, but push 100% at times without a problem, although I did a lot of amateur road, mtb and biathlon racing. I have run a bit since my surgery without issue but I mostly stick to cycling. I have no issues whatsoever. Had a serious mtb crash on ice about 5 years ago, smashed the head of the right femur, had to be rescued, but came through it ok in the end. I do weight training, squats, lunges, etc. I am small boned, size 50 on both. Dr Su trained my surgeon. He has done many athletes and is in NY at the HSS. Range of motion is what it is, nothing spectacular, never was, do lots of stretching without issue. Good luck.  Moe
Bi-lateral, BHR, Dr Marchand. 7-13-09

SW27

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Re: Running and Biking Performance after Hip Resurface
« Reply #8 on: May 11, 2019, 06:42:46 PM »
 Hi Brian
 At first I was just gonna do the right side and wait some for the second. Set the first surgery up and went to consultation and just seen the costs involved ( first one was pricey 2nd one was at around 1k ) then another 6 months recovery. So I decided to set the 2nd side up. Gross is about 3 months out which the 2nd date was in April then Nancy gave me a shout and said they had an opening so I jumped on that. Its pretty much 2 months to the day and to me doing both the same week would have been way tougher. Second side went way easier then the frst. I run a construction biz and really only missed a week each time.

 On the bike there more ways to skin a cat! I waited 6 weeks each time before I started spinning so I didn't mess with the 90 degree rule. I raised my seat 5 mm and run a cheap pair of flat bottom pedals. I put the left foot on the downstroke pedal and swing my right leg over to start. Feet aren't always perfect but my knees haven't touched the top tube in a long long long time unless I forced it. Now they are right there but have to consciously make em touch which isn't hard to do. The right one isn't out floating around in right field 8) . im pretty much trying to keep the ball of my foot over the spindle for now and that would put my knee just in front of it which is the same being clipped in. I raised the bars up,flipped the stem and currently run 165 mm cranks.

 For me before surgery I was better off spinning higher , I was always 90 or higher and if I tried to push big gear was when the pain started hitting. Towards the end I think the arthritis really started kicking in and when it did the pain shot down my leg to my knee. That pain is no fun. I was dealing with the hip joint pain which was there but not killing me to the point I had to stop riding or skating.

   My surgery story was quick and easy both times , in and out in 6.5-7 hours start to finish. Back at the hotel. Took a nap then got up for a shower and ate a little food from the cracker barrel next door. You cant go wrong with this group and from what I've read on here it seems all the Surgeons listed are top notch. I wanted to go MOM , cementless , Columbia is a little town easy in and out and Gross has done his research and has his craft and numbers down to a T . I had a guy in mind down this way ( south florida )as option B for a THR in case I wasn't a candidate for resurfacing but I have an uncle and 2 friends ( two bilateral , one single ) and to me they look off in the way they function.

 Steve
« Last Edit: May 11, 2019, 06:46:05 PM by SW27 »
right side Bio-Met Gross 1/4/19
  left side Bio-Met Gross 3/4/19

einreb

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Re: Running and Biking Performance after Hip Resurface
« Reply #9 on: May 13, 2019, 12:27:20 AM »
The plus is the negation of the MOM concerns.

What actual MOM concerns do you have?  Unless I'm missing something (I realize this is a common concern), good surgeons with proper placed quality devices don't have issues. 

Data-point to your original question... I was a recreational road/crit/cx type up until my surgery in 2011.  Maybe 300 ish FTP?  (Edit added the following)  However, the increased pain deterioration of my hip had me off the bike for several years prior to the surgery. 

Surgery in 2011 and started back up on the bike.  Recreational riding/racing started back up in 2012.

In 2017 I took things serious (coach, etc) and just before cyclocross season was pushing 340W as an FTP at 163 lbs at the grand old age of 46.  The hip was in no way a limitation and the lack of pain post ride was so nice.

-Bernie
« Last Edit: May 13, 2019, 01:15:11 PM by einreb »
40yo at the time of my 2/16/2011 left hip uncemented Biomet resurface with Tri Spike Acetabular cup by Gross

bgoetke

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Re: Running and Biking Performance after Hip Resurface
« Reply #10 on: June 07, 2019, 03:30:44 AM »
Hi Bernie,

The MOM issues are still a concern even with experienced surgeons... a very low percentage, but still a possibility (1% ?)   Whereas there are 0 MOM issues with Pritchett's Synovo device. Of course, that's not to say there is a huge track record for the highly-cross linked poly... the prev poly liners where prone to wear and release of particles.

You mention having to stop riding.  Was this because your ROM became too compromised?  Did you also see your knees start flairing out when on the bike?   Now?

Do you do strength work in the gym?  If yes, are you comfortable doing squats.. deadlifts?  I'm hoping to be able to do some strength work again.  Even doing core work is quite difficult...  I'm limited to planks. 

Who did your surgery?

Thanks,

Brian

bgoetke

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Re: Running and Biking Performance after Hip Resurface
« Reply #11 on: June 07, 2019, 03:35:51 AM »
Hey Bernie,

I just saw your signature stating the Dr Gross was your surgeon. 

Brian

bgoetke

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Re: Running and Biking Performance after Hip Resurface
« Reply #12 on: January 21, 2020, 03:27:42 AM »
Progress Report:
I've got to still post a summary of my resurfacing experience, but for now I'll just contribute to this forum post.

My surgery went pretty well.   I think my adductor muscles took a bit of beating.  I could barely move my right leg laterally for about a week.  I chatted with a fellow hipster at breakfast the next day and he was able to sleep on his side the first night!   Amazing how everyone has a different experience.   Anyway, everything healed pretty quickly.   

At four weeks I decided to do some stair climbing at my work place.   3x7stories consecutively with a short recovery.  It took me four days for my quads to loosen up enough to walk reasonably normally.   

At 5 weeks I ramped back up again...  2-3 miles walks every other day at a good pace alternating with Elliptical work on off days.   So, I came into my 6 week PT evaluation (per Dr Gross post surgery requirements) with very tired legs.  PT took ROM measurements and then relative strength comparisons.  Like an idiot I resisted 100% effort with "good" leg and I spend the next two weeks limping badly and thinking why the hell did I push off surgery on the 2nd hip.   

Anyway, at 8 weeks I started spinning -  4 days a week.   I was amazing at how good the surgical hip felt.  Being clipped in was fine.  I did have to be careful coming out of the saddle initially.  I progressively added more out of the saddle work to strengthen my hip.  I started training on my bike on a trainer at 12 weeks.   

I'm now at 16 weeks (4 months) and my surgical R hip is stronger then my non-surgical hip.   47/53% split.   I'm still very clunky when riding out of the saddle.   I'm guessing that is due to the hip flexor still being weak and the left leg being slightly shorter than my new hip. Hoping it all smooths out.   My surgical side enjoys spinning at higher RPMs again. 

Left hip is getting done Feb 7th.   Hoping that all smooths out by June.  Going to be tough to not venture outdoor after 4  months - especially in the middle of the summer. 

btw, the question of PT has come up.  I've been going once every week or two since week 7.  I feel it keeps me on track with strengthening the adductors/abductors/etc.   Cycling hits the glutes, hammies and calves, but not so much the stabilizing/balancing hip muscles.

Good luck to all.  I'll keep you posted.

Brian

 

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