T Nation

Total Hip Replacement or Hip Resurfacing?


#1

Due to arthritis I am going to have to have one of them done. Anyone on here had either one? I found one instance of a person who had the resurfacing done and loved the results. The major difference besides the actual surgery is that the Doctor said it was possible to do THR on both hips (they both need done) during a single procedure.

He said for the resurfacing, he would only do one and then a minimum of 3 months later, he could do the other. That is a little more downtime than I wanted. The other big difference (that I remember from our conversation) was there is a small (he said fractions of a percent) chance of a hip dislocation if something extreme happened if I had the THR. He said a dislocation occurring after the resurfacing is even smaller. According to him, both have similar recovery times.

He also won't give me HGH for recovery... I asked.


#2

If you have the ability to keep your hip with the resurfacing I'm not sure there is any reason you would ever prefer a replacement?

How old are you? What type of activities are you looking to return to?

The clients I've had with hip replacements all lost a ton of their activity. They also became extremely scared of dislocating the hip after the procedure. Even many months later.


#3

After reflection on the conversation with the Doc, I am going with the resurfacing. The only reason I considered the THR was they could be done at once. That was the only Pro I came up with. If the resurfacing can get me another 10-15 years of activity, I'm OK with that. This summer or next winter, I will have the other side done.

I am 40 and the doc said based on my x-rays, my hip issues are genetic and probably started manifesting itself around 13-14 yo. I want to be able to squat and run. Neither of which I can do now without a lot of pain. I also lose sleep because of pain as well.


#4

Sounds good.

What position do you sleep in? Do you have really wide hips?

Curious.


#5

I start out sleeping on my back with a pillow underneath my knees. Most nights this works. If it isn't working or in the middle of the night, I will roll onto my left side and put a pillow between my legs. I cannot sleep on my right side at all. The right side is the worst one and is the one I am having done first.

I don't think I have really wide hips. I am think I am proportionate. How does one tell if they have wide hips?

Doc said that around 13-14 years old, my bones didn't ossify correctly. He was not anymore specific than that. I am giving him a call in the AM to get scheduled.


#6

What else bothers you? Stairs? Sitting for extended periods of time?

Have you ever looked into femoral anterior glide?


#7

Sitting a long time in and of itself doesn't bother me. When I stand up after sitting a long time, my hips are very stiff. So does standing conversely.

I believe at one time I had/have femoral anterior glide syndrome but after seeing those x-rays, it isn't the big problem. I plan to address it (if it manifests itself) during after the (possibly) during the rehab process.


#8

I have had total hip replacement. It will limit your weights drastically, but for me, the new mobility and the lack of pain is wonderful. There has been a recent scare about Johnson's hip resurfacing kits. Apparently metal ions get released into your bloodstream and a recall is under way. There are other makers.

I do feel silly lifting with a 55kg barbell, but you do what you can.


#9

I am having my right hip resurfaced on Jan. 4, 2012. The device is the Birmingham which, according to the doctor and what I have researched, is that it has the best track record (least amount of revisions). It was the ASR device that was recalled.

I was told about the metallic ions being released and possibly causing an allergic reaction. I have metal in one hand and in an elbow, along with a BB (I was shot as a kid) in my upper left arm. I have had no issues with any of them and the Doc said that was telling.

I am looking forward to getting it done... I told the Doc that if I can get back to a 405# squat, I would be content with that but we will see.


#10

Good luck for tomorrow!


#11

Had a BHR (Birmingham Hip Resurfacing) in Aug. 2001. Got it in the UK from Derek McMinn. If you really want to stay in the game, go to him -- he invented the implant and is one of the best sports orthopedic surgeons alive. I live in the US, BTW. It cost 1/4 what the procedure in the US would, insurance payed for it too. Seriously, IM me and I'll get you some contact info. BHRs preserve as much of you as possible and restore anatomical function. That is the key -- you will be able to do before the operation what you do after it. Moreover, should it ever fail, you can always get a THR (see below).

As for me, I've been very active. Still squat and deadlift regularly with no issues at all and am a very, very active martial artist. Couldn't be happier. Just a couple of weeks ago (51st b-day) I decided to go back to doing sprints to compliment my deads. Yeeeeeee-haaaaaaa!

A THR (total hip replacement) removes a lot more bone and mishaps include things like leg length difference which can completely ruin any possibility you will have of doing athletics. Also, depending on the implant, there can be a lot of "stress shielding" which means that forces do not go through the bones normally. This causes bone loss which leads to fractures and other failures. THR is the standard, but is aimed at people who are quite elderly -- in their late 60's or beyond and for whom the implant is more robust than they will ever be. There are serious mobility restrictions that go with them (squat to parallel = disaster) and yes, dislocations are a really scary part of it. I knew of one lady who had 9 of them because the implant was installed a smidgen off. If you get one, you will have a very high risk of getting more. A lot of people dislocate on the operating table and don't know it too...

As for not doing a bilateral, this is the surgeon's decision. I have been on a large message board called surfacehippy (yahoo group) and many people have had same-day bilaterals. This is very, very stressful though on both the patient and the surgeon. Be sure you need one though. When I first went to McMinn I was sure I needed a bilat too. He told me to get the first one done and see what happens. Most all of the pain was because the good leg was doing all the work for both. Not a peep from it since I got the bad one fixed.

-- jj


#12

Thanks TQB!

Thanks JJ-dude but I got your posting a little late. I had the surgery at 0730 this morning (Jan 4). So far, I haven't had a bit of pain. I have been lying in bed all day. Whatever they gave me around 1300 hours for pain is still working. It is 2030 hours now. I start rehab tomorrow. I went with the BHR as well.

I'll update this thread periodically. I am also keeping a journal to help others and to assist me when I have the left side done sometime in the future. I, too, may not have the left side done as soon as I once thought depending on how this one turns out. Having one good side may alleviate the other sides issues. I joined surface hippies when I embarked on this journey. I'll post my journal on the associated blog when I am completely released from the doctors care.

The surgery took about 3 hours because of the amount of ossification that was present. I haven't spoken to the doc since the surgery but he told my wife everything look excellent.


#13

If anyone wants to see a picture of my incision, I will post it. I am warning you it shows my swollen butt and I am a hairy guy. The incision is bigger than the typical one because of the room needed to remove my femur from the socket due to the bone growth.

Or PM with an email address and I can send it that way. That could spare some of the masses from the trauma.


#14

Howya doin?


#15

I am doing well. Thanks for asking. It has been 13 days since the surgery and I really don't need my walker anymore. Although without it, I have a noticeable limp. My wife yells at me when she sees me without it. I can traverse stairs normally (one foot per step) for the most part. I haven't been using pain meds because the pain is now muscular and not from surgery.

The only issue I see is that my right glute is dormant. I was wondering why my right hamstrings and adductors were so sore and I realize now they are compensating. The right glute was an issue before the surgery because of the compensation. Hopefully, I can get everything back to where it needs to be. I still have pretty limited range of motion but I am working on it.

Overall, the surgery was a huge success in that I am not having the arthritic pain anymore but the recovery will some time.

My first follow up appointment is tomorrow.


#16

Surgery "stuns" the concerned muscles. They have to relearn how to operate. I would not worry as that is a quick process, but where compaound movements are concerned it will create some imbalances. Use good form even when taking a dump....


#17

Glad to hear from you! And it sounds like everything is moving along just fine. Course, you no longer have an excuse for doing things half-assed! :o)

First and foremost, you do not need more ROM than whatever your post-op restrictions are. People trying to get ROM too soon (as in the first year) while the implant is still getting ingrowth has been implicated in several failures. If you move the implant a bit, it will fail. My doctor was adamant about that and it worked well. Besides, no lift actually requires that you exceed post-op ROM. Think of building the foundation for future use. And take those calcium supplements! After a few months, start jumping rope. This gets impact, cardio and keeps your feet under you. It also greatly improves your balance and coordination. You don't have to go at it hard (1 rep = 1 minute, do them in circuits with everything else as 2 x 5's, e.g.)

Forget the glutes and hammies for a bit. You need to practice activating those, for sure, but you should work on stabilizers (there are something like a dozen of them for the hip in contrast to the shoulder that has 4 in the rotator cuff) and isometric core strength. Concentrate on single-leg exercises when you are able. Chances are excellent you have compensations all over the place, such as with the knees and lower back. If you do not fix these, you will never really get your hip stronger and you will get chronic training issues (e.g. always lower back pain after working out).

Do not underestimate how adept at cheating you've become! Hip OA is a complete show stopper for most people (as in 5 years after diagnosis is the mean time until most folks are completely handicapped). That you are still in the game means you have learned slowly and painfully how to compensate. It takes thousands of reps to pattern something until it is automatic (like good squat form) unless pain is involved in which case it only takes a couple, then thousands of reps to fix it. It is far better to avoid an exercise you have bad form on for a couple of month post-op rather than totally fubar it and spend a couple of years fixing it. Trust me. I product test damned near everything, including me!

Cheers,

-- jj


#18

I got back from the doctor a bit ago. They took xrays and removed all 38 staples. He said everything looked excellent and to come back in 4 more weeks. He said after that appointment, I won't have to come back for a year for my right hip. He also said to use a cane or walking stick for another week in order for the musculature to strengthen a bit more.

I am starting outpatient therapy next week and going back to work on light duty. I have no more excuses as you said!!! I have been doing dips and pull ups and am going to try and incorporate in some upper body DB and BB lifts. All my compensations are coming out now that my hip is anatomically correct. It will take some time to fix everything but I am game for it!!


#19

I suggest you do some research about the surgery you're about to do. Gather information of what are the pros and cons of the device that's about to be implanted. And recently there are hip implant devices that failed. You always have the option to take precautions before doing the thing that you are not so sure of. And recently there are hip implant devices that failed.

Good luck.


#20

Had thr in 2006. Either surgery will be fine. The important things are the surgeon and your ability to stick religiously to the rehab schedule. I was 52 at the time and was able to return to karate as well as squat again.

Google Matt Kroczaleski hip replacment. He's had one and is squating in the mid 600's.