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Hip Resurfacing Bilateral BHR, Need advice

Bioguy501

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Hello Bonesmart members,

A complete newbie to Bonesmart with my first post and I need advice.

I am 56 years old in a LOT of pain and 4 different hip specialists all say that my osteoarthritis is severe in both hips. They all recommend bilateral hip replacement. I have been researching the options and I am torn between anterior approach total hip replacement (with local surgeon Dr. Andrew Yun - Santa Monica, CA)... or BHR (Birmingham Hip Resurfacing) with Dr, Peter Callander (up in San Francisco, CA.). If you can comment on either surgeon, I would be most appreciative.

I plan on retiring after my operations and wish to be able to still be active for the next 10-15 years... especially in golf which I enjoy and play very well. For a guy my size, 6'4" tall, 180-185 pounds... the revision rate over time on the major Joint Registries (Australian, UK and Sweden) for the metal-on-metal BHR resurfacing is about the same as the total hip implant with the highly cross-linked poly. (Not so for smaller boned women, however.) Moreover, Dr. Callander says that his patients have absolutely no restrictions (run all you want, contact sports, whatever you want after 6 months). Moreover, it seems to me that the metal on metal BHR implant, IF installed correctly, will never wear out. When I analyze the data carefully... and exclude small-boned women... and exclude low-volume inexperienced doctors out of the equation, the BHR resurfacing appears to be superior to the THR... and keep in mind, BHR patients are typically younger and more active than the THR patients.

Yet... most of the local surgeons disagree with me. Those surgeons (that do the total hip procedure) say the new total hip implant can easily last 20 years or more. Yes.. I agree, the polyethylene liner is definitely better than the old poly... but aseptic loosening of the stem down the femur is the more common issue.... not the liner. And if the stem becomes a problem, revision total hip surgery appears to be more problematic with an even larger stem installed down the femur for the revision. (If the BHR goes bad, they simply keep the cup and put in a dual mobility total hip THR... like getting your first total hip.)

My question is: Is there anyone out there in the Bonesmart Universe that has one of each??? And if so, which side feels more natural. (or which side do you like better?) Does one feel more stable? Any input at all would be great.

Is there anyone out there that has had BOTH hips replaced with a total hip implant (or BHR) and is playing golf 2-3 times a week without pain or stability issues? I need advice... good or bad. Thanks in advance for your help. Gary
 

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@Bioguy501
Welcome to BoneSmart, glad you joined us! :welome:
Is there anyone out there that has had BOTH hips replaced with a total hip implant (or BHR) and is playing golf 2-3 times a week without pain or stability issues?
We have members that are playing golf 2-3x a week, don't know if any are currently active on BoneSmart.
Your most important consideration is the skill of the surgeon, then let the surgeon pick the prosthesis they are best at using.
I am going to tag @Mojo333 , she has a bilateral THR, to come and talk to you.

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:
Score Chart: How bad is my arthritic hip?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?

If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:
Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?

And if you want to picture what your life might be like with a replaced hip, take a look at the posts and threads from other BoneSmarties provided in this link:
Stories of amazing hip recoveries
 

NightQuilter

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Welcome to BoneSmart @Bioguy501 Gary! You've come to the right place. And since you're from the LA area, I may be able to help a bit. Others will be on soon!

I had a bilateral hip replacement in 2003 with Dr. Brad Penenberg in B.H. who does his surgeries at Cedars Sinai. 3 years ago when I went in for my 15 year check-up, he said they looked like they were good for another 20. (I retorted that by then if they were in need of replacement, just shoot me. :rotfl: ) When it came to needing my knees done some years later, I interviewed a number of other surgeons, including Dr. Yun who was then with the Marina del Rey Ortho group, but is now at St. John's. He is clearly the current westside wunderkind and I know many who have had very happy experiences with his knee replacements. No bedside manner but very competent. Since he would not consider doing a bilateral, I went back to Dr. Penenberg for my knees. While scheduled for bilateral knees, I ended up having them on different dates, but that was because of blood oxygen levels, not Penenberg. My hubs the sainted Joe, went to him for his knee. Penenberg has a research institute and consults with implant manufacturers around the world. You may want to check in with him. I live in Pacific Palisades and found it worth traveling to B.H and Cedars for him.

He did not cement my implants and I've been an active hiker for years since. Never golfed so cannot speak to that.
 
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Mojo333

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Hi @Bioguy501
:welome:to the forum.
It really sounds like you have already done your homework as far as proud and cons of hip resurfacing vs total hip replacement.
There are a few members I know have had both... And some that have BHR converted to THR due to metal issues.
The ones I remembered and looked up haven't been on the site for a while...:unsure:

I can only give my experience with replacements and I am 4 years out from Bilateral THRs and still hip hip happy.:happydance:

I think that the resurfacing does have some short term weight bearing restrictions which I didn't have with my hip replacements and I know, for me, the first year especially... My new hips didn't like a twisting motion while soft tissue was still healing.

I'm not a golfer either but I have a very physical job...lots of walking and loading and unloading trucks.
My weekends are active too ...I love to go boating and fishing, ATV riding, swimming and walking in nature.

I really never engaged in high impact sports like tennis or running, but certainly would probably not want to do that now as I had my surgery at age 54 and would like them to last for my lifetime.

Of course there are no guarantees, but I don't jump down off trucks like I used to and a few other precautions.

Mostly, I do everything I want with no pain and no issues with balance or range of motion.
Hopefully some others might weigh in and ultimately, as you know, the decision is something you need to be comfortable with.
Giving either procedure the appropriate recovery time will be the key to getting back to full swing! :yes:
 
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Eman85

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I think there's a point of doing your homework and reading too deep into the story. You say the specialists say you have arthritis in both hips but I didn't see you mention pain.
I've had both hips replaced but not at the same time. Doing both at the same time might be easier since you just get it all over with at once. Approach and implant really didn't concern me after I chose the OS. Some people can take and oak tree and make beautiful furniture and others make firewood. I chose the guy that did fine work and left it up to him.
Unless they've changed the game of golf to include some other additional physical challenges I'd say I could do that every day pretty easily even walking the course.
 

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@Bioguy501 I was older than you when I had my BTHR (64yo) and definitely not of the athletic persuasion. When my surgeon discharged me from his active case load he told me the only thing I could NEVER do was bungy cord jumping! 9.5yrs later I love my hips and do pretty much what ever I want to do with no problems (other than some minor effects of aging not at all related to the hips)

Just anecdotally from what I've read here at BoneSmart hip resurfacing often turns out to be either unsuccessful or merely a stopgap temporary measure and then person needs a hip replacement any way. Why go through 2 sets of surgeries when the hip replacement option is already being offered? Current implants are expected to last for 30+ years and even some of the older types have lasted 40+ years.

If you go over to the recovery side, find a Bilateral THR tag - click on the tag itself and you'll get a list of all the BTHR threads here - there are quite a few of us around. Read any/all the threads to see how others have managed.
 

DGrant

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Hello Bonesmart members,

A complete newbie to Bonesmart with my first post and I need advice.



My question is: Is there anyone out there in the Bonesmart Universe that has one of each??? And if so, which side feels more natural. (or which side do you like better?) Does one feel more stable? Any input at all would be great.

Is there anyone out there that has had BOTH hips replaced with a total hip implant (or BHR) and is playing golf 2-3 times a week without pain or stability issues? I need advice... good or bad. Thanks in advance for your help. Gary
Since you've asked a few questions, I'll answer to what I can in my experience. As for the BHR, I never went through that, and had ultimately had both hips replaced about 5yrs apart. Left side first in 2015, then the right side May 5th. All due to OA(osteoarthritis)... so I can't comment on which side feels more "natural"... but I will say my left hip is as natural as I've ever had. My activity level was quite high for quite a while until my right hip started going away(which we knew it would in time)... and now with the right hip done, I'm getting back into life again, after only a few weeks give or take.

As for golfing 2-3 times a week, I'm not a golfer, but active in other ways, and always wanted to give golf a try. It might happen at some point, and I can say I don't anticipate pain or stability issues... of any sort with the hips. Matter of fact I had many stability/pain/balance issues that were associated with my hips, that were eliminated very shortly after hip replacements.

When we have bad hips, we already have pain/stability/balance issues... and compensate in ways we don't even realize. In my experience, replacing the hips and gaining stability/balance/mobility was actually easy and natural after weeks/months/etc of moving about with bad hip joints.

I've found in both my THR's after a few weeks of re-teaching my legs/hips/etc muscle memory that had been lost for a while, and getting the muscles shored up to the new hip and positions again, the balance/stability definitely returns... sometimes better then it's been in years.

How long have you been having issues with the pains?... Just curious. Most times we're like a frog in boiling water and don't realize we're in trouble. I know for years I thought I'd wake up one day and the pains would be gone magically... and it's happened, but it took a few surgeries and some work to get there. I wish you well on your journey.
 

Mojo333

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You say the specialists say you have arthritis in both hips but I didn't see you mention pain.
You missed it @Eman85 ...it's a capital LOT though.
I am 56 years old in a LOT of pain and 4 different hip specialists all say that my osteoarthritis is severe in both hips
Eman is right on point with this great analogy
Some people can take and oak tree and make beautiful furniture and others make firewood. I chose the guy that did fine work and left it up to him.
:) :-) (:
 

Eman85

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Sorry about missing the part about a lot of pain.
 

Mojo333

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Sorry about missing the part about a lot of pain.
Not sure I've seen you slipping like that.:heehee: Easy enough to do.

@Bioguy501
We really would be interested in your ultimate decision
If you would like we can change your thread name to Hip resurfacing or THR?
Maybe that will attract some folks who have had both to share their experience.
 

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I just recently took up golf for the first time in my life @Bioguy501. With an ankle, knee and hip replacement I play comfortably, and there's nothing restricting my movements, I just need practice! :rotfl: Walking is not an issue either, being on an island the course we play is short, but has huge elevation changes. A challenging walk even with a cart, (and being a beginner I'm often in the most challenging areas to walk) but it's nothing but a breeze now. Be smart and pick what's best for you, just don't think a THR will slow you down at all.
 

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I noticed you didn't mention anything from your research about the risk of metal ion release from a hip resurfacing. This is something to consider because metallosis can create real problems in addition to the need to have the joint revised. We have several articles in our BoneSmart library that you might want to read:

Metal-on-Metal Hip Replacements: Solving The Uncertainties Dec 2011
Metal on Metal ion levels: safe upper limits for MoM hip resurfacings set by scientists
Metal on Metal warning (old but ongoing news) (thread in hip pre-op forum)
Metallosis: what is it?

If it was me, I'm not sure I'd buck the opinions of four surgeons who advised your to have total hips done. This is such successful surgery these days and the experts who study this type of thing feel that today's hips will last 30 years or more. Of course, they won't know that for sure until the most recently done hips are 30 years old. Picking an experienced surgeon (one who does at least 150 hip replacements a year) is the key to improving your odds for longevity. But your chances of having a "one and done" surgery with a THR is very good. I've not seen any data that indicates a hip resurfacing has the potential to last the rest of your life.

It's good you've done a lot of research and have become an informed patient. In the end, you must make the decision that feels right to you. Hopefully you'll continue to get some input from our BoneSmarties.
 

Wyn wombat

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Hi, i am 6 days post opp for bilateral thr and another good night sleep, regarding @Bioguy501 concerns when I asked my surgeon about possibility of having resurfacing work done instead of both THR my surgeon refused point blank due to metal on metal ions floating in hip and eventually through the patient internally, he didn’t have to tell me twice, hence why i am now sat up in bed with 2 new thr and a cup of tea, hope my experience was of help to you, happy days, :treadmill:
 
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Bioguy501

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Wow... this a great community on BoneSmart. So many replied to my post!! I read them all... twice... and thank you so much for your time. I would like to reply to some of the things in your posts and I welcome your replies: (And yes, @Mojo333 ... can you post this thread to the appropriate location... BHR or THR?)

1) I totally agree that surgeon skill is the most important factor... regardless of the implant. I have done my research in this area and will not even consider low-volume inexperienced surgeons doing either the BHR or the THR for my hips.

2) Of the 4 surgeons I have consulted, 2 prefer the THR... but two said it is really a toss-up between the BHR and THR... which are both good options. The two that said THR is the way to go... do not do BHR surgery. Logically, it's is obvious why they prefer the THR (because they do not even do the BHR). The latest surgeon I consulted was Dr. Peter Callander (San Francisco area)... an excellent surgeon by many, many accounts. He does both operations that I am considering (anterior approach THR... and he does the BHR surgery too.)... so one would think he would not have a bias toward one or the other, because he does both, just like all BHR surgeons. To quote him... "it's a no-brainer for a guy my age (age 56)... BHR is the way to go." Faster recovery, walk the same day, almost no chance of dislocation, no restrictions at all on activity after 4-6 months... and simple revision if anything ever went wrong many years down the line.

Yes... it is TRUE that hip resurfacing has had it's issues years ago! But the key is to do an in-depth analysis... and research is my specialty. These issues happened with implants that were not designed like the BHR... which are off the market now. They also happened with inexperienced surgeons that did a hundred or so resurfacings then gave up on them. The BHR's results (especially in high-volume experienced surgeons like Ed Su, Peter Brooks, Jim Pritchett, Thomas Gross, Peter Callander) exceed those of THR implants... but more importantly, the BHR has been, and is still going into patients that are 10-20 years younger... who went with this surgery (instead of THR) because they still wanted to be highly active. The fact that the BHR has a better success rate long-term in younger, more active patients than the THR stands out to me. Moreover, the data should naturally favor the THR. As a science educator who teaches on medical and scientific data analysis, let me explain one reason why. The THR typically goes into older patients (compared to hip resurfacing). If a man gets a total hip replacement at age 70... and let's say he dies at the expected age of 80... that hip replacement has no chance of going into the "revision" column... even though it might well have if the man lived another 5-10 years. This very common scenario should skew the data quite favorably toward a lower revision rate for the THR... but it does not.

3) The Metallosis Issue: This was a very real issue early on with hip resurfacing and total hip replacement too... especially in the recalled metal on metal implants... which were ALL of the MoM THRs... AND all of the hip resurfacing devices... except the BHR for men. Doctors discovered the key reason for metallosis. It was mal-alignment of the cup in the acetabulum which caused "edge loading." Since this became known, metallosis is extremely rare in the last 10 years... and is approx .3% over 15 years according to the Joint Registries. Another factor was the size of the implant. Smaller boned women had a mechanical disadvantage compared to larger boned men. I am 6'4" tall with a large frame... but still slender at 180 pounds.

It should be clear from my writing that I have a bias toward hip resurfacing with the BHR... but I was "preaching to the choir" on the somewhere else Forum where there is nearly a cult-like following for hip resurfacing. I figured, let me hear from the other side of the coin on BoneSmart (where I believe most members have the total hip implant). As I tell my students, it is only when you examine BOTH sides of an issue can you truly make an INFORMED decision.

So what is holding me back from the BHR? Well... I have one of the best anterior THR surgeons (Dr. Andrew Yun) a short drive from my house... who is claiming the new THR implant with the highly crosslinked poly should last for the rest of my life. In and out the same day... and sleeping in my own bed that same evening. Moreover, the incision for the anterior THR is only about 5-6 inches long (near the groin). With the BHR, they have to go in through the back, and it entails an 8-10 inch incision (on each side - remember I need both hips done)... which my skinny butt will be sitting on for the rest of my life. On top of that, the anterior approach THR does not cut any muscles... they simply stretch and separate them along the "fascia" (the connective tissue that covers each muscle). With the BHR surgery, they cut through some big muscles... and tendons too. While you do have a very stable hip joint right away... and you can walk right away... muscle strength takes about 6 months to get to 90%... and one full year to be at full strength. And I have to do this TWICE... oh, lucky me!! Plus, at 56, I can definitely say that I am starting to break down a little bit... everywhere... feet, shoulders, muscle pulls, et. Isn't aging fun? Nearly every friend of mine that is older than me is telling me that "you are going to spend two years recovering to get "Ferrari" hips... but you won't need them for the "Prius" activities you will be able to do in your 60's and 70's." By the time I recover from all of this, I will be close to 60. Is it worth the effort?

That is why I posted the question: how does the "bilateral" THR (or BTHR) feel... and if anyone is active (playing high level golf 2-3 times a week) on these hip implants... with a metal stem going down each femur. How stable do you feel with two total hip implants? As an Anatomy instructor, I can say that our body was not designed to have forces torque the femur from the inside-out... and golfing at a high level (I have a 2 handicap... from the blue/black tees... on tough courses) will torque the stem rotationally in the femur to some degree. To me, cupping the pelvis (acetabulum) and capping the ball of the femur seems like a smarter, more natural design.

I respectfully welcome everyone's thoughts and opinion... and sincerely thank you for your time. Gary
 

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@Bioguy501 I was 64yo when I had both hips replaced and am 74yo now. I rarely ever think about having artificial hips ... until is sign in here :) While I am not athletic I do feel very stable on these hips and do not have any sitting discomfort, laying on either hip discomfort, or aches/pains in thighs or hips.
Over the years I've traveled quite a bit, done a lot of swimming, playing with big energetic dogs, bike riding, walking, a bit of hiking and horseback riding.

Each person's journey through hip surgery is different. For me I was walking well without aids by 2 months post op, climbing stair easily, and off narcotic medication too. I took my first cross country trip at 6 months post op with no problems at all.

Here at BoneSmart we have seen a lot of people get hip replacements and return to physically demanding jobs ( police officers, firefighters, construction folks, farm work, even one guy who was a farrier and his horse clients were big Percherons, Clydesdales, etc) and high impact sports and activities ( golfing, hiking, cycling, golf, horseback riding, etc)

I hope some of our athletes will chime in here to answer your concerns.
 

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@Bioguy501 Interesting discussion here. Thanks for posting all your information and questions.

You talk a lot about stability. I can confirm that from the moment I was weight bearing (hours out of both THRs) my hips felt very stable. Sure, you have the tentative feeling that something is different just post op. But as Deb said, once those hips are healed you won't even think about them.
I have one of the best anterior THR surgeons (Dr. Andrew Yun) a short drive from my house... who is claiming the new THR implant with the highly crosslinked poly should last for the rest of my life.
Wow - this would be a no-brainer for me. And I totally agree - highly cross linked poly is the way to go. That's a forever hip.

We changed your thread title. I hope you will keep us updated!
 

Mojo333

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Hi @Bioguy501
Just a few thoughts on your post but as you mentioned Dr. Su, some of the questions I had regarding this, online research from HSS and Dr. Su so I will put his words in green type. These are only thoughts...certainly I've seen successes and complications for both procedures reflected on this site.

BHR is the way to go." Faster recovery, walk the same day, almost no chance of dislocation, no restrictions at all on activity after 4-6 months... and simple revision if anything ever went wrong many years down the line.
Revision definitely less traumatic, IF needed, with BHR. Don't know about my particular dislocation risks, but I do more in a week physically than even the athletic sport folks I know, and I'm good.
Walked the same day, no restrictions except common sense and listening to my body.

A risk unique to hip resurfacing that is not present in traditional hip replacement is that of femoral neck fracture. The femoral neck is a vulnerable area of bone that connects the ball of your hip joint to the rest of your thighbone. When elderly people fall and “break their hip”, this is the area that breaks. With a traditional hip replacement is done, this bone is removed, so it cannot break. With a hip resurfacing, the femoral neck is preserved, so there is a risk of fracture. We believe the risk of fracture in this area is between 1-2%. It is because the surgical exposure, preparation of bone, and placement of the component with cement may cause this bone to be more vulnerable.

The risk of femoral neck fracture is why crutches are necessary for 3-4 weeks post-operative and impact activities are not recommended for 6 months. If you have a femoral neck fracture after hip resurfacing, you will need another operation to convert it to a traditional total hip replacement.


The fact that the BHR has a better success rate long-term in younger, more active patients than the THR stands out to me.
As long-term results are still being documented with the improvements in procedures and components...hoping I skew this data!

Doctors discovered the key reason for metallosis. It was mal-alignment of the cup in the acetabulum which caused "edge loading." Since this became known, metallosis is extremely rare in the last 10 years... and is approx .3% over 15 years according to the Joint Registries
This is a controversial topic. There have been many studies looking at this issue, and none have been conclusive. People with healthy kidneys seem to excrete the metal ions in the urine. Metal/metal hip replacements have been around since the 1970’s, and they have never been linked to an increase in cancer or other diseases. We do not know “safe levels” of these metal ions in the blood, nor is it likely that we will be able to determine “safe levels” in the near future. It is not advisable to perform metal/metal hip resurfacing in patients on dialysis, kidney transplants, or with renal failure.

That is why I posted the question: how does the "bilateral" THR (or BTHR) feel... and if anyone is active (playing high level golf 2-3 times a week) on these hip implants... with a metal stem going down each femur. How stable do you feel with two total hip implants?
I can't speak to the particular torque for high level golf, but as I said...I do very physical work EVERY day.

Seriously not advocating for either procedure, just including some other points to ponder.
 

Mojo333

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Please allow me one last thought...

As an Anatomy instructor,
Great to have an anatomy instructor on the site.
As such, I'm sure you are aware of the carpentry involved with both procedures.

I would point out that I think there are surgeons who interact with a patient who wants to recover quickly often make light of the short term and long term recovery issues...and this leads to people doing too much too soon.
These major surgeries require a period of healing and caution, and then a gradual return to normal activities....your long term goals are absolutely dependant on this, in my opinion.
 

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Well you said you're in a lot of pain, that's obviously a problem. As far as a more natural normal thing I don't think any of it qualifies for natural and or normal including playing golf. Seems to me the rotation or torque thing is more a factor of dislocation than the metal in the bone. I agree that lopping off the head of the femur and driving a spike in then reaming out the pelvis and screwing in a piece of metal just ain't natural, but the pain goes away. I have no knowledge or experience with resurfacing except from some that have posted on this forum and their stories. you can search specifically for those posts on here. I don't know how much the muscles are strained to do a resurface but the straining and stretching of the muscles is the big factor with a THR. In the case of playing golf I'd say it would take time and patience before one could rotate and drive through their hips. Planting a foot and twisting is one of the things warned against with a THR as it can cause dislocation, which the chances of diminish with time and the muscles regaining strength. With resurfacing that might not be a factor, I'd ask about that. I remember from my hip class and textbook that any type of cleats for any reason should be avoided to prevent dislocation.
How does it feel? I don't feel a thing as far as any bone thing goes. I feel pain and stiffness in muscles. I can walk as far as anyone and can do anything I want to do. I think about my 2 hips and try to not do anything to damage them as I don't want to have to replace them because I did something dumb. But I climb ladders, walk on roofs, carry 2 full 5 gallon buckets, climb up kneel down and do plenty. I have jumped out of pickup trucks and off of tractors I just don't make a habit of it. I can run if the need arises but I don't go looking for reasons to run. I can sleep 8hrs and haven't taken an aspirin, Tylenol, Advil or Aleve for anything associated with my hips.
 

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