What bearing surface are you doing and why?

[Uncivil]

I have been doing a lot of research on the bearing surface options for replacement. I am an active 43 year old female. I am leaning towards ceramic on ceramic which is what my surgeon recommends for young active females. I am curious what other are doing and why.

 

[dlp]

I didn't have much of an opinion, really, other than avoiding those that had been proven to be a problem (such as metal on metal). My surgeon prefers to use the Stryker ADM X3 ceramic/poly, and I didn't find anything objectionable about it. Was more intrigued by it's dual-mobility than anything else. No complaints so far for either of them

 

[Jaycey]

If your surgeon is recommending an implant - let them make this decision. Surgeons use the implant and approach they are most familiar with given your own medical situation. Sounds like your surgeon is already taking your lifestyle into account. Trust your surgeon - it's their day job.

 

[SwampHiker]

My surgeon is also recommending ceramic on ceramic due to the fact that I am a young active female as well. I know we communicated over on my thread, have you heard from Dr Chow?

 

[Constanze]

I think ceramic on ceramic is the right choice for young active females. I had my hip replacement in April 2015 and had a ceramic ball and a ceramic cup. I'm vey active and have finished 2 marathons and 1 half-ironman (triathlon) every since the operation. Never had any problems. The bearing is very durable.
Good luck with your operation and do carry on posting about how you're getting on. Best wishes - Constanze

 

[MrDIY]

My surgeon is also recommending CoC for me. I guess he must think I am also an active female?

 

[Uncivil]

MrDIY that is funny. But you are young, so 1 out of 2 criteria is pretty good. swamphiker I am waiting for Dr. Chow to review my films that were sent from out of town. I am hoping he gets to review them this Friday. I am hoping to schedule surgery in December if he will take me on.

Wow that is awesome. From what I have read running isn't recommended after hip replacement in general. Good to here you have had such great success.

 

[Jamie]

Ceramic on ceramic hips do appear to be an excellent option for more active patients as the wear is minimal over time compared with other types of implants. But, they are not without risks and the skill of your surgeon is a prime consideration. Dr. Chow is an excellent surgeon and you will be in good hands if you continue with him.

As for running after a THR, generally it is discouraged. But things are changing and we certainly have a number of active BoneSmarties who have chosen to resume active sports to include running with their new hips. So, it's not impossible.

If this is your goal, you need to discuss it with your surgeon as each person's situation is unique. And once you have your new hip and start recovery, take things slowly and methodically as you return to your normal activity. This is a time where you won't want to try and rush things. Any pain, swelling or discomfort during the first year or so of recovery will be an indicator to slow things down for a while longer to allow your hip and the surrounding soft tissue time to recover fully and build the strength you need to do what you want to do. You'll have the best result if you allow yourself at least 3 months for complete healing before you try to start any type of strength training.

 

[Going4fun]

I have a ceramic ball on a cross-linked polyethylene liner ... In the past, I think my surgeon has done ceramic on ceramic ... but these days he thinks that the record so far with ceramic heads and the cross-linked polyethylene liners (CoP) ... is amazingly good ... Extremely low wear rates going on more than a decade now.

My surgeon is confident I can be as active as I want to be with CoP. He places no activity restrictions after a few months.

My goals are to return to dancing and treadmill running, long walks, the elliptical, biking and weight lifting. I told him this, and he had no objections. Another top surgeon I consulted--who specializes in very athletic patients ages 40-60--also uses ceramic on cross-linked polyethylene. And this surgeon and my surgeon are pretty confident the device will last for decades.

The only knock I've heard against ceramic on ceramic is that there was squeaking in a small number of these (not sure how much of a problem that still is--device makers seem to always be making improvements) ... and a small risk of fracture (though again the fracture problem has apparently decreased a lot). I've seen some studies mention that ceramic on ceramic devices might have less margin of error for placement than other materials--that if the surgeon doesn't place the device just right, there can be problems.

My non-expert review of the research found that CoC and CoP had pretty much the same survivorship rates over time ... Yes, the wear rates of CoC have been reported lower than for CoP ... But this is lower than already amazingly low ... and these studies found no clinical advantage to this difference ... and no increased survivorship rates for CoC vs. CoP.

So CoP is excellent ... CoC is potentially even more excellent ... But surgeons are paranoid, from what I can tell ... They've seen all kinds of materials that SHOULD have been better (like metal on metal) ... later turn out to have problems.

The best wisdom is to pick a really good surgeon and have a frank talk about your goals with the surgery ... and trust their judgment.

Good luck. Hip replacement has come a long way.

 

[Constanze]

Yes, running in general was discouraged when I had my new hip in 2015 and it looks as though it still is. Whether or not running is still possible/to be encouraged depends on the individual. I think it depends on how much running you have done before, your weight, your general health, your running style, and many other factors. As far as I'm concerned, for example, I had finished 10 marathons before I needed the new hip. There is also a website for runners with artificial hips www.hiprunner.de with lots of information and athletes who exchange ideas and experience in the forum. There is no evidence that running would wear out an artificial hip joint prematurely, but surgeons always wish to be on the safe side and don't recommend running.

I consulted 3 surgeons before I chose my surgeon in Wiesbaden, and the 2 previous surgeons discouraged running. By the time I had my appointment with the last surgeon - the one who performed my hip replacement - I had given up asking. But when I was in rehab (in Germany you can go to a rehab center after hip replacement for 3 weeks), an orthopedician examined me and I had to admit to the fact that I had done marathoning - he was able to tell from the general condition my body was in . So at 13 weeks after hip replacement, I thought I would give it a try - starting with the run-walks-run method. and gradually increasing the amount of running. I was doing ok. I recommend that if you do wish to take up competitive running after hip replacement, do include a variety of other forms of exercise into your training like swimming, gymnastics, cycling etc. to obtain a balanced training regime, or you will were out your muscles (not the artificial hip device). That's why I also take part in triathlons now. Best from
Constanze

 

[Rascali]

I researched this heavily and went with Ceramic on VE-XLPE because of my Misophonia, as a squeaky CoC might have been a death sentence in my case... lol

In my research it seemed the primary advantage of CoC is the lack of Particle Disease with osteolysis and muscle wasting. There are a lot of reasons and inevitabilities that go along with revision surgery that a surgeon can deal with, but PD is a messy dead end. Eliminating that possibility turns revision surgery into something more akin to changing oil filters! As a younger patient you need to plan as much for your revision(s) as you do for your primary THR.

As Goingforfun mentioned, proper placement for CoC is perhaps more crucial, as less than optimum orientation can lead to edge wear that may become noisy or lead to premature failure. It would probably be a good idea to choose a surgical approach that allows intra--operative fluoroscopy for some small guarantee of accuracy.

Have any of you runners discussed cup migration, subsidence or stress shielding with your Dr.?

 

[pikesan]

Hey all, this is my first post. I've had hip pain for years.. like more than 7? Thought I was too young to get a replacement, but I'm finally done worrying about something that MIGHT happen 15 years later (or more).
That said, I'm starting to wish I was an athletic female! I'm a pretty athletic 48 year old man, but have no intentions of running a marathon (hats off to you!), but I do want to continue lifting weights and mostly I want to sleep thru the night w/o getting woke up by hip pain.
I'm also a mechanical engineer which makes hip material choices more difficult. I'm trying to get in with Dr. Chow (set my appointment today for Jan 15 2019!!!) so I'll most likely let him decide.
From the little I know now, I'm leaning towards the ceramic with plastic? Those highly engineered plastics got my geek going!

 

[SwampHiker]

Those highly engineered plastics got my geek going!

I actually lol'd at that comment. I understand, we all have "our thing". I did let my surgeon choose what he thought would work best for me and it was an easy decision for him to make.

 

[Uncivil]

Glad I am not the only geek on this board @pikesan. Have you run any moment equations, and figured out the force on the bearing material while making such decisions? Get back to some good old Dynamics.

 

[SelfHelp]

Hi Constanze, here is a thread on high performance sport after THR: https://bonesmart.org/forum/threads/revision-of-7½-year-old-hip.37821/

 

[Josephine]

From what I have read running isn't recommended after hip replacement in general.

That's old thinking and no longer regarded as valid.

As for the bearing surfaces, there are three types: ceramic on ceramic, ceramic on poly and metal on poly. Each one is as good as the other two. There are no "Rolls Royce" hips. They all have similar outcomes. So choose you surgeon and let him make these decisions. It's what you pay him the big bucks for, after all!