What Is The Top Recommended THR for Serious Running???

[Canadian-Ice]

Hi Mark, read your post with interest.

What was the problem with your THR? Good that you can run well though, sprinting. Is it actual present physical limitation making it hard to move on the tennis court as in the past, or the desire to be cautious to protect the device?

I did an internet search on Bo Jackson, but as in the past couldn't find much from his perspective. I wanted to know what restrictions he has now after 3 revisions on a 1991 device...

What your OS advised you with respect to running on concrete makes sense to me. To be honest, I wouldn't want to run on concrete much with a BHR either. Soft surfaces, cross country and trail trunning are probably generally better. Running technique and body weight go hand in hand. I think running stairs and uphill might be easier on the hip, device or not. What do you think? Trampoline running; interesting idea. How often do you do those sprints and what's the routine when you do?

I try to think of it as follows. We likely live 80-100 years on this planet. Over that time, our goal should be to live the best quality of life possible for as many of those years as possible. How can that be achieved with the resources available? A couple of revisions may be the most rational choice if they help achieve this end.

Recovery time and suffering, degree of soft tissue damage, availability of bone, chances of chronic pain and limitations. These are the things I would gauge in weighing the costs of a revision. Not just chance of revision occurring at all.

Everyone around us has a vested interest. The OS will usually want his hard work to last and to lower the number of failures/revisions in his series. Our spouses and mother's will usually emphasize short term protection of the hip over long term spirit. Risk adverse or non-active people will often advocate their values. But in the end, in my opinion, it should come down to one thing -- rational evaluation of the big picture. We must remember that risks apply not just to our hips -- they also apply to our spirits. The human spirit. Living with limitations that ultimately prove unecessary also has a profound cost, one that I (for one) would rather not pay. I guess I'm speaking to myself and all the couch potatoes out there. You know who you are! :th_heehee:

Having said that, Mark, I totally get where you are coming from and choosing to make your implant last as long as possible is a great and valid decision for you. You've adapted and adjusted and found ways of getting many of the same feelings as before. There's more to running than concrete, more to exercise than competition, and more to life than exercise. Hey look, a lot of the joy of working out is becoming stronger -- and wearing out a hip is not doing that. What adjustments to make is definately a personal decision in the end.

On that note, this OA thing has given me exposure to swimming and Tai Chi I never would have had otherwise. There's quite an experience to these disciplines, I've discovered. It also has deepened my empathy for those with disease. Can't say it's helped my relationships with my son, though. Can't wrestle with him like I want to, model for him in the physical ways a man should. I'm also more irritable than I used to be (not usually with him). Guess most people know what that's about. :wink1:

Thank you so much for sharing your experiences.

 

[Rusty dmw]

Ice,

You are correct, the research seems to focus on two areas:

1. Reactions to the metal at the implant site;
2. Reactions or potentially adverse affects of the metal micro particles on other body organs.

I have to make the disclaimer that I am a technical person and tend to quickly spiral into research numbers too quickly and pretty soon find I am over my head. I'm great in the field of civil engineering but admittedly way in over my head in the medical field.

The links and discussion provided on this site on this topic are great and cover pretty much what I read elsewhere so much of what I say has been thoroughly covered already. Here are a couple of other links:

https://www.mayomedicallaboratories.com/articles/communique/2012/01.html

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60353-5/abstract

The Mayo Clinic study was focused on blood samples as a predictor of joint wear and not really applicable, but has a lot of references to studies on MOM joints if you are so inclined to dig deeper.

All of the materials have the potential for problems due to potential reactions between the bone and the implant (Metallosis for MOM, Osteolysis metal on plastic) so no way to avoid some risk. The percentage of problems appears to be relatively low, less than 10%, with the numbers bouncing around depending how they slice and dice the data. In my reading it seemed that the proper placement and orientation of the device were critical factors which comes back to having an experienced surgeon.

I waivered back and forth right up until two weeks before the surgery between total hip replacement and the BHR. For me the deciding factors were the unknown reaction of my body to the metal micro particles, and most importantly I found a surgeon that was very highly regarded. He only performed minimally invasive total hip replacement, and no longer used MOM so my options were ceramic or metal on plastic.

Yes I did put off the surgery for roughly two decades. Up until about a year and a half ago I was convinced I could just strengthen and stretch which I did daily and I am sure that helped a me delay. However, I hit a wall when the pain took a dramatic jump. While I was waking up after the procedure the surgeon showed me the joint and described it as looking like someone had sanded it down smooth. I'm glad I was still mildly sedated! The point is, I had reached a point where no amount of exercise, stretching and gluco was going to help me. Once it was bone on bone replacement or resurfacing were the only options.

Still very early for me but I remain amazed at the difference and speed of recovery. I was in Seattle yesterday for meetings and walked several blocks up the hill from the Pike Street area without any discomfort. In November I walked the same route and had to stop at each half block to allow the pain to subside.

Good luck with your decision and I will be interested to know how things progress.

 

[Canadian-Ice]

Hi Rusty, just took a scan of the Mayo clnic article and it was good to know that MoM implants don't use Chromium+6 which is a known carcinigon but as you say the main thing might be the citations. The Lancet article I have seen and is behind a lot of the renewed interest. Some of the MoM devices use smaller heads, but really the long term risks are not known of any of them. What were the facts which turned you away from metal -- the sub-10% risk of adverse interaction (must pertain to under 10 years)?

I'm not prepared to dig deeper yet because I'm not prepared for surgery. To be honest, this post might have been a bit premature. I could well have put a post up on "How to Prevent or Delay Hip Arthroplasty". I guess my hip is still intact enough to last a while yet.

Could you share your strengthening and stretching regimen? I would be most interested to see what I may be missing in my program.

I have to say though that your concern about MoM definatley gives me pause. Close to 10% complication risk is definately something to think about. I'm going to look into Dr. Bose's reports in particular.

 

[MarkC]

hey canadian. I will try to answer your questions...the first one is loaded. I do have a pennicle large cup MOM. My sergeon recommened it because of my age and activity level. I had a lot of pain with it, but I also had an arthroscopic procedure on that same him and that guy was a ...how shall I say it..less than expert at hip arthroscopy. My OS said that he would hav never scoped that hip because it was too far gone. Lesson learned by me...do background research. Anyway, I trusted this OS (Paul Greenlaw) because he had done several of my friends hips (older and younger) and was highly recommened. He did his minimally invasive technique training at Duke University with my current OS Dr. David Attarian. At the time (now almost two years ago) many people were doing these hips for younger active people (including the guys at Duke).

I had pain and the bottom line is that my iliopsoas tendon is the route of much of it...but we thought the metal was as well. Still don't know for sure but my metal ion level has gone down and is not pushing my OS to revise. I am getting a second opinion but I can't make a sergeon take it out either. My OS says that all the tests we have done look good (mri, fluid extraction, ions, etc...). There are also lots of people with this very device that are doing great and I don't know how good I would be if that tendon was released. It pops right over top of the oversized cup and many people have had that tendon released with great results. I can still do most anything I want, but that tendon hurts (straight leg test) and I just don't iknow how much of my pain is attributed to that.

When I sprint, I run what we call gassers (down, back, down , back). I usually do 10 of them. I do not do this much anymore but have done it.

I don't play tennis right now because I have been through a lot with my hip and just don't have the drive to get out there and go. I have been going back and forth to the Dr. for a while and found out I had Hoshimoto's desease (which is auto immune attacking thyroid) so I have been tryng to get control of that as well. In other words, tennis has not been a priority for a while...hell, hip has not been a priority for the last couple months. When it rains, it pours.

I am intersted in my second opinion (another Duke sergeon who has great reputation) and am not sure what I will do if he says the same thing. I stil have pain, not dibilitating, but pain indeed.

Oh yea, the left one started bothering me and I am havine the arthroscopic expert at Duke have a look at it to see if anything can be done to head off replacement. that is the new thing now and some of these guys are very good. He is a partner to my current OS and I believe that my OS will be honest with me about potential. He knows I had the other one scoped and it did not good. The left one is much better off than that one was but has the same anatomical condition (FAIS). I would have to really be sold to go through another scope...but I figured I would take a look and listen.

 

[Rusty dmw]

Hi Canadian
There are a lot of people with the MOM hips that are doing just fine. I mentioned that I found a surgeon that was highly recommended and I liked. I interviewed several but he had the best track record and a friend went through the same replacement same surgeon in October with very good results. The OS used to include MOM but felt the "industry" needed to sort through the results and data a little more thoroughly.

My routine isn't anything complicated I just alternate days with cardio on one day and weights and resistance on the off days. Stretch everyday. I worked with a trainer several years back to set up a routine for the weights to keep from overdoing it.

 

[Josephine]

I was wondering what the "body of evidence" on MOM is to which you referr? From what I've gathered anecdotally, and it's hard to ascertain this from the journals themselves, is that known MoM reactions are from a tiny percentage of people with an allergy, and imperfectly placed devices from average surgeons.

I have a report from a meeting I attended in London last December (Metal-on-Metal Hip Replacements: Solving The Uncertainties) which was looking into this very thing. Fact being that there is no body of evidence as yet. The things that are being discovered haven't ever been researched and until recent years, weren't even on the radar as being issues even needing to be researched. At that meeting, many things were brought up that caused sharp intakes of breath. This article - https://www.thelancet.com/journals/la...353-5/abstract - resulted from a directive from that meeting and will be further discussed at a follow-up meeting next month which I shall also be attending. It should be noted that the closing comment from the JR/UK was that MoM stemmed hips should not be used.

Sadly this body of evidence will likely take about 15-20 years to acquire any substance.

McMinn's argument is that properly placed devices will not have a problem. Wear follows excessive interaction between compenents especially when the cup is placed outside the optimum angle range.

Prior to the December meeting I didn't know he had that opinion but I have been expounding that hypothesis for years. Perhaps he's been reading BoneSmart!

 

[Canadian-Ice]

Hi Mark,

Thanks for sharing. That really sucks that your psoas tendon is rubbing in that way, after all you've been through already. I really hope you can have that surgically addressed. When will you have an answer?

I had heard something about hip scopes before. Almost all my symptoms started March 2011 when my left leg muscles atrophied to the point where chronic hip pain set in. The OA was pre-existing, but for whatever reason I didn't really have any pain until I let the muscles atrophy. I did that because a physiotherapist accidentally caused 3 tears to my left quad and, not getting any advice from the 3 doctors and 3 physiotherapists and chiropractor around me, I chose to keep off the left leg to give the quads space to heal. Wrong decision. As it turned out, this was the exact wrong thing to do, and it must have caused some hip damage, because it has not been the same since, even thought the quad tears eventually healed and I eventualy re-strengthened the left leg. Does this make any sense? Question: do you think hip arthroscopy could help me?

If anyone reading this has a theory as to what happened to my hip in March and what can be done at this point please tell me.

Sorry to her hear about your Hoshimoto's Disease. Hard the way several things go wrong at once in life sometimes. I just might know exactly how you feel. I know you are the kind of guy who is doing everything about it that can be done. Always good to get a second opinion.

I'm not surprised the other hip has started to bother you, as it often does get OA. There are a lot of compensatory symptoms on the other side, as you know. It could be bursitis or another condition.

 

[Canadian-Ice]

Rusty, I find it hard to believe you had not done something exceptional to last 20 years despite playing basketball and hockey. There must have been some exercise you did which made a special difference, no? Even inadvertantly. I wish I could see your routine!

 

[Canadian-Ice]

Thanks Josephine. I do so appreciate your first hand experience of these major OS conferences!

Hope to hold out long enough to get some information on these metal devices, anyhow. Would you by chance know what they've learned from the metals used in the 1960s? I'm sure no statistical data yet, but the metal inquiries might investigate old devices not only the new ones where the metal is the same despite the different design.

 

[Rusty dmw]

Rusty, I find it hard to believe you had not done something exceptional to last 20 years despite playing basketball and hockey. There must have been some exercise you did which made a special difference, no? Even inadvertantly. I wish I could see your routine!

Canadian,
My routine has been an ammalgamation of weights, resistance machines and cardio that I have slowly added over the years. The beginnings were from high school sports teams but have been refined as exercise science has pointed out that many things we did 30 years ago might not have been as efficient. A couple of months with a good coach a few years back helped a lot to trim out the useless exercises and improve technique.

I have often wondered if the consistency made a big difference. There has never been a time in my life when I was not working pretty consistently performing both strength and cardio. I go through cycles where I ramp up for two or three months getting ready for a big hike or climb which includes tracking weights, repetitions and sets. A lot of cardio on the elliptical and stairs. With the exception of my hip I have had no other joint pain and that has helped a lot. Like I said before, I alternated days so pretty munch every other day was a hour to two hours workout. One day a week off.

About four years back I was running stairs quite a bit but that came to a dramatic halt about 1-1/2 years ago. Wish I could offer a couple of silver bullets to help with hips but not sure which were the best. For sure I probably hastened the process with the high impact activities but....it was a lot of fun. No doubt I have slowed down but still consistent. Just this week started back to the old routines in the gym and it's clear it will be a long haul but PAIN FREE!

Good luck
Rusty

 

[Canadian-Ice]

Rusty, you're inspiring me to continue on with my rehab. Unfortunatley my knees been bugging me which has held me back from some of it. Before that the soft tissue injuries so basically 2011 was a right off. Anyway, get the sense of your routine and know I'm on the right track.

The stairs might have caused a bit of damage as it is running. Probably the best kind of running on the hips but still running. I've started running a bit up little hills and it feels just fine.

Basically, I do 30 minutes of PT exercises targeting glute med, adductors, flexors every other day plus lunges/leg extensions/calf raises. Reps between 15-25. I try to swim 45 minutes a day but get in about 5 days a week. I feel the pool is therapeutic. I have 20 minutes upper body strength workouts-- body weight only -- 2 days a week. Core everyday. I try to do 2 yoga workouts, just 20 minutes, for flexibility a week. Have these Tai Chi videos but have not been consistant with them; still figuring out how to put that into the routine. I do plan on adding impact back in, MMA just two days a week, a soft ground run once a week or two weeks. That's about it. That's 2 hours most days.

 

[Rusty dmw]

Canadian,

Sounds like you have a good routine with a lot of variety including strength and streching. Although I have not looked for anything to verify, I have to believe that with good muscle tone and strength going into the surgery improves your odds of a "relatively" smooth recovery. Particularly the core muscles including the hips. It would not be fair to discount the importance of a good surgical team and condition of bones etc., however, I did feel that aside from the surgical trauma to the tissues around the new hip the rest of me bounced back in good form. During the first few days of bed rest etc. it was nice to have good upper body strength to help heave myself around.

Getting my strength back at the gym has been a little slower than I hoped but I am beginning to see progress. I have continued to execise into middle age because I like the stress relief and extra energy boost. Some might say I am nicer person to be around too. At my 6-week checkup this Monday the OS surgeon said I was clear to go back to skiing when I felt strong enough. That will obviously be next season.

Good luck with the fitness program and rest assured that when the time comes that you need the joint replacement, it will not mean the end of physical activity.

 

[Canadian-Ice]

Hi Rusy, I always like hearing stories like yours where folks are back at workout out. My way of doing that properly is with a little help from synvisc, cortison, and celebrex. It's too bad that recovery is going slower. Seems this cannot be predicted generally. Main thing is to get back at it at some point, am I right? Can you "feel" the THR device in any way? I mean, other than the surgical soft tissue issues, is there any way in which you experience leg movement, sensations, or proprioception different from your other leg?

 

[Rusty dmw]

Hi Canadian,
No I really cannot feel the implant at all and the truth is I already have a greater range of motion than before. Looked at the Xray with my OS this week and it almost did not seem like it was me as the motion of my joint feels very natural. Still a little stiff when I first stand up but that goes away after half a dozen steps. Sitting down and laying down I have no sensations that my joint isn't my original.

The exercise is not a problem that time won't take care of. I will be happy if my strength and stamina are close to preoperative condition by August or September. The only real surprise was that I could not last more than a couple of minutes on the elliptical the first day. The muscles on my left hip were too weak but that has improved each day. The rest of my aches and pains are the usual that comes from muscles that have become lazy.

All in all even working back slowly feels great and I cannot wait to get back in the alpines this fall. Keeps me motivated.

 

[Canadian-Ice]

It's like you are going to be completely back to normal with the exception that you want to impose some restrictions to protect the device. Amazing.

There are a couple deadly cardio exercises that are arguably as much an impact on the heart and lungs as intense running: versa climber and aerodyne bike, although both are hard to find and expensive. There's this experienced athlete Randy Couture who does his cardio by walking on high incline treadmill. This guy has exceptional endurance, a truly exceptional record. That's something I intend to try out, myself.

Did you find any knee problems dissapearing?

 

[Rusty dmw]

Sounds like exactly the kind of workout I want and need to keep heart healthy without excessive routine risk. I figure I will leave that for the skiing. Won't know for sure how that will work out until next season but am optimistic.

Regarding knee pain, I did have some in my other leg the last two or three months before surgery. It is no longer a problem so must have been due to over use. I really was to a point where my good leg was doing all of the work.

 

[Canadian-Ice]

Good luck with the skiing. Such a great sport.

 

[Bumpa]

A recent paper indicates that my subjective concerns about active sporting activities following joint replacement is not good. My opinion is that if your joint is stable and pain free anything else is a bonus - unless you have a wish for early and repeated revisions!

High impact sports reduce durability of hip implants April 27, 2012

French researchers have confirmed that high-impact sport, such as jogging or soccer, increases the risk of total hip arthroplasty mechanical failure, according to a study published in Clinical Orthopaedics and Related Research.

“Since participation in sport is now a reality for a significant number of total hip arthroplasty (THA) patients, surgeons may need to adapt their choices of bearing surfaces in implants to accommodate this growing trend,” the authors wrote.

According to the study abstract, the researchers investigated 843 THAs performed between Sept. 1, 1995 and Dec. 31, 2000, focusing on two cohorts:
- one of 70 patients who engaged in high-impact sports following THA
- one of 140 patients with low-activity levels following THA.

All patients in the study underwent evaluation by two independent observers at a minimum follow-up of 10 years. The researchers then, according to a Springer news release, compared the function, wear rates and lifespan of hip implants between the two cohorts. Patients were also asked to complete sports and quality-of-life questionnaires. According to the study results, mean Hip Osteoarthritis Outcome Score for the high-impact sport group was higher in three of five subscales. Linear wear and the number of revisions were higher in the high-activity sport group.

At 15 years’ follow-up, according to the release, the implant survivorship rate was 80% in the high-impact sport group compared to 94% for the low-activity group. The researchers also found that males had increased wear rate over time, but reasons for this gender difference were unclear, according to the release.

Reference:
Ollivier M, Frey S, Parratte S, et al. Does impact sport activity influence total hip arthroplasty durability? Clin Orthop Relat Res. 2012. doi: 10.1007/s11999-012-2362-z

 

[Josephine]

Interesting, thank you

 

[Canadian-Ice]

Thanks Bumpa, very interesting.

My first thought is 84% with impact over 15 years isn't too bad, better than I would have thought. My second thought is, what caused the 16% to fail and how can those factors be mitigated? Looking forward to more studies like this over time.

I'm not worried about revisions, per se, but about a highly restricted life in old age and nerve damage. A somewhat restricted life now to avoid a somewhat restricted life later doesn't make sense, however.

I should put up a post about the restrictions and risks of the post 2000 revision hips. Any wisdom on the downside of the potential tail-end would be much appreciated.