Cityofsmokingjoe

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  • in reply to: Minor Swelling #20118
    Cityofsmokingjoe
    Participant

    Better still, sign up for PT … go to a really smart PT and go serious. The older we get the more we have to have a bunch of muscles strong and active. Just a cruel fact of life.

    Six months after my surgery, I went to a serious PT. My conclusion: I wasn’t simply “recovering” from the surgery. I was catching up and getting in all around-balanced muscular strength.

    in reply to: Restarting running after hip surgery #20024
    Cityofsmokingjoe
    Participant

    I got the clear for impact at three months. My surgeon is really cautious and follows the research carefully, and he said it takes three months for the bone to grow into the device. At that point, it’s a matter of can you muscles handle it?

    Go slow … so easy to overdo it … Your muscles and soft tissue and nerves from surgery (the soft stuff that was pulled and twisted and yanked and cut and sewn up and aggravated) are still healing for up to a year.

    in reply to: 1-year post – op #20000
    Cityofsmokingjoe
    Participant

    A good PT can help you fix that glitch in your stride. Probably some weak muscles that are out of balance and need some attention and strengthening.

    in reply to: THR = Running – Surgeons Response #19995
    Cityofsmokingjoe
    Participant

    First runs (after a long break) are always awkward. You feel so excited to be running and yet your body is out of practice and with the new hip your body hasn’t had practice with a reliable hip. The entire body has to adjust now that your hip is reliable.

    Think about doing glute exercises and some quads exercises as time goes on.

    in reply to: THR = Running – Surgeons Response #19988
    Cityofsmokingjoe
    Participant

    Bluebirds

    Of course I’m sure there are people who there who had problems with hip and who ran. So what? There are people out there who barely move and end up having revisions. People who midly move and need revisions and people who moderately move who need revisions.

    You have all the information you’ll ever get on this subject. You will have to take the leap or not. Asking for more details–you’re not going to get to any information that definitely or overwhelmingly favors one side or the other. We don’t have that level of clarity. YOU have to step up and decide. I will say that most revisions have nothing to do with patient activity. Nothing. And when I say I’m thinking 99 percent of them, not 51 percent.

    You know you can try out running for a year or so … or for a few months. I don’t think any claims that a few months of running or a few years will ruin a device. The ruin the device would be after years and years (for those who have that view).

    You are the one who has to decide–there is no data or study out there that will decide this for you. And btw: I’m someone who did indeed look for such data before I had surgery.

    in reply to: THR = Running – Surgeons Response #19982
    Cityofsmokingjoe
    Participant

    No, the recommendations on running are not based on surgeons using particular devices vs othrs. No, the devices are basically all the same. The tools surgeons use to insert the devices, the steps for inserting the device, the feel, the subjective experience–those are why surgeons choose certain devices.

    You’re barking up the wrong tree looking for registry information on different devices. Keep in mind that some surgeons cut from the front, some from the back, some from the side … That’s all personal preference and comfort level and confidence … No one approach is better than the other (despite all the hype about the anterior approach) …..

    But maybe you mean materials … again, registries don’t break out info like this from when I last checked. But yes, there are academic studies on various materials … and the materials used by many surgeons these days is ceramic head on cross-linked polyethylene liner, uncemented cub and uncemented femoral stem … though as I mentioned earlier, i don’t think cement or not is the big deal here …All the surgeons I encountered who were fine with running were using ceramic on highly cross-linked polyethylene. This is easy info to find out. Don’t worry about other details–the details are ridiculously similar and NONE has some great and noticeable advantage in survivorship than the others or else all surgeons would be using that particular device.

    I did go looking for surgeons who are comfortable with running because I wanted not to have to contradict a recommendatin. I wanted the full placebo effect, as it were, for running afterwards … But I admit I got lucky. Surgeons don’t loudly advertise this recommendation. Often I would have to go to a website or read a review and see that a patient was running. My surgeon has no information endorsing running out there in public, but I found an obscure interview with him in an orthopedic journal where he disclosed his view on running. His practice’s website has testimonies from a few runners who were patients, but no officials works (other than one younger surgeon in the practice) endorsing running. Really good surgeons do not want to over promise. And in fact, my surgeon said he could not guarantee that I would enjoy running after surgery. He said some patients just feel funny or awkward running after the surgery.

    I learned that the surgeons comfortable with running were not rebels … They were just confident in the results and survivorship rates in their active patients and they looked closely at research … Once I got all this, I was able to find a number of surgeons who were OK with running. It was like I decoded the modest lingo to figure out who was ok with running.

    BTW: a surgeon at my surgeon’s practice actually talked about something that is relevant to you. Are you really going to exercise at the same level you would in running? If you are going to skip running, you really want to find a new activity you LOVE! … For your overal health. You don’t want to be out there moping around feeling sorry for yourself, doing some exercise that reminds you of tasteless food. You need to find something challenging and juicy. You will need to experiment. This thinking was one of the reasons that one of my surgeon’s partners gave for being OK with running–overall health, physical and mental!

    in reply to: THR = Running – Surgeons Response #19977
    Cityofsmokingjoe
    Participant

    I’ll share the thinking, as I understand it, of the surgeons who think running is fine on a hip replacement.

    There are several parts to their thinking. One, there are studies of younger active patients, people under 50 and so on, and over time, top surgeons at least have not found a high rate of failure in these “younger” patients. Those studies of people under 50 are one source of evidence. In other words, the theory propounded by your surgeon would hold that that people under 50 would have much higher revision rates because people under 50 are going to be more active than people over 50, impact or not.

    Well with the cross-linked polyethylene liners, they aren’t seeing higher revision rates among the younger people who are presumed to be more active.

    Second, the way hips break down (even on old materials) is NOT by some big crack. Your surgeon’s sense is off base here. They break down overwhelmingly by a process called osteolysis … which is particles falling into the bone where the femur is and over time those particles weakening the bone and the femur comes loose. Cracked hips, even in the cup or the femur device, isn’t where hips typically fail–absent falls or car accidents of the type that would fracture a “natural” hip.

    Note that your surgeon points to no evidence in his assessment. He’s using all intuition. And look, a surgeon’s intuition isn’t to be disrespected for sure. But surgeons are starting to track what they call “high activity” patients vs low activity patients … and there’s not any strong evidence apparently that high activity shortens the lifespan of the device.

    Let me pause and say I get how strange it can be that a total hip can support running or basketball. I get how strange that seems. But keep in mind that manufacturers have been building total hips for what 50 to 100 years now … and manufacturers have been constantly tweaking those devices with the impact of research and the imput of surgeons. And surgeons have been learning to operate in ways that stabilize the devices. And again, the main way hips fail is not through cracks/breaks … but through loosening of the device as a result of wear particles. The breakthrough of cross linked and highly cross-linked polyethylene liners has reduced particle falloff to close to nill going on 15 years of monitoring.

    The way my surgeon (and his practice) reads the research: they are not seeing more failures about people with high activity.

    BTW: the way I read your surgeon’s note, the last line is the give-away. He doesn’t want the responsibility to have OK’ed you to run, but that last line saying the choice is up to you–no heart surgeon would say that for an activity that was seriously deadly to a heart patient. That last line seems to me to be his way of saying, “You might be ok, but you’re on your own there.” I don’t read your surgeon’s note as a strong recommendation against running. I read it as he wants to be cautious.

    BTw: here’s one link to a study that found that in fact high activity people had lower failure rates than low activity people about 5 years after surgery.
    https://www.arthroplastytoday.org/article/S2352-3441(21)00123-0/fulltext

    Cityofsmokingjoe
    Participant

    I’m responding to the downhill skiing question.

    I’m not at all a skiier but I don’t sense skiing is a controversial at all among surgeons. The real controversy (or disagreement) is whether people can/should play basketball after surgery or run marathons (really high-impact activities).

    An increasing number of surgeons don’t put any limits on their patients after surgery. My surgeon is like that. His only hesitancy is that he recommended against taking up an entirely new high-impact activity. I run, but if I didn’t run before surgery, my surgeon didn’t think it was a great idea to start running for the first time after surgery. Notice his words here were kinda wishy-wasy. He didn’t recommend. He didn’t say it a new activity would damage the device.

    Skiing should be fine. The device is not fragile. It’s locked into the bone (mostly uncemented in the U.S.) It is not fragile.

    in reply to: Left THR Posterior Approach #19956
    Cityofsmokingjoe
    Participant

    Actually Dr. Thomas Gross uses an uncemented resurfacing device–the Biomet– and he’s probably the most prolific hip resurfacing surgeon and certainly one of the most successful in the United States–out of South Carolina. Dr. Gross pioneered the uncemented resurfacing device because he thought the cement was the one weak sport of the Birmingham Hip Resurfacing.

    Dr. Thomas Pritchett, another top five (in terms of cases) hip resurfacing surgeon in the U.S. also uses an uncemented resurfacing device, though he also performs BHR’s, I think. Dr. Edwin Su in New York also uses uncemented hip resurfacing devices (the same Biomet that Dr. Gross uses) on women who are banned from the cemented Birmingham Hip Resurfacing device.

    Survivorship for cemented total hip devices is higher in some studies than uncemented devices. Uncemented has become the default in the U.S. but survivorship studies don’t show an advantage and in some cases show longer survivorship for cemented devices. I admit: I was shocked to learn this given that uncemented have become the standard at least in the U.S.

    So it’s not clear that the recommendation for activity would be different for cemented total hip devices than for uncemented.

    in reply to: Left THR Posterior Approach #19953
    Cityofsmokingjoe
    Participant

    I am not sure the device matters. I’m not sure cemented vs uncemented matters. The Birmingham Hip Resurfacing, a very robust device, is cemented and tons of athletes get that procedure precisely in order to return to running and other aggressive activity.

    I don’t think any of the device makers, including the BHR, advertise “running is fine for our device.” Manufacturers are too cautious for that. Traditionally surgeons did not have specific data indicating running was harmful. Their caution was largely based on intuition (not to totally dismiss specialist intuition).

    The reason I don’t think the device particularly matters is that I think all the major manufacturers build devices that are very very similar.

    Just to back up and elaborate on what an earlier poster said, the way hips traditionally “wore out” was because the new ball rubbing up against the new socket led to particles that fell into the bone and over time led to loosening of the device. This process is called “osteolysis.” Well these lots of surgeons are using ceramic heads (with incredibly low friction) against cross-linked polyethylene liners and that combination generates almost no particle falloff. Surgeons have been able to monitor the level of fall off/osteolysis over time and they are finding almost no wear with ceramic heads and cross-linked polyethylene liners.

    I do think it’s worth it to call your surgeon’s office again. There’s been a sea change on running in just the past ten years and there’s a chance your surgeon’s views might have shifted. Surgeons’ views change as they go to conferences, read research and talk to other surgeons. Also there’s a difference between a surgeon strongly recommending against running vs. a surgeon not recommending running. The latter position might be what your surgeon ultimately embraces, which is a yellow light for you, not a red light.

    BTW: my surgeon didn’t promise that I would like running on the new device. He said some people just feel like running is odd after hip replacement. And for what it’s worth, my surgeon is a stickler for research and is part of a huge nationally known practice and he said there was just no evidence from the research that running was harmful for this new generation of hips.

    in reply to: Birmingham Hip Resurfacing Pain, 6 years post operation #19952
    Cityofsmokingjoe
    Participant

    Sorry to hear of the pain.

    I’d recommend you go to a physical therapist to see if there is some muscular imbalance that is getting in the way. The older we get, the more various muscles seem to go to sleep and over time those weak muscles or muscles we don’t use (don’t “activate” in the words of PT works) can cause all kinds of problems. Problems that can seem like device problems.

    Can’t guarantee that PT will help but that’s a good place to start. You mention repairs on two gluteus muscles. Did you do PT after those procedures? It’s very typical for those muscles to go to sleep as we age and after surgery. Since you’re athletic, PT’s will love to work with you. I say focus on finding a really smart PT over someone who emphasizes working you hard. You want the smartest most precise exercises, not just hard exercises randomly chosen.

    Good luck.

    in reply to: Thigh Pain? #17035
    Cityofsmokingjoe
    Participant

    Sorry to hear of the sudden pain. I had surgery 15 months ago, and I’m still easing into running.

    I’d highly recommend that you go to physical therapy … If I had to guess, I would say your glutes are weak and inactive, not propelling you forward anymore. Thus the muscles that are activating (most likely in the front) are overwhelmed and thus the pain. That was my problem at 6 months when I went to PT. My therapist had me stand this way and that … and lie this way and that … and she pushed against my leg … asked me to resist … and she quickly concluded I had a weak and inactive glute medius muscle that is key for propelling us forward.

    It’s quite easy to develop a major muscle problem (and a glute problem) … because in the years before the surgery, we make compromises in how we walk and move … and also because just aging in our society tends to involve a lot of sitting and muscles can go to sleep.

    A really good PT should be able to pinpoint the problem and develop exercises to activate and strengthen the right muscles. (Sometimes we can have strength, but through office living and sitting, the muscles stop firing. You probably need exercises to strengthen and activate muscles.)

    Tip: find a PT that is really good … and that people report is fun to be around. Go online and find some place that is fun to go to. I’ve gone to PT multiple times and it was only at 6 months after hip replacement (when I was having serious problems running and moving) that I made sure to read reviews and I found a PT place that was so much fun … the clients chatted and cracked jokes … and there was great conversation. And none of this detracted from the exercising under close supervision of the PT.

    And because I loved the Pt … and loved the atmosphere … going to PT wasn’t work. It was fun. I never missed an appointment in 5 months. (You probably won’t take that long, but I also had back issues.)

    Sometimes surgeons can miss problems on the X-ray, but what they are looking for is generally that the bone (white on the x-ray) has grown into the device. They can see gaps if there is a problem with the device not binding to the bone. But sometimes surgeons can miss problems on the X-ray. I was having a muscle problem a few months back, and I went to my surgeon to make sure the device was OK … and he showed me how the white streaks on the x-ray (bone) was right up close (with no gaps) to the device. (Turned out some stretching fixed my issue.)

    The good news: Since you can apparently walk and do the elliptical without pain … I’m thinking this is most likely a muscle problem. Severe problems (device problems like a loose device) tend to make even walking painful.

    You can ask your surgeon for a PT script … a GP can also write out a script. Going to PT to resume running is actually legit.

Viewing 12 posts - 1 through 12 (of 12 total)