Reply To: THR = Running – Surgeons Response

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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.