Left THR Posterior Approach

Hi Rob, welcome!
I am the UK, near Leicester, and do mainly 5k and 10k races and hopefully will be doing parkrun number 400 on New Years Day with my Zimmer ceramic/ceramic THR and my metal on metal Birmingham resurfaced hip, at which point I shall be 71 years old. I have no worries about my devices lasting the distance (ie another 20 years…) and I had my surgeon’s blessing to continue running, climbing, biking and mountaineering. The THR is uncemented, the BHR uses a small amount of cement to cover the re-shaped femoral head and is in compression so not likely to cause problems. You might have had a ceramic/polythene combination which is becoming the new standard, there is very little wear of the plastic when in contact with the highly polished ceramic ball and no real risk of failure by cracking. Go for it, I don’t know of anyone who has worn an implant out yet!

See you at parkrun sometime?

Hi Rob,
I had the BHR 7 years ago because my research led me to believe that THR was not suitable for an active life whereas BHR addressed the issues of bone-loading in a natural way by just replacing the “big end” bearings. The operation is more complicated than a THR and my surgeon used a lateral incision “Hardinge method” which left a long scar down my thigh but saves the glutes from being parted. You need good quality bone to take the implant, when the right hip was attempted two years later the ball fell off my femur as the metal cap was being tapped in place, hence the THR. I was disappointed to get second-best but quickly realised that if the bone was that weak it could have failed anywhere, miles from anywhere, at any time. Also, he assured me that I would not be able to break my ceramic device and so far he has been proved correct…
With the first hip, I had got to 177 parkruns with arthritis and about 80 more with one hip, so the BHR has done about 220 and the THR 140. I had to be gentle with the BHR so did not jog 5k till about 9 weeks after, the THR did not get mollycoddled and I had jogged 5k before my 6 week checkup.
Regarding distance, I have run marathons and ultras in the past but in deference to the metalwork resisted longer distance running until a year with the BHR, doing a 2 hour half-marathon distance as a systems check before my 12 month appraisal. The THR leg has given me some limpiness from time to time and this eventually let to full-blown sciatica this June, the whole problem being spinal not leg related, but last spring I was running up to 30k and (virtually) racing all the shorter distances to meet county standards Gold level for a 70 something. During the 4.5 years I have had 2 fake hips I have done the Yorkshire 3 peaks and the Welsh 15 peaks/3000 footers, longest single walk was the Derwent Watershed at 42 miles. Best 5k this year was 23:27 but I am a couple of minutes off that at the moment, still regaining the fitness lost to sciatica.
One other thing – my brother’s wife had an Exeter implant, cemented stem, and was told not to run. I think that is probably correct, the cement is supposed provide a cushioning effect and allows the stem to float a little. Let’s hope that is not what you have got.
Cheers,
Pete

Hi Rob,
I could have made that clearer, I guess, but the second op. was going to be another BHR so the incision was lateral again. People on the SurfaceHippy website/forum who run have had both anterior and posterior incisions, I think posterior is easier for the surgeon but takes a bit more recovery as big muscles get cut. Some of the anterior people are discharged same day, the operation becomes outpatient with the top surgeons.
X-ray cannot show wear, merely placement and possibly movement of the implant.
Metal bearings get a chromium/cobalt blood test avery 3 years which can indicate excess wear if metal ions exceed a certain level – both are toxic in excess. My next test is due…

Hi Rob
I am 64. I had my right hip replaced 7th Sept 21 after a very similar story to yours. I also went private in the UK. My running had been deteriorating during 2020 and finally ground to a halt in May 21. I went to a physio, who pointed me at a surgeon who dealt with active people. The first question I asked was ‘will I be able to run’. He was cautiously optimistic, but I got far more negativity out of everyone else I saw, including the physio the hospital used post-surgery (who wasn’t the person who I had originally seen).
Like you, the operation and recovery went well. I have been back swimming, using the gym, doing Aqua classes etc for a while. I hadn’t intended to try running until I was closer to 6 months, but quite honestly everything is feeling fine now, so I tried a very short trial run this morning. If there are no after effects (and everything feels fine at the moment) I will ease back in gently with C25k.
I had the posterior approach, scar is about 6 inch long. Uncemented. Smith + Nephew Polar 3 so it has an oxinium femoral head – zirconium heated up to a ridiculous temperature to ceramicise it – sitting in a highly cross linked XLPE liner.
I think surgeons who don’t themselves run are cautious about encouraging running because they can’t understand why anyone needs to take the risk when other forms of exercise are available. Those who run, understand. Mine is an amateur tri-athlete.

Hi Rob
If you can’t get the information about your implant from your surgeon, I think you can contact the National joint registry to obtain the info, as all UK hips, knees etc have to be recorded with them, so they can trace the effectiveness of different implants over time.

A couple of things that might help you guess as to whether it’s cemented or not. If you saw the X ray after surgery, then can you remember how long the stem was? Uncemented femoral stems are quite a lot longer than cemented ones because they are designed to press fit into the bone. Also how long did you need to use crutches? Typically you can walk unsupported very early with a cemented implant, but need to use crutches to bear some of the weight for the first 3-4 weeks with an uncemented implant.

At your age, I would think it’s quite likely to be uncemented. Cement is most commonly used on older people either because of osteoporosis or because it helps mobilise them safely and more quickly.

Ultimately you can always try a few minutes of running and see how it feels.

The info on what you have should be enough to work it out – although all the manufacturers sell both types of system, they have different names. If you download the NJR data you will see the tables are split between cemented and uncemented, both for the femoral and acebetular components. You can have one half cemented and the other not, but I think it’s more common to have both either uncemented or cemented. The manufacturers sell things that are meant to work with each other. Mine is this one https://rediscoveryourgo.com/verilast-hip-home/polar3-total-hip-solution/

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.

• This reply was modified 1 year, 9 months ago by Cityofsmokingjoe.

@cityofsmokingjo BHR is different from THR in that it preserves your femur and there isn’t any other way to resurface the femoral head other than cementing a new layer onto it. THR lops part of the femur off and then sticks an implant into the bone. The implants for cemented THR are totally different to those used for uncemented THR and I think it does make a difference.

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.

• This reply was modified 1 year, 9 months ago by Cityofsmokingjoe.