Stan’s Pre Op…

Just had my Pre-Op Dr. appointment. 5 days till surgery date. I have been
dreading all this surgery stuff. But what are you going to do? Hip won’t get any
better without surgery! I was a bit bothered in that I didn’t even have appointment with my Doctor, but instead with his PA. I really needed to hear the words from the Surgeon. I expressed that running has been a huge part of my life for as long as I can remember and wanted to build back my fitness post surgery by cycling but still wanted to be able to run 5k’s occasionally. PA’s response of course was “we don’t believe you should ever run on a prosthetic hip. That it will just not last! And that if a revision is needed later the surgery is
I’m supposed to be getting ceramic/ceramic and I was curious if maybe I should be getting ceramic/plastic because of my goals.
I left the appointment wondering if 1) I have the right doctor, 2) If I still even want to go through this! Guess I have some real soul searching to do!

17 thoughts on “Stan’s Pre Op…

  1. Hi Stan,

    My doc uses ceramic/cross linked polyethylene. I research it myself and the durability seems nearly infinite, although ceramic is still used too. I returned for my 6 week post-op checkup. The PA saw me first. When I asked if I could run yet, he said “We don’t ever recommend that you run.” That was not what I had been told by the doc. When the doc came in, I reported what the PA said and he laughed out loud. “Yes,” he said, “Brian sticks to the old liability line.” The doc then recommended I wait until 12 weeks to run, as the bone is still knitting to the implant. Thereafter, he assured me, the implant will be as strong as or stronger than my natural hip. I asked if I could jump down 4 feet with a 40 pound backpack when trekking this summer. He said, “Sure.’
    No restriction on running. Basketball is fine. Anything is fine. He was not careless in his assurances, but he says the evidence is fairly clear that the new materials are highly unlikely to show wear at any time in the future, regardless of my activity level.

    I don’t know if you should find a new doc at this late date, but many of us have gotten much different stories. My doctor is at the Hospital for Special Surgery in New York and they probably do more THR procedures than any place in the country.

    1. Another comment, not yet published, from Kevin, cites ceramic as the most durable material for the liner. While not wishing to quibble, my research indicated that this may no longer be the case. In several comparison studies between ceramic and the latest iteration of cross-linked polyethylene, the polyethylene wear was slightly more rapid in the early months, but the graph lines crossed thereafter and the polyethylene wear was less, long term.

      However, the important “takeaway” is that either is likely to last a lifetime, provided the surgeon got the alignment right. This argues for the computer-aided techniques like Mako, which dramatically improve accuracy of alignment. As my surgeon described: It is analogous to getting new tires. They will work well for some time, but will eventually wear more rapidly if the wheels are not in proper alignment.

  2. My doc used the ceramic/plastic. He also said “as per the manufacturer’s guidelines, you aren’t supposed to run with it.” He also acknowledged that he knew I would “use” it. Are there other surgeon options in your area, with your health coverage. Most surgeons are open to explaining why they use what they do. Email now and ask. Voice your concerns NOW. You’re not on the table…it’s not too late to change your mind. Fact is: most of us “youngsters” will most likely have a revision somewhere down the road. Bo Jackson is my age and he’s had two revisions (3 THRs). I read an interesting quote from him regarding how to know when it’s time to get it dine. His words of wisdom were, “when it starts bleeping up your sex life.” I’m almost a month post-op and I am so glad to be on this side. Ask your questions now. There’s no shame in postponing until you feel ready. Good luck and we’re here for you 🙂

  3. I’m very much a newbie, having just had my THR last Mon. But I sure wish I had chosen a different ortho surgeon. I didn’t have time on my side. I tripped and fell at a trail run bout an hour north of my home. I had always used a hospital close to my house for elective surgery so thought it best to go there. Instead of taking an ambulance to the nearest hospital, I had nice people carry me to my car and my husband drove me to the ER of the hospital nearest my house. That was Sat and I did not have surgery till Mon (Sun was Easter) . Not only was my pain really bad but they said after the fact that my bone died within 6 hours so could not be used. Not sure what I had except for posterior entry and porcelain. My surgeon said I should not run because of limited miles on it. As soon as I can, I plan to change to another ortho, one who will help me with my goals and so I won’t have to hear “don’t run” at each follow up apt. I’m going to try a sports group that services some of the local sports teams. I suggest you talk with other orthopedic surgeons and find one that will aim to help you with your goals. You could postpone surgery. Carol

  4. I went with Temple sports medicine in Philadelphia my surgeon initially said no running then changed it to you will loose 20% if you run. so i did the math with him I was 46 and the projected life of the hip was 30 years so i could be 76 year old couch potato or a 70 year old fit runner and i asked him who he would rather operate on. He said the 70 year old and he added it didn’t matter to him because he would be retired. i had and anterior approach with a J & J hardware. with the polyethylene liner, Start asking questions.

  5. Stan
    The one complaint that I have heard about ceramic on ceramic is squeaking. I understand it is pretty durable, but I suspect that with very little nudging and a pain free hip, you might be hitting the road/trails heavier than most down the road. You might check with your ortho and see if they have the highly crosslinked polyethlene cup instead…..

    Hip Brother Tom.

  6. Hi, Stan
    I had THR about 6 months ago. At that time, I had no ideas what sorts of component is the best. I only asked my surgeon, I need very hard wearing one, otherwise, I will wreck it in a minutes. He knew me I can not keep still. He implanted ceramic and plastic . For me, so far, it works very well. If you have a concern , just ask your surgeon. ( my surgeon does not agree my running, but, He recommended cycling ) I do jog, run, cycling and swimming. So far, It’s perfect.

  7. I think trust in your surgeon and respect is key. Maybe you do have the right doc but need 1 more conversation with him? What my friend calls a “come to Hay-soos” discussion? I consulted 3 docs. #2 was older gent & gave me the “no running” lecture. Used the example of sitting in a chair to extend life of implant to 50 yrs. 50 yrs sitting in a CHAIR? Sayonara #2! Doc #1, was “not sure about running, let’s see.” Huh? Doc #3 does mini incision anterior. Same ortho practice as Doc #1, though they’re both directors of ortho surgery at different hospitals. Within 2 mins of consult with doc #3’s PA I hear “you can run again, marathons if you want”. Wow! Except after meeting Doc #3 I didn’t like him. Not much of a communicator. Glossed over questions about the mini incision method. Its the same implant, why does 1 say “run” & the other says “not sure”? I went with Doc #1 because he listened to me & he & his staff answered all of my questions. The doc called me from his car and spent 25 mins addressing my concerns. I wanted my surgeon to know that post THR I was going back to martial arts to work on my aerial spinning kick, was going to add on to the small pond I dug in my yard a few years ago, & though I don’t need to run marathon distances I will run again. One size implant does not fit all. Your doc needs to know who you are to choose the right device. And he should not be so arrogant to believe you won’t run just because he forbids it. I think if you call your doc’s office and kindly express your need to chat with your doc a few mins they’ll accommodate. It won’t take long to know whether you have the right guy. Though I hope you do because I’m sure you’d like to get on with the healing! It sure beats dragging a stiff & painful leg around! Best wishes! Keep us informed.

    1. Hi Julie – I really enjoyed your post (re: finding a surgeon that understands what your activity level will be post THR) I’m scheduled with a surgeon I like & respect, but haven’t settled on hip material yet. Do you mind sharing what you went with and how it’s working for you?

      thanks –

  8. I had surgery last year for a labral tear and femoral acetabular impingement and I never successfully graduated from PT because a few months later, my cartilage was gone but my ortho didn’t find it until almost a year later. I was so devastated I switched doctors the day the old doc said I needed a THR and should wait as long as possible because of my age. Screw that. He told me to make peace with running. Screw that twice.

    I live in a smaller city and must’ve asked 30-40 people and even strangers who they recommended and then did research on those names on the net. I found news stories on the doctor considered the anterior approach expert in the area and the stories centered around patients who went back to marathon running which was exactly like I needed. I don’t like to think about if running won’t work out for me after this round of surgery but it makes me feel better that I did as much as I could for what I could afford to get me back to the things I love to do. Ceramic and plastic for me and no squeaking so far.

    The best thing for me after getting surgery was being able to sleep at night. Shooting pains through my leg at night especially with the IT band, let’s say it together, SCREW THAT.

  9. I have the highly crosslinked polyethylene. there is some pretty good research on the net that discusses it’s durability. If you don’t feel comfortable with your Doc and he sent the PA in for the pre-op, I’d find a better Doc. I finished the La Jolla Half Marathon this past weekend and emailed a picture of the finish line to my Ortho. He sent back a smiley face.

  10. Tomorrow is the big day? Best of luck. AS others have said in the past, It’s not a walk in the park and has its challenges, however it wasn’t nearly as bad as I expected.

  11. Stan
    -Tough call to make. Here are a few things to consider.

    Ceramic/ceramic (CoC) is by far the bearing with the lowest wear rates and is bio-inert. Less wear means less debris which means less potential immune response from your body. This immune response is what causes revision surgery, and the Metal/Metal bearings, to be difficult as it results in soft tissue damage and bone loss. Fracture and squeeking are CoC are rare but do happen. For what it’s worth, the strength properties of modern alumina ceramics (Biolox Delta) support loads well in excess of 10k lbs, provided they are aligned properly by the surgeon. If your Ortho recommended CoC, which cost significantly more than CoP, then he believes your activity level requires a bearing that has wear properties that can withstand the load and number of cycles you will generate. CoP is a great option, and by far the most commonly utilized bearing, but does generate wear debris (as do all bearings) that may initiate a lytic (bone loss) response under excessive loading. Basically, he thinks that the downsides (squeeking/fracture) are worth the benefit of the low wear properties. But, there is no free lunch so either way presents benefits and drawbacks.

    The most important thing to consider is the skill and experience of the surgeon. Regardless of what their recommendations are, the prosthesis is going to support the same activity. One surgeon says ok to run, the other says never, either way their guidance doesn’t affect what the hip is able to do.

    If your surgeon’s skill and experience is there, then you have a very high probability of success. But as others have pointed out, it is never too late to get a second opinion so if you’re not ready, then cancel. Honestly, they don’t really care as this is a relatively common thing to happen. I myself cancelled three times, andvisited 6 surgeons before having my surgery.

    1. I don’t mind the squeaking of ceramic on ceramic, but what do you mean by fracture? I hope that is not as bad as it sounds. How does one sustain a fracture on ceramic?

      1. Ceramic heads/liners are very hard and somewhat brittle.

        At least if the components are malpositioned it´s possible to fracture ceramics. However with modern components this is very, very rare.

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