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Thread: A Guide to Getting and Recovering from a Hip Replacement | Matt Lorig

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    Default A Guide to Getting and Recovering from a Hip Replacement | Matt Lorig

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    I hate to be the bearer of bad news, but if you have worn through the cartilage in one of your hips, the only solution is to get a hip replacement. On the plus side, most people that get a hip replacement can return to full activities (including heavy lifting) after a roughly six-month recovery period.

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    Thanks for this article. I'm in the midst of trying to figure out a hip replacement option for my elderly Mom and this was helpful.

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    Thank you for the article.

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    This is a timely article as I may be looking at one. I'll find out in a few weeks. Thanks.

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    Hello,

    Matt Lorig’s article is especially interesting to me as I underwent total hip resurfacing in September of last year. There is a lot of information and misinformation out there and American doctors aren’t always the most knowledgeable about hip resurfacing, for good and bad reasons. I hope that by telling my story I can just share with others, but also highlight some spots to amplify or where I disagree with Matt.

    First, I must say, the beginning contention “if you have worn through the cartilage in one of your hips, the only solution is to get a hip replacement” is just not really true. I saw doctors who advised no surgery of any kind despite the fact that I had suffered through significant pain and end-stage osteoarthritis for several years. The fact that I had suffered through it as long as I had is proof positive that you do not need surgery of any kind – you will not die from osteoarthritis, chewed up cartilage, and wicked bone spurs. You can choose to modify your activity and manage the pain. I obviously decided this was not right for me. Similar to Matt, I’m a 40-something active male, and I didn’t want to give up on all those activities, simply manage pain, and senesce.If I was going to have hip replacement at all, hip surfacing seemed obviously the way to go for me. But that was very much to do with the particularities of where I am in life and the risks I am willing to take in exchange for potential benefit.

    It seems implicit to the article that, once surgery is decided on, hip resurfacing is obviously better than the standard total hip replacement. Again, I opted for resurfacing so my choice here is clear. But I think resurfacing really only makes sense with today’s technology and understanding for a relatively small set of surgical candidates, and even then it is not obvious what the right choice is. You really have to think about where you are in life, the risks and benefits, and the knowns and unknowns. These things should be thought of as probabilities, and hip resurfacing has a lot more uncertainty relative to the standard total hip or no surgery at all.

    An unmentioned major disadvantage of the hip resurfacing vs total hip replacement is the lack of American data. A previous hip resurfacing implant was recalled in the late 90s/early 2000s, effectively ending hip resurfacing in the US for a long time (insurance and reimbursement rates to doctors also discourage hip resurfacing). The web is full of scary articles about it, and lawsuits are ongoing. The upshot being that not many American doctors do it and so again, not much data or local knowledge. Many American doctors still trot out all that scary stuff, not seeming to understand the current state. Most data come from Europe and Australia, and South Africa if I recall correctly, and most of these data accompany new implants starting around the early 2000s. I have the cobalt-alloyed Birmingham hip replacement, which is the hip resurfacing implant most commonly used today.

    The lack of data makes it hard to get your head around another major potential advantage of resurfacing: longer implant life. If you are a 45-yr old active male who expects to live long, the 20-25-year average life of a normal total hip replacement sets you up for multiple hip replacements through your life, each surgery taking more and more bone stock. This goes back to the first advantage Matt lists: even if your hip resurfacing has to be replaced on the same schedule as the total hip, you have more bone left (one surgeon who advised against surgery didn’t think it would really work this well in practice – again, data limitations). In any event, the lack of data hurts here – total hip replacements have been done for decades and have lots of data (“surgery of the century” per the Lancet). Modeling of how many “cycles” a resurfaced hip can survive vs a total hip, and some experience, suggest a resurfaced hip will last longer. But while the data may not be there yet, it was an important part of why I chose what I did.

    Hence, the usual patient for total resurfacing is a younger active male above a certain bodyweight – all pointing to good bone stock as Matt mentions, a good reason to try harder for a “truer” hip that might allow for greater return to activity as Matt also mentions, and better long-term results. But the average hip replacement comes at ~67 years of age, and for such a candidate, the normal hip replacement probably makes more sense. All of the preceding paragraphs are to say that hip resurfacing is not obviously better than the traditional surgery (or no surgery at all) for everyone, and that for good reason traditional hip replacement will likely be the predominant form of surgery for quite some time.

    My recovery has not been as fast as Matt’s, in part because I have been advised not to chase full recovery as aggressively in the first year, but also because I seem to view the problem differently from Matt. One disadvantage of hip resurfacing is the need to actually cut through muscle in the surgery. Weirdly, what seems like a less invasive surgery requires more deft maneuvering and the need to cut more tissue. This is part of why having an experienced surgeon matters. In any event, paired with the lack of data, recovery is generally slower than with total hip replacements, which typically have no need to cut through muscle at all (harkening back to “which surgery is best?”).

    My surgeon’s guidance restricts lifting anything beyond 135lbs for 1 year. This is obviously an arbitrary weight limit (my unimpressive pr squat and dl is 340 and 365) and just kind of weird. But abiding by it for me is not an issue. I can still squat and deadlift, and just recently power cleaned. Eventually I will do more, but the game here is about longevity of the implant and my hip. The evidence is that using what folks around here might make fun of as low (no?) quality recovery techniques can collapse the risk of femoral neck (not head) fracture to essentially zero after 1-year (empirically the risk of fracture is reduced greatly by 6-mos, but essentially the background rate after 1-yr). Considering how near-disastrous fracture is, I am happy to go slower and make sure the long-game works out. Because the decision to undergo hip resurfacing really is about the long game. And after 1-yr, the restrictions come off entirely. My surgeon has no issue with any activities including squatting and deadlifting.

    In any event, my recovery first focused on just recovering from the surgery – silly exercises to slowly get back ROM, deal with pain, and avoid blood clots. That kind of thing. Then, walking was really the best thing I could do. Daily stretching, the usual PT, all helped and I slowly got back to squats/deads. The right point of comparison is hard here, but honestly, I think the best thing for my hip has just been using it, and using it normally which admittedly includes squatting and deadlifting. But the real point is it will just improve on its own if you let it. Which is all to say that Matt’s claim that you should “absolutely be squatting and/or deadlifting after getting your hip replaced” or is really untested hypothesis. And an important point is that the science doesn’t really understand why the femoral neck is at risk, although they have reasoned guesses. It seems reasonable to believe that the normal bone adaptations driven by lifting could help the bone recover, but only if you make assumptions as to what the underlying problem is. What we know is that the more conservative approach recommended by my surgeon works quite well after one year, and what we think is that squatting and deadlifting can work better. Personally, I think lifting will help, but am more cautious about my own lifts or advising it for others.

    All that said, I am still grappling with my decision 8-months in. I am happy with my strength level and almost have full ROM back. I can tie my own shoe again! I recently took a walking-intensive trip that I definitively could not have done a year ago. My daily pain is gone, and I am confident that the only thing between me and sports and that 315 squat is time and effort. But, I have discovered that I am allergic to the cobalt in my implant. Given the alloy nature of most implants, there is a good chance I would have had the same reaction to a more standard total hip replacement implant, but it’s really an unknown. The data for this is basically zero, and I am “at the forefront of medicine” here. The hope is that the allergy eventually just goes away and in the meantime I can manage with OTC medicines. But it all just highlights the hard-to-see embedded risks of surgery, and the complexity each individual faces when making a decision.

    So, that’s my story. Hopefully just hearing about another’s experience sharpens your thoughts if you are considering surgery and gives more insight as to what to expect, but I also wanted to highlight some spots where I agree with Matt and also some where I think he over-simplifies or misstates the case.

    Ben

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    starting strength coach development program
    Thanks for posting this. Well-reasoned and informative.

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