Hip Replacements/Rebuild

[cammas]

Well I got the results from MRI today and had a chat with the specialist and everything to do with the hip replacement is 100% perfect, there is no bruising on the bone left from where they bashed it in and there is no muscle or ligament damage that he suspected. So I have been given the okay to ride and now have to monitor it and may have to go for some nerve testing as it may be a nerve rubbing on some bone, so more poking and prodding.

So this weekend after I get the pool set up for the kids (finally some hot weather coming our way) I will be free to get back on the bike and have some fun.:Banane32:

 

[Slowman]

G'day cammas,

I've worked in out patient rehab for many years and rehab'd a few hundred hips and a lot more knees, I am also coming towards the end of a PhD which I am investigating improving outcomes following joint replacement.

I think that waiting until the last possible point to have the replacement is a bad choice, have it ASAP.

Why? the longer you wait the worse off you are for several reasons, you'll have significant alterations to your gait pattern, typically with the contra lateral limb excessively loaded, this results in a very high chance of developing osteoarthritis in that leg, particularly the knee.

Secondly, pain is a noxious stimulus for the body, it results in the inhibition of muscle activation, so your brain effectively stops using those muscles around the area where the pain is, resulting in the above point. But more importantly it is a bilateral effect, both legs are inhibited, not just the bad hip. This again compounds with the above point, your 'good' leg is under increased loading, but at the same time it is getting weaker.

lastly the longer you wait the more muscle mass you will lose (and overall fitness, health and quality of life), muscle mass is not easy to recover, having the surgery early will reduce the rehab times and get you back you your life and hobbies faster.

Depending on the surgical approach and the surgeons requirements, hip flexon of over 90 degrees is a commonly not allowed as it as a high chance of dislocation, this normally lasts for 3-6 months, sometimes longer. It just depends on what the surgeon states. If this is the case you must not ride a bike in this period! Ask the surgeon upfront, he'll/she'll know best.

Overall, hip replacement surgery is excellent, not particularly painful and being young you should be in the top 5% for recovery time and function post replacement - six months is the standard time, and most older folk pretty much completely plateau at around this period, a young man doing some serious rehab, especially gym based resistance could do a lot better a lot quicker.

. My father had a bilateral hip replacements 30 years ago, cemented approach, has not had a problem since, they'll last him until he carks it.

All of this contains good advice! When people come to me that is pretty much my advice - the sooner the better. Get on and start living pain free as soon as you can.

One thing I would have done differently though I have not read through the whole thread yet is whether you were contra-indicated for a Birmingham hip resurfacing (BHR). Maybe the 3 breaks caused some bone density or other structural problems.

I recently had a BHR in June 2011 and had to go 6 months without hyper-flexion (more than 90deg) of the hip. Cycling was OK but surfing and a range of sexual positions were out! My history dates back to 02/09/1993 when I had a cycling accident and crashed badly coming down Waterfall Hill. If they had the BHR back then I would have had it but they only had THR (Total Hip Replacements) and I still wanted to run. So at the end of 1994/new year 1995 I had the first of 2 high femoral osteotomies - believe this is an operation that doesn't tickle. 10 days recovery in hospital to give you an idea, relying on nurses to wipe your backside in the very early days - leave your dignity at the door.

I went on to do lots of triathlons, lots of long course and a few ironmans and finally needed to get it resurfaced around 2004 but not before one last painful IM. The specialist gave me the news if I wanted the full range of movement back the osteotomy had restricted I'd need another one to reverse that before the BHR. "Oh dear God!"
I thought but after the hardest and most painful race I'd ever done I figured I could hack it. 2005 I had a revision osteotomy which restored leg length equality (so I was higher again!) and even the joint space, which was very unexpected. Joint space or space between the joint is good it means there is cartilage there keeping the bones apart. I had been taking lots of glucosamine and chondroitin sulphate since the first operation and yes some fibrous cartilage had regrown and repaired the surfaces. The specialist could see that once we finally did the BHR. Fibrous cartilage is OK maybe to fill in some little holes in the joint surfaces but not large areas. It will wear quickly and it did. You need what is called hyaline cartilage for articular joint surfaces. It's very tough and polished.

So finally in 2011 I had the BHR and have been pretty much pain free since. One thing I learned throughout this process, 5 operations in all, counting the removal of screws and plates and rods, was patience.

After each of the major operations it took me roughly 18 months to 2 years to get back to my previous level of sports performance mediocrity There were even some set backs which put me back on crutches - a little bit of the 2 steps forward 1 step back at times. In some ways I was to blame. I hit the bike so hard in one instance and over developed my ITB too quickly and it pulled the patella out of alignment and it impinged on the fat pad. I thought I had experienced severe pain, and I had, but it was severe deep sustained pain. The kind of deep throbbing kind, this was different it was excrutiating, instantly crippling pain. It happened to me at work and fortunately a guy in the car park could see I was in trouble and helped me to my car. There were a whole lot of things going on in my leg my muscles had to stretch to the new length femur and I was asking too much too soon and after 2 weeks back on crutches I realised I had to just be patient. I could still ride but hard training had to be backed off a couple of notches. I did more stretching and had to go to my physio to get me knee taped in special patterns to help keep the patella in alignment.

Remember, your muscles have been pulling in all sorts of bad ways for a while to compensate for the pain, so you have to do it at a rate that allows everything to readjust. It is the same as being fit and doing a days work of renovations on the house and discovering soreness in muscles you thought you never had. Different movements require time to adapt. Hopefully you are working with a physio that can diagnose all these little issues and give you exercises to correct these along the way.

 

[cammas]

Remember, your muscles have been pulling in all sorts of bad ways for a while to compensate for the pain, so you have to do it at a rate that allows everything to readjust. It is the same as being fit and doing a days work of renovations on the house and discovering soreness in muscles you thought you never had. Different movements require time to adapt. Hopefully you are working with a physio that can diagnose all these little issues and give you exercises to correct these along the way.

Yes certainly has been a learning curve it took a while for me to get use to having two legs the same length, I had to change my runners and work boots due to wear patterns on them and that made a big difference for normal day to day stuff. As for fitness on the bike it is bit frustrating trying to get back to where I was but I am getting there I lost a chunk of weight that I had put on and still more to go. My GP has suggested some acupuncture to help get some of the muscles to relax and get things back into shape so that begins next week.

I am hoping to get back into shape and trying to line up my first event in April ( that will 1 year on) as I am going to give racing some marathons and doing some 6hr solos again, going to start out small and hopefully do the 50 at the Wombat as I have always had something on or been out injured when its been on. Looking to sell my Tallboy LTa by then and hopefully buy something a bit more suited to the task but one step at a time and spending little bit of time on the road bike as well to help as I don't push as hard on that (a little boring) and it seems to be helping.

 

[Slowman]

Hi Cammas, I should add the 2 hi-femoral osteotomies changed my leg length too. The first made my right leg shorter by about 2cm and the 2nd made it same length as the left. Initially the right leg was longer by about 12mm. I was doing a lot of running back then (50-80km/week) and so I also had some other adjustment issues too with the sacroiliac joint and some pain. Sometimes the muscles would go into spasm. I'd bend over to pick something up and JESUS CHRIST my back would just go. I got very good and detecting the very early signs and would straighten up immediately.

If I didn't catch it in time it would take a 3-4 days to get better. Hopefully, you aren't running and so it probably won't become an issue. At least I think in my case running made it seem more likely. After the revision osteotomy I backed off running for a while and it seemed to help reduce the number of incidents and their severity. I remember one holiday up at Forster with my daughters I pinged my back then I managed to crack a rib, of a morning I couldn't pull myself up by either side (the spasm was on one side and cracked rib on the other). I had to roll out of bed onto the floor in a push up position and get up like that. Lucky it was a holiday and I wore thongs, putting shoes and socks on was a killer!

Strangely I found riding my bike good for it, unless I tried to lean over and put it in the back of the car, without bracing myself so my back wasn't taking the load. Anyway just be careful and be on the look out for it. The first time it caught me unaware. Swiss ball exercises always helped too, they are also very good to help prevent it too according to my physio.

 

[fourbyphil]

G'day cammas,

I've worked in out patient rehab for many years and rehab'd a few hundred hips and a lot more knees, I am also coming towards the end of a PhD which I am investigating improving outcomes following joint replacement.

I think that waiting until the last possible point to have the replacement is a bad choice, have it ASAP.

Why? the longer you wait the worse off you are for several reasons, you'll have significant alterations to your gait pattern, typically with the contra lateral limb excessively loaded, this results in a very high chance of developing osteoarthritis in that leg, particularly the knee.

Secondly, pain is a noxious stimulus for the body, it results in the inhibition of muscle activation, so your brain effectively stops using those muscles around the area where the pain is, resulting in the above point. But more importantly it is a bilateral effect, both legs are inhibited, not just the bad hip. This again compounds with the above point, your 'good' leg is under increased loading, but at the same time it is getting weaker.

lastly the longer you wait the more muscle mass you will lose (and overall fitness, health and quality of life), muscle mass is not easy to recover, having the surgery early will reduce the rehab times and get you back you your life and hobbies faster.

Depending on the surgical approach and the surgeons requirements, hip flexon of over 90 degrees is a commonly not allowed as it as a high chance of dislocation, this normally lasts for 3-6 months, sometimes longer. It just depends on what the surgeon states. If this is the case you must not ride a bike in this period! Ask the surgeon upfront, he'll/she'll know best.

Overall, hip replacement surgery is excellent, not particularly painful and being young you should be in the top 5% for recovery time and function post replacement - six months is the standard time, and most older folk pretty much completely plateau at around this period, a young man doing some serious rehab, especially gym based resistance could do a lot better a lot quicker.

. My father had a bilateral hip replacements 30 years ago, cemented approach, has not had a problem since, they'll last him until he carks it.

I would agree with all of this,

short story is I have bone dysplasia, hips started going from about 20 and could hardly move by about 28, in that time I lost all my fitness, gained weight etc. at 28 had both hips totally replaced and have never looked back. only regret is that i didn't get it done sooner.

now (31) out riding three times a week with no pain and slowly clawing back my fitness.

 

[cammas]

Well I have seen my acupuncturist a couple of times now and we have had some good conversations in regards to my recovery and in his books it will be easy going. The only thing is it will take a little longer as it has being going on so long as I should of seen him earlier but it at least I'm on the right path now. Now its just a matter of training and getting fit again, hit the road bike today but bombed a bit the strong winds wrecked me today.

 

[cammas]

Time for a bit of a grave dig and an update.

Just completed my first 6 hour solo since the replacement at Victorian Enduro Series on the single speed, I did not have the ideal form coming into it with have the flu/cold for the last two weeks and still do, so unable to do any decent riding for the last two weeks. I hit my goal of more than 100 kilometers in the 6 hours by clocking up 112klms, I hit a low patch between the 4 to 5 hour mark and had take a breather for 10 or so minutes, it was good to sit in transition and have a chat with a mate it re-motivated me.

So in the end I did 112 kays in 6 hours and 5 minutes with a riding time of 5 hours 50 minutes, considering the lead in to this I am pretty happy with the results who knows if I did not get the flu/cold my results may have been better as they say there is always next time. As for the hip a not an issue at all, it is a little sore but that is due to washing out on a corner and corking it with a little gravel rash just happen to fall on that side so just coincidence.

Considering doing the Forrest 6 hour in two weeks and then round 2 of the state series in 4 weeks but first I have to break this flu/cold what ever it is.

 

[Slowman]

Good to hear things are progressing Cammas.

Currently I am rehabilitating after removal of bony growths (exastoses) in ear canal due to surfer's ear so for a week or so I won't be doing much except keyboard exercises!