Hip pain

[Hilltopperny]

I have started having hip pain and issues this winter. Mine is from overcompensating while my other leg and back were a wreck. I have not reached the point of going to the ortho and having it checked out yet.

My wife's grandmother has had two rounds of hip replacement surgery as has her uncle. Grandmother had the second one done at 93 and was up and walking the same day. Uncle had his done at 72 and is still running regularly in the local running club. Neither regret it and recommend having it done.

Sent from my SM-S127DL using Tapatalk

[paredown]

My $.02 -- since you have tackled diet -- would be to see if you can do guided physio to strengthen and relieve the discomfort.

And in related "news" -- a friend who did just go through hip surgery (and is recovering brilliantly) discovered that unbeknownst to him, his Apple phone had been monitoring the steadiness of his gait. What was amazing was to look at the time series -- you could see the point last summer where his gait steadiness dramatically started to deteriorate (he was in pain by that point and that escalated his determination to not postpone surgery any longer).

Just as interesting though was to see the graphics other side of surgery--the improvement through his first bouts of rehab, then slow improvement as he continued to do his exercises, to where he now. His gait is pretty much rock steady at a higher level than it was when he first got the new phone.

It was not so much that it was new information, but it was really remarkable to see the time series and the graphic representation of the point where he decided to 'get 'er done'.

Apple deets here: https://support.apple.com/guide/ipho...hff1bf03ed/ios

[dcama5]

Lavi, sorry to hear about the hip, but you're right, it's a fairly common thing. I also agree that no orthopedic surgeon is going to do hip replacement on a 51 year old that has pain while riding a road bike with super long drop.

I had a cortisone injection in my right hip about a year and a half ago and I now take Meloxicam daily. This is a NSAID that is used specifically for arthritis-related joint issues. Celebrex is another.

The procedure for the cortisone injection involves a very long needle (as you might expect) to get into the hip joint. They go in from the front of the leg below the hip and they use ultrasound to guide the needle. Once in place, they connect a syringe and push lidocaine as a numbing agent. They leave the needle in place, disconnect that syringe, and connect another syringe with the cortisone and push that. It's actually not too bad.

My injection lasted well for over a year but I am starting to have issues again. That's still pretty good because I workout in a gym about five days/week with pushing a weighted sled and doing leg presses. My wife and I also do 40-50 mile road rides in season.

I am now 70 years old and would get the cortisone injection again, but would only get a hip replacement if I could no longer ride, workout, or walk.

[biker72]

Originally Posted by rnhood

I don't think any reputable ortho doctor will recommend hip surgery with only slight hip dysplasia and early mild arthritis. More than likely there is something else at play.

Agreed. Good luck getting your insurance to approve the surgery.

Surgery would be my last choice. Lots of good therapists out there that can do wonders. I went through an extensive rehab after my fractured hip. Mine was repaired and not replaced.

[Gasman1440]

How old when this started??

[RWL2222]

While you sort this out, have you tested different bed cushion levels? I had to switch to a pillow top to stay comfortable at 50. Made a huge difference as a side sleeper.

[robt57]

Originally Posted by ERK55

100% agree with this.

I also agree. Especially with folks under 60. Wife with pretty severe dyspepsia was put off until 56 for first, and second quicker 2 years later. I have the Bionic Woman theme music for her ring tone...

The shots worked once, and waste of time and deductible twice after initial treatment, FWIW.

[numberSix]

Originally Posted by lavi

. I wouldn't really mind except that it's now starting to creep into my cycling. I cannot ride too much drop or it starts flaring. If I try to get really low, that bugs it. .

I know you’re mostly asking for medical feedback, but the above indicates opening your hip angle might get you some relief.

An up-and-forward saddle position, and/or midfoot cleat position might be a big improvement. Shorter cranks also works but sometimes the abbreviated leg motion is more difficult to adapt.

From a medical standpoint also consider if you tilt your pelvis or sit flat and roll your lower back. There might be a sciatic nerve component to the discomfort.

[soulspinner]

I had a full hip replacement. Could not believe how well it went. I had a slipped epiphysis while young and it was pinned. Second surgery removed pins.. Finally 6 years ago it got bad and my legs went from 22 millimeters difference to none with the surgery. Doc said we cant do it better than this.

[robt57]

For the thread, most recent hip replacement procedure is the
Direct Superior Approach. [write it down] It has a few advantages over prior methods, equating to being ambulatory almost immediately. I had her [with Dr. blessing] on stationary trainer with a Mixte on day 3. No load, just mobility PT, no PT otherwise. Where as the first replacement she went 3 visits for PT.

The entry incision is 3-4" depending on your size, and on the side of your buttock mid way. Under most under garments.

My wife is a 25+ year surgical tech, and only after assisting on this procedure did she aggressively pursue seeing the Dr. she deemed best at it which she had assisted.

We have several friend referred that have had the procedure either one of both.

If you are in PDX, PM me for Dr. name if you desire. Wife has assisted in these in high numbers. Both procedure and this Dr. are superlative in the scheme of things.

[einreb]

I'll speak specifically to my experience with hip surgery and an implanted device. My situation is/was different in that I had a hip disease as a child and balanced putting off the surgery for as long as possible but wanting at some point to live pain free. Prior to my hip surgery 12 years ago at the age of 40 I had run marathons, raced bikes (poorly) etc but worked to manage the pain in various ways to put it off as long as possible. I'm an engineer by training and have issues in overanalyzing things so spending years researching surgeons and devices was both a blessing and a curse for the way my brain is wired.

Consider understanding the history of hip replacements and the impact of that on today's devices and surgeons. There were many different types of devices and attempts at solutions. For quite a long time the solution was a 'small ball' metal bearing and a polyethylene socket. These were generally easy to install and appropriate for elderly and inactive people. There were attempts to have younger folks use them and be active (Bo Jackson) but they were prone to wearing out, dislocation, etc.

I think it was in the early 90's that a different approach was tried. This is/was referred to as 'hip resurfacing' and essentially involved capping the ball of the hip with a metal bearing and then putting a metal acetabular component in the socket as a 'metal on metal' bearing replacement. This was improved on over time and eventually made its way to the US in the early 2000's. This is what Floyd Landis got following his hip fracture and avascular necrosis. This caught my eye and I started following it as a possible future option.

In the 2000's hip resurfacing really started to pick up as a potential option for younger folks. The long term data looked *really* good, full return to running, impact activities etc. However, the surgery is more complicated, there were some bad device designs that had bad press... so there was some pushback to this as the perfect solution.

That being said, metal on metal hip resurfacing is the route that I went. I live in Chicago and narrowed my surgeon options to ones in Madison WI, South Carolina, NYC and Belgium. Note we had plenty of *good* surgeons in Chicago but I'm really picky. I was also trying to balance the latest device technology with the longest track record. I went with a surgeon in South Carolina that was methodical in tracking success/failures and very public with that information. Last I looked, his failure rate at 14 years is < 1% and the failure curve is very flat. i.e. if the initial year goes well the long term viability is really good.

12 years out I'm pain free, do 3-5 mile runs, ride, still occasionally race bikes (poorly), etc.

Currently I think there are much better full hip replacement options than I had back in 2010. Now improved large ball ceramic, cross linked polyethylene, etc have shown promising results. That being said, I suspect I'd go the same route if I had to do it over again with what is available today since the long term data is fantastic and the results for me were good. Both components are connected to the bone in compression, there is more bone left in the surgery if a revision needed to be done, etc

People facing some sort of implant surgery may approach it completely differently... getting some sort of local referral and putting their faith in that decision. If you do want to dig into it more, I'd nudge the following:

• Research surgeons and if your finances allow, consider those that are not local. I flew home 3 days after surgery. Not horrible and allowed me to have access to what I had determined as the best option for me.
• Understand the devices, approaches and possible limitations of those combinations. You may hear that X approach or device is best, but you want the surgeon to be very experienced in that approach and device.
• Minimally invasive sounds good but if the scar is 1" longer and the recovery is 1 day different and the benefit is the surgeon having better visibility to the work that needs to be done it is worth the bigger incision. My incision is <4" but at this point it makes no difference in performance.
• consider other patient success stories, surgeon history, hard documented results etc.

No matter what people say, this is serious carpentry and should not be taken lightly. However, limiting activities and living with chronic pain sucks. At some point surgery may make sense.

[B4_Ford]

I injured my hip about 3 years ago at age 48. I’ve experienced chronic and at times severe pain ever since. This spring is better than the past few, I’m actually going to be riding a century in a few months. Last year the longest ride I could manage was about 40 miles. I’m telling myself that it’s better because I’m exercising more. It’s more of a dull ache as opposed to the wince-inducing pain causing me to walk with a limp. I’ll be 52 this year. Far too young in my own mind to consider surgery but if it gets bad again, I’ll be seeing a specialist.


I have bad ideas…

[PortlyPuncheur]

Lavi, I'm sorry it's happening to you. Didn't you just take delivery of an Argonaut? Talk about terrible timing.

At 46, I think I'm in a similar boat to you. Went in dreading that I had a torn labrum, but x-rays showed significant arthritic changes with cam and pincer deformities causing femoral acetabular impingement (FAI). My understanding is that any arthritis basically makes one a poor candidate for the less invasive surgeries, and hip replacement comes in to play earlier.

I'm still trying to put it off for a while, it's been about 2.5 years now. Physical therapy helped me an awful lot. I can still feel it, but frankly I feel it less on the bike than many other places. I also changed to 160mm cranks. Between the PT and the cranks, I haven't needed to make any changes at the front end of the bike (yet).

Wish you the best of luck.

[2metalhips]

I had bi lateral Birmingham resurfacing (BHR) in 2009 at the age of 56, both done the same day. I had serious pain for years, barely able to walk around the block, had to basically lay the bike down to get on and off, lots of problems sleeping. I never tried any injections. Had 2 opinions that agreed that THR was necessary. Right hip was worse, bone on bone, the left was right behind, hence the decision to both at once, one recovery/rehab. I went with the BHR because it is better suited for athletes, many hockey players, MMA, tennis pros (Andy Murray), etc. It is bone conserving, the top of the femur is not cut off, it is shaped and covered with a metal cap. The recovery and rehab is similar to a THR, but the choice of surgeon is very important. It is a more challenging procedure for the surgeon, so there are much fewer doing it. Dr Su at the HSS in NYC is famous for his clientele and expertise, he also trained my surgeon. I am now 70 yo and it was one of the better decisions of my life, ride road, gravel and mtb, weight train, no issues or pain. I truly expect these implants to last the rest of my life barring crashing and serious injury. Only a surgeon can determine when you are ready for surgery or something less invasive. Good luck.

[sparky33]

Originally Posted by Ken Robb

OTOH I have had several pals get total hip replacements and they all had very rapid recoveries and wished they had done it sooner.

Originally Posted by rnhood

I don't think any reputable ortho doctor will recommend hip surgery with only slight hip dysplasia and early mild arthritis. More than likely there is something else at play.

True and true.

I had a total hip replacement at age ~36 because I had zero cartilage and bone-bone contact in my left hip. Replacement was the only option. I do not run anymore but can bike as much as I like... I can do 90% of what I used to with some limitations in my range of motion. Stretching and fitness is key to a good outcome.

If you exhaust less invasive options, find a surgeon who does total hip replacements many times each week and shows consistently excellent outcomes.