Hips--And too many years of skiing on them--Resurfacing in the forecast

This is an infomercial for you young guys to remember when your hips decide to quit on you.

Well, it started about 2 years ago on an extended trip at Powder Mountain, Snowbird and Alta. Several days of hard skiing and moderate hiking after which the hips were screaming. I've got about 40 years of skiing on them, with many other things that beat you up. Yep, I'm one of the old farts here.

My initial ortho x-rays and says you need a hip replacement. What about skiing? You're done. Not what I wanted to hear.

Fellow on patrol with me sells ortho implants. I ask him and he refers me to another ortho who skis. He knows the drill, impact of skiing on the hips, snowplows for sleds, etc. Tells me not to do a total hip, but a procedure called resurfacing. Says he can't do them right now because the FDA has recalled his implant. Shit.

Three sets of steroid injections later, I'm looking for a solution. I'm to the point that while skiing isn't any more painful than walking, but I've started to lose muscle strength because of the lack of use due to chronic pain. As such, skiing is tentative at best.

I start poking around on the interweb a few weeks ago to see if the devices have been re-approved by the FDA, and found a doc in Columbia, SC who specializes in hip resurfacing. Basically, they trim the femoral head and recover it, and do a floating socket in the hip that the bone weaves into. Unlike a total hip where they whack off the femoral head. He uses a different implant that was not recalled.

Dr. Thomas Gross. http://grossortho.com/
Has done more than anyone in the U.S. 4,300 so far.

Assuming I can get insurance squared away, looks like surgery sometime this spring. I'm leaning to the process of doing one side on Monday, next side on Wednesday and out of the hospital on Thursday or Friday. Six weeks of no driving, six month recovery. Self imposed physical therapy. Says I will be walking a mile a day in six weeks.

He asked what my long-term goal was following surgery, to which I replied skiing next December. His website shows a bunch of folks who have resumed skiing after the surgery.

I have found three folks locally who have used him for the procedure. One had it done in 2000 and 2002, is an avid outdoorsman and hiker, says it was a lifesaver. Fellow that is 18 months post surgery, 64 years old and a professional tree trimmer. Got him back in the game using climbing spikes. Wife's cousin's husband who is a veterinarian and says it is great.

Biggest concern is the metal on metal fatigue and metal leaching. Gross says if he sizes the replacement appropriately and get the alignment of the implant correct, no problems. Annual blood tests to check. The three folks that used him have had zero issues.

Waiting on a surgery date, bone density scan, and insurance bullshit.

Fingers crossed.

Ken

Best luck, sounds like he has a large number of cases and referrals. Had a friend go to a top clinic in India for it 8-9 years ago. Great for a couple years, then I believe had to go replacement. He was a climbing guide, so may have had other issues, not sure.

Resurfacing seems like a better choice over total hip if the metal leaching issues can be mitigated. But it sounds like that's a big if. That resurfacing typically allows for total hip later on if necessary is a big boon. I'll undoubtedly be in the same boat at some point. Hopefully Shredhead will chime in.

My doc doesn't do resurfacing because he says failure rate is too high. I had a total done almost 4 years ago. Had it done in April so I'd be ready for the next ski season. I've skied 50 or so days a season since I had it done. Why do you think you won't be able to ski anymore? Only things my doc wants me to avoid are running and jumping.

I have had two ortho's tell me with a total that skiing puts too much pressure on the joint causing it to dislocate. If you read Dr. Gross's literature, basically it is a function of the weight bearing surface, which is substantially less than your normal joint using a THR.

With a THR, one of my docs said no more, one said nothing but green's, maybe blues. Both said no snowplowing which severely limits my sled puling ability.

Further, studies indicate that for a THR, lifespan of the replacement for an active adult is 10-11 years. Dr. Gross says 70-80% at 8 years. With resurfacing, lifespan is around 20 years. One of the guys I talked to is on year 17 with one of his, 15 with the other.

No offense, but what I suspect is that with the metal on metal problems, most doc's can't get insurance coverage on installing the resurfacing components. Hence they steer you away. Best I can find out, there are only a handful of docs still doing them.

Hard for me to see that skiing is less risky than running or jumping. How could chopped up snow be less of an impact than running or jumping. With the resurfacing, only limit he imposes is no sky diving.

If you can find a doc that uses an anterior approach for a total hip the issues with snow plowing and posterior dislocation are greatly mitigated. A plus would be finding a doc that can do the anterior approach and who uses a large diameter femoral head prosthesis, either ceramic or metal, and a UHMWPE liner for the acetabulum(socket). I have a couple occasional ski partners with THA. One is early 60s and we hike and ski powder and funky snow frequently. Metal wear with metal on metal resurfacing is real and can be quite ugly IME. How old are you?

I had anterior. I'm a patroller too. I try to stay on the snow, but still ski bumps

Aaron, if I'm not mistaken, the metal on metal THR's have been pulled because of Stryker. Truthfully, I haven't focused on the THR's because of what I keep being told. I just hit 60. I'm probably going to stick with the resurfacing because of the folks I have talked to. Gross has the procedure down, helped Biomet design the replacement he uses, was Biomet's lead in the trials, and has a very low failure rate. His 5 year revision stats are .9% in men. Women are an entirely different story.

And my biggest concern on the THR is the longevity. All the docs I have spoken with state for an active adult, you are looking at a lifespan of 10-11 years or so on the THR.

Interesting, having seen 4 hip replacements on people I know in that last 3 years I will say that if you are healthy (and it sounds like you are) you should come away in good shape. As for the pizza I don't know but one guy is back playing hockey, on older cat is still snow boarding and gets in a kayak more than in the previous few years before replacement and the woman who had both done has seen a big bump in the quality of life and is back on xcountry skis and the dog sleds. The biggest impact that waiting it out seems to have is on compensation injuries that build as the hip degrades and that complicates recovery. Good luck mag. And if the worst thing to come of it is having to straight line with a rescue sled that ain't too bad (at least for you.)

I'm 58, four years post op Anterior Approach, large diameter ceramic. I have about 120 ski days on it and can ski relatively hard, in good conditions. Yesterday was soft and I went bell to bell, with a hike to the bowl, with the best guy in town > 50.

Most of the Doc's scared me off of BHR with the metal on metal, plus there wasn't anyone in Chicago that did the procedure.
I've since talked with lots of guys that have had it and I'd say go for it.
You can always get it redone, which is the biggest benefit of BHR IMHO.

Get in the best shape possible, prior to whichever procedure you choose. Then minimize impacts to your body, ie. don't charge in Shit Fuck conditions.

I'm retiring next year and can't wait until I can just go 2-3 hours a day and only ski good conditions.

Thanks guys. That is the benefit of BHR, it gives another option down the road.

Here is a kind of cheezy website with references to a lot of resurfacing options. http://surfacehippy.info/

Yep, I know the metal leaching is a possibility, as is revision with both procedures. It basically is a choice between two evils, neither of which are perfectg.

Bone Density Studies done this morning. Date set for May 22 and May 24.

Doc asked what was my long term goals. Ski next December.

Best of Luck!!

Try to find a PT with an in water treadmill to work on your gate. Baring that, just walking in chest deep water and doing a lot of ROM exercises in a non weight bearing environment, helped me the most.

About 30 days out.

Working through the insurance bullshit. The hospital is in network, doc is not. I've met my deductible, but surgery costs are $5,000/side. Ouch.

Good days and bad. No rhyme nor reason. Worst thing I have found is riding the lawnmower on 3 acres.

Keep running into people that have used Dr. Gross or are acquainted with him. Strange. Was at a Mets minor league game in Columbia SC watching my future SIL play. Turns out one of the other player's mom was sitting beside me. Turns out she was a tennis player with his wife. Guy on patrol ran into an ortho rep that supplies his implants. Small world. Everyone says good things with fantastic results.

Fingers crossed.

11 days and counting.

Met my doc and his team last week. Neat folks. They have this procedure dialed in. They said after two weeks, I would decide I might live. Oxycontin for pain with Hydrocodone for breakthroughs.

Bad two weeks. Fishing trip last weekend, and after being on the boat for 2 1/2 straight days, pretty rough.

I'm ready to get this done.

good luck wishing you a quick and successful recovery.

First surgery two weeks ago today, second one two weeks Wednesday.

First surgery was late in the day, and PT got me up the next morning. Wish I would have been that day, but.... Surgery went perfectly. Oxycontin, hydrocodone, and morphine injections for the pain. Second surgery went perfectly, and I was up three hours after I got out of recovery.

Both surgeries done using a spinal block. Nope, don't remember a thing. Black and blue from the top of my pelvis to my knees. Incisions about 5" long on the lateral sides of my buttocks. Small incision at the ishium on my pelvis to measure the length of my legs. He lengthened my right leg by 3.3mm.

Out of the hospital on Friday and home. Only issue I had was getting constipation from the pain meds. Got that straightened out and quit all my pain meds cold turkey the Sunday after surgery. No issues. Controlling what little pain there is with Tylenol.

No joint pain whatsoever. Gone. Sore from the surgery, but nothing excruciating. Two weeks out, and the only sore spot left are the incision lines.

I'm walking about 1/4 mile a day. Weening myself off to one crutch/cane. In two more weeks, I get to ditch it.

Today is my first day back at the office. Doubt I will make it all day, but there is stuff I need to get done.

So far, I'm a happy camper.

Attachment 207391

I'm 18 days out from the left and 16 days out from the right side. Down to a cane and walking 1/2 a mile a day. Sore from the surgery, but no joint pain. Polar care Ice wrap is a good thing.

keep it up!

Yesterday was my 9 week anniversary. Things are going great. I'm walking 3 miles a day (no impact activities yet), elliptical, been out on the boat a bunch, went offshore last week.

Still a little sore in the gluteus at times. Doing leg lift exercises to get them firing. When I first stand after sitting for a while, the left side takes a step or two to start working after which it does fine. Both joints are 100% pain free. Drove 11 hours to Florida last week, and of course, was somewhat stiff for gas and restroom breaks. But, did fine.

100% pleased with my decision at the moment. I certainly don't miss the guy with the sledgehammer that was driving the spikes into my hip joints!!

Ken

Ken,

I'm just running into this dilemma and reading this thread has been helpful. Any status update to provide or general recommendations looking back?

Thanks!

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Originally Posted by TNKen

Yesterday was my 9 week anniversary. Things are going great. I'm walking 3 miles a day (no impact activities yet), elliptical, been out on the boat a bunch, went offshore last week.

Still a little sore in the gluteus at times. Doing leg lift exercises to get them firing. When I first stand after sitting for a while, the left side takes a step or two to start working after which it does fine. Both joints are 100% pain free. Drove 11 hours to Florida last week, and of course, was somewhat stiff for gas and restroom breaks. But, did fine.

100% pleased with my decision at the moment. I certainly don't miss the guy with the sledgehammer that was driving the spikes into my hip joints!!

Ken

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I looked at resurfacing, but nobody in the Midwest had more than 200 procedures under their belt.

Since you’re are Seattle, you got nothing to lose going to see Pritchett.

I skied 165 last year and over 50 so far this year. But I kind of wish I’d had the BHR, just because I know I’ll eventually need a revision.

Unless something else gets me first, in which case, I made the right decision.

I'm 4 weeks out from a total hip replacement with Dr. Mayman at Hospital for Special Surgery (who does 700 annually) and HSS has lowest infection rate in the country. I've been hiking and even some uphill running against doctors orders it feels so good. Plan is to snowboard in September if Chile ever gets snow again.

Best public data I could find doing research was the UK registry:

http://www.njrreports.org.uk/Portals...ort%202018.pdf

Check out table 3.8 for revision rates (rate at which replacements fail and have to be redone) by age and type of implant. Ceramic on ceramic shows lowest wear rate, but overall lowest revision rate is ceramic on cross-linked polyethylene. Ceramic-on-poly failure rate for those under age 55 (me), is 5% at 14 years. For resurfacing it is closer to 11%, and for metal on metal, it is over 20%.

^ Treasure trove of information. Thanks.

Trials for CoC resurfacing started last year. Looking forward to the findings.

Well shit...

I'm 45. Not really in all that much pain, plenty of vert over the weekend, but ROM is definitely compromised. Even hardpack skiing is fine, I could go bell to bell without much trouble. That said, my first visit to a hip specialist wasn't what I thought I was going to hear. I thought I'd have a relatively straightforward bone smoothing and labral tear arthroscopic fix, but the doctor (Mei-Dan UC Health) said I was borderline too far gone for that. The only reason he would even consider it was due to my high activity level. Not sure I really want to go through that with what he described as a high level of outcome uncertainty.

So, pending 2nd and 3rd opinions (trying to get in to see Philippon at Steadman), I'm not leaning towards arthroscopy, but resurfacing instead. Mei Dan really seemed to favor sending me to Europe or Australia for ceramic, and it seems like the reports linked above support that as well. Seems crazy to pay out of pocket when I have insurance, but everything's on the table right now.

And maybe I do nothing for a while given my pain level (or is it pain tolerance). I would just need to get an keep an eye on my bone to make sure it stays strong enough for resurfacing.

Last thing, the right hip is 4-5 years behind the left in its decline. So do I get that arthroscopic surgery now? Questions, questions...

My left hip has been bothering and my rolfer asked me if I slept on my stomach with that leg bent up.
I said yeah and she said that caused hip failure.

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Originally Posted by goldenboy

So do I get that arthroscopic surgery now? Questions, questions...

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I’d get your ducks in a row as far a procedure/surgeons. Then wait as long as possible.

I went from mild groin pain at the end of ski season, to not being able to get out of the car the next February. Skiing and biking were never the problem. It was getting up afterwards , after I’d sat for a while.

I think at your age, you should definitely consider resurfacing. You can always do a THR later.

Good luck!

^^ Thanks.

Amazing all the different opinions doctors have. Philippon said he could scope me and fix me up without a resurface or THR. Then I went to a 3rd doctor locally since they do free second opinions and he agreed with Philippon's assessment. But he also didn't recommend resurfacing of any kind, only THR.

In the end, I'm starting to think, "why do anything right now?" I've always had some mild discomfort and stiff hips- I didn't really like sitting "Indian style" when I was a kid. Maybe I have another 10 years before I really have to pay my dues and get a THR. Tough call, ugh.

Random question for you.

In your skiing have you spent a lot of time hiking with your skis shouldered and if so is the failing hip the side you mostly shouldered your skis on?

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Originally Posted by Not bunion

Random question for you.

In your skiing have you spent a lot of time hiking with your skis shouldered and if so is the failing hip the side you mostly shouldered your skis on?

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Ha, nope. I don't spend much time hiking with skis shouldered (like at bridger). And when I do, it's right shoulder, but the left hip is in worse shape than the right. My hips were born to get trashed due to an imperfect shape of femur head and socket.

Got it. Friend who was at the Canyons on their SS staff claims he ruined his right hip joint hiking Murdock and shouldering his skis.

Quote:

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Originally Posted by goldenboy

Amazing all the different opinions doctors have. Philippon said he could scope me and fix me up without a resurface or THR. Then I went to a 3rd doctor locally since they do free second opinions and he agreed with Philippon's assessment. But he also didn't recommend resurfacing of any kind, only THR.

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Philippon also gives free 2nd opinions, if you fill out a questionnaire and send in your films.
I just got a voicemail from a tech, “not a candidate”. I called several times for an explanation, but never got a call back.

I thought I had more time and was planning on seeing a few more Docs. Then having a procedure in May. But the hip locked up and I had to take what was available.

My left hip THR, was the result of having right knee pain for decades. Favoring the right knee and taking hard impacts with my left hip.

I will eventually get a TKR on my right knee.
I’ve already got approved by three Docs and just have to call and schedule when it’s time.
I’ll probably go with Dr. Kim at Steadman, if everything works out.

I skied a 165 days last year and about that, so far this year. So a THR’s, not the end of the world.

Well I'm sitting here today, one week post THR. I found this thread as I was doing research prior to surgery and although I didn't post anything in the thread, I did find the comments and insights very helpful in my decision making process. Short version of the story is that I began to experience immobility and pain in early December 2018. I initially tried to work thru it with PT sessions and continued to ski in the resorts, go on backcountry treks and wrapped up with ski mountaineering trips this spring. The pain finally got too much the end of April. I scheduled the right hip x-ray and the results came back as severe osteoarthritis in the right hip. The next several weeks involved the process of selecting the surgeon and getting ready. BTW I'll be 61 in August. If anyone is interested in more of the details, I have been keeping an active account of the whole thing in my blog. http://hi-adventure.com/the-next-adventure-chapter-i/

http://hi-adventure.com/the-next-adventure-chapter-ii/


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I'm probably going to need both hips done, they told me 18 months ago I needed it on the right (they told me that when I fucked the left one up). But I'm getting around okay and no real weakness so I'm waiting on it. Left one's sore pretty much all the time, especially after sitting, but loosens up after 5 or so steps. I asked the Doc when I saw him in May when I would need it done and he said, "when you tell me it's time". So far I'm keeping on.

You definitely want resurfacing before you get to the full replacement stage whenever that is. Friends with resurfacing came back quick with much less atrophy. Full replacement is more of a crap shoot. Good surgeon can make a lot of difference it seems. Seen friends in and out with equal length legs. They gave 'r before tgey went in and came back quite quick. 2nd hip seemed quicjer and less atrophy. Not sure why. I think he said less scared to get back on tfe go after surgery. Then see others that gavs to wear the thick sole shoe. My resurfacing bud skis as always. Smooth as

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Re-surfacing is the way to go. Mine was May 2013 at 59 (Doc. Pritchett, Seattle) and was skiing just fine by the time we had snow. The re-hab time isn't long and expect 6 weeks of therapy. My Dr. had to fix a life-time of joint deformation and strange looking ball / socket that was whacked so not a typical re-surface. Do have different alignment but I completely trust it. He asked if I wanted to lengthen the affected leg to equalize them & said nah, pretty used to it and it ski's just fine. The hip may feel odd....kind of a synthetic and lacking sensation feeling but there is no better answer if it's right for you. 6 years of hard skiing and many, many tours later, hasn't done anything but improve.