Hip replacement tuned to rowing?

[EllenB]

I'm an ex-college athlete who rediscovered rowing a couple of years ago. I spend time OTW in a 1x and get both undeniable joy and the challenge of an infinite learning curve from rowing. And I erg, at first as a way to stay fit when I can't get in a boat but more recently for its own sake (including when gently badgered by challenge team buddies). I've come to regard rowing as nearly perfect exercise.

But, I have osteoarthritis in one hip -- oddly enough I can row without significant limitations but am starting to have difficulty walking any distance. Based on consultation with hip surgeon, my goal is to hold off the replacement a little longer, which probably translates to 4-12 months. In the meantime, I'm ESPECIALLY interested in whether rowers who have gotten hip replacements by rowing-literate surgeons had their implant's socket position tuned to help their rowing or any other techniques to aid rowing + general quality of life. My surgeon is aware of how to tune socket position for other lifetime sports; I'd like to connect her with another surgeon or two with expertise specific to rowing.

Earlier c2 forum postings indicate:
- hip replacements in mid- to late-50s work well,
- erging to rehab seems quite effective even though surgeons are not all on that same page,
- larger sized ball-socket total hip implements work best for erging,
- it is possible to regain almost full range of motion (angle of thigh relative to trunk), and,
- Of course, c2 forum insights can't replace expertise of physicians and individual consultation.

New or updated insights on prep, the surgery itself or rehab afterwards would also be appreciated.

[jamesg]

I have osteoarthritis in one hip -- oddly enough I can row without significant limitations but am starting to have difficulty walking any distance.

That's what I found too, both before and after one-side replacement. My implant has given me no permanent angular limits, afloat, or on erg/bike.

It would seem that for hips the most severe application is walking, at least from an engineering point of view: the load is heavy, one leg at a time and no seat, and the rotation small, which perhaps limits lubrication.

[lindsayh]

Earlier c2 forum postings indicate:
- hip replacements in mid- to late-50s work well,
- erging to rehab seems quite effective even though surgeons are not all on that same page,
- larger sized ball-socket total hip implements work best for erging,
- it is possible to regain almost full range of motion (angle of thigh relative to trunk), and,
- Of course, c2 forum insights can't replace expertise of physicians and individual consultation.

New or updated insights on prep, the surgery itself or rehab afterwards would also be appreciated.

Have you searched this site? I think there maybe some threads already.
There are 3 THR ergers that I am aware of who I am pretty sure wouldn't mind helping:
Jim Grattan (cyclingman) on this Forum who set WRs after his a few years ago - you could PM him from here - he logs a lot on training threads.
Susan Young (Two Pudding Kid) from Sub7 team who posts here on the Teams sub forum with Sub7 who is still rehabbing hers and seems to be doing really well.
Richard Steventon had his Jan '18 and I know went into a lot of thought about surgical approach and the like to help get back OTE. You could find him via the FB page of "The Diamonds" IRC
best of luck

[Cyclingman1]

Hopefully, I can shed a little light.

I've had two hip replacements [2013 (L), 2018 (R)] after I started erging in 2012 with two different doctors. Both were aware I was an athlete. As far as special measures - maybe. I wish I could say exactly the product that was used. I do know that the materials and the size were consistent with someone who was going to be active. I recall some combination of titanium and ceramics.

My replacements were done from the anterior approach, which is considered better in terms of possible dislocation in the months after surgery. Recovery was different each time. There will be swelling and undoubtedly a walker will have to be used for 1-2 weeks. And then easy recovery walks. Strengthening exercises should be done. Perhaps PT can help, although I ignored PT.

My first THR went really well. Within a couple of weeks I was erging and pretty much back to normal after a few more weeks. I had little down time, so regaining strength was not an issue. I have full range of motion and use a full stroke on the erg. I spent one night in the hospital each time. Also, my doctors got the leg length issue correct - sometimes they don't.

The 2nd THR is more complicated. I had back surgery a few months before with complications. Even after the THR, I still had those complications, though I can say that the THR went OK. Because I had so much down time from the back and THR, I lost a lot of strength in legs, etc. This time I started erging 4 months after THR and have gotten back to maybe 80% of where I was. Being strong before THR is a huge factor in how fast one can recover.

Last thing to say is that everyone will react differently to THR. Don't listen to stories about people dancing two weeks after surgery. First, they're probably being inaccurate, and, if not, they are one in a thousand.

JimG

[georgie]

Last thing to say is that everyone will react differently to THR. Don't listen to stories about people dancing two weeks after surgery. First, they're probably being inaccurate, and, if not, they are one in a thousand.

JimG

Ellen, I am so sorry for not replying to the mail you sent some 5 weeks ago. It completely slipped my mind, and I will remedy that today.
Jim points out that every outcome can be very different. A lady who had the op. the same day as me was walking quite normally without the aid of crutches or stick within a couple of weeks. My recovery and outcome was quite different.
Georgina

[loblaw]

I'm an orthopaedic surgeon-rower who does hip replacements. There's not much I can imagine doing with the position of the cup really specific to rowing. Physiologically the cup is tilted laterally about 45 degrees and anteriorly (anteverted) about 15 degrees and that's where you want it. The risk with rowing is potentially a posterior dislocation because of the hip flexion so you could theoretically antevert it more but then you risk an anterior dislocation getting out of a car or something. When you row there isn't really a posteriorly directed force either so I don't think it's an issue.

There are three main approaches for hip replacement: anterior, lateral, and posterior. I do anterior and lateral. At the end of the day, the literature shows they all do the same. Anterior has quickest recovery and low dislocation rate but more likely to have wound issues because the incision is near the groin and more likely to have fractured femur intraoperatively. Lateral detaches some of gluteus medius and minimus so you have a limp for a while (longest recovery) and sometimes some lateral pain but dislocation rate very low. Posterior has a reasonable recovery and less limp but dislocation rate is slightly higher. All three have about 95% good to excellent results with a few people having problems with all approaches.

If there was one thing I'd tell the surgeon maybe it would be that, if they do a posterior apporach, not to retrovert (angle less than 15 degrees) the cup. The materials used now are so good though that we can use very big heads so dislocations are very rare. Someimes the cup goes in a little bit neutral (or the patients version is naturally more neutral) so if it goes in like that easily and feels stable I wouldn't change it but maybe if it was a rower I would make sure it was 15 degrees anteverted.

Good luck, hope that helps! I'd also add that I won the Head of The Charles in the 40+ eight a few years ago with a guy who has a hip replacement and we finished ahead of Matthew Pinsent!

[EllenB]

First, thanks to all for the insights. When I widened my search terms AND did searches from within the c2 forum I was able to find more relevant content than when I did external searches via google. I've also gotten the benefit from experiences shared by a couple of rowers via private messaging. Happily, I understand that replacement joints can handle virtually unlimited meters of rowing. And that through enough rehab and patience, most rowers are able to get to a decent catch angle OTW and on an erg.

Next, the details from loblaw are exactly what I was looking for. I am very grateful for such a community of rowers. Some additional info: the surgeon I've chosen usually uses an anterior approach and does relatively high of volume of hip replacements (around 300 each year out of about 300k total hip replacements/ year in the US). She reported using a minor tweak to the position of the socket to give a biomechanics benefit to lifelong horseback riders but was not aware of any similar tuning for rowers.

Another issue (that motivates some thorough prep) is that my brother had a hip replacement about a month ago and subsequently dislocated it (day 2 at home). Partly as a response to that situation, many of my questions for the surgeons whom I checked out were focused on risk management and how rigorously they avoid complications.

[Priaptor]

I'm a physician who recently had my right hip done. I had "ignored" it for close to 4 years. I was an avid runner and was on my way to breaking my personal 5 k times when I felt something in my right hip. Took some time off but couldn't back on stride and started rowing. The hip progressed to the point I couldn't even get into my car so I knew it was time. I had it done on November 12th.

I am 66 and will give my personal, not medical opinions, although my medical knowledge did go into my personal opinions and decision.

I was initially going to go back to where I trained in Hospital for Special Surgery to have it done, where they are rated #1 in the USA BUT decided it was too much of a pain and I wasn't choosing to get "hip resurfacing" which is a whole different discussion so for a routine THR local was just fine, assuming I could find someone I liked. For me I found the surgeon I thought was great, loved his perception on THR and his staff was awesome. He has stopped using the anterior approach and the "approach" IMHO is less important than the ultimate results. He believes he gets better placement using a posterior approach. You can do your research as to the type of prosthesis, metal/ceramic/combination, etc but ultimately the skill set of your surgeon is the most important. The robotic stuff and pre-planning CT stuff from my perch is not as important as if you need a total knee.

My surgeon has a device he uses during surgery to ensure as close as he can leg length parity. Anyone who tells you they can guarantee you perfection is lying. He was also (and I repeated to him my activity level) very cognizant of my goals and did a masterful job of seating the acetabular cup and sizing accordingly. I had a mildly dysplastic hip joint and what he did to ensure total coverage and angulation was really impressive. He basically remodeled my acetabulum. He is also a sculpture, in his off time, which was another reason I liked him. I have seen thousands of post-op hips via x-ray in my long career and his are as good as I have seen.

In any case, I was one day with a walker, never used a cane, was walking up the stairs to my home gym on day two post op to do some upper body stuff and walking at a decent pace on a treadmill within 2 weeks. I had a great rehab person who came to my home and she put me on an accelerated path. My surgeon didn't want me to row for 4 months (started at 3 months) so I began my rehab on a Precor AMT within 3 weeks. I had my ups and down along the way but now 7 months out am back to my routine of about 90% capacity.

So my point is that in addition to the prosthesis and the latest anterior approach craze and hip resurfacing craze/debates you want to ensure your surgeon will work to get he right size prosthesis in and as important the right angulation and coverage. One of the big failures in early resurfacing trials was the failure to obtain proper angles and coverage. My only remarks regarding resurfacing over THR is that if you choose to go that route, make sure you choose someone skilled, such as the guy in South Carolina or Hospital for Special Surgery.

Yes many people with THR go back to rowing.

[Valdus]

Is there a hip replacement team? It would be interesting no?

[Two Pudding Kid]

I am not aware of any THR indoor rowing team. Been nearly 2 years 8 months since the op. Never going to be the athlete 5 years back I was but glad I can still ergo, (running seems unlikely which is rather sad). Eventually I will need the other hip done but not going to worry about that at present. I ensured the surgeon knew I was a rower but I am not sure that made any difference to the method of surgery, placement or hip ball size - would rather he stuck to the methods he knew best. Seem to suffer muscular lower back problems more than I did before so I expect the limping gait I now have is overloading something. Big plus is to be rid of finding 400m walk agony, but dont think I will ever be able to do more than 1 hour at a time without burning glutes. Sitting down exercise suits me better if I dont go mad at it.

[EllenB]

I am now 10 months THA post-op for my right hip. My surgeon used an anterior approach. Though she had not done total hip replacement for any rowers in the past, she had done other athletes with specific needs (e.g. equestrians). In advance of the surgery, a rower friend put me in touch with a Florida ortho surgeon who is a masters rower with rower-specific hip replacement surgery experience. He helped set my expectations for post-op timing to get on an erg and on the water. He also recommended a relatively large ball/ socket size. My surgeon ended up using a 36 mm ball size for the joint replacement. She also tested out range of motion of my hip while I was still in the OR to make sure that full compression like at the catch was not impaired.

Aside from being delayed and rescheduled once due to regional COVID concerns, the surgery and post-surgical rehab could not have gone better and I could not be happier with the result. All credit to a very capable, well-run surgical team that does a high volume of THAs and works very cooperatively with nursing and PT groups. At this point, I have no difference in range of motion from left to right and I've gotten back to full strength. I have no limitations related to my hip while rowing on an erg or on the water. My only limitation related to training is to avoid deep squats (fine with me...I prefer dead lifts and leg press). It took significant effort to be patient as I came back from the surgery. After 6 months out I could handle high volume weeks (high volume for me, at least, at 90km). Three things were surprising to me. Since I had been limping for perhaps 18 months prior to surgery, I had to re-learn a symmetrical walking motion. It took substantially longer than I expected to be able to walk more than an hour with full coordination and agility. And, first on the erg and then the boat, I had to revise my drive to get continuous pressure from my right leg and symmetry L to R. Lastly, the on-and-off nagging back pain I've had since my 30s has moderated significantly. Not sure if that's a result of significant PT work or a consequence of the surgical approach to precision on leg length.

If any rowers have questions about this experience or my pre-op research, feel free to drop a note.

[pmv]

Could anyone who has had a successful Total Hip Replacement or Hip Resurfacing performed by a physician in California please post the names of the physicians or DM me with their names.

I am 64 years old. A lifetime (over 45 years) recreational athlete (rowing; cycling; weight-training) who needs a right hip replacement/resurfacing due to osteoarthritis.

Thank you!

pmv

[megz in NH]

This is my first post ever. I just joined this forum. Thank you all for sharing your hip replacement stories. I am scheduled for surgery in March of 2022. My right hip labrum tore in October of 2018, two months before I turned age 60. After X-rays and MRI, it was quite a shock to learn that I was born with (congenital) hip dysplasia. My ortho (at Mass. General in Boston) and a second opinion in New Hampshire, where I live, both advised that the only repair option for me is a total hip replacement. Any attempt at repairing the labrum when you have hip dysplasia only results in that repair failing. But insurance would not pay for the surgery until I had more arthritis. My hubby got me a Concept 2 rower in 2019. I don't know what I would do if I didn't receive this blessed gift. It's the only exercise I can do on a consistent basis. The ortho in Boston, after another round of X-rays in September this year, wrote in my medical records that "I should consider a total hip replacement." I burst out laughing when I read that because I was ready to have this surgery 3 years ago, but my insurance company was saying, "No, no, no." My ortho said he will have no problem justifying the surgery now based on the recent X-rays. I fear COVID and canceled "elective" surgeries might derail these plans, but I will keep on rowing as long as I can. I am lucky that I can sit, sleep, drive, work (sitting), and row essentially pain-free. My problem is walking, being upright, standing. The pain is pretty intolerable after I've been upright for more than 45 minutes or walk more than 1/3 of a mile. The only thing I use for pain is nano CBD. Yes, it does help.
Happy Holidays to all and I really appreciate the shared information. It helps me form my questions for the surgeon, and also gives me some expectations of what will follow during recovery.
- Meg

[EllenB]

Good luck in this journey. I hope that you'll share new insights from slugging through your current painful situation and from your post-process. Also, great that you can continue to erg well; I think health care providers greatly value the proactivity of patients who make every effort to show up with good fitness and follow prep instructions.