Member Case Study: Running after Hip Replacement

author : AMSSM

comments : 0

How can I separate out muscle strain from getting stronger, from pain referred from the joint replacement. Can I run instead of just swimming and biking?

Question from jasugar
I'm a 53 year old physician - started training for triathlons in '05 anticipating a hip replacement, which I got R hip in Aug 05 (steel/titanium on plastic). I set a rehab goal for doing 1/2 Ironman bike and swim in Aug 05, which I did, along with the swim and bike portions of 2 sprint triathlons, and a complete Olympic tri - walk/slow jogging the 6 mile run.

I'm training now, and have included some treadmill walk/running - trying to find a low impact way of running. I'm swimming 6K to 10K yds/week, biking 60 - 100 mi/week, lifting weights (lots of core stuff) 2 - 3 times a week. With some of my swims, especially kicking, I feel some muscle (?) pain in the R glute, occasionally in medial aspect of anterior thigh on right, and some muscle pain/strain just above R patella. I am still somewhat tight in R quads and hamstrings.

So... is even thinking about running a bad idea? How can I separate out muscle strain from getting stronger, from pain referred from the joint replacement. I'm working with a tri coach, and enjoying the challenge lots. Am wondering if ongoing pt, or massage might help...
 

Answer from Craig Burnworth M.D.

Member AMSSM
 

I’m impressed you are doing so well with so few problems following your major surgery. The company line from orthopaedists would be to not run due to the increased wear on your prosthetic joint. Both the American Academy of Orthopaedic Surgeons website and UpToDate® recommendations are limited to “while high-impact sports such as running or contact sports should be avoided, patients can typically participate in activities like walking, cycling, and swimming.” So the short answer is yes, I would not recommend running to you. Looking at your current level of fitness and a hip replacement at age 52, you will outlive your first implant. Anticipating the life expectancy of a hip replacement being 10-15 years, your second replacement will wear out at age 72 to 83 if you were the average patient. I don’t believe it is worth the risk with the current technology.

I found only one study (1) that looked at adverse outcomes in young athletes. They looked at 110 patients (all male, average age at the time of the operation 55 years, 42 bilateral). “Sport” was practiced in 78 and 56% of the cases prior to and after the operation, respectively. The patients with intense sporting activity were examined, and the findings compared with those who did not participate in a sporting activity after the operation. The incidence of replacement due to loosening is surprisingly higher among the group of patients with no sporting activity (14.3% to 1.6%). They found that there was no need to prohibit sport in these cases. They recommended a gradual return to sport to allow for a proper healing and rehabilitation. They did not refer to running, specifically, and the long term problem of wear.

The latest recommendations (2) from a more current literature review speak to two separate factors: patient and activity. If you are a Clydesdale category athlete, your wear will be faster. Running puts five times your body weight on the weight-bearing surface of the joint with each heel strike. I can imagine that with the level you are performing, you will put too much wear on the joint.

As for your pain, I’m sure your gait has changed since the surgery. You may want to look into Vastus Medialis Obliquus (VMO) strengthening and hip abductor strengthening to round out your rehab. Even young healthy runners can have these problems without recovering from a major surgery. Your hip pain may be from weakness and early fatigue of those muscles. Continued physical therapy could help focusing on these areas. You can work on side-lying straight leg raises, 3 sets of 10 reps, advancing to 15 reps and a 2 pound weight on your ankle. Be sure to do each side—nature likes symmetry.

Your knee pain is likely patellofemoral pain syndrome from your altered gait and/or loss of strength. You can do wall sits, leaning your back against the wall and holding your knees flexed to 45 degrees with your feet planted, heels around 15-18 inches from the wall depending on your height. Two sets of 60-90 seconds twice a day will work on this area. A leg extension machine can help. Do these between 45 degrees extending to zero degrees at 50-60 % of your max, 12-15 reps 3 sets. A second possibility can be nerve injury/irritation of the lateral femoral cutaneous nerve during surgery. The pain pattern is right. Ask your surgeon.

Good luck on those aquabikes, or join a team. Find someone like me that is a runner, but is bad at the other parts.

Craig Burnworth M.D.
Moses Cone Sports Medicine
References:
(1) Archives of Orthopaedic & Traumatic Surgery. 101(3):161-9, 1983.
(2) Clinics in Sports Medicine. 25(2):359-64, xi, 2006 Apr.
 

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date: June 11, 2007