John:

Well, you've got me curious. I am an orthopaedic surgeon, and have suspecialty training in joint replacement, and know of nothing like you're describing (ie a replacement type procedure that you should be doing an Ironman on). I do know of a number of procedures that have been promoted as such, but with virtually no evidence or track record, and generally to the dismay of the arthroplasty community.

More details please.

Deke

Holy cow! Are you kidding? Two words: Bo Jackson. Granted, there is a lot more twisting involved in baseball than running or biking (maybe swimming), but I haven't met a single orthopaedist or, possibly more importantly, biomedical design engineer who would recommend that type of training and competition on a joint replacement (especially hip). Sure physical activity is important to recovery from the joint replacement, but the phrase "physical activity" is usually modified by the word "moderate." It's very important to distinguish those who might have completed an IM on a new joint from those who were recommended to do so by their medical professional: zero (I'll take the Vegas odds on that bet).

Granted, I've been away from the field for about five years now, but unless they've made some major new materials breakthrough (and the medical industry doesn't turn on a dime), that wouldn't be recommended. Geeze, last I was involved, the medical community was just starting to realize how much better bone in-growth is than using PMMA bone cement. I'll have to read up on what I've been missing...

Deke,

So, that begs the question as to whether we should be doing this on our original joints. Any long term studies of IM triathletes? I am 44, have done 12 IMs and 135 Tri's. So far so good, but will I pay a long term price?

Many thanks,

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David
* Ironman for Life! (Blog) * IM Everyday Hero Video * Daggett Shuler Law *
Disclaimer: I have personal and professional relationships with many athletes, vendors, and organizations in the triathlon world.

john,
I used to do jt arthoplasty rehab about 5 years ago. For a research project I did a comprehensive lit review. there were a few small studies involving more than moderate exercise but nothing along the lines your suggesting.
keep us posted

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Brian Stover USAT LII
Accelerate3 Coaching
Insta

John,



I have MANY clients and good friends who are Orthopods...I will ask them their thoughts and see if they are able to share any information with out violating HIPAA.

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What if the Hokey Pokey is what it is all about?

Well I knew if I hung around here long enough, I could get the information I was looking for. I am a 47 year old worn out runner rugby player. I have done neither in 6 years. I am scheduled to have a total hip replacement in October. Currently I just do the swim and bike for sprint and oly distances. I hate to swim and my biking is just fast enough to keep up with my slowest training buddies. No orthopod that I have talked to agreed that running would be a great idea on a hip replacement (I think it would void the warranty). I have talked to 2 guys that have hip replacements and have trained enough to do sprint distances. I will see if it is possible for me to physically do that. We'll see come next summer.

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Rebuilt with twice as many titanium parts as Portland79.

It is easily possible - most people can run on them. That's not the question - it's should they be, and the answer for Ironman distances at the moment is no. For sprint distances - if you could fake the run, maybe, but there is no evidence that training any significant distance on them will not shorten the longevity of the implant, and lots of anecdotal eg Bo Jackson evidence that it will. If it were my hip, I'd stick to riding and swimming.

Deke

There is a very good section on this in The Lore of Running. The answer seems to be that unless you are an ultra elite marathoner - like sub 2:15 - (don't imagine that any of them lurk here) running does not increase the risk of osteoarthritis.

Deke

I'll chime in here because my wife has been selling orthopaedic implants for 2 years now and having done a few IM's (won Kona a couple of times) and marathons herself she knows what its like to want to keep running. She's an orthopaedic rep here in New Zealand. I asked her if it was me (and I might be closer to this than I'd like to admit) "what should I do?" She said since she knows I would run the crap out of my replacement hip she would suggest I had a ceramic on ceramic modular hip put in. Then when I wore it out I could get the "end" or the head replaced and not have to get the stem taken out which is the biggest issue in a revision which is what you have to get when the first one wears out. She also said that she had no idea how an insurance company would view this situation - if you sped up the wear on your replacement through running how would they feel about paying for a revision. She also said she would probably just shoot me if I still wanted to do IM's after getting a hip replacement, but she's just looking any reason to shoot me anyway.

Geez, who knew that guys like you hung out in a place like this?

The logic of the modular ceramic component makes sense, and is probably what I would have if I had to get a hip replacement (there isn't anything like this in general use in knee replacements). The problem is that ceramic components don't wear much, but they have been known to catastrophically fail. Although this has generally been a manufacturing problem, who knows what would happen if the Molinas of the world start running on these things? When you're trotting down the road and your hip shatters, this can damage the locking mechanisms and make the modular switch impossible, so then you get the full Bo Jackson.

BTW, someone above mentioned warrranties - there are no warranties on these devices.

Deke

PS How do I get Erin Baker as my orthopaedic rep?

Yeah, what deke said. The other main problem with ceramic balls and sockets is the risk of particulate. If you get any small particles between the ball and socket, wear is increased dramatically over full titanium and polyethylene or teflon. More wear causes more particulate and you hit a slippery slope pretty quickly. That's more on the surgeon's plate, though, to keep the joint pristine as their operating and closing.

The other thing to remember, is that it's not just the ball that wears out. Due to the mismatch in material properties (elasticity, hardness, etc.), your body learns to rely on the implant and begins to resorb bone. When the bone gets thin enough, it can no longer support the implant properly. THEN, you've got some issues. Time estimates vary (many years usually), but I can't see how over-working the joint running marathons could possibly lengthen that amount of time.

OK guys I know it is possible, and the real question is not even, should I, it's more of what happens IF I run on it. I'm not talking Scott Molina, run it in the ground run, running. (I have access to cheap,wife physical therapy, not cheap, wife spare parts) I'm talking recreational, couple times a week, just enough to fake the 5k, running. I have not run in 6 years and waited the last 2 for the FDA to approve the minimum wearing ceramic on ceramic unit. When diognosed with arthritis and told a hip replacement would be inevitable, I pretty much gave up the idea of ever running except to save my ass from a burning building or some other non-moving object. But since John started this thread, I thought I could get the chance to maybe hear from some others who have gone back to running, what problems that may have encountered and if they would looking back on it. I know no ortho guy is going to say "Oh yeah, no problem, go ahead, go back to running your age on your birthday, show those guys at the running club you could run them in the ground. Not even the orthopods that hang out here, they are too responsible for that, and I respect them for that.

And yeah Deke, I know there is no warranty.

Thanks guys, I'm still listening...

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Rebuilt with twice as many titanium parts as Portland79.

I really appreciate you readers chimming in on this so far and I hope more people will add input. I know from experience that when a long time athlete is told to don't run or don't do whatever, their usual response is to find a doctor that will let them keep training. So many people have had active lifestyles that as we get older it will be difficult to consider not excersizing. By getting input from groups like this we can go to the joint manufacturers and prod them along to develope better joint products. The Europeans have some new proceedures that seem to be working over there and that technology will trickle in here after a while. Please continue to post some results on this thread so that other racers can understand that some running is possible [but probably not endorsed] after these procedures are done.

I realise I'm posting a lot on this thread, but it's one of my interests, and it's something I actually know about, as opposed to the tri stuff, where I'm still a relative newbie.

John, this is an area that concerns a lot of orthopods. We realise that our patients don't tell us half of what they actually do, but this is a different situation than say an ITB sydrome. Failing to restrict your activities with ITB might prolong your recovery, but will not likely be permenently disabling, and it will hurt to remind you not to do it. With an arthroplasty, it won't hurt in the short term, but people can and do get into situations where they have an unreconstructable problem, and then it's not just not doing sports, it's being unable to walk. I saw a 44 year old this morning who has been playing volleyball on her replaced hip, and although it felt OK to do it, she now is right on the verge of being unfixable.

It becomes much more complex because of marketing issues. It's not that the companies don't know that this type of implant is needed; they're rushing to make something that lasts forever. This is actually the problem, because you can promise anything before a joint replacement, and really not know how it will do in the long term. They almost all feel good in the short term. Because of the market pressures, implants and techniques with very little track record are being released with the promise that this will be the last joint you'll ever need. They work fine in a wear simulator, but in the body, it's quite different.

To take a recent example, there is a British center promoting a metal on metal resurfacing arthroplasty of the hip, with excellent short term results, and heavy market penetration in Europe. The inventor has literally told people that it will last forever. We now know that the people with this type of implant have greatly elevated Cr and Co ion levels in their blood, past levels that would be considered safe in metal workers. We don't know exactly what effect this will have, but I don't think I'd want this operation done on me at present.

I am not saying that we shouldn't be trying to achieve a joint replacement that you could run on. I am saying that people should be very aware that running consistently on a joint replacement could be disastrous, not just an ache that will go away, and that all "new" developments in this area need a big caveat emptor.

Thanks for the interesting topic, and for letting me babble.

Deke

I was at the UltraMax IM in 2002 and at the awards brunch I am almost sure the winner of the masters group (who went an amazing 10:50:09) had a hip replacement the previous year. Everybody in the room was absolutely blown away. If I am correct, his name was Dru Dixon from West Plains MO. Can anybody else confirm that?

Rich G

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Rich G.
Proud member of the Geritol wave!

This is an area that I'm very interested in too, as I'll likely be the orthopaedic indutries' poster child in about 20 years. The problem with such a litigious society as the USA is no one (not the manufacturers or the surgeons) is going to put their butt on the line to tell you to go ahead and try to get back to normal after a hip replacement. Perhaps its unrealistic, and I'm planning on taking up a bit more golf in my 70's anyway. But I don't think any one should under-estimate how important it is for some of us to run more than a little bit. At the moment I can't run because of chronic plantar fascitis and my beer consumption has tripled. My disposition has been less than perfect as the prospect of a lengthy amount of time off has becomemore likely. So if a person wants to get the best hip available to run on and try to make a cautious start back with hope and a prayer that they might be able to run then I for one can have alittle empathy for them.
As for getting my wife to be your orthopaedic rep - if you lived in N.Z. she'd treat you like a king! She loves the wining and dining part of the business I can assure you.

I don't live in the US, and the medicolegal environment here (small town on Vancouver Island) is quite different. My reasons for saying not to get back to running any significant distance after a hip replacement with the current technology is honestly not based on any legal consideration, but simply concern for my patients. My experience thus far says that people that do this can end up in a disastrous situation that may not be fixable (and it's not just theoretical - saw it this morning). I have lots of empathy for someone who needs to be able to run, but at present the answer for someone who intends to do this is: don't have a hip replacement.

Down the road, the answer may be different. In the next 10-15 years I think it will be realistic for us to start tissue engineering a biologic hip resurfacing, which will not have the current mechanical constraints. So hang in there - it will almost certainly be quite different in 20 years.

I did actually do some of my orthopaedic training in NZ, but in Wellington, not your part of the world. At the time, I was a lowly registrar, so no one wined and dined us.

Deke

GO548, i saw this post and others from you since saying you had the surgery. How's it going? Have you run with any success? I had my THR 5 years ago and have been running for the last 4.5 years. I love every second of it, and I savor each run - thinking that maybe this could be the last run. It gives you a different perspective on training. I'm out there b/c I love it and I love my body and what it can do. I'm probably the stupidest person on earth for running still, but i got a replacement so that I can enjoy life and live it the way i want to. My choice. I would never advise anyone else to run on a THR b/c i think that it's too personal of a decision for anyone to advise on. But I am well aware of the consequences. I've been on the tri scene for 4 years now - mostly local sprints. Finish at the top of my AG in the smaller ones. Ran a marathon in January (3:54:18)...something I thought I could never do. I cried so hard at the finish. I'm signed up for a HIM in October. I've never had any problems running, but i started out very very slow. Even during marathon training, I ran tues, thurs, and saturdays and did the rest of my training in the pool or on an elliptical machine. And LOTS of stretching. I highly doubt that I am typical. I thank my doctor everyday for the fabulous gift he gave me. He was a great surgeon. I am also very young (and foolish) and very lightweight. Keep me updated on your progress!

[reply]I'm doing a study on athletes that have had hip or Knee replacements and have continued to race or train regularly. I have several racers that have completed Ironman distance events with hip replacement and I'm involved with a new type knee repair that should help keep athletes going at a high level of performance for many years. Your input would be greatly appreciated, e-mail me at [url "mailto:jcobb@bicyclesports.com"]jcobb@bicyclesports.com[/url][/reply]

One of my customers has had bilateral hip replacement and is continuing to train and compete at a very high level. Of course, she has now switched to PC's to take the stress off these joints. I will send you the email contact shortly.

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Frank,
An original Ironman and the Inventor of PowerCranks

david wrote: So, that begs the question as to whether we should be doing this on our original joints.

I hear people talk about joints as if they are non-living and non-self repairing. I don't think that's the case. Sure, they are slow to heal, and incapable of healing some levels and types of damage. But, I am totally not convinced that they are like a mechanical part that simply gradually wears out after so many movements.

And, I do not know the answer to your question. I do know I've had literally hundreds of people tell me that popping my fingers would give me arthritis, and riding/running will result in my knees/hips being "used up" by the time I reached 40. I'm nearly 50, with no more pain that I usually have had and I've never stopped popping some finger joints (they do it on their own, I don't have to force them to pop) nor riding/running...although I don't usually push past activity levels that tell me I'm beginning to do some damage in those joints. I'll be very surprised one day if my "service indicator" light tells me it's time to change out a ball and socket joint.

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Quid quid latine dictum sit altum videtur
(That which is said in Latin sounds profound)

Deke,or any one with info,

I was a candidate for THR three years ago (glucosamine and the bicycle have spared me so far). When doing research at the time I came across a few references to a synthetic-diamond coated metal on metal hip being used in Scandanavia that was supposed to have a fifty year life span. I haven't been doing any research lately so can any one tell me what became of this?

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Azby

The history of joint replacement surgery is littered with implants that were supposed to last forever, but have been worse than what we already have. One problem is that things act differently in the body than in a wear simulator.

To answer your question, I am not aware of this being in clinical use - I did see an exhibit on it at a meeting once. The problem isn't "are they doing them", it is "have they been doing them for over 15 years", when you'll actually know that it's better than what we've got.

Deke

On the subject, I've been diagnosed w/ a significant level of osteo arthritis in my hip sockets (genetic - father & uncles w/ the same). Two questions:

1) Doc at the time (just before Kona '03) said that I may need some sort of injectable replacement cartilage(?) that may prolong the life of the hips. Does anyone in the industry have info on anything that has worked along this line?

2) Doc also mentioned coming back in for x-rays periodically. What does that mean? I haven't been back in about 18mos. How often should I go?

Yes, my hips hurt when I train and when I ride my motorcycle (but don't tell my wife).

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kangaroo -- please do not read or respond to any of my posts