# Advice needed: I've been diagnosed with hip arthritis



## dougmint

OK, I am a competitive Cat 4 racer (just upgraded to Cat 3). 41 years old, male. 6'1'', 167 lbs. I started noticing stiffness in my right hip about a year ago. I've been to 3 doctors, and they tell me I have the hips of a 75 year old.

The problem is that I have pain when I try to bring my right thigh up to my chest - therefore, when I ride, the lower I get, the worse it is. Putting on socks/shoes is very challenging. 

I've been doing yoga for 2 years, and this hasn't helped much. I am currently going to a chiropractor every other day (3rd week of this). This hasn't helped either. I am taking glucosamine and chondroitin. I stretch regularly. 

Does anyone have any suggestions?  I am thinking of getting a cortisone injection to see if that helps. 

Thanks, Doug


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## deadlegs2

Do you sit on your wallet? I had a terrible time with leg sciatica ,,,That wallet muscle was cramped and contracted putting pressure on the nerve.. pinaformis I think.. Anyway.. I read about rolling on a tennis ball , finding the pain point and putting a minute of pressure on it then rest and repeat. I had almost instant relief doing this..I could barely make it through mowing my small yard this last summer, then tried to ride and found it almost impossible until I found the tennis ball routine. I had thought my hip might be going out.


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## dougmint

I do not sit on my wallet. I've had it in my front pocket for at least the last 20 years. Also, I do use a foam roller, the stick, and a T-ball to roll out tense muscle areas. This helps stretch the muscle out, but I don't think it will help with severe arthritis.


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## uberalles

this helped me a bunch and my wife when she was pregnant and about to deliver
we got one of those big excercise balls to sit on, it relieves hip and back pressure

we have one the top womens hospitals in the country here and those balls are in every delivery room of the hospital

sitting on it just helps


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## wim

*Mild case.*

I've got a touch of arthritis in my left hip. What helps me to some degree is having pushed two fit dimension to their functional extremes in order to open up my hip angle: 1.) cranks as short as possible, and 2.) saddle as high as possible. I can see the bars-higher-than-saddle coming my way. But so far, I've been able to resist that by cutting back my on-the-drops riding a lot.


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## dougmint

wim said:


> I've got a touch of arthritis in my left hip. What helps me to some degree is having pushed two fit dimension to their functional extremes in order to open up my hip angle: 1.) cranks as short as possible, and 2.) saddle as high as possible. I can see the bars-higher-than-saddle coming my way. But so far, I've been able to resist that by cutting back my on-the-drops riding a lot.


What did you change your cranks from and to? Also, did this change affect your performance and placing in races?


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## wim

Other than doing my annual 40 km time-trial and one or two 500-meter track time trials a year, I stopped racing about ten years ago. Performance has done nothing but get worse over time. But that's a perfectly natural occurence because of my age (67) and has nothing to do with equipment changes.

I changed my road cranks from 175 mm to 170 mm after I stopped racing. My track cranks have always been 165 mm. So the only cause-and-effect observation I have for you is that the 5 mm shortening of my road cranks with a concurrent 5 mm raising of my saddle diminished the pain level in my left hip noticeably. In a sense, I've become much more aware of where my foot is at *top* dead center of the crank revolution, rather than blindly following the customary concentration on bottom dead center only when setting saddle height or adjusting for a crank length change.


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## kbiker3111

Brand new ceramic hips?

What do the three docs say?


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## dougmint

kbiker3111 said:


> Brand new ceramic hips?
> 
> What do the three docs say?


The first doc said that the arthritis is bad, and referred me to a specialist. The second doc agreed, and suggested physical therapy. The PT was mostly stretching, but I am limited on how far I can stretch my muscles. I reach pain in my hip, before I can stretch out my muscles sufficiently. 

The second doc referred me to a specialist at the U of Michigan. This doctor said that they could do a re-sculpting of the hip to remove the calcium build up and smooth out the joint, however, they said that they have not had much success with that procedure on people with severe arthritis. They said it might help, but it could make it worse. They suggested that if I can live with my current situation, that I should avoid surgery. They said I eventually will need a replacement.

So I am at the point where I am too young for replacement, but I still have pain. I was taking 16 Ibuprofins per day to get through the racing season, but I don't want to do that again, due to other potential side effects. 

I was hoping that there were other cyclists out there who have had severe hip arthritis.


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## kbiker3111

dougmint said:


> The first doc said that the arthritis is bad, and referred me to a specialist. The second doc agreed, and suggested physical therapy. The PT was mostly stretching, but I am limited on how far I can stretch my muscles. I reach pain in my hip, before I can stretch out my muscles sufficiently.
> 
> The second doc referred me to a specialist at the U of Michigan. This doctor said that they could do a re-sculpting of the hip to remove the calcium build up and smooth out the joint, however, they said that they have not had much success with that procedure on people with severe arthritis. They said it might help, but it could make it worse. They suggested that if I can live with my current situation, that I should avoid surgery. They said I eventually will need a replacement.
> 
> So I am at the point where I am too young for replacement, but I still have pain. I was taking 16 Ibuprofins per day to get through the racing season, but I don't want to do that again, due to other potential side effects.
> 
> I was hoping that there were other cyclists out there who have had severe hip arthritis.


I'm not a doctor so I can't tell you if surgery is the right thing to do or not. If its pain that only limits you on the bike, perhaps you need a better position on the bike or to rethink cycling as a whole. 

However, I know that there are many options in hip replacement. The typical metal on polymer (Charnley style) hip replacment has, as you know, a 10-20 year lifespan. Cementless ceramic on ceramic hip replacements have a much longer (30+ years) lifespan. While they've been used in Europe since the '70s, the FDA only approved them in 2003. That novelty, combined with a reluctance by insurance companies to pony up for a more expensive implant, has made their use rare in the US. It may be the right option for you, though. If you're young, healthy and avoid risks to the implant, there is no reason is shouldn't last most of your life.


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## dougmint

kbiker3111 said:


> I'm not a doctor so I can't tell you if surgery is the right thing to do or not. If its pain that only limits you on the bike, perhaps you need a better position on the bike or to rethink cycling as a whole.
> 
> However, I know that there are many options in hip replacement. The typical metal on polymer (Charnley style) hip replacment has, as you know, a 10-20 year lifespan. Cementless ceramic on ceramic hip replacements have a much longer (30+ years) lifespan. While they've been used in Europe since the '70s, the FDA only approved them in 2003. That novelty, combined with a reluctance by insurance companies to pony up for a more expensive implant, has made their use rare in the US. It may be the right option for you, though. If you're young, healthy and avoid risks to the implant, there is no reason is shouldn't last most of your life.


I have had a professional bike fit done. To decrease pain, I need to make myself more upright. The problem with this, is that this position does not lend itself to making me faster on the track or in TT's, or to some extent, in crits and road races.


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## dougmint

Well, I've been going to the chiropractor now for 4 weeks (9 adjustments), and have noticed no change in pain relief or mobility. Next step is to get a cortisone injection. Hopefully, this will help.


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## Coolhand

dougmint said:


> Well, I've been going to the chiropractor now for 4 weeks (9 adjustments), and have noticed no change in pain relief or mobility. Next step is to get a cortisone injection. Hopefully, this will help.


Higher bars need not make you much slower in TT's and certainly not in mass start stuff. 

Mass start stuff = drafting. Shorter cranks (170mm and higher bars for sure)- I doubt you will lose much speed. Open up those hips.

TT's- if you elbows are close and your arm positioning is right- the height of the bars doesn't matter that much.


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## Sherpa23

You might try to move your saddle forward - very forward. You may have to get a new bike, maybe even custom, in order to keep the proper reach because you move the saddle more forward, you are in effect shortening the top tube.

I am curious: has any of the doctors mentioned whether or not you might have a condition called FAI?


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## dougmint

Sherpa23 said:


> You might try to move your saddle forward - very forward. You may have to get a new bike, maybe even custom, in order to keep the proper reach because you move the saddle more forward, you are in effect shortening the top tube.
> 
> I am curious: has any of the doctors mentioned whether or not you might have a condition called FAI?


None of the doctors have mentioned FAI. I did google it, so I understand it. From my x-rays, it seems pretty clear that I have severe arthritis.


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## Sherpa23

dougmint said:


> None of the doctors have mentioned FAI. I did google it, so I understand it. From my x-rays, it seems pretty clear that I have severe arthritis.


Sorry, I should have been more clear - I didn't mean in place of severe arthritis. FAI can lead to premature or severe arthritis in the hips. I was just curious.


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## frontierwolf

I had a boss with the same condition. Arthritis in both hips at a young age (40's) that was caused by a genetic condition. His sports were mainly basketball and martial arts. He had both hips replaced, at Duke U. I think, and by all accounts his results were amazing. According to him he had more mobility than ever before and no more pain. 

This was several years ago but I seem to remember that his replacement was a newer type that would last longer and designed specifically for active people. He was able to resume the activities he had quit and now has his own martial arts academy.

Didn't Floyd Landis have the same thing? I'd look up his condition and see if there's any info out there on his surgery. Just to see if it gives you any ideas about your own case.


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## PotatoGuy

*I feel your pain*

I with out doubt share your pain!

Im 50, and been back on the cranks for about 4years. I rode as a teenager,but then adult realities of work and income took over. I took up the sport again as a form of recovery from cervical spinal injury in a MVA. I now train and am working towards becoming an endurance/Audax rider with RAAM being the long term goal. I had a crash in the bunch back in Jan 2011. Since then I have noticed increasing stiffness and pain on my groin ,lower back and left hip region. A visit to a specialist 2 months ago confirmed the worst. Advanced Osteoarthritis in the hip. The considered assessment is hip replacement. I have spoke to a lot of people who have had similar surgery and they all report a huge improvement in their lives. So Im booked in for the 1st week of Dec 
I have put it off until then as we have 3 enduro events between now and he end of Nov which I need to do this year to get my card stamped. I have been managing on Voltaren and Ibroprofen until 4 weeks ago when my stomach finally called it quits and I suffered ulcers. So now Im riding on clenched teeth and will! I did a 250km ride on Saturday, with 2200m of climbing and could barley walk Sunday, but it was worth it.

I don't see the surgery as an end, but a beginning, a chance to write another chapter in the book, and the chance to scoop a few more trophies at events.!


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## dougmint

Great attitude Potato Guy. I can tell you that there is a good life after your recovery. I had the Birmingham hip resurfacing done in March of 2010, and after 2 months off, I started riding again, very slowly. My hip now feels really great, and I am so thankful I had this surgery. This year I raced CAT 3 road races, crits, tt's, and mountain bike races. I didn't win any races, but I did get a couple top 10's.


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## hdbiker

Although you say you are too young for a replacement, perhaps you should reconsider. The ceramic replacements can last 50 years. It is one of the most simple operations available. I had the replacement done at age 57. I had been in pain for over ten years. I had the operation done in November. I was given a pain pill after surgery. It was the last pain medication that I needed. Six weeks on crutches at that time of year in my climate is no big deal. I was in spinning class by early January.Back on the bike early March. 
By far, one of the best decisions I've ever made. Eight years later, I'm riding 5000 miles a year.
Many friends have gone through painful, difficult recovery from knee replacements. Hips are much easier. I was out of the operating room in 45 minutes. 
When I first met my surgeon, he said that before he became a doctor, he had apprenticed in his father's tool and die shop. He said he was very good at fitting parts together. That's my kind of doctor. I hope you're that lucky.


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## shawndoggy

what kind of arthritis and has your rheumy suggested meds or is he just saying your hips are garbage?

I've got ankylosing spondylitis. It can impact the spine and the hips, among other things. I went round for several years with NSAIDs and some corticosteroids and never got great relief. Having done all that my rheumy moved me to a tnf inhibitor (Humira, but there are others... Embril is one) and it has effectively "cured" me. No pain, no symptoms.

So long story short, rather than fishing around here, I'd go back and press your medical treatment providers for what your options are.


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## asudevilrider

Hello,
I am your same age and my hip got to a point where I could no longer turn the pedals. I had it replaced 3 years ago and it has been wonderful. No issues whatsoever on the bike. Previous posters are correct, with the new materials, you may never need to have it revised. In my opinion, its is better to take care of the problem while you still have strength and movement. It will make recovery easier and quicker.


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## new2rd

You all have me worried. I'm 40 and have the left shoulder of a 70 yr old and two knee's that aren't much better. According to the docs, genetics got the best of me and arthritis is ruling my body. The good news? My knee's haven't felt this good in 10+ yrs, cycling seems to revitalized them. It's inevitable that I have all three of my "old man" joints replaced and I've heard the same story "too young.. they won't last long enough". Well, thanks to cycling, I don't mind waiting. I can't plan racquetball, basketball, or volleyball anymore. Running also isn't an option, but if I'm able to ride, play golf, and walk around without pain I'll take it for now. Cycling really helps! I'm scared to get my hips looked at. No pain.. yet.


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## BacDoc

dougmint,

If you got 3 opinions and your x rays indicate severe arthritis, your best option is surgery. I am a chiropractor and do my best to keep patients from going under the knife but have never seen a case of severe hip arthritis resolve with anything but surgery.

I am a good example. At age 48 my left hip had been giving me problems and previously responded to adjustments, nutritional supplements and hip exercises. A couple of days a week in the gym doing squats and lunges, abductor and adductor work and the pain was minimal. Miss a week and started to hurt. After a while nothing helped. Had trouble walking a block but could still bike 20mi at good effort but my cadence suffered.

My research in a surgical option (total hip replacement, arthroscopic, injections etc) led to the best choice for young active patients - Birmingham Hip Resurfacing (BHR). Several advantages to this procedure:

No amputation - total hip replacement involves amputating the top of the leg bone and attaching the prosthetic. With BHR a cap is put on the femoral head and a cup in the acetabulum (polished Swiss surgical stainless steel).

Longevity - BHR is considered permanent. Complications can happen with any surgery but the BHR is considered one time permanent fix. If complications occur you can still get a total hip (THR).

Recovery is fast and no restrictions to lifestyle. In fact impact activity is encouraged.

To make a long story short I had the BHR 10/28/10 at 54. Riding stationary bike 1 week post op. Riding mountain bike on the road with moderate effort 2 weeks post op. Road bike with serious effort 4 weeks post op. 

8 weeks post op able to snowboard and hike the backcountry with no pain or problems and full effort on road bike and aggressive XC mountain bike.

To be honest I felt stiff and weak for about 3-4 months post op but nothing that would prevent any activity just long rehab for muscles and ligaments that had adapted and compensated for my arthritic condition.

Approved in the US a few years ago and certification thru BHR is available in the US. I had my surgery here in Fl. with a BHR surgeon. My insurance covered 100%.

If you don't have insurance one of the best BHR surgeons in the world is in India, VJ Bose and the cost with rehab, airfare etc is around $12,000. I have referred several patients to him and all have raved about the experience. You can google him for contact. He was one of the original BHR developers and is now working on other joints.

Stem cell looks promising but from my research probably not in my lifetime(I'm 56).

Got questions shoot me pm or email, love to help you out. 

Kevin


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## UrbanPrimitive

Well, this is a rather moldy old post, but could still merit adding a little information should it come up in future searches, or heaven forbid, the arthritis rears its head again.

Alternating heat and cold, ending on cold, can be very useful for managing symptoms of osteoarthritis. Of course there are dietary things that are supposed to help as well, like huge amounts of pure cherry juice, glucosamine and cartilage supplements, et cetera. But what I wanted to point out is the practice of _the best_ doctor I have ever encountered.

Dr. David K Vallance, based in Ann Arbor MI.

I had severe arthriotic pain in my knees, slowly getting worse, from the age of 12. At 19 I frequently relied on canes and by 22 had learned how to slip in and out of mild shock as a pain control tactic. I had stumped seven doctors (including a jerk who told me my legs were too long, and maybe I should take up running and power lifting. I asked for my canes and shuffled out). It took nine months of waiting to get in for my 1.5 hour initial appointment with Dr Vallance. He was the first doctor who really _listened_ to me and treated me with some dignity. Four months later the pain was gone and I had begun building strength in my legs. I haven't taken pain killers for anything joint related in the five years since. Seeing a proper rheumatologist was literally a life changing experience.

I strongly recommend seeing him to anyone in the great lakes region who's running out of options.


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## BacDoc

Wow! I feel pretty stupid, just read the first few posts and didn't look at the dates. Everyone should read all the posts before responding.

There are times when surgery is the best option and for younger active patients BHR is currently the best way to go.

Anyway glad you got the resurfacing and hope all is going well.


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## Jerry72

Hello, I just came across your discussion about biking with hip arthritis and thought I would put in my 2 cents worth. I'm a 72 yr old Triathlete who has Osteoarthritis in my left hip since 2009 when I was runnng training on a nearby track. I awoke the next day with unbearable pain in my left hip. Having some education about exercising and training, I thought I could cure myself by doing exercises for my left hip. Well, after three years of trying everying, on and off, I could think of. I finally went to a Physiatrist (SP?) and after what I thought was a throrough eval. she told me I had Osteoarthris in my left hip. The root cause she thought was from my right leg being 7 to 9mm shorter than my left leg, which meant my pelvis was tilted toward my right side and resulted in my left hip socket being slightly misaligned in its socket causing uneven wear and tear on the joint cartilage. She referred me to a hip replacement surgeon. I then chose to take another approach, I thought I had tried everything butone thing I forgot to try....... to rest the joint for a couple months and do nothing, no exercise or training, just to see if the pain would subside and viola! My pain became less intense and I subsequenty could stop taking meds for the pain, especially at bedtime. I can tell you, I just completed my 5th Triathlon yesterday and my hip is a little sore and stiff but nothing like it was 4 years ago. I guess I should stop rambling and tell you that the bottom line for me was to REST my hip for several weeks if not months in order for my hip to heal from the injury I caused it while running. Oh BTW, I also have a 7mm shim in my right shoe nowadays to keep my pelvis level while walking and training in the gym. I've stopped all meds for pain. If you have any questions fireaway. I'll tell you what I know. Good luck with hip rehab, for me it was a long process because I wanted to keep exercing it while it was trting to heal, thinking that would make it feel better when in fact it made it feel worse.


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## Kristatos

A gal I know - not a cyclist but active - just had a hip replacement and what amazed me was how easy the recovery was. Hers was done at UC Davis using some technique that minimizes the incision and all I know is she wishes she'd done it 10 years sooner. Good luck getting it fixed, whatever route you take - sounds like you have a lot more racing in those legs!


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## Jerry72

*Sincere thanks for your prompt and encouraging feedback Kristatos!*



Kristatos said:


> A gal I know - not a cyclist but active - just had a hip replacement and what amazed me was how easy the recovery was. Hers was done at UC Davis using some technique that minimizes the incision and all I know is she wishes she'd done it 10 years sooner. Good luck getting it fixed, whatever route you take - sounds like you have a lot more racing in those legs!


Yes, I have heard stories both good and bad, it sounds like a surgical procedural issue. Some surgeons do less cutting on muscle than others, hence less scare tissue and less recovery time is required as well as less residual and follow-on pain. I'm not confident my HMO would use the best procedure out there for an athlete, but instead the cheapest. I will likely chose to limp along for a while longer until I can't stand it, then try to seek out a sports medicine surgeon with a outstanding record of fully recovered athletes. Just a matter of $$$ at this point. At 72 it will also take longer for healing to occur just because of the older physiological processes taking place in my older anatomy.


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## Jaferre

I know this thread is a bit old, but nevertheless, it looks like there are many of us with hip trouble. I am 47, arthritis in left hip. Probably less than one year away from replacing my hip. My main problem is loss of mobility in the left hip. I saw someone else comment about putting on shoes and socks. It's brutal and really awkward. I've adjusted my position on the bike and barring a new custom made ride, am maxed out and opened up and have lost speed and power. I live in the Boston area.

Question - what kind of life can one expect from a hip replacement these days while maintaining an active riding schedule, no racing. What is the best technology these days? Ceramic ball and socket?


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## Jerry72

Hi Jaferre,
my left hip osteoarthritic pain fluctuates depending on what I've been doing. I limped badly for nearly 2 yrs or more nowadays I have a slight limp. At times, the pain radiates down to my left knee. When cycling I use an 11" cloud nine bike seat on my bike, it helps in distributing the weight across a wider area of my hip joint. It really looks funky mountied on my Tri-bike but it works! I've also had limited success with a regular narrow cycling seat since it appears not to put pressure on my hip joint the way just sitting down at the table to eat does or sitting on the couch or in a chair. So if you haven't tried experimenting with different bike seats you might want to try that. Exercise is also very important in rehabbing and pain management of arthritic joints. For exercise, I swim, bike and lift weights. I think the swimming and lifting weights helps my hip since exercise is known to help strengthen the muscles in the hip that help support the hip joint itself. I got my hip issue from running training for Triathlons. I just Bronzed in a Sprint level Tri and had no more than usual hip pain afterward. Before hip surgery, if you haven't tried swimming or exercises which include hip abduction, adduction and knee extension, flexion movements with light weights and high reps, I'd try that first. Oh, BTW I've been at this for nearly 4 years experimenting with different exercises, bike seats, and swimming so all I'm saying is if you have tried the things I've mentioned, you might want to do that before seriously considering surgery. Just a thought. Good luck with that hip, and let me know if you have any other questions. I'll be happy to chip in my 2 cents worth. Take care. Jerry72


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## BacDoc

Jaferre said:


> I know this thread is a bit old, but nevertheless, it looks like there are many of us with hip trouble. I am 47, arthritis in left hip. Probably less than one year away from replacing my hip. My main problem is loss of mobility in the left hip. I saw someone else comment about putting on shoes and socks. It's brutal and really awkward. I've adjusted my position on the bike and barring a new custom made ride, am maxed out and opened up and have lost speed and power. I live in the Boston area.
> 
> Question - what kind of life can one expect from a hip replacement these days while maintaining an active riding schedule, no racing. What is the best technology these days? Ceramic ball and socket?


At the time I had my hip done the Birmingham (BHR) resurfacing seemed like the way to go, no amputation and supposedly longer life. I am 4yrs post op and starting to notice some problems. I was issue free all those years up until recently and just starting to feel a "catch" on sudden flexion. This may be an indication or warning sign of failure.

Current medical thinking is all metal on metal leads to many problems and almost all these implants will need revision. The BHR is chromium cobalt and we are finding complications with metal ion toxicity in BHR patients. Review of the professional literature concerning metalosis is disturbing if you have one of these implants. Blood test for chromium cobalt is the first step and search for revision surgeon is the next. I have just started that process.

I have referred many patients for this procedure over the years and feel bad about how all this is turning out as the procedure was touted as the longer lasting over total hip replacement. I think there will be a ban on all metal/metal hips.


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## Jaferre

*Type of replacement?*

What type of hip replacement did you get? Total Hip replacement? Ceramic on ceramic?


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## BacDoc

Jaferre said:


> What type of hip replacement did you get? Total Hip replacement? Ceramic on ceramic?


I got the BHR in '08. This is chromium cobalt, metal on metal. One of my patients is a retired ortho surgeon who has had 2 revisions himself and he is currently part of a team that is studying hip procedures post op. Their research has me thinking all metal/metal hips will need revision due to either metalosis or mechanical failure.

I'm not sure what the answer is now as most of this research is relatively new and not anticipated as the BHR was promoted as a permant fix for younger athletic patients. All materials have advantages and disadvantages and I'm just starting to look into revision options. I have some time as my last blood work was good. Ceramic shows some promise but I am still investigating.


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