Training with artificial hips

[mlentzner]

Rip,

I have a poker buddy who has shown some interest in doing some weight training with me in my little mini-box home gym. The complication is that he has had a double hip replacement about a year ago. He's not particularly old, maybe late 30's, I'd guess. I never asked why this procedure was necessary since up until now, it was none of my business.

He's a fairly big dude, tall and overweight as well. I found out that he has been doing step aerobics (bleh) so I would assume he would be cleared for at least some sorts of resistance training. I told him to ask his doctor what range of motion is allowed for his hip.

I was wondering if you had any experience training a person in this situation. What questions should I be asking? I was thinking that, because of the range of motion in a squat at the hip joint, deadlifts might form the main training stimulus. How would you train this? I would assume that bench and press would be unaffected and that power cleans would have to be dropped.

Thanks for your help,

Matt

[Mark Rippetoe]

I'm pretty sure the SEARCH FUNCTION would turn up a lot of stuff here.

[KJ43]

I just had a full replacement last October 12th. I had avascular necrosis from a previous injury (crushed hip) and surgery 4 years ago. I discovered it when it partially collapsed from deadlifting (I had worked up to a 365lb deadlift when it happened). I'm 42 years old and have been active most of my life.

My surgeon gave me the go-ahead to do whatever I wanted 4 weeks after surgery. His words were "now you can go squat 400lbs". I'd been talking to him about how much I wanted to squat again and I didn't tell him I'd never squatted over 200 before, but basically he gave me the freedom to get there if I wanted to.

He was the third surgeon I consulted. I had "sports experts" asking me why I wanted to lift heavy weights and all kinds of bullshit. They wanted to talk to me about what I was doing instead of helping me fix my hip. I got a great surgeon...he fixed me and didn't give me any crap about anything he didn't know about.

The newer replacements are much better suited to active people than the older replacements. I have a large diameter (40mm) cobalt chrome ball against a cobalt chrome socket with a titanium shaft (to flex with my bone). No plastic in my joint.

I have great mobility in my joint. I could squat below parallel 4 weeks after surgery and I started the SS novice program 5 weeks after surgery. My squat start weight was 65lbs and I fought hard to get all the way up to 145lbs (todays scheduled weight). I full expect to lift as heavy as I want to in the future.

I'm happy to share any information and experiences I have with you. I've communicated with other people that have lifted heavy after hip replacements without issue as well.

Be careful asking the surgeon much about what you do physically...they do not know much about it. The only thing I've specifically been told NOT to do is to pull my foot up and touch it to my ear (LOL!)...which is almost garaunteed to dislocate my joint.

I can touch my face to my knees if I want and I can squat down all the way to my butt on the floor if I wanted to. The new larger diameter balls are much more stable than the older ones.

What did he get for a replacement (materials, etc.)?

[Mark Rippetoe]

Good info, KJ.

[tescott]

Who manufactured your Co-Cr on Co-Cr replacement? I studied and worked in the biomed field, particularly with joint replacements, and I'm interested to see how they're doing metal on metal these days.. I'd be worried about metal wear particles..

[Steve in ATL]

Good info, KJ.

I was glad to hear that artificial hips gives one larger, and more stable, balls.

[Mark Rippetoe]

Considering the operation, Steve?

[KJ43]

Who manufactured your Co-Cr on Co-Cr replacement? I studied and worked in the biomed field, particularly with joint replacements, and I'm interested to see how they're doing metal on metal these days.. I'd be worried about metal wear particles..

Honestly I don't know the specific manufacturer though I'm sure my surgeon would give me the info if I contacted him for it.

The options I came up with after doing my research was to use a ceramic on metal joint or a metal on metal joint. Ceramic has a (very) small chance of shattering and metal has people worried about metal particles. If there is plastic in the joint it will be the thing to wear out faster.

I could worry less about metal particles personally...I've already had a metal plate and screws in my ankle for over 20 years without anything untoward occuring. I know nothing is moving or shedding particles there, but we are talking about really insignificant things here (imo). I think people are worrying about something that isn't an issue when it comes to metal wear particles, but hey...maybe I'm wrong.

I wanted durability and bomb proof design over anything else. Every option has pluses and minuses and I picked the one that I was comfortable with and would give me the best chance to be active.

[tescott]

Yeah, sorry, I shouldn't have made that comment just out like that. Just because I'd be worried about it doesn't mean that you should.

FYI, the thing with wear particles is that even though the material itself is bioinert, once there are very small particles of it floating around, their size and shape can stimulate an inflammatory response. This response is probably what causes osteolysis, or the breaking down of the bone surrounding the joint replacement. This is a primary cause of loosening of joint replacements after 10-15 years.

My experience in particular is with UHMWPE (the plastic your talking about) in knee replacements. The high impact and low contact surface area in knees means that UHMWPE must be used. Of course, it will produce more wear particles than something harder, the size and shape of these wear particles stimulates an inflammatory response, and it will eventually break down from surface fatigue, but its the best they can do for knees.

My experience is only limited with hips, but it seems that the higher surface area makes metal on metal and ceramic on ceramic a viable option. The wear particles of Co-Cr will be far less in number over a given period of time (since one surface isn't harder than the other), and this reduced number would mean that it would probably be less severe than with the UHMWPE.

You're absolutely right to say that every choice has pluses and minuses. That's the nature of life. You just need to choose which one you're happy with. I think you made a good choice.

[mlentzner]

KJ,

Thanks for the information. It helps me get an idea of what to expect.

I don't know any of the details of this guy's operation and replacement, but I will find out and post the info when I get it.

Rip,

I was never able to find much by searching. And I'm pretty good at that kind of stuff in general.

I found one thread where you mentioned in passing that you had hip replacee's squat, but it was in the context of a long discussion about the perils of socialized medicine in Belgium.

There was another where you offered to talk on the phone with a guy who had a similar situation as I. I wish a transcript of that call was available online!

There is nothing on the subject in MOMG.

Best Regards,

Matt

[Mark Rippetoe]

The help you'll find here is from guys like KJ43, since I've never worked with anyone directly with a hip replacement. Knees, yes, but no hips. There are scattered comments from guys in his situation on the board for the past 2.5 years.

[mlentzner]

Here's the report I got:


I've had both hips replaced. I have full recovery, but am sensitive to two things, primarily:
1) Any huge torsion on the joint risks popping it out. Again, I'm a pretty healthy, young-ish guy, who's built muscle up around it, but once it pops out, the odds of a second displacement go up, etc.
2) I have titanium metal with a ceramic-oxide contact surface. (The ball and cup of the joint, the two surfaces that come in contact) This gives tremendous friction benefits, but at a cost of impact. So any jumping or running or high impact would be out.