UKC

Ive recently started having serious hip pain when running. Doctor arranged X-ray which shows quite bad arthritis in one hip (probably from a cycling accident where I slid along tarmac on it) . He has advised against hip replacement for now as it may restrict range of movement and I wouldn’t be able to run on replacement hip. Any thoughts appreciated!

Listen to what an orthopaedic surgeon says! 

I've just found out I've got arthritis in hip. I spoke to a surgeon friend who said carry on for as long as possible and don't get a replacement or even arthroscopy unless you really need it. 

How bad is your pain? Is it all the time? Does running make it worse? Do you want to be able to run?! 

It’s ok when I don’t run unless I walk a reasonable distance. Climbing and cycling is ok but I love running☹️mind you I’m a lot older than you at 67!

Get a BHR (Birmingham Hip Resurface) otherwise known as an Andy Murray hip these days. I had mine done 13 years ago and have been running, caving, climbing and skiing ever since and it's still going strong. I went to the Royal Orthopaedic in Birmingham and had it done by Ronan Treacy one of the worlds leading experts in this procedure ( https://www.ronantreacy.co.uk/). All paid for by the NHS. I had been advised that the only times this prosthetic failed was when it was done by someone inexperienced.

I was advised against this by my GP and my local hospital but I stuck at it and have never looked back

Good luck.

I had mine done, the only thing I was advised not to do was run but running because of the risk of prematurely wearing out the replacement however it doesn’t actually stop you running (I did my first half marathon after my replacement). 
There are different types of replacement hip depending on what how active you intend to be.

My hip was preventing me doing the things I loved (as well pain, stopping me sleeping, stopping me putting my socks on and closing the car door etc) so I took the decision to have it replaced at 50 as I didn’t want to miss out on  the next decade’s climbing etc. If I need another in my lifetime I’ll deal with it then but they last 20 years and I know someone who has been climbing to a high level on his for 30 odd years. 

I note from your profile that your age is 67? The BHR is generally done in younger population groups and there is good evidence that it is a good option for younger men (not women).  If you google BHR research you can see the evidence base.

I'm 49 and close to a THR (I'm a physiotherapist) and have discussed the options with two well regarded surgeons in Sheffield.  They were not keen on the BHR. 

Have a read:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809170/

Functionally post replacement (traditional method) they wouldn't put any restrictions on my activities (running, snow boarding and climbing). Ideally they don't want me falling off high boulders as there is a slightly increased risk of fracture. They would expect it to last at least 30 years. 

My advice would be to discuss this all with an orthopaedic hip specialist.  GP's (unless they have a real speciality in this area) are not best placed to offer too much guidance. I'd also caution against making a judgement purely from your x-ray.  

Good luck.

I wrote an article on here about a year ago about my battle with arthritis, hip replacement and subsequent recovery. Not sure how to put up a link to it, but hopefully it will be of use to you. 

Honestly I'd just get referred for an opinion if the pain is significantly limiting your activities.

Locally it'll take you a year to be seen and then another three-four for a hip replacement so plenty of time to consider things.

I have a Birmingham resurfacing from 2014, age 63, selected by researching options on the web and knowing two people who have them. I was at the limit regarding age and bone quality but it is still going strong, having done 325 parkruns since. Right hip lasted a couple of years longer but the operation in May 2017 failed due to the head breaking off my femur during fitting. I ended up with next-best option of a Zimmer ceramic/ceramic total replacement which my surgeon assured me I would not be able to break. This one has done about 240 parkruns, half a dozen half marathons and many long days in the hills, including the Welsh 3000s, and actually has a better range of movement than the BHR - I don't feel it in normal use, I know the other hip feels a bit different to normal.

I always recommend people to check out Hiprunner and SurfaceHippy websites to get other anecdotes - there are all sorts of runners, sprinters to ultra runners, with fake hips. Modern devices look to be set to last 30 years or more, no great threat of multiple operations. You do want a decent surgeon who understands your requirements, some of them even have replacements/resurfacings themselves!

Mine were done privately via BUPA, by the way. Pretty expensive otherwise, probably £12,000 but shop around - London Hip Clinic are pushing themselves on YouTube at the moment...

I’ve had both of mine replaced in the last few years.

My take on it is different to some of the other contributors and your medical advice.

The pain and degeneration will only get worse over time, and will accelerate. Until it becomes debilitating. So get it done as soon as you can. The younger you are, the better the result. The more time you have to do good things in the future.

Ian

Thanks all, your time and effort in responding is really appreciated. Lot of food for thought, I think I’ll ask the gp to send me to a hip specialist and have a discussion about options. I really want to keep on running as I’ve run all my life and need to keep climbing as I’ve climbed since the age of 17 and still love it just as much as my first trip to Glencoe in 1974!

I have some direct, albeit somewhat dated, experience in this industry including providing guidance to surgeons on specific implants and I have attended 100s of hip replacement surgeries.

There are a number of major manufacturers such as Zimmer, Stryker, Johnson and Johnson, B.Braun, Biomet, Smith&Newphew and many more and each manufacturer has a number of 'models' within their portfolio which are used for different circumstances.

The most basic hip implant is the one used in replacing the femoral component if the old person has a slip. The most advanced are staggeringly expensive augmented systems which are used when a previous hip prosthesis has to be replaced because of failure due to breakage or simply time - called a revision hip procecure.

Considerations over what choice is used are often around age, sex, weight, quality of bone, activity levels, complexity, but also often what is 'on the shelf' at the hospital. There are a range of materials of femoral stem metal and a range of fixing techniques, including press-fit and cementing. The same is for the acetabular (socket) which can be screwed, cemented or press fit. The articular surface is created by a femoral head fitted to the stem which can be ceramic or metal and the socket lining can be UHMWP (plastic), ceramic or metal. Ceramic on ceramic is often used for younger active patients and has minimal longer term issues because the material is so tough, together with press-fit stems. Metal on plastic is used but can have longer term problems with plastic particulates damaging the surounding sinovial tissues. There's also been some comment above around the BHR (metal femoral head and acetabular replacement). This is used for the youngest patients with the best underlying bone onto which the prosthesis can be replaced although there are some studies which suggest metal on metal can cause some issues because of particulates, but this might have changed now.

There are a number of units and centres of excellence and within each there will be hip specialist surgeons (who do little else and also conducts the most difficult revisions), general orthopeadic surgeons (who do a range of standard hip/knee replacements) and then smaller surgical units where the surgeon will 'do' hips but will be less frequent and therefore they will only do very easy stuff.

Surgeons will have a preference of what manufacturer they use because of what's on the shelf, they prefer the manufacturer's instruments and they 'work well in their hands' and then some will want the newest tech or model. There are some small longevity differences with different brands but my main selection factor would be to have a good surgeon who has good results regardless of the brand. A poorly implanted top brand would be less prefereable to a good implanted average one. 

There is also a relatively new innovation which involves surgical navigation which uses clever IT and sensors to help with measuring biomechanics rather than simply 'feel' and experience, which was the historic method.

Having seen the quality of the work from the 'inside' I would be very careful who I choose and would ask for their history, failure rates, how often they do the procedures and over what period. Are they specialist or jobber, are they using advanced tech etc etc.

Not all hip impants are equal....

https://www.ukclimbing.com/articles/features/me_again_-_climbing_with_arthr...

Thanks Mark 

If it's only come on recently See a therapist first. Do some committed rehab for 6 months. Then decide. Even Andy Murray did months of rehab and had an arthroscopy prior to going for his. As a physio and having worked in orthopaedics I would give it a chance to recover with rehab first. 

For what it's worth - my left hip is bone-on-bone. I can manage with a corset (compression shorts as now known!) - for how long I don't know - it's my choice. No cartilage, but muscular thingees - so I can still run (but not as I once knew it) and climb a bit. I had the right hip replaced late 2017 - a basic implant from Wrightington - where the original was conceived - and it's holding up well. I'm 76 and I don't want to give up what brings me pleasure, but there are limits and I am nowhere near where once I was. You are probably at the stage - what is best? and no-one can tell you, because it's a "mind" thing, and it plays tricks on you - 4 o'clock in the morning and it's aching because you're lying on it, and you want rid of it - but then you think of the op, and the rehab - and you (I) hesitate - your move, I'm afraid - good luck!