Return to running possible after hip resurfacing

Lindsey Konkel

NEW YORK (Reuters Health) - Recreational runners who undergo hip resurfacing, an alternative to a total hip replacement, may be able to return to the sport after surgery, according to a recent study from France.

Researchers found that more than 90 percent of hip resurfacing patients who ran before surgery resumed running afterwards.

“I’m convinced that quality of life is strongly correlated with sports possibility for younger patients,” said lead author Dr. Julien Girard, an orthopedic surgeon at Lille University Hospital in France in an email to Reuters Health.

Intended primarily for active adults younger than 60, hip resurfacing is an option for patients with severe arthritis who want to return to being active after the surgery.

Hip resurfacing represents a fraction of all hip replacement procedures in the United States -- roughly five to 15 percent. More than 285,000 hip replacements are performed in the U.S. each year.

During hip resurfacing, a surgeon removes only the damaged parts of the head of the femur bone and covers it with a metal cap, while replacing the hip socket with a metal cup.

In conventional hip replacement, the entire head of the femur is removed and replaced with a metal implant; a plastic cup is replaces the hip socket.

Over time, the traditional implant can wear and loosen, especially in patients who participate in activities, such as running, that put repetitive stress on the joint.

“Numerous studies have shown that total hip replacements fail in younger more active people who want to continue doing what their peers are doing,” said Dr. Harlan Amstutz, founding director of the Joint Replacement Institute at Saint Vincent Medical Center in Los Angeles.

Amstutz was not involved in the current study, though he previously helped develop one of the implant systems used in the research.

For the new study, researchers followed 36 male and 4 female patients, average age 51, who were runners before hip surgery. A total of 43 hip resurfacings were performed on the 40 patients.

At the end of about three years, 33 of 40 patients (36 of 43 hips) were still running.

The runners spent a similar amount of time -- about three hours per week --running after the surgery as they had before. Their weekly mileage decreased significantly, however, from about 24 miles a week to 16 miles a week among the patients over age 50.

According to Girard, some older patients preferred to switch to lower impact sports, such as swimming or biking after the surgery.

While the results suggest that a return to running is possible after hip resurfacing, the study did not look at the long-term effects of wear on the implant.

Other studies have found that patients can maintain a high level of activity for 10 to 20 years after surgery.

Running doesn’t appear to harm the longevity of the implant, but a follow-up of more than 20 years is necessary to draw firm conclusions, Girard said.

Less intense runners also may not see the same results, said Dr. Michael Anderson, a joint replacement specialist at Aurora Sinai Medical Center in Milwaukee who has seen a smaller percentage of joggers return to the sport after surgery.

Still, hip resurfacing represents an attractive choice for active individuals.

A hip resurfacing implant is easier to revise or repair than a total hip replacement, researchers said.

It also feels more natural than a traditional total hip replacement, according to Anderson, in part because less bone is removed from the head of the femur in hip resurfacing.

“The body has a more normal awareness of that hip, which makes the joint feel more secure in sports with a lot of running, cutting and twisting,” Anderson told Reuters Health.

SOURCE: American Journal of Sports Medicine, online February 1, 2012