Bi-lateral THRs  Dr. Snyder Sept. 2010  & April 2011


"My story is one of 20 years of gradual hip degeneration, in my case classified as FAI: femoral acetabular impingment, simply a heavily used hip joint from a highly active lifestyle, perhaps initiated by some labrum tear at a moment of particular stress/strain and then progressive involvement of joint tissue with cartilage wear, bone on bone conditions developing, and consequent osteophyte growth.

The images above show over twenty years of osteoarthritis development in my hips, as compared to a normal non-OA hip (blue image), with my left hip showing more severe degeneration and cyst development (right side of image)

I’ve played soccer since my youth, began motorcycling at age 18, and began rock climbing and mountaineering at age 20. I first noticed compromised movement in my left hip at age 36 first only as an obvious reduction in range of motion during rock climbing moves yet felt no loss of strength or pain. I continued my active lifestyle until I was diagnosed with osteoarthritis at 4 years later whereupon I limited my activities in the interest of preserving what function remained for as long as possible. These diagnostic x-rays indicated substantial OA in both hips even though my right showed no limitations that I could tell.

Throughout my 25 years in the healthcare field I’ve helped with the rehab of many joint surgeries and have seen both successes and failures and held a reluctance to undergo surgery myself. As an alternative therapist I’ve used acupuncture, craniosacral, jin shin jyutsu, chi healing, muscle therapy, tai chi, and yoga regularly for my own health maintenance for many years and each contributed to prolonging the life of my hips. However, by my late 40s I found I needed to give up many of my outdoor interests including ice skating, skiing, and running, as they all became too painful. I continued my rock climbing only because of my love of it yet limited my climbs to short easy outings.

My choice to wait was based on the original diagnosis that recommended waiting as long as possible to assure that the prothesis would outlast my needs and not ever need revision. I was age 42 at the time and the year was 1996.

Then in 2009, I heard about hip resurfacing from one of my taiji teachers – a procedure that provided a possible path to renewed hip joints without restriction in activity or range of motion – and saw this as very desirable for myself as a young athlete.

My intense research of hip surgery procedures and of hip resurfacing as a technique lead me to choose the direct anterior approach and therefore to find a surgeon that made this approach the norm. Soon I had found my surgeon and scheduled a date for my left hip first which was now the weaker hip.

However, at this point of waiting, my left hip had degenerated to the point of needing support often, and although I was still active with canoe trips and bicycling, my distance in all activities was growing very short, running at most 20 feet, bicycling only 2 miles, and even my taiji was being shortened. Had I discovered resurfacing sooner perhaps my femoral head would have accepted a resurfacing., but as it was, pre-operative X-rays of my joints showed possible excessive necrosis that may be precluding hip resurfacing for me, at least on my left side.

It was then that I learned of the new bone-conserving MiniHip prothesis which, like resurfacing, supports complete range of motion, no dislocation, and continued sports activity. The MiniHip design offered to me is a Stryker/Corin product: a Stryker ADM X-3 dual articulating Co-Cr ball, cross-linked poly large diameter ball, and titanium bone growth cup matched to a Corin titanium bone-growth mini-stem. This is a non-metal-on-metal solution for hip OA and is considered an appropriate choice for younger, active patients that wish to continue being active. Certainly the hip resurfacing would be a better choice for bone conserving should revision be needed, yet this MiniHip design was said to be easily revised without the need to re-enter the bone implant components. Designed so that the cup and stem stay fixed, the articulating components can be replaced easily, and with cup and stem being bone growth there is some arguement for the fixation being longer-lasting than the commonly cemented resurfacing stem.

So, I chose to schedule for hip resurfacing and to accept this new MiniHip option as a backup option should the hip resurfacing prove to be contraindicated due to the advanced necrosis.

I underwent my first operation in September 2010 and was up using my hip again that same day. Although the muscle rehab was hard work, I was thrilled with the results – within one week I was down to one crutch, largely finished with the cane at four weeks, and at five weeks had resumed my favorite activities of rock climbing and motorcycling. By 12 weeks I felt as if no surgery had ever been done. What a gift this was considering what I had endured.

With my lightness of gait from years of tai chi I was able to last a long time before surgery, yet endured much limitation in the final two years. Early on I did not consider that I would ever recover a wonderful, natural feeling joint again and assumed that any THR would include some limitation and should therefore be avoided as long as possible. With the MiniHip, I have had a seamless return to normal strength and flexibility in my left hip and I now find it easy to do powerful activities that I long ago gave up on. My winter was filled with ice skating, skiing, and sledding with my young children. ies.

I am so pleased with what this MiniHip has given me that I elected to have one for my right hip as well and surgery was done in April 2011. Some of the decision was clearly for symetry with the left, some for the smaller incision and lessor trauma over the resurfacing procedure, and some on the chance that it may have actual advantages over resurfacing.

My April recovery has been rapid, more so than the first, with my progress easily measured in days in contrast to the week milestones of the left hip. Here are some of the measurable milestones: 1 crutch at hospital on day 2, 50-50 unassisted by day 7; in week one I can do all PT exer as per week 5 of last time; plus ride bicycle, drive car; in week two ride motorcycle, bicycle 5mi. to work daily; in week three hiking w/ child carrier, stairs two at a time, canoe onto cartop and lake paddling, first out-patient PT session; in week four five straight leg raises, can lift R leg to bed/chair height, walking normally, mowing grass, outdoor rock climbing w/ packs, canoe and kayak outings, some running, some easy basketball play, I can cross legs at knees - first time in 15 years! I am now at week 5 as I write this.

I don’t know if my recovery is typical. It does seem faster than stories I have read of HR or THR. I feel that the DAA contributes and this was common to both so does not explain the difference. I understand from my surgeon that my right hip was more typical OA and could have accepted a resurfacing, whereas my left was angry and inflammed so perhaps this was the difference. In any event I am very pleased with my post-op condition and my ability to resume long ago lost athletic activities, some as simple as playing outdoors with my children.

I am very pleased that my waiting brought me to this place and am very grateful that the technology in hip replacements advanced to meet me when I finally needed it. I am delighted to have such natural strength and movement returned to my body – I feel that I have many years of enjoyment of life ahead of me."