UKH

I hope to have a Dual Mobility Hip fitted in the next few weeks. I am trying to find a Physio who understands climbing and Dual Mobility Hips (as against standard 2 part hips). Most Physios I have spoken to so far don't understand climbing, let alone the difference between a normal hip replacement and a Stryker Dual Mobility one. I currently climb 6a ish.

Can anyone help me out? I don't mind paying for someone who knows what they are talking about.

You could probably do with a location in your title. If you're near Sheffield, Bristol or London and maybe a couple of other cities with a high concentration of climbers then it'll be easier to get a recommendation, I would say.

I just had a read online about DM hips, interesting stuff. Good luck with it!

I now have two of them, the right in 2010 and now the left in Feb this year. I can’t imagine that the physio is any different to that for a normal prosthesis. The main thing you’ll find is that it’s virtually impossible to dislocate, so the physio has less to worry about when doing exercises to increase your flexibility. Persevere with physio to build up muscle strength and range of movement, especially if you weren't that active before the op. If on the other hand you were active right up to the op, your recovery should be rapid. Don’t hesitate to email me if you’d like any specifics.

Thank you for your reply. You might have hit the nail on the head. I'm in Norfolk - a bit flat to say the least. I was hoping to talk to someone, even if I can't get to see them that often.

It has just occoured to me that as I work in Surrey that might be a better option as it's near to London.

Thank you for your reply. I'm please to see your first hip has lasted at least 9 years. I would regard myself as reasonably active climbing indoors at least once a week. I like what you say about a rapid recovery.

Any guidance you can give me would be most welcome.

http://climbingphysio.com

Presumably once you've had the operation you'll be referred to a physio who should be familiar with your specific circumstances.

Just read the Sept 2019 paper on DM hip technology and the potential benefits - I knew jon had them because France does not do Birmingham resurfacings, I did not know they were offered anywhere in the UK. I have a resurfacing from 5 years ago and a ceramic/ceramic total replacement (in the other leg) that is 2.5 years old. For my money, at the moment, the ceramic bearing is the better one and with the better range of movement. No risk of dislocation or metal or polythene debris, no need for anything more complicated in my case. The Birmingham hip is technically superior, which is why I chose it, but that is the one I can feel as being 'different',  now it has settled down the THR feels 'normal'.

With both operations I was running and climbing, carefully, within 2 months. Up to 6b/V4 indoors, E1 on grit, with never a sense of impending dislocation from either. Managed to get around the Welsh 3000s this summer, currently trying to get my parkrun time down...

Good luck with your fancy new joint!

Don't count on it. My experience with NHS hip replacement is that physio is limited.

Do a search here on physios in London if you go down that route. There's been a few threads, and I seem to recall one or two climbing physios recommended. 

Dual Mobility hips - the bees knees

Over here (USA) they are only used for hip revisions due to price (I think) - a second surgery is much higher risk for dislocation, presumably as the patient is older and so generally higher risk. But, as jon says, in more enlightened places they can be used for a first orthosis. 

But you ask about PT. My therapist was mildly freaked out by the magic words "no hip precautions". I'm not sure why I was in that exalted class, but it is very much up to the surgeon and therefore up to the type of surgery (anterior, lateral, posterior, minimally invasive lateral (mine - although this is more like posterior IMHO)). 

No hip precautions means you don't have to worry about not going over 80-90 degree flexion. This may not sound like a big deal but when you practice for that (as I did prior to surgery), you realise how often you do actually flex your hip over 90 degrees. So I was chuffed to bits when my surgeon said the magic words. Partly, I think, in the case of regular hip replacements it is the size of the head. My surgeon demonstrated with a device in his office how difficult it is to actually dislocate a large headed device. BUT, I also think it depends how ready you are. I did nearly a year of "pre-hab" to make sure recovery would be as quick as possible and, indeed, my recovery, I was assured, was quick. Although not quick enough for me! I was driving (although still using 1 crutch, much to my surgeon's disgust) and doing proper physio at 3 weeks and essentially fully functional at about 6 weeks (which is a good bit slower than some on here). Now, 9 months post-surgery, I am going up multiple flights of stairs 2 at a time which is something I hadn't been able to do for ages. Florida is a bit like Norfolk in terms of lack of opportunity to walk up hill! 

So I don't think that there is any particularly special PT for dual mobility hips vs. regular hips. The PT, after all, is just for all the soft tissues. The new joint doesn't care. 

By coincidence a friend in Manchester has been offered one in March next year.

It's interesting that you say it's the THR that feels more normal than the resurfacing. If I remember correctly you were a little sceptical about it at first?

Slightly off-topic but interesting- suggestion that risks of dislocation are lower than thought:

https://www.sciencedaily.com/releases/2019/03/190312170818.htm

Interesting indeed - there's a lot of hocus-pocus in hip surgery and much of it has no basis in real data. On the other hand, as pointed out, there have been significant changes in procedure that result in more rapid recovery.  

It is predicted that THR will be an outpatient procedure before too long. Knees already are (in the USA) and their recovery is definitely more arduous. 

Indeed. My friend who's getting the DM hip in March has been told that all being well he'll be home the same day. I'd be worried if it was me, there are so many things that (I can imagine) could go wrong at that stage.

Hi

Thank you for the link - looks very promising.

Re "Presumably once you've had the operation you'll be referred to a physio who should be familiar with your specific circumstances."

Unfortunately that doesn't seem to be the case.

Yes, I was skeptical about having a metal rod stuck down my femur, there is a commitment about that which is absent in the resurfacing which can easily be revised to a total hip. I know they have tools to extract the metalwork if necessary but mechanically it seems less than perfect, and there is stress-shielding of the femur bone to worry about. However, the operation is easier and quicker and more surgeons are competent to perform it. I'm very pleased with my ceramic bearing now, this time last year I was limping and imagining the worst was happening. The BHR is good, no doubt about it, but for range of movement the ceramic has it beaten, and the BHR is the joint I notice if I run for a couple of hours, or spend all day on the hill. 

To the OP, the best physiotherapy, according to the physio I had, is walking as much as possible and as well as possible (don't learn to limp!). Gentle bouldering from about 8 weeks, no wide bridging or outside edge stepping, should be ok but lots of walking is the main thing...

I meant to start a thread on the state of all the recent hips - I will hijack this one instead! How are you all doing?

Blimey, an outpatient procedure?! 

Can't imagine being sent home immediately with a knee replacement - takes time just to get the pain relief right. 

It happens in the US - operation in the morning, tested up steps in the afternoon, released to local hotel for overnight stay, visited next morning then allowed home, even if flying for several hours. Amazing!

Ah, I see... I wondered how they'd manage it. Staying in a hotel overnight is probably a lot cheaper than staying in the hospital there!

Pleased to hear about your good recovery. I’m very keen to know more about your pre hab which is something I’ve done with ops in the past and know how great they are at making sure that you recover quickly from surgery.

Essentially the same as post-surgical - leg presses against a wobble board, unilateral and bilateral, sideways extension exercises to strengthen whatever the muscles are that stabilise the hip, balancing on a wobble board. Some of them were a bit painful pre-surgery and improved a lot post-surgery! Buttock lifts featured a lot as well (lie on back and bring hips into the air. Hold. Relax. Repeat) Everything seems to be repeated 10 times, cycled through whatever you are doing and repeat the lot 3x. 

The idea is to strengthen the smaller muscles, I gather. The big ones are pretty easy (squats, for example) and tend to bear up fairly well. Although everything gets a bit strained. The surgeon will usually dislocate the hip at least twice during the surgery. Once for obvious reasons and once to do the final adjustments to the device. 

One thing that surprised the heck out of me was that the joint capsule is put back together to result in a capsule that can lubricate the new joint. That was rather cool. 

It is good to get in the habit of doing the gentler exercises as they will be the main ones for the first week or so, 4 times a day. 

And as petemeads says - walking. As much as you can stand, but not so much that you can't repeat a few hours later!

So are DM hip replacements or resurfacing covered by the NHS?.

I might have mine done before Boris dismantles the NHS.

At the moment I use crutches to get to the Crag but climbing is OK, that is why I am delaying the Op.

Cheers 

Delaying it works against you in the long run. The speed of recovery post op is largely dependent on the state of your muscles prior to the op. The prosthesis itself is brand new and needs no physio or ‘running in’. It’s the muscles/soft tissue that requires the physio. I appreciate it’s a big step to take when you can still function - I felt exactly the same.

Hi

I was in the same boat - I could climb but getting to the crag was painful.

Yes I am (if everything goes to plan) going to have a dual mobility hip on the NHS. I will say I had to badger the Consultants to agree to this and it was only when I threatened to go to Lithuania to get a Dual Mobilty Hip that he realised I was serious.

This type of hip seems to be common in France but only given to old people who may fall (and hense dislocated) and people with MS / muscle spasmes (who may also dislocate) in the UK. Having one in the UK in order to continue to have an active life seems to be the exception.

The other thing I have learned is that as the hip worsens, and walking becomes more challanging, so the muscles loose strength. Given that the NHS grinds incredibly slowly I would suggest it may be worth starting the process sooner rather than later. I started the process back in April and should have the operation at the end of December (and I have been told that is quick !!).

As has been advised by others, get it done sooner rather than later. I felt like you but the surgeon just looked at me and reminded me that exercise/physio/delay etc wasn't going to make things better. He picked up a joint that he kept as a paper weight in his office and said, 'only this will'.

I had the op here in France back in October and am rapidly recovering. I did lots of cycling and swimming right up to the day before the op. I could climb but was struggling with walking. Get your legs strong before the natural avoidance of using them makes you weak for the recovery after all the stretching they will have to undergo.

Thanks to all, I was going to have mine done here but I was told I would not be able to climb ever again by the surgeon, I could go ball room dancing and bowling instead he said. Forget surfing as well. So I delayed. Now I have had to reduce the leg loop size considerably for harness to fit.😦

Bollocks. You'll climb better and without pain. Just shows how important it is to hunt around for the right surgeon.

Edit: sorry if that seemed a bit abrupt, it just pisses me off to hear things like that. I was told the same by a physio after my first hip. So I went elsewhere.

My thoughts exactly. A surgeon with no confidence. Run away!  
I suppose there has to be a “worst orthopedic surgeon in the world”. Looks like he’s been found. 

There are UK surgeons who are runners and triathletes who specialize in getting runners and triathletes back into competition, and of course Andy Murray. There ought to be a separate register of surgeons who are specialist in treating active people, even the NHS will allow treatment by any surgeon in the country but how do you find the right one, except by recommendation or the internet forums/self-help groups?

I discovered SurfaceHippy (for BHR and similar resurfacing) and Hiprunner (for all hip replacements), both US sites with Brit presences, where anecdotal evidence overrides the surgeon/manufacturer cautious recommendations. And a small number of less successful outcomes - there is no guarantee...

Had a dual mobility hip installed april 2017. After a couple of months of recovery, I have been climbing and surfing ever since.
Both much improved after the surgery as compared with before... especially straddling the board which was really uncomfortable prior to surgery.
The new hip is now the more flexible of my two hips by a noticeable margin.

My comment was a bit tongue in cheek! There are certainly very rare* bad outcomes in THRs and I wonder how much that colors a surgeon's view? After all, they wouldn't do the surgery if they didn't think the outcome highly likely to be good. There's also the aspect of where they got their training - if they were taught by someone who is overcautious then they will likely be overcautious themselves, even though the data suggests they don't need to be. 

So, you end up with confirmation bias:

1. overcautious approach and advice- patients take up bowling and ballroom dancing after decades of being triathletes.

2. all my patients are doing well! 

3. the overcautious approach is obviously the right one 

*Very rare depends on whether you are the one with the bad outcome or not! It is in the very low single digits. From France: https://jamanetwork.com/journals/jama/fullarticle/2441262 post-operative complications 2.3% after elective THR.