© Copyright – 2020 – Athletics Illustrated
HipRunner.com and Athletics Illustrated (HR-AI) partnered to survey 219 respondents who had Total Hip Replacement (THR) surgery and are either former runners planning to return to the activity, hope to begin running for the first time or are seeking a similar option.
The consensus among patients was of relief, satisfaction and having bought a new lease on life.
Note: Of the many (nearly 1200) published articles that discuss post-surgery satisfaction the vast majority are assessing satisfaction on foundational outcomes: pain management/expectations, sex, quality of life for all patients, not specifically those intending to exercise.
This survey’s results are not taken from people who simply wish to be in less pain but plan to be physically active.
For example, a review published in by Biomed Central (BMC) (Okafor, L., Chen, A.F. Patient satisfaction and total hip arthroplasty: a review. Arthroplasty 1, 6 (2019). https://doi.org/10.1186/s42836-019-0007-3) narrowed down the criteria for gathering patient information from 1197 published documents to 33 and used that data to determine that 7% of patients were dissatisfied – a different score than we found.
Of the 219 respondents, 178 or 80.54% rated their post-op experience with the highest level of satisfaction available: “very satisfied”. Thirty-three indicated that they were “satisfied,” three answered “neutral,” four “unsatisfied” and one “very unsatisfied”.
Of the respondents, 67.12% or 147 are male, while 32.88% or 72 are female. The average age for surgery was 54 years and 362 days or 54.99 years old. Twelve of the respondents were 70 years of age or older when they had the surgery, three of which were 79.
Fifty-five and one-third percent had the anterior approach, while 44.67 posterior.
The average length of time between surgery and participating in the survey was 2.3 years or two years and four months. One outlier was 25 years on the first hip of two that the person had done.
The short period of time between surgery and survey is likely not enough to know how the prosthetic or surgery will hold up to the typically not-recommended act of running. So, this survey should act as a general satisfaction and general information summary. However, a little more than half of the surgeons did not recommend running.
The materials of the implant varied with the two greatest being ceramic femoral head into a polyethylene cup or acetabular (socket) at 32.10%, while ceramic into metal (COM) was at 29.63%. Ceramic and ceramic (COC) at 12.35%, while polyethylene into metal (POM) is at 16.67% and metal into metal (MOM) at 9.26%.
The reported sturdiest way to go is ceramic into ceramic, however, patients (not in this survey) have reported audible squeaking sounds when they move, which could have been a deterrent.
Some patients had not yet returned to running or running significantly by the time that they filled out the survey. Swimming and cycling were common forms of exercise with cycling being a favourite as the first step back to potentially running again.
Spinning and cycling are almost unanimously recommended by surgeons.
Of the 153 who returned to running, they average approximately 18 miles or 30 kilometres of volume per week. While 66 reported zero kilometres or miles run.
There was one person running 80 miles per week (130K), while three were running 70 (113K) and three were running 60 (97K) per week.
Twenty-eight of the 219 had both sides done.
Reason for surgery
Overwhelmingly, the reason for having surgery was indicated as Arthritis. Of the 219 answers, 197 indicated either “arthritis,” “osteoarthritis,” or “congenital defect” (which most commonly means that the femur head is too large, or the socket is too small, so, therefore, causes “osteoarthritis”. Four indicated a fall or accident that caused a broken hip that did not heal properly.
From diagnosis to surgery
Of the 175 respondents to the survey, the average wait time from diagnosis to surgery was 21 months and one week. The outliers were 180 months and three people at zero months (no actual time was given).
Asked how far the patients travelled to have the surgery, the answers were overwhelmingly “within 50 miles or 80 kilometres” from home. Of the 178 who answered the question, 141 had surgery close to home, six “left the country” – those answers came from people who lived in six different nations.
From the Centers for Disease Control (CDC) in the U.S., the National Center for Health Statistics indicates that the rate of THR from 2000 to 2010 increased for patients age 45-54; the largest demographic for the surgery.
(NCHS Data Brief No. 186, February 2015 Monica L. Wolford, M.A.; Kathleen Palso, M.A.; and Anita Bercovitz, M.P.H., Ph.D. ttps://www.cdc.gov/nchs/products/databriefs/db186.htm)
During 2000, there were 138,700 and by 2010 the number was up to 310,800, with the age continuing to trend younger. However, there are indications that a linear rate for all age groups throughout the same period shows a similar increase.
The largest age-group matches similarly to the HR-AI survey.
From the NCHS data brief:
The number and rate of total hip replacements among inpatients aged 45 and over increased significantly from 2000 through 2010. The greatest increase in absolute numbers was in the 55–64 age group, where the number of total hip replacements almost tripled, whereas the greatest percentage change was in the 45–54 age group, which experienced a 205% increase. The 45–54 age group also had the greatest increase in rate, which more than doubled from 45 to 117 total hip replacements per 100,000 population.
In the HR-AI survey, respondents were asked a multiple-choice question regarding the timing of surgery with the available answers:
1. I should have done it sooner.
2. I did it too soon.
3. The timing couldn’t have been better.
The majority at 50.84% felt that they should have had the surgery sooner. While 43.58% answered that the timing couldn’t have been better. And just 5.59% felt it was done too soon. No reason was indicated for why they felt it was too soon.
Patients, 143 in total, overwhelmingly chose their surgeon based on reputation alone, while interestingly 81.56%, as indicated above, travelled less than 50 miles or 80 kilometres to have the surgery.
Athletics Illustrated will, from time-to-time, continue to publish the results from the perpetual survey at www.hiprunner.com.