Post Hip op do's and dont's

A snowHead

In June 2019, Mrs SHAP had a total hip replacement after several years of pain. She's never been the best or most confident skier, but now she is refusing to go at all. She seems to think that only people who were good before the op should ski after it.

My concern for her is that since she left the hospital, there has been zero follow up, no physio, so suggestion of exercises for her to do, so she hasn't done anything... she is still sore, but more from the op site itself rather than the 'bone' pain that she used to get.

Has she messed up by not doing any kind of physio for the last 6 months, or is it normal to do very little post op? For ref, she has been doing light yoga and little gym cardio for a around 6-8 weeks, but nothing directly recommended by the surgery team.

Cheers

A snowHead

My father had both his replaced in his 60's. He was an ok week a year holiday skier but not a good skier. He was active after the ops but didn't do any specific exercises and wasn't supplied any from what I remember. After the ops he skied sixth months later to much the same standard as before but with a lot less pain. So from his experience it was business as usual. He still skis but as he in his 80's only an hour or so a day.
What did/do the doctors say about skiing. My father's consultant was fine about it.

Well, the person's real but it's just a made up name, see?

I should add that she was just 49 when this was done.

@pieman666, I'll be delighted to be skiing in my 80's. I'll check what the Dr said.

I think I'm more surprised that there was no post op plan...

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Me too @SHAP I will be very happy to be skiing at 80.

The difference between pre op and post op was amazing for my father. He was in extreme pain before the op post op it had gone. One thing that was more difficult afterwards is putting on ski boots. I help him or he gets one of the boot room attendants to help.

Anyway, snowHeads is much more fun if you do.

@SHAP, as related in one or more other threads here, I had a hip resurfacing nearly 5 years ago now (at 55) and was skiing 3 months later - albeit indoors. Last October I sustained multiple fractures to the same hip, which amongst other things resulted in the resurfacing being removed and a full replacement inserted.
I was given limited exercises by the inpatient Physios and referred on to the local Physios who I am seeing once a fortnight. Together we are building up the exercises that I do every day, which currently includes a 2 mile walk (with a walking stick at the moment) and 30 mins on a static bike as well as some very limited weights. I also apparently get 6 weeks free gym membership curtesy of the local Health Board.
It is my hope that I might be able to do some skiing right at the end of the season.
Now I do, under normal circumstances, ski around 8 weeks a year as well as skiing indoors most weeks; hill walking; mountain biking etc.
Perhaps worth noting that in the case of both incidents I have not had anything I would describe as pain after a couple of days after the operations.
Now my experience of all this is that you have to be very pushy. Emphasise that your wife does not lead a sedentary life style; that skiing (and whatever other activities) are essential parts of her life (and yours) and not being able to participate is likely to have a hugely detrimental impact on physical and mental health. I’m afraid that with tight budgets the authorities won’t do anything unless you ask and ask again.
Before my leg was operated on in October Mrs SL (normally a woman of few words) spoke to the consultant making it very clear that the most important outcome was that I needed to be able to ski when it was all over.
Good luck to both of you and do not give up or take no for an answer.

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I had a full hip replaced just under 3 yrs ago at 55. Straight away I was put on Walking every hour and exercises 5 times a day. I skied 11 months later and was stunned howgood the hip was.
I would get her to see the best physio you can afford and get some work in. After 9 months I hit the gym hard and the hip really benefitted.

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Mrs NBT had a hip replacement after an accident and has resumed skiing with no issue whatsoever. However she was given a programme of exercises to do as part of physio following the op, and continues to swim regularly some 3 years later in order to help build the muscle. No physio and no follow-up sounds like awful patient managment from the hospital, I'd be straight onto them to get something sorted

After all it is free

Thanks all.

I think we need to head to a decent physio, and go from there. It's definitely a massive improvement from pre op, but I think we were expecting to be in a better place by now, 6/7 months post op.

I'm skiing with son this year, and wife and daughter are having a beach hol, but I'd love her to want to come back to the mountains.

Edit for typo...

My french neighbour is in his mid 80s. Not a local but has skied here most of his life, they've owned their apartment since 1969. He knows all those of a similar age here and went heli skiing in Canada with a group of mainly instructors when younger. He had both hips replaced last year in 2 ops. He skied a bit between the 2 but is now back in full swing on both. Not just pootling around, still skiing anything, to a good standard.

My mum fell and broke her hip on Christmas Eve 4 years ago at 80 and had an emergency replacement. They sent a physio very soon after she got home to get her moving, getting upstairs, etc. She hasn't skied since, but she didn't before either wink

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Thanks again all.

@pam w, just to add a little - she has always been very keen, just not overly confident. Shame really, as I think she could be pretty good if she trusted herself to go a little faster (but that's another thread altogether...)

She loves the mountains, and we had considered her coming as a non skier, but the more she has thought about this, it seems that she feels it would frustrating for her to be there, but not ski IYSWIM.

Physio it will be....

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I had heard somewhere that after a hip replacement you can only do the cross county as opposed to Alpine Skiing. Does it have any negative effect on your Alpine Skiing?

@GarryC, I’m afraid you heard wrong. It is possible to do both. I will personally be returning to alpine before XC (as I did after resurfacing) not least as in my case a fall is more likely on XC skis than alpine.
As long as you can get muscle strength back, should not be a problem.

You know it makes sense.

Hi, @SHAP,

My wife had a hip resurfacing in Jan 2008 having only being able to ski a little immediately prior due to the pain from her arthritis. Due to the metal ion issue with resurfacings that was replaced with a total hip replacement in May 2014. In both cases she returned to skiing the following January and was skiing just as well as before the operations. The two issues to overcome are firstly the phsyio after needs to be done as a major muscle group has been cut and needs to recover. The second is the mental aspect of "What happens if I have a bad fall, will I damage the replacement?" which is countered by "Isn't it nice to ski and not be in pain."
Hope your wife gets back to fully enjoying skiing.

Otherwise you'll just go on seeing the one name:

@Ski lots, can I ask why you had a resurface over a replacement (if you were offered one?) I've just been diagnosed with osteoarthritis and have been told I needed a replacement without a discussion on why resurfacing was not available/suitable. At 45 I'm keen to try and avoid a hip replacement for as long as possible, but I'm starting to not be able to do things I enjoy such as cycling and running. I'm hoping skiing in 3 weeks will be ok Shocked

Seeing the reply's on here has given me confidence that I should be able to ski again if I have a replacement.

A snowHead

@C Holt, When you get to needing a replacement/resurface do research on femoral head size. When my wife had her resurfacing she made it very clear to the surgeon that she skied and wanted to continue. That led him towards resurfacing which at the time had much larger femoral heads than the traditional THR which had a tendency to dislocate in falls. Since then the trend in THRs has been towards larger heads which give a much more stable joint. Lots of info on THR websites and discussion groups. DO the physio your joint will be better than ever, it's the muscles around it that have been cut that need to recover.

A snowHead

Well, the person's real but it's just a made up name, see?

@C Holt,

Hip resurfacing has had a bad press recently (mainly around the DePuy ASR device which was recalled). Total replacement has improved over the years and now offers options with larger heads as @Timc says. The original hip replacement was small metal head in polythene socket which could dislocate, hence advice not to to ski on those. For these reasons surgeons appear to be favouring total replacement even in younger patients.

That said, resurfacing is still an option, some surgeons will offer it. My surgeon still does them but last time I met him he said it was the exception these days, whereas it was the default choice 11 years ago when I had mine done.

I would go back to your consultant with some questions - 1) why no resurface option 2) what does he/she recommend and 3) what are the implications for exercise. If you are not happy with the answers seek a second opinion.

As for skiing in three weeks' time, I advise doing as much exercise as you can now (squats, lunges, weight machine) to build up really good stability in your hip. Do a lot of stretching after skiing too, that won't do a thing for the hip but a side effect of arthritis is pain in the quads, knee and lower back that can be helped by stretching. Also pack industrial quantities of ibuprofen, or diclofenac if you have been prescribed it. I kept on skiing to the point where I could barely walk afterwards; I'm not advising that, it's not clever but so long as you ski in control and keep focused on good technique it is possible to enjoy the skiing. If you are doing a full week also consider a day off mid week.

Regarding post-op physio, I think most surgeons recommend it but some do not insist. I *think* Sarah Muirhead-Allwood is one who does not require on it for example. I heard that second hand so may be wrong, I've never met her myself. I think it helped me, but physio (and hydro therapy) before surgery was even more important in keeping me mobile and ensured the muscles stayed in reasonable shape. With severe arthritis there's obviously a good chance you won't do a lot of exercise and you can lose a lot of muscle tone, which in turn just make the pain worse.

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Thanks for the comments. I've got another appointment in a couple of weeks and will go armed with questions and also what I want to be able to to after the operation. The pain isn't too bad at the moment and I managed to get my ski boots on and off unaided at the weekend, I thought trying to open and shut the buckles might be a problem.

Recent experience is the local hospital recommend physio after surgery. I only realised I might have arthritis after my Mum was in having her hip replaced in the autumn and she was telling me the symptoms she had, and I was thinking, sounds just like me........

Anyway, snowHeads is much more fun if you do.

@C Holt, I originally had my resurfacing done due to a laboral tear, which was itself caused by some bone damage in the joint. The resurfacing was superb, from my point of view. No pain and easy to mobilise.

I only had the full replacement as I managed to smash up the whole of the femur and as I understand it there was not enough stable bone to support the rather smaller metal work of the resurfacing.

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I had my hip replaced in June 2017, went sailing in the October and skiing in Feb 2018.

After the op I was on crutches for 6 weeks, and then did gentle walking. I have to admit I didn't keep up the exercises. I did diet and I went swimming 2 or 3 times for a few weeks before we went for the first time; but I am basically not very fit.

I now get intermittent pain in the other hip, but nothing on the false one. I skied again in Feb 2019 and at New Year this year. I have put some weight back on and am much less fit - but my "new" hip didn't hurt at all.

I used to be a better skier - but that isn't because of my hip - I have lost my confidence. At New Year my own hip was playing up while walking, but was fine on the slopes. Weird.

I stick to cruisy blues and reds and prefer quiet pistes - my biggest worry is someone crashing into me. I also tell the ski shop that I want the bindings set so that the skis fall off long before I would twist my hip/knee.

At the end of the day though - if you pay for a new hip its a waste of money if you don't then use it.

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Encouraging message from Mrs Pralognan! I am a rubbish skier, in my 70s, and had both hips replaced, the first in Sept 2016 and the second in Feb 2017. Our medic son said very firmly to me when back in Pralo in Feb 18, that if I didnt ski that hol, I probably never would again... So I wobbled off down the nearest green run in fear and trembling. No problems, but I am still a happy cruiser on blues and reds, so no dramatic improvement! On the advice side, our NHS hospital was very clear on exercises and that my recovery was dependent on my own efforts. I like exercise, and weigh less than 50 kilos, which helps. My bindings are set very light, and I ditched my old rather too long and soft skis, and bought a modestly priced shorter, meatier pair. Good luck, hippy hoppy skiers!

After all it is free

Had my left hip replaced 18 months ago (aged 52). Part of a study into a new approach (AMIS - anterior minimally invasive surgery): they go in the front and separate quads to access the joint so no cut muscles to repair therefore much quicker recovery and less risk of post-op dislocation. I was off crutches in 2 weeks and walking (tentatively) without aids. Back teaching PE in 6 weeks (but carefully!). Skied again 9 months post-op and it was a revelation: no pain and much freer movement after 4 years of constant pain. I suppose I had a big advantage being fit with already well developed leg muscles for recovery, and thick strong bones (my surgeon swore and said I'd made him work a lot harder than he ever usually does!); but I had excellent physio aftercare and followed the exercises religiously to get back to full fitness asap. Personally I don't think Mrs SHAP need have any worries about returning to skiing, especially if you insist on decent physio (or bite the bullet and have to pay for it yourself). Good luck!

Another thumbs up for skiing post THR.
I broke my left hip in an accident and had a new unit installed. Quite a shock at the time but I skied 8months later and now 2yrs in I hardly notice it. Unless I run far !
Had no proper physio but back to biking after a month which nicely stretches things out and increases mobility .
Hope all goes well for everyone.

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I got Skippy (my titanium hip) on 31/7/19. I’m now on my way back from a successful week in St Anton.

I would definitely recommend physio to any who have hip surgery (whether hip scope or replacement) if you want to get back to your favourite activities. The muscles they separate or slice through need a lot of healing and pretty much all muscles around the hips and glutes need retraining as you develop compensation issues before surgery. I saw a great physio couple from 2 weeks post op until last week!

I’m a keen skier and it has only been the prospect of the next ski trip that has kept me from sinking into a black pit of depression post each hip surgery (2 hip scopes and 1 replacement in the past 4.5 years)!

Find a great physio, one who does the same activiities as you, and they will get you ready to get back on that horse!

My surgeon was fine with me skier because I’m an experienced skier. He would not recommend a hippy to start skiing post THR at 48. He did say to say of the black runs, anything steep and moguls. Ha!! Good luck with that in St Anton! Even blue runs turn into mogul fields by 11am! Oh well! I had fun! New hip did great! The other hip is on its way out but as long as it’s still fine for my end of March trip, I’ll be happy Smile

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Wayne Watson, one of the guides working in Alpine Experience in Val d'Isere, has had a hip resurfacing operation but it certainly hasn't stopped him skiing. He skis off-piste pretty much every day of the season and has been doing so for years after the operation. His exploits appear every day in his blog https://alpineexperience.com/en/waynes-diary/

So anything is possible!

Are replacement hips like replacements knees?
Ie they delay it as long as possible so you dont need a 2nd?
Just curious, as I have a degenerative knee condition and was told 10 years ago it needs replacing at some point.
I have alread lost the ability to run, or twist, turn, etc. As my knee wont take the impact.

You know it makes sense.

Bone on bone is very painful. Once you’re at that stage, you are begging for the replacement. I delayed mine a couple of months (a bit of denial going on) but once I faced the situation, it was sorted I think a month. If you wait too long, it can cause other issues (for pelvis, other hip, knees).

I will know when the other hip needs doing. It was a bit painful yesterday so I did not ski as much on the last day. Shame as the conditions were great. Oh well... I’m no masochist!

Otherwise you'll just go on seeing the one name:

@Mr.Egg, get it done now.
Who cares what its like when yr 85.
New Joints last longer these days

A snowHead

Just had a call from a recently turned 85 year old friend who is based in Val d’Isere. He was telling me that he was up skiing on the glacier today as it has opened early. He had his hip replaced last Xmas (2020), following on from an earlier resurfacing. Said he didn’t think he had lost any of his skill, but still needed to work on strengthening his leg muscles.

A snowHead

@Mr.Egg, my free and friendly advice to you and others is to do it now! They do last longer now, but we don't. My pal limped around the basketball court for five years doing the waiting game. Then he got cancer and died. Boy did he regret not getting it done.....

For the OP:
1. your BH is hardly the first to be disappointed at the pace of recovery. Full steam ahead with PT, which does not sound like it has received the attention it deserves from her healthcare provider.
2. Once #1 is complete, she'll be physically ready to ski. Physically.
3. But you've noted, there is also a confidence deficit. Completion of #2 will help, but definitely not solve that problem, which is common. This is a tough nut to crack. I like spending time with such folks on slopes they are comfortable on, and when the time is right I get them to start looking for speed on those same slopes. It only changes their speed from 8 mph to 10 or whatever, but it changes their mindset 180 degrees. Confidence is building from the successes at this point. Increase difficulty very incrementally, keeping the conditions in mind. I also find such people become exhausted very quickly because they are terrified and using massive amounts of energy controlling speed they don't need to control but do anyway. I'll yell at my person on a cat track, "are you relaxed?" and they never are, so they'll jangle out a bit and relax. Then they learn to watch for that themselves....eventually they can make it to lunch! Good luck to both of you.

Well, the person's real but it's just a made up name, see?

@Scooter in Seattle, thanks for that. Definitely some good info there, and she's been working online with some semi personal training sessions for a good few months, and it's certainly helping.

Cheers.

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I notice I commented on this back in January last year - we sneaked in a weeks skiing in March finishing literally hours before the lockdown. By March my other hip was giving me noticable gyp while walking although skiing was ok, so I decided to bit the bullet and had the 2nd THR done in January this year. I got a longer scar but was up and about much quicker. Am now swimming and occasional gyming with the intention of skiing again next year, covid allowing. I don't even think about the fact that my hips are both replacements, and I would echo what others have said - don't wait, life is too short. Its not till you get them fixed you realise how limiting hip pain has been.

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I had a THR in Jan 19. Was driving after 6 weeks and taking long walks without sticks at 4. I was given exercises by the physio which got more intensive every 2 weeks after the op. I was religious with the exercises with the warning do the work or don't ski again Very Happy

I was skiing on the dry slope in the September and did a full week in the mountains in March 20. I was told to avoid running and impacts like jumping but otherwise to ski as I did before or risk injury by trying to protect the hip.
I know the other one will need doing eventually but it's pain free at the moment so no rush.
The loading on my annual travel insurance was about £12.

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I thought I'd help to keep this thread running as a resource for those considering hip surgery. I had mine done in October 2019, at the age of 47, after 12 years of progressively declining function due to osteoarthritis. I was lucky in that until about 2015 my problem was functional impairment but with little or no pain. In summer 2019, my surgeon advised that the time was right for me to have a total hip replacement. In the months before the surgery, I tried to find information on skiing following THR (which my surgeon was fine with) but it was surprisingly difficult. I was able to talk to several climbers who had returned to climbing after THR but first hand reports on skiing were hard to come by.

My experience of the surgery and initial rehab is almost identical to @tarrantd, with the same 2-weekly physio review (excellent) and lots of walking and home exercises. The message is definitely to put in the effort to get a good outcome. In the longer term, lots of hillwalking during lockdown helped me to regain strength, control and confidence. I avoid running, squash and football.

My target had been to return to skiing on a family trip at Easter 2020 (that went badly!) but I did manage a couple of test outings in the UK in late Feb and early March (4-5 months post op). I'd say this was the earliest point at which I would have been happy to try skiing as the operation gave me instant mobility but it took time to rebuild the muscle control. This continued to improve up to about 12 months post op, which was what my surgeon had told me to expect.

To give some idea of what skiing with a hip replacement can be like I've posted a couple of short clips on YouTube, taken 21 and 26 months after my op. The quality isn't brilliant and it's only indoor but I am able to ski reasonably well and without pain. Just as importantly, I'm not worrying about the hip and I'm having fun.

http://youtube.com/v/jdgVEAkHCWQ

http://youtube.com/v/O0afQzagH_E

Bottom line is that wishing to keep skiing is not a reason to delay hip replacement, provided you're prepared to put in the effort on the rehab. I've no doubt that someone having THR in April/May could be fully ready for the following season.

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Encouraging videos, @fatboyfat- welcome to Snowheads.

Your post clearly sets out the work you did - and the time you took - to get back on form, having obviously been a keen and good skier to start with. Given the age I am, I know a lot of people who have had hip or knee replacements (sometimes more than one) and the difference between the minority who really put some work in, with their physios, and the majority who can't be arsed, is striking.

The other point I would stress that if people who are not great skiers want to continue after their ops, some lessons to improve technique would be worthwhile, as well as the physio. Watching you ski those moguls, it's clear that your technique is putting a lot less strain on your joints and muscles than I'd be feeling. wink

After all it is free

@SHAP, You wife is more likely to have some mental barriers (i.e. nervous the first time out) rather than physical ones. If I were you I would book a good private instructor for the fist morning for her, and explain the situation to him/her. I am sure that will get her pretty much immediately back to previous standard, largely from building confidence.

Related issue with my wife who did her ACL whilst pregnant with child number 2. Medics were unwilling to scan due to pregnancy so we did not know the extent until a few months later. Cue 2 more kids in the next 4 years so no real possibility for surgery, she did not ski for that time but did commit to physio and exercise. She had been a VERY good skier, but was understandably very nervous about starting to ski again. We decided on muscle strength and brace rather than surgery. When the day finally arrived I left her in the hands of a high level instructor I know who is also a qualified physio. One run on the nursery slope, and he then took her straight to a steep black. No way she would have gone there with me, but 2 hours later she was back to her standard (bit slower and more cautious) and has not looked back since. Addressing the mental side was definitely the most important aspect.

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I hope that sharing my experience will help others to make an informed decision as to when it's time to have the surgery. With the exception of those who need immediate THR following an accident, it's usually a question of when - orthopaedics marked me down as a future customer more than 10 years before the main event.

One of few personal accounts I was able to find when looking pre-surgery was Dickie Fincher's article in Fall Line, which is definitely worth a read but describes a rather rockier journey than my own https://www.fall-line.co.uk/skiing-after-a-hip-replacement/

The comments others have made about the challenge of regaining confidence are spot on. My first forays back onto skis and into moguls were both nervous moments, approached with considerable caution. For me, other activities were key. Doing lots of home physio (balance board, squats, theraband) helped with the strengthening but walking on uneven terrain is probably what really convinced me that everything worked as it should, to the point that I don't think about it.

Help!!

Post Hip op do's and dont's

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