# Hip Resurfacing



## Moementum (Oct 21, 2006)

After years of pain and stiffness a year ago I was told I had advanced arthritis and would need a hip replacement. Of course I ignored the doc and kept riding right through the fall, winter, and spring and my symptoms got really bad. I could no longer put up with the pain, I could not even sleep at night, could barely get on and off the bike. I knew about the procedure that Floyd Landis had in 06 and did a ton of research on it. It was approved by the FDA in 06 but had been done in the UK and elsewhere for about 10 years. It is a better option for active people. But the thing is, if you don't see a surgeon who does it, only about 10% do, they won't even tell you about it. There is a great surgeon in my home state who is experienced in the procedure. I had both hips done on July 13th, one surgery, one recovery.

I spent 10 days in two hospitals, 4 weeks on crutches, 2 weeks on a cane. The rehab is really hard work, but I am now able to do easy 25 miles on the road, and 5-6 mile hikes. I still have a hell of a long way to go, it was really major surgery. I don't know if I will ever do single track like I once did, but being pain free is worth everything I went through.

Don't ever take your health for granted, I was with people in rehab who did not have a bright future. I still have all my limbs.


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## MTBigSky (May 26, 2008)

Incredible you had both hips replaced at the same time. Good to see you're returning to your normal activities


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## Green Giant (Dec 19, 2003)

*Good to hear*

Wow, both hips at once.

I'm eventually headed towards the resurfacing or a new hip at some point. I'm 37 and broke my pelvis 20 years ago.

Last year a torn labrum really hosed things up and I lost most of the season. I thought it might be time. Fortunately they were able to clean out the labrum with a scope (good) but couldn't repair it (bad).

I was given a number of options, but for now I'm 80% better. I am not supposed to run, jump, or impact the hip all that much. But, if I can bike, I feel good about things for now.

Skiing will be interesting. They said I am allowed to keep skiing, but absolutely no moguls or jumping (which at 37 with 3 kids is probably smart...).

I'm also trying to lose a bunch of weight to help save the hip.

Great though that the hip resurfacing is helping you thus far. I've heard mainly good things as long as you can get out of that first 8 weeks without any major complications (like the stem breaking...).

Did you get the Birmingham?


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## Moementum (Oct 21, 2006)

Yes, it is the Birmingham system. Good luck with your hip issue, surgery should always be the last resort. Choice of surgeon is critical, there is a steep learning curve to resurfacing.


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## moto367 (Nov 20, 2006)

Wow, both hips! I had my right hip resurfaced July 21, 2008. I'm facing the left one too but wasn't as bad so I'm waiting to have it done. My surgeon had done over 200 of these and I can't say enough of him. He was great and new his stuff (Dr. Keith Berend at Joint Implant Surgeons in New Albany, Ohio). The surgery is kind of major I guess. But my recovery was very quick. They had me walking the next day and was on my way home (I live 3 hours away from the surgeon). I took care of my own therapy with their guidance (They called daily). At 4 weeks I was back to work, 6 weeks they told me to do what I want. Four months after the surgery I did a 12 hour race. I think my age (37 now) and previous fitness condition had a lot to do with my successful recovery. I also followed the surgeons instructions to a "T" and gave myself a full year to get back to my normal activities. Just a little extra caution I guess. But damn! Both hips?? I think back to all the things a person takes for granted like taking your morning "call" to showering and it was difficult enough with just having the one hip done. More power to ya dude!!!:thumbsup: Good luck. Oh yea, I had the Birmingham system also. There were issues with the Stryker like squeeking and staff virus at the mfg. facility.


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## Big Foot (Oct 16, 2006)

*Hip replacement*

I am 48 , had had full replacement 1.75 years ago ( metal on metal no plastics) at university of Georgetown by Dr. Brian Evans he told me this is alot more durable and should last 20-30 years. 
Spin class at 4 weeks, on bike 6 weeks ,big endo over a 18" log, at 10 weeks, naturally I fell full weight on my left hip (the replacement). Told Doc and he was not concerned.and my hip was fine.
Sking I am must stronger, have done a triathlon and a Xttra . But I mostly enjoy Mountain biking. 
Highly recommend it if your are in pain and cannot do what you want. Dr. Evans is the best.
Gary


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## moto367 (Nov 20, 2006)

I know most doctors who are doing the resurfacing have an "age guideline". I was 36 when I had my resurfaced and for 4 years I couldn't find a doctor who would touch me for a full replacement. I was still somewhat functional even though it hurt like an SOB and I was bone on bone. Basically the resurfacing is a "bridge" for younger people until they get to the point of getting the THR. It also preserves more bone density.


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## Tufinit (Dec 16, 2009)

I had hip resurfacing surgery on both hips. The first one was done by Dr. Harlan Amstutz at the Joint Replacement Institute. My advice: STAY AWAY. Horrible service and care. I came out of surgery with sciatic nerve damage that three years later still persists on a small scale.

The other hip was done by Dr. John Rogerson in Madison, WI. My advice: go to him if at all possible. The followup care and therapy he provides is second to none. His staff is excellent. Because of his followup care, in fact, recovery is almost immediate. Literally.


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## Moementum (Oct 21, 2006)

Tufinit said:


> I had hip resurfacing surgery on both hips. The first one was done by Dr. Harlan Amstutz at the Joint Replacement Institute. My advice: STAY AWAY. Horrible service and care. I came out of surgery with sciatic nerve damage that three years later still persists on a small scale.
> 
> The other hip was done by Dr. John Rogerson in Madison, WI. My advice: go to him if at all possible. The followup care and therapy he provides is second to none. His staff is excellent. Because of his followup care, in fact, recovery is almost immediate. Literally.


I saw an interview with Dr Rogerson and was impressed. Sorry to hear about your bad experience with Dr Amstutz and the JRI, he is quite well known in this field. Did you get Birmingham's? I went down hard on my right hip today on ice, no problem.


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## Tufinit (Dec 16, 2009)

*Birmingham*

Yup, Dr. Rogerson used the Birmingham. The interesting thing about Amstutz and the JRI, when I came out of surgery and had sciatic pain, they told me (!) I had the pain before surgery. They claimed there was nothing they did during surgery that would have caused sciatic pain.

Dr. Rogerson, on the other hand, warned me _beforehand_ that sciatic nerve pain was a possible side effect of the surgery. However, he must have been much more gentle in there than Amstutz because the only pain I felt afterward was wound based.


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## Moementum (Oct 21, 2006)

That sucks about the sciatic pain, is there a chance it will ever go away completely? The Birmingham is the best system. I wouldn't go with anything else. I can't believe how good I feel compared to pre surgery.


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## Tufinit (Dec 16, 2009)

I don't know about the sciatic pain but the hip Amstutz did, the left one, is causing pain in my groin sort of like when I first found out the hip was bad. The right one with the Birmingham, the one Dr. Rogerson did, is better than new.


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## Green Giant (Dec 19, 2003)

Well,

Bummed out, good chance I re-tore the labrum in my hip last week. I knew there was that chance, but bummed it may have happened so quickly.

I have some arthritis, and some FAI. Pain mainly is in the greater trochanter area, generally a dull to moderate ache. A few sharp pains (which makes me think I re-tore it).

For you guys who bit the bullet - I know it's real tough to describe, but what level of pain were you in, how often, what caused it etc.

I'm on that fence where this is livable as I can sleep etc, but if this doesn't cool off I do have to pull back activities to keep the hip pain down.

Praying this is just a scar tissue issue etc... but since the scope I've been good after a day or two if it flairs up, this has been over a week now. So... reseraching the resurfacing again.


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## Moementum (Oct 21, 2006)

Sorry to hear that GG. I don't know anything about labrum pain but this is my experience. My pain was totally activity related, the more I did, the more it hurt, that is typical of OA. It was very bad at times, walked with a limp, very painful in the groin turning over at night. It was also impacting me at work also, I need to be flexible and active. I was always cutting back on riding, hiking etc, it was just too much. Eventually you end up living like an elderly person, that's not for me.

I haven't regretted my surgery for one minute, but it is early in the game, the real test will be long term, 5-10-20 years. If you are interested in resurfacing be aware that there is opposition to it from the old school orthopedics. They will want to give you a total hip replacement.

Good luck http://surfacehippy.info


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## moto367 (Nov 20, 2006)

Not sure where exactly you're located GG but here is the link of the surgeon I went to in Ohio. Absolutely unbelievable!! They were really top notch. Dr. Berend is one of the best. He has done well over several hundred. I have no regrets on having this done. I decided to get mine done when I no longer could sleep. Let this go for about 6 months and finally said enough! Good luck.

http://www.jointimplantsurgeons.com/


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## Green Giant (Dec 19, 2003)

Thanks Guys.

Well, today some big improvement. Hoping I'm headed back towards where I was (not perfect but able to ride).

It was as bad has it had been in over a year for a full week. So, hopefully I'll get back where I was.

If I can ride, and do some other things moderately it's livable.


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## DurtGurl (Dec 10, 2001)

Moementum... your story is inspiring! While being treated in late 2008 for a broken shoulder, I complained about my persistent hip pain... Xrays and MRI indicated advanced OA in both hips with the right being much worse than the left. Do you have any MRIs or xrays of your hips prior to surgery? The doc said it was amazing that I am so active, and that another person with my condition would have given it up to surgery long ago. I credit begin strong and active (and stubborn) to keeping the pain at bay, but I feel my good times are limited. 

I took up downhilling this year... after a day of pounding it on the big hits of South Mountain PHX, I am pretty much in agony for days. I fight it by riding more. Funny that it never hurts (or I don't notice it) during riding - it's only after. Sleeping is always uncomfortable and long hours at the computer can be agony. When I let up on the riding, the pain does subside, but it is always there. With my bones looking like swiss cheese (cysts) at the ball of the femur, I am amazed that I have not just broken. I ride hard and I fall hard too. I wear lots of body armor for the big bike, but being a chick I'm not too keen on wearing the hip guards.

I have another appointment with a hip specialist at The Core Institute in Phoenix next month. I will hopefully get a new MRI to see how things have progressed. Will they recommend that I continue to grin and bear it? Or maybe it's time to go for some new parts.


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## Moementum (Oct 21, 2006)

DurtGurl, I'm sorry to hear about your diagnosis of OA. It sounds as though you are at the fairly well advanced stage. I'm also amazed that you haven't broken a femur with your hard crashes! Your symptoms are very similar to mine and typical. When I first went to a doc he said hips are like car tires that need to be replaced at 40,000 miles and my left one was at 35K. The final 5K would depend on how fast I drove, of course that was the time to put the pedal down! You know that the condition does not improve, it only gets progressively worse. You can prolong it by modifying your activities as you have found, meds only mask it and cause damage. 

If you are interested in resurfacing be aware that there is a window of opportunity for the procedure. If there is too much damage (including cysts), the window may close and at that point you are looking at a THR. THR is a very succesful procedure, but there are drawbacks. There are risks to all surgeries. 

Does the Core Institute do resurfs? If not you may not get an accurate picture or opinion of the procedure. You need a very experienced surgeon when cysts are involved. Check out the link that I posted earlier for much info.

I haven't decided at what level I will return to riding, here in snowy icy New England it's been mostly hiking lately. I want these implants to last a very long time. There is no real consensus on how they will hold up to extreme impact sports. Although many athletes have returned to running, backpacking, skiing, martial arts, etc. I'm sure I could return to a very high level even though my best days are in the past. I know it will be difficult to hold back because I already feel great. I do have an earlier x ray but I would have to dig it out, on old film, it was ugly.

DurtGurl, you need to do research and get more professional opinions and to ask yourself how you want to go through the rest of your life. Don't wait too long. When I asked my surgeon what my options were, he said I could live with it, or get it fixed. I booked it right there, it was time. No regrets. Tomorrow will be six months.

Good luck and keep me posted, Moementum


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## DurtGurl (Dec 10, 2001)

Moementum said:


> DurtGurl, you need to do research and get more professional opinions and to ask yourself how you want to go through the rest of your life. Don't wait too long. When I asked my surgeon what my options were, he said I could live with it, or get it fixed. I booked it right there, it was time. No regrets. Tomorrow will be six months.
> 
> Good luck and keep me posted, Moementum


So no regrets? that's pretty cool and seems to be a common feeling for resurfacing patients. Thanks for the advice... I definitely need to do the research and the Core Institute is likely just a first stop. At 47, I'm probably a prime candidate for the resurfacing if, like you say, the damage is not too great. I've been broken and put back together numerous times and always bounce back better than before. Surgery is never fun, but if it cures this hip pain it could be worth it!


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## rooster44 (Jan 18, 2009)

I'm curious, why Burminghan & not Anterior?


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## Moementum (Oct 21, 2006)

rooster44 said:


> I'm curious, why Burminghan & not Anterior?


Anterior? Do you mean the Articular device (ASR)? I like the Birmingham long track record, 13 years, also the very successful results.


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## rooster44 (Jan 18, 2009)

No- I was talking about the Surgical Approach. Anterior Minimally Invasive is Muscle & Tendon sparing surgery so the recovery is shorter. A good Anterior postop will be up & walking (allbeit slowly) 24 hours after surgery without any aid. I couldn't tell from your staples. 

You should enjoy many years of pain-free riding with that implant  Cheers!


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## Moementum (Oct 21, 2006)

Thanks! My surgeon uses the posterior approach, 90% of them do. Almost none use the min technique.


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## Nubster (May 15, 2009)

I have congenital dysplasia of both hips. I used to suffer from frequent hip dislocations and could actually pop my hip out whenever I wanted. I started lifting weights and I guess strengthening of the girdle muscles really helped and now my hips are stable. The doctor told me when I was diagnosed in 2001 that I was most likely going to have to have surgery at some point but for now everything is or seems ok. I am just glad that with today's technology that surgeries like these do not spell the end of an active life. Good luck to all that have had surgery and glad to see you're all back on the bike. And best to you too DurtGurl, hope things turn out for the best in your case.


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## dougmint (Oct 29, 2006)

Having my right hip done tomorrow afternoon. Birmingham method. Creg Carpenter of Chelsea, MI is my doctor. I am going to try to video tape my progress daily, and post on youtube. I am a cat 3 roadie and expert mtn biker, and hope to be racing this summer.


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## Moementum (Oct 21, 2006)

dougmint said:


> Having my right hip done tomorrow afternoon. Birmingham method. Creg Carpenter of Chelsea, MI is my doctor. I am going to try to video tape my progress daily, and post on youtube. I am a cat 3 roadie and expert mtn biker, and hope to be racing this summer.


Good luck with your surgery! I would advise you to think long term for your hip, don't do too much too soon. There are some who have messed up their implants/broken femurs by being too aggessive post surgery.


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## dougmint (Oct 29, 2006)

I just got home from the surgery. I am walking with a walker and moving very slow. My operated leg muscles are super stiff.


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## DurtGurl (Dec 10, 2001)

Hip update... I've been to three docs and none consider me a candidate for resurfacing. First reason is that my joint is too small (typical of most females). Second reason is the recent problems with metal-metal devices and the small chance of ion reactions like psuedo-tumors. These reactions are more prevalent in women. So, I'm left with only one option - total hip replacement. I think I'm going to go for it. Reading back to my Jan posts, I talked about how it didn't hurt while riding. The Core Institute guys gave me a cortisone injection in Feb - that helped for a few months - but I'm now back to sleepless nights, painful days, and now.... pain during riding. It's gotten so that my hips cannot control the DH bike and I'm just a floppin rag doll out there. Pedaling is super painful. I guess it's time to take the plunge. I found a doc in Tucson (Dr. Russell Cohen) that I really like so think I'll go with him. I'll report back later if anyone's interested...


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## rooster44 (Jan 18, 2009)

"So, I'm left with only one option - total hip replacement." 
I don't know your background but from this it seems like you have consulted with some lazy doc's. THA is the _easy_ surgery for most Orthopedic Surgeons.

If by "my joint is too small (typical of most females)" you mean too small for resurfacing -because your acetabulum & femoral head are too small for instrumentation & implants then you are either an undergrown gymnist or someone has misinformed you. The resurfacing systems on the market (BHR, C+) have sizes in the 40 range which is well small enough for you.

As for your concerns with Metalosis there are definately some papers to substantiate your consults. This leaves you with Ceramic on Ceramic (which as a mountain biker I would worry about cracking), Metal on Highly Crosslinked Polyethylene, or Ceramic on Highly Crosslinks PE.

I would caution you with a Total Hip Arthroplasty though. At your age it will have to be revised down the road. They're going to take off your entire femoral head, broach down into the femoral canal, and you will have a lengthy rehab and muscle reconditioning. I can't tell you my opinion of what's best because I don't know the indications but I would be very cautious considering a THA at your age & lifestyle. Ask more questions of your docs, find out how many resurfacings they do (many areas dont have any docs that do 50+ a year.) An orthopod that specializes in resurfacings (100+/yr) might be worth traveling for considering your have to live & ride with it for 15-20 years to come.

If in the end, you decide to go with a THA-do yourself a favor and get a doc that is proficient in the anterior approach-Intramuscular & intranervous (no muscle cuts)- You will be on your feet the next day & going to your 2-week postop without any weightbearing assistance. You will also have much less muscle atrophy & get on your bike sooner... Good luck & sorry about all this:thumbsup:


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## DurtGurl (Dec 10, 2001)

rooster44 said:


> "So, I'm left with only one option - total hip replacement."
> I don't know your background but from this it seems like you have consulted with some lazy doc's. THA is the _easy_ surgery for most Orthopedic Surgeons.
> 
> If by "my joint is too small (typical of most females)" you mean too small for resurfacing -because your acetabulum & femoral head are too small for instrumentation & implants then you are either an undergrown gymnist or someone has misinformed you. The resurfacing systems on the market (BHR, C+) have sizes in the 40 range which is well small enough for you.
> ...


Wow... thanks for all your thoughts. Is that a medical background talking? or personal experience? There is one doc up here in Phx who does a THA without cutting any muscles or dislocating the hip. Method is called Superpath and doc is Jimmy Chow. http://www.chowhipandknee.com/superpath-thr.html But he's really young and the procedure is so new. He does however say that I'll be ready to rock in 6 weeks or less, and walking the day of surgery. The Tucson doc who has more yrs experience and 100s of resurfacings under his belt says that he will no longer do resurfacing due to the metal-metal issue. He will go in thru the side/rear of my hip in only a 5-6 cm incision and plans to use the new Stryker new mobile bearing hip http://www.aboutstryker.com/hip/why-stryker/mobile-bearing-hip.php The materials scientist in me is impressed with this technology.

All docs said that removal of the femoral head is no big issue. As long as there is some bone left in the femur, future implants can be performed and legs/hips can be rebuilt. And no matter what I go with - resurfacing or THA - it appears that revisions are down the road for me anyway. Also, some of the newer THAs, including the stryker mobile hip are modular, allowing for "easy" revisions.

So yea, they all talked a good talk and got me on the THA wagon. I was told by two docs that they would not do a resurfacing on a hip < 45cm. Mine is about 42. Interesting that you say 40cm cups are available. Perhaps I could travel far and get a resurfacing, but I'd rather stay close to home. I do want something that will allow me to eventually continue mtn biking, DH biking, and hiking. I could care less about running. Right now, it hurts to do much of anything and I am getting desperate. I do need to ask more questions and perhaps talk to more patients for feedback on their experiences. thanks again.


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## Moementum (Oct 21, 2006)

Kathleen, sorry to hear about your present condition but I felt it was inevitable when you first posted. There is a lot of misinformation being generated about resurfs at the moment regarding the MOM issue. Yes, women hips can be more challenging for some surgeons, but there are many female athletes out there who are enjoying all their previous activities thanks to resurfacing. THR is a very successful procedure but there is wear debris with any hip implant, be it plastic, metal or ceramic.I personally like having my femur intact.

I would not stop at local doctors opinions. I'm sorry, but the fact that one has stopped doing resurfs altogether is a dead giveaway that he has limited skills and experience. I would advise you to get opinions from the top resurf docs available. Dr Su in NY, Dr Gross in So Carolina and others, if these agree that you are not a candidate well then you will have exhausted your options. I would also encourage you to check on two patient advocate websites, Pat Walter's and Vicky Marlowes hip resurfacing sites. A wealth of info and advice. 

Believe me, I totally understand the pain and frustration you are going through but you will have to live with your decision a long time. After just over a year I am back to 100%, road and mountain biking, I'm doing all the things I thought I would never do again. I am almost 58 yo and ride a rigid bike on rooty, rocky NE trails. Good luck.


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## DurtGurl (Dec 10, 2001)

Moementum said:


> Believe me, I totally understand the pain and frustration you are going through but you will have to live with your decision a long time. After just over a year I am back to 100%, road and mountain biking, I'm doing all the things I thought I would never do again. I am almost 58 yo and ride a rigid bike on rooty, rocky NE trails. Good luck.


Thanks Moe.. that is fantastic news that you are back 100%!! I am very happy for you. My femur head is pretty much swiss cheese with the cysts, but perhaps I'll e-mail some MRI and x-ray scans off to the docs you mention and see if they think resurfacing is an option for me. I hear ya on having to live a long time with this decision!! Thanks for taking the time to write.


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## rooster44 (Jan 18, 2009)

I didn't realize your OA was that advanced (swiss cheese comment). Doc's don't want you to get a resurfacing because they don't feel your bone stock (in the femoral neck) is solid enough to support the stresses; the smaller the head on a resurfacing, the more stress on the neck. I have a buddy that does ~3 of those a week & has done them as small as 36 but obviously not severe OA. 

The ADM by stryker will work out well for you-No real clinical track record for that particular cup (just released this year) but it is basically a copy of a cup from 1976 with better materials. Dislocation & wear rates are superior to the alternatives without the complications (which are absolutely real) tied to metal-on-metal. (To the previous poster who said that all wear debris is the same, dont believe everything you hear -do some research on osteolysis vs. metalosis & volumetric wear of highly crosslinked polyethylene on 28mm ceramic.) 

As to the "SuperPATH" approach-that just looks like a way to market one's practice. Depending on the muscles it goes between its just a variation of poserolateral-but thats good. If they say no muscle cuts then you're golden. The part about dislocation is a farce though, they need to dislocate & reduce to do the procedure (trialing.) 

Sounds like you're on the right path-report back on here during recovery will you?


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## Moementum (Oct 21, 2006)

You distorted my post, did not say "all wear debris is the same".


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## dougmint (Oct 29, 2006)

dougmint said:


> I just got home from the surgery. I am walking with a walker and moving very slow. My operated leg muscles are super stiff.


5-1/2 months since my surgery. I have been riding for 3-1/2 months, and am continuing to feel better and better. I no longer have pain in my hip, and can enjoy my rides again!


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