# Recovery after total hip replacement



## jeph (Apr 3, 2008)

Hi, wondering if any folks have had a THR and how their recovery went. 

I finally pulled the trigger after holding off and had it done. I am about 10 days after surgery and still working through swelling and walking around the house. 

I had the anterior approach which seems better as far as not cutting/detaching muscles. swelling has subsided mostly but my quad area is very sore still.

I have had a few home PT visits and the exercises are still pretty simple and walking, around the house with weight on the new hip is part of it. 

Pre-op my doc (a road rider) poopoo'd mountain biking for a while. I get his thinking of falling. Our local park is pretty rocky and somewhat technical. 

He thinks a stationary bike might be ok after about two weeks. I have my follow up appointment and start outpatient PT next week. 

So how soon where folks here back on a bike. Any thoughts or tips?

Thanks

Jeff


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## leaguerider (Sep 6, 2010)

I was riding on the streets after 3 weeks after I had my hip replaced. It should help that you had the anterior approach for your surgery. I seem to recall it being 4 to 6 months before I was riding hard.

The most important thing for the next two years is don't get an infection. If you get as little as 10 colony forming units (bacteria) you can get an infection at the implant / bone interface. Any little cut I got was imedialty cleaned with soap and water. I also carry soap loaded surgical scrub brushes to scrub any injury out. If you do get cut up you will need to get antibiotics. https://www.amazon.com/BD-Surgical-Brushes-Impregnated-Chloroxylenol/dp/B0018QS0F2/ref=pd_sim_328_1/139-8437426-4819105?_encoding=UTF8&pd_rd_i=B0018QS0F2&pd_rd_r=07494072-2649-11e9-96f5-33801498f23a&pd_rd_w=2ZIl2&pd_rd_wg=Hz7pE&pf_rd_p=90485860-83e9-4fd9-b838-b28a9b7fda30&pf_rd_r=NYHNRBHF3DK64P85AE4P&psc=1&refRID=NYHNRBHF3DK64P85AE4P

I did two months or so of PT afterwards. It really helped and it showed me that I had been neglecting other exercises

There are probably better references out there but this is the first one I found. 
From "Femoral osteolysis following total hip" replacementhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600070/

Over the last two decades, complications associated with total hip replacement (THR) have declined significantly.1 Prophylactic antibiotic treatment has reduced infection rates and anticoagulants have lowered the incidence of deep venous thrombosis. However, bone loss following a total joint arthroplasty (periprosthetic osteolysis or aseptic loosening) still remains a significant concern.2 It was identified as the most significant long‐term adverse effect associated with THR at the National Institutes of Health consensus conference on total hip joint replacements.3 The incidence of periprosthetic osteolysis in many studies is greater than the sum of all the rest of the complications.2 In the Swedish Total Hip Replacement Register, osteolysis accounted for over 75% of the patients undergoing revision hip surgery.4

Both the acetabular and femoral components may be affected. Prevalence of aseptic loosening, in most series beyond 10‐years, is reported to be between 32-62%, depending on the type of prosthesis used.5,6,7​
The other imporrtant thing to remember is that your implant will only last a certain number of cycles. I am now a little more decerning about my rides as each peddle stroke gets me closer to having the implant replaced. I have been trying to find the mnimum number of cycles that hip implants are designed to survive. In the cardiac world that number is 400,000,000 cycles or so... (10 years at 72bpm). If you had that number you could start to predict how long you might expect your implant to survive before having to be replaced.


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## leaguerider (Sep 6, 2010)

All that being said, getting my hip replaced was a great decision. I am back to mountain biking and rock climbing. I would highly reccomend it to other folks who need it.


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## jeph (Apr 3, 2008)

Thanks for the encouragement that I made the right decision. 

How long ago did you have your THR? 

As far a "cycles" I haven't heard about that being a wear issue. He did caution against impact sports, basketball etc. 

Skiing is probably what wore mine out. He said I could do easier runs but not the steep and deep so much.  Certainly hardpack days with all the chattering would be bad.

Thanks for the tip on the infection. I carry hospital antiseptic in my bike stuff. I will make sure to have that on hand on rides.

Hope to be riding soon.

Thanks,

Jeff


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## cyclelicious (Oct 7, 2008)

I have not personally had a THR but I have observed the recovery of individuals having hip and knee surgeries.

Knees can be trickier as there are more ROM issues. In addition hips heal faster because it is a smaller less complex joint with more protective (and deeper) tissue. 

My brother had a hip replacement at age 52. After years of playing hockey (from childhood to university to recreational leagues as an adult) aggrevated by injuries and a job that required +++ mobility. Eventually both hips suffered so much wear and tear that he needed replacement. (He had THR on the worst hip) Long story short, his recovery was steady and 2 years later he is skating again as a hockey coach and is contemplating replacement of his other hip.

mtb is not his sport but in summer he rides bike paths and gravel.


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## Radium (Jan 11, 2019)

In my experience, post-surgical PT is an absolute essential towards making as full a recovery as you can. Also, don't exceed the PT's guidelines; you may be like I am, and feel that the PT is going too slowly. But consistency in doing the stuff that is prescribed is still the essential. 
It takes time, patience, and consistent effort, but in my case it was the big ticket behind all my surgeries.
Pay attention, and good luck! (A little luck never hurts). :thumbsup:


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## wayold (Nov 25, 2017)

[delete]. Hopes for a speedy recovery to the OP.


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## Sanchofula (Dec 30, 2007)

Taking it easy on a new hip so it doesn’t wear out is kinda silly, esp considering the reason you get a hip replaced: so you can use it.

I’m fortunate to have good hips and knees, but knowing they’ll wear out in time does not make me favor them or limit my “cycles”.

That just seems like a miserable way to view life.

I say wear it out and get another one, or two, or three even.

Life is too short to set premature limits, get at it and don’t worry so much.


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## Cuyuna (May 14, 2017)

A buddy of mine had his hip replaced about 3 weeks ago. We just got back, along with several others, from a week snowmobiling in the mountains around West Yellowstone. He didn’t ride as much as he hoped, and he had more post-ride pain that he thought, but I was impressed that a) he could do it at all and b) his surgeon let him do it. The surgeon’s biggest concern was the incision, not the joint. Otherwise, the main consequence of doing too much too soon, like snowmobiling, was just pain.


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## Cuyuna (May 14, 2017)

Nurse Ben said:


> Taking it easy on a new hip so it doesn't wear out is kinda silly, esp considering the reason you get a hip replaced: so you can use it.
> 
> I'm fortunate to have good hips and knees, but knowing they'll wear out in time does not make me favor them or limit my "cycles".
> 
> ...


In patients over 60, about 25% of THR's will develop significant osteolysis 5-10 years post-implant in high-activity individuals, compared to about 5% in low-activity and 7% in moderate-activity patients.

A total hip revision is a big deal. A second revision is a _really_ big deal. A third revision....be afraid, be very afraid.

Aseptic loosening is a big problem but the article that jeph cited above is from 2007. New materials have resulted in less ionic and particulate shedding. Osteolysis causing loosening is still a problem but in terms of incidence, that article has little relevance today.


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## JimmyAsheville (Oct 21, 2018)

My hip is starting to go, probably get it done in the next couple years. Has anyone resumed running or hiking with a new hip? I like to keep some shorter track runs in my quiver for fitness, and I had to stop.


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## jeph (Apr 3, 2008)

Have you had an xray and been diagnosed with osteoarthritis?

I was doing running sports and had pain and got that diagnosis 15 years ago, I was 45 then and the doc said hold out as long as you can before the surgery.

I still did some skiing but that ended my ultimate frisbee and soccer careers. Hiking and skiing was assisted by some ibuprofen.

I also went to a great Physical Therapist guy. I would visit him every few years when it got worse. Often I was slacking on some stretches etc. 

My doc pretty much said no to running and jumping sports with the new hip. He kinda said to back off skiing a bit. He is also saying that the new hips are not seeing the plastic wear like they did in the past. I am really glad I held out.

for me it was I was really limping in my walk and started to have some back issues. Also, had some pain after bike rides. still a tough decision to pull the trigger on the surgery. 

Don't know old you are, but holding out IMHO is a good call if you can. certainly try PT first if you haven't been

Good luck

Jeff


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## Cuyuna (May 14, 2017)

I think "holding out as long as you can" before getting a THR is unfortunate advice. I'm always sad to see people relegating themselves to a less-than-fulfilling life, curtailing activities that they love, due to hip or knee osteoarthritis. Your orthopaedist can make that hip pain go away. You should base the timing of the THR decision on the point where to pain keeps you from doing the things you like to do and steroid injections no longer keep that hip comfortable enough to let you live your life satisfactorily.


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## windsurfdog (Apr 5, 2018)

I had the Birmingham Hip Resurfacing (BHR) procedure in Jan., 2015. About 3 years before, after xrays, my hip guy said "You'll know when it's time"...and, believe me, I did. 

According to the surgeon, the cutoff age for BHR is 60. I was 62 at the time and an avid windsurfer (I only started serious MTB 10 months ago) and, because I was in very good physical shape, my surgeon gave me the choice between BHR and THR. And his take on the windsurfing was NO for THR and OK for BHR. I can only assume that his opinion of MTB would be the same. 

BHR spares the femoral head and adds a cobalt/chromium cap to the head with a cobalt/chromium cup in the hip socket. Unlike THR where patients are encouraged to start putting weight on the new hip immediately during recovery, BHR required one month of non-weight bearing on the new hip. After 3 weeks, I was back at work (desk job) with crutches in tow for another week. PT continued for about 8 weeks total and by the end of April, I was windsurfing again.

So far the hip is completely pain free except for occasional cramping around the incision area when hydration is slack...and that's on me.

If you are contemplating hip replacement, give BHR a look...I'm certainly a believer.


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## JimmyAsheville (Oct 21, 2018)

Thanks for the replies. I just turned 64. Have bone spurs on the socket, the hip motion is limited. Biking and lap swimming doesn’t hurt, but it feels achy in bed sonetimes when I am trying to sleep. The most pain in in front inside of hip. Doc said when it gets too painful I should get it done. Every room if my house is on a different level I might have to move into a one level house first! Guess running is out if the question, either now or with a new hip. Hate to think if missing several months of exercise.


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## jeph (Apr 3, 2008)

Well I'm a little over 3 weeks since my THR. I turned 60 last September. 

As far as waiting , for me I was only 45 when I was diagnosed and it only hurt when I ran. At that time they said it would need a revision in 15 years (now). Yeah I quit running sports and backed off skiing and rode my bikes a lot more. 

I am glad I waited as the surgery and the components are much better now.

At 64 you're certainly not too young to do it. If it is keeping you from doing active stuff then you should probably see about getting it done. But, that definitely a personal choice.

So, I'm on week 3 post op. Doing outpatient PT. I can get around the house without a cane, maybe will lose that completely next week. Also riding a stationary bike. I am still not cleared to submerge my incision yet BTW, so swimming is still out. That might be another week or two.

Good luck


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## JimmyAsheville (Oct 21, 2018)

I am inclined to wait as long as I can, the choice between not running and some discomfort , versus a long period of doing very little during recovery. I’ve had numerous surgeries and this one sounds like the mother of them all.


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## threepin (Nov 2, 2006)

I probably waited too long have my hip done and it was really starting to hurt my sleep and mood, I never even had injections because by the time i went for some palliative care i had been bone on bone and the surgeon explained that all i would be doing is delaying the surgery. PT did provide some relief but eventually skiing and then later biking became painful.I did make myself bike up to the surgery but i had trouble getting on and off the bike.

After the surgery i pushed things bit and paid the price in pain for a couple of weeks.
Once i could get on a stationary bike things got better rapidly. 3 months after surgery i did a hard 3 day bike pack. At 4 months i did a 1 day 110 mile dirt road ride with 7k of climbing and felt great.

Regarding the concern about "wearing it out" - i could be hit by a truck in the morning, at least i will have used it.

I have a good friend who got a set of hips 30 yrs ago and was told to expect a 15 yr life span on them. He's still got them and has been quite active the whole time.

I choose not to just live on one floor during recovery and it may have caused some add pain but i would probably do the same again. After all the have you standing on it a couple of hours post surgery and they make you walk and do stairs in the hospital



JimmyAsheville said:


> I am inclined to wait as long as I can, the choice between not running and some discomfort , versus a long period of doing very little during recovery. I've had numerous surgeries and this one sounds like the mother of them all.


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## Cuyuna (May 14, 2017)

threepin said:


> I probably waited too long have my hip done and it was really starting to hurt my sleep and mood, I never even had injections because by the time i went for some palliative care i had been bone on bone and the surgeon explained that all i would be doing is delaying the surgery. PT did provide some relief but eventually skiing and then later biking became painful.I did make myself bike up to the surgery but i had trouble getting on and off the bike.
> 
> After the surgery i pushed things bit and paid the price in pain for a couple of weeks.
> Once i could get on a stationary bike things got better rapidly. 3 months after surgery i did a hard 3 day bike pack. At 4 months i did a 1 day 110 mile dirt road ride with 7k of climbing and felt great.
> ...


Putting off joint replacement surgery and giving up things that you like to do is silly. Hip replacement in particular.


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## Ladmo (Jan 11, 2013)

threepin said:


> After all the have you standing on it a couple of hours post surgery and they make you walk and do stairs in the hospital


This is the way they do it knowing best practices towards good outcomes, etc, but it still makes my butt pucker to read. Dang.


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## JimmyAsheville (Oct 21, 2018)

Cuyuna said:


> Putting off joint replacement surgery and giving up things that you like to do is silly. Hip replacement in particular.


Wut?! You rode your bike to surgery but had trouble getting on and off the bike? Why not just wait a little longer and crawl to the hospital? Dude you are awesome. 🙂


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## threepin (Nov 2, 2006)

JimmyAsheville said:


> Wut?! You rode your bike to surgery but had trouble getting on and off the bike? Why not just wait a little longer and crawl to the hospital? Dude you are awesome. 


By up to i meant up till not to, besides the hospital is down hill from here

And yes i am ,,

Thanks:thumbsup:


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## jeph (Apr 3, 2008)

Wow, great recovery inspiration Threepin. I hope I can ride 100 mi and 7k after surgery. (I couldn't before but I can hope )


I'll be 6 weeks out Wednesday. Spending more time on the stationary bike and walking greater distances. 

I meet with the Surgeon Wednesday and get x rayed. So far so good.


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## jeph (Apr 3, 2008)

So, had my 6 week appt with surgeon and x ray. He said the x ray showed good bone attachement to my new hip 

He also cleared me to ride my road bike. He did say don't crash. Start out on easy flat paved bike trails. 

I have a PT appointment tomorrow and will ask her about that.

Any folks with THR have any thoughts about that?

Jeff


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## chuck guy (Mar 28, 2016)

I had a THR in 2004 at age 47, Stryker Trident ceramic on ceramic, have backpacked, skied, rode and crashed hard a number of times. I recently saw my ortho at a 15 yr check as I was achey in the hip from another fall. He said your fine and that the hip will outlive me!

Now I actually try to behave myself as I am 62, will not ski in breakable crust with a pack, not into down rides fast, try to appreciated that generally speaking I do not bounce like I used.


Getting my hip down was one of the best things I ever did, saved my life. but did take a solid year or so to get strength, rehab and the start of some endurance back.


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## jimmy (Jan 19, 2004)

Great discussion, thanks everybody. I too need a THR, really need both done but the left hurts all the time and limits my walking & hiking. I can still ride tho! Has anyone done both at the same time? My surgeon offered to do it, a friend who had both done about 2 year apart recommends a double, but my good friend who is a PT says don't do double! I am an empty nester and don't have live in assistance at my house. I would think getting around to PT, work, etc would be really tough with a double. I have to say the surgeon is thinking the trainer will be OK after 2-3 weeks. Good think I have come to like Zwift and my Wahoo trainer. Any thoughts are appreciated. I am definitely a bit scared about doing it, but I have to. Sooner the better I guess.


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## Cuyuna (May 14, 2017)

jimmy said:


> Great discussion, thanks everybody. I too need a THR, really need both done but the left hurts all the time and limits my walking & hiking. I can still ride tho! Has anyone done both at the same time? My surgeon offered to do it, a friend who had both done about 2 year apart recommends a double, but my good friend who is a PT says don't do double! I am an empty nester and don't have live in assistance at my house. I would think getting around to PT, work, etc would be really tough with a double. I have to say the surgeon is thinking the trainer will be OK after 2-3 weeks. Good think I have come to like Zwift and my Wahoo trainer. Any thoughts are appreciated. I am definitely a bit scared about doing it, but I have to. Sooner the better I guess.


Recovery from a bilateral THR takes a little longer, but if you do them separately, you'll find that your total additive down time for both hips is significantly less if you do both at the same time rather than separating them into two different operations. I persuaded my surgeon to do both of my TKRs at the same time and it was great. If it was MY hips, I'd opt for the bilateral THR if offered as an option.


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## Radium (Jan 11, 2019)

At 65, I am blessed with the bone density of some type of freak. A leading area ortho told me that my bones were very difficult to saw and drill through. I spite of the Adamantium skeleton, I've still managed to get hurled into solid granite boulders on multiple occasions. When that happens, something's bound to give. A while back, at around 30mph I slammed directly into a solid granite outcropping on a very large granite chunk. I lay their immobile for several minutes, certain that my acetabulum having hit direct on that granite had shattered something. Well, nobody came along, so I tried moving. I ended up getting up and walking for a few yards, before I re-mounted my bike and kept on riding. That was some crazy ****, right there.


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## jimmy (Jan 19, 2004)

Thanks Cuyuna. If doing both, how can you get around? Can you drive? How do you get to PT, etc With just doing a left hip, I figure I could drive after I get off the meds, etc. My PT says I could drive with an automatic. Going to PT would not be bad. If I do both seems I would be homebound for a while?


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## Radium (Jan 11, 2019)

I had a friend who lived an "active lifestyle", that received a cobalt hip implant, supposedly the most durable at the time. THEN, they found out that microscopic patrticles of cobalt began to show up ion his blood and body fluids, even his semen. It was doing something unpleasant to his liver, or his kidneys, or both. His steady girlfriend also had detectable levels of cobalt in her blood stream,! I don't think cobalt is so good for the human body. 
My late friend came to believe so, too. 

So, I'd suggest that anybody contemplating a THR think twice, or thrice, about any suggested cobalt bits being installed inside their bodies.


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## jimmy (Jan 19, 2004)

Radium, thanks but your comments seem more like trolling than helpful. You are not responsive to my questions, please give it a break


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## Radium (Jan 11, 2019)

Sorry, Jimmy. 
Over and out.


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## jeph (Apr 3, 2008)

jimmy said:


> Thanks Cuyuna. If doing both, how can you get around? Can you drive? How do you get to PT, etc With just doing a left hip, I figure I could drive after I get off the meds, etc. My PT says I could drive with an automatic. Going to PT would not be bad. If I do both seems I would be homebound for a while?


Yeah, doing both at the same time might be a lot. I had mine done in January and I'm riding as strong as ever. I was riding a trainer at 2 weeks. Doc said I could ride on flat paved trail at 6 weeks. Walking was also a big PT. I had an anterior approach which is a quicker recovery. 
I'm fortunate that my wife is a great caretaker in my recovery and is nurse in the OR that did my hip.
This was my first surgery of any kind so I was also a bit uneasy. From what I have seen with friends have other surguries, knees, shoulders etc. THR is a pretty quick recovery.

You may ask about PT/recovery of doing both. With one I was really only 'homebound" for two weeks.

Good luck


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## jimmy (Jan 19, 2004)

Jeph, thanks very much. Very helpful. I am doing the left on June 26. I am nervous but less worried at the same time. It will work out. I have a Wahoo trainer + Zwift, which I actually like!


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## Sanchofula (Dec 30, 2007)

Hey Jimbo, Radium is correct and you were being smug:

https://www.the-rheumatologist.org/article/cobalt-toxicity-complication-of-hip-replacement-surgery/



jimmy said:


> Radium, thanks but your comments seem more like trolling than helpful. You are not responsive to my questions, please give it a break


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## Lone Rager (Dec 13, 2013)

My mother in law crashed and burned a few weeks ago (getting out of her LaZboy to go for a smoke), broke the ball off her femur, and they put a new ball and neck on the same day. They were making her walk on it a few days later. She's getting around pretty well already.


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## Jembo (Dec 13, 2019)

*At Home Support After Surgery ??*

What kind of in-home support does one really need after hip replacement? Was there anything you just could not do for yourself when you got home? Has anyone recovered at home, alone without someone living with them?


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## RickBullottaPA (Mar 4, 2015)

jeph said:


> Hi, wondering if any folks have had a THR and how their recovery went.
> 
> I finally pulled the trigger after holding off and had it done. I am about 10 days after surgery and still working through swelling and walking around the house.
> 
> ...


I had a hip resurfacing in 2013 at age 51, and the basics I was given are "do what you can, when you can, but don't fall for 6 months". I did a lot of "pre-habbing" prior to surgery, so went into it in decent shape, but the first two weeks post-op were just some basic rehab activities and light walking. Two weeks in I got on the trainer and started easy spinning. 8 weeks in I rode outside (carefully). 5 months in I raced an ultracross. I've since been able to snowboard, XC ski, dirt bike, played box lacrosse, and have raced enduro, cyclocross, and XC. I don't do any sustained running, largely because I don't enjoy it and because it does increase shock/wear on the joint.

One key for me was a PT doctor who works with athletes and pushed me pretty hard rather than giving me the "old person" routine.

I still do my rehab exercises 2-3X a week, including on my other hip. I wear protective shorts for dirt biking and MTB enduro, just to be prudent. I have no activity restrictions, no pain, and am beyond happy with the outcome.


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## RickBullottaPA (Mar 4, 2015)

JimmyAsheville said:


> My hip is starting to go, probably get it done in the next couple years. Has anyone resumed running or hiking with a new hip? I like to keep some shorter track runs in my quiver for fitness, and I had to stop.


I have chosen to stop running, as it does increase wear on the joint substantially. My friend who had the same procedure/doctor has continued to run, including a number of competitive distance runs. He's rethinking that choice now.


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## RickBullottaPA (Mar 4, 2015)

Jembo said:


> What kind of in-home support does one really need after hip replacement? Was there anything you just could not do for yourself when you got home? Has anyone recovered at home, alone without someone living with them?


1) Visiting nurse to check on general recovery (wound healing, pain, vitals, proper digestive system functioning, etc.)

2) Starting basic in-home PT immediately (range of motion, strength, balance/position)

Those are both CRITICAL steps to recovery and your doc will likely coordinate a visiting nurse for this.


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## rlee (Aug 22, 2015)

Jembo said:


> What kind of in-home support does one really need after hip replacement? Was there anything you just could not do for yourself when you got home? Has anyone recovered at home, alone without someone living with them?


I was care for my wife during her replacement. If I were single I would go through it alone. Consider hiring a care worker for the first week then you will need access to a driver for a few more.
I don't know what other peoples doc's requirements were but My wife was not allowed to bend her hip past 90 degrees for a few months. So you cannot sit regularly at your desk or on the toilet. And no driving. Does you Medical system provide a pre surgery class for all the info before, during and after?


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