Ask the Doctors

Dear Doctor: Before I had a double hip replacement at 47, I was an avid daily runner, participating in several marathons per year and any charity event possible. Everything I've read says not to run with hip replacements. Do I really have to cut running out of my life?

Dear Reader: The advice regarding running and hip replacements relies on basic physics. The more stress you put on the new prosthetic joint, the more wear-and-tear can occur, and the sooner you may be a candidate for revision surgery to replace the device. And although the current wisdom is that a modest, even moderate, amount of running can be OK in some cases, the life you have described, with as many races as possible (and, we imagine, plenty of training in between) is not a good fit for someone with artificial hip joints.

In a total hip replacement, the surgeon removes the damaged or diseased bone and cartilage and replaces them with a prosthetic joint. People consider the surgery when medication, lifestyle changes or walking supports fail to have an effect on pain or impaired mobility. From its introduction in 1960, hip replacement has undergone a sustained evolution in surgical techniques, as well as the materials and technologies that go into making the artificial ball-and-socket joint.

However, the data regarding the effects of regular running after a total hip replacement haven't kept pace.

A few studies have looked into what happens when individuals with a total hip replacement continue their running regimens. The results suggested that running could be OK, but there is disagreement among scientists as to whether the sample sizes in those studies were adequate, and whether the subjects were followed for a long enough period of time.

A larger study published several years ago, in which hip replacement patients took part in a diverse range of physical activities, including running, uncovered some potential problems. Though not widespread among the participants, these included fractures, dislocation, loosening of the prosthesis and mechanical wear that resulted in the production of metal ions, which passed into the bloodstream. The long-term effects of this type of exposure are not yet understood.

But here's the good news. Although running isn't recommended for people with total hip replacements who would be new to the sport, it's a different story for experienced runners. Those individuals who had been regular runners before the surgery and who have completed their rehab period can take part in a moderate amount of running. Needless to say, there are some caveats.

-- Before you run a single step, get the OK from your surgeon and your physical therapist. This is non-negotiable. You've put a lot of effort, time and money into your new hips.

-- Take your time and get back into shape with low-impact exercises like swimming and stationary cycling.

-- Be aware of your stride. Twisting of any kind can cause the ball of the prosthesis to separate from the hip bone. Choose flat, straight surfaces that won't tax the joints.

-- Stick to the distance and frequency that your medical team allows.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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