Diving with Osteoarthritis in the hips

[MyDiveLog]

I'm writing to learn about the experiences of fellow divers who are dealing with osteoarthritis of the hips. Four years ago I did 120 dives, mostly beach dives. Since then I have dove progressively less as life ... and my physical limitations ... have intervened. Today I am almost embarassed to admit to fewer than 20 dives this year, and all of them "warm water" dives because I'm not sure I trust my body to withstand the rigors of beach diving. I'm only 46 and am"too young to feel this old!"

After a couple of consultations and months of physical therapy not much has improved. I am not grossly overweight ... although, at 6'3" and 230# I'm working to take off 20 pounds. I'm in decent shape ... I can swim a mile in the pool easily without stopping and coach multiple soccer and basketball teams. I'm struggling with the decision about whether to undergo a hip replacement and would appreciate the prespective of any of you that have dealt with a similar problem or have had a hip replacement. It seems pretty drastic but, at the same time, not being able to dive when & where I want is making me feel like a big part of my life is missing.

Any advice?

 

[DocVikingo]

Hi MyDiveLog,

Total hip replacement is primarily performed on those 60-80 years of age and many orthopedic surgeons are reluctant to do this procedure on those aged 46 for several reasons. Chief among them is evidence that those who receive total hip replacement at younger ages (say younger than age 50 and/or with life expectancies of greater than 20 years) are more likely to be more active and to live longer and thereby more likely to wear out prostheses, requiring consideration of a second replacement. This is quite problematic in that second replacements or revisions of the initial operation tend to be technically more difficult and to provide lesser benefit.

This notwithstanding, it can be argued that indications for total hip replacement should include, but not be limited to, pain that restricts everyday activities; discomfort that continues even while at rest; stiffness the restricts ability to move or lift the leg; and pain that has benefited little from anti-inflammatory drugs and PT.

Certain total hip prostheses do appear to wear out more slowly and continued improvements in prosthesis longevity are to be expected. The type of fixation of the prosthesis and the material from which it is made are important in terms of its expected useful life. And, total hip replacement isn’t always the only alternative. Depending upon the state of the joint, less major procedures such as arthroscopy, osteotomy and surface replacement of the hip can be considered.

Provided that patients understand the evidence, the increased risks associated with recreational or athletic activity after replacement and are trained to minimize these risks, there may be no compelling reason to arbitrarily delay replacement surgery or an alternative procedure when such delay makes the patient "feel like a big part of my life is missing" and has a significantly reduced quality of life.

The decision should be arrived at after extensive discussion between the patient and his orthopedic surgeon.

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice.

 

[fisherdvm]

American academy of orthropedic surgeons recommends the following concerning hip prosthesis:

http://orthoinfo.aaos.org/topic.cfm?topic=A00356

"Avoid activities that involve impact stress on the joint (such as tennis and badminton), contact sports (such as football and baseball), squash or racquetball, jumping, or jogging.

Lifting weights is not a problem, but carrying heavy, awkward objects that cause you to stagger is not advised, especially if you must go up and down stairs or slopes. Plan ahead to have a cart, dolly, or hand-truck available"

 

[fisherdvm]

I guess if you can enter the water, little that you do while diving can impact the prosthetic hips.

Entry whether it is a shore dive, or a boat dive, and exit, either through rough waves, on on rough sea in a boat - is especially a challenge for small framed individuals with nearly 100 lbs of scuba gear, and a very high center of gravity.

I guess from my viewpoint, generically saying that all scuba activities are safe is not wise. But with proper care, diving is probably safe for a 100 year old frail woman with two prosthetic hip if all she has to do is enter a pool and blow bubbles.

 

[MyDiveLog]

Thanks for all the good advice, Doc. I've decided to make the next 6 months an intensive PT period and will reassess then.

 

[DocVikingo]

Hi MyDiveLog,

My pleasure.

Sounds like a plan.

Keep working on the weight reduction and best of luck.

Regards,

DocVikingo