At 60 years old, I was trail running, doing CrossFit, and competing in Masters Olympic weightlifting. I developed lateral pain in my left hip that ultimately expanded into my groin. Imaging revealed severe osteoarthritis and labral damage. Several surgeons recommended a total hip replacement. I delayed surgery for over a year before deciding it was time.
I’m not a medical professional, and I'm not offering medical advice. You should consult with a physician or other qualified medical professional for diagnosis, treatment, and advice. The content on this site is for informational purposes only.
In December of 2024, I was 60 years old and humming along just fine. I was trail running, sprinting, and rucking long distances. I was squatting, deadlifting, and doing the Olympic lifts (snatch and clean & jerk), no problem. I was doing burpees and box jumps and lunges. All good.
The pain began toward the end of a long ruck in January 2025. The pain was sharp. Very sharp. It felt like someone was driving an ice pick into the side of my left hip. Initially, the pain only occurred when rucking, and not every time. It didn’t hurt when I ran or snatched or squatted. I did some research and decided it was likely some sort of tendinopathy or greater trochanteric pain syndrome caused by the repetitive movement of long rucks. So I backed off the rucks but otherwise continued training normally.
In February, I began having pain in my left hip flexors and left adductors. The first episode followed some high-volume front squats, which I hadn’t done in a while, so I assumed that was the cause. I continued training around both sets of pain.
The wheels came off in March during a track workout that culminated in a max-effort sprint. I wanted to see if I could beat the time of my middle-school niece who had recently run 200 meters in 30.36 seconds. I failed by one second, adding insult to literal injury. I limped off the track with severe pain laterally, medially, and deep in the joint.
The pain progressed over the next several weeks to the point where my hip hurt constantly. I was limping around the grocery store, could barely get in and out of my car, had trouble sleeping, and felt pain even when lying on the couch. I couldn’t even begin to initiate an unweighted squat movement without pain. Bending over to pick up a barbell was out of the question. Some days I couldn’t even walk a quarter of a mile.
By April, I had stopped all running, rucking, squatting, and Olympic lifting. I was still operating under the theory that I was dealing with two separate tendinopathies, one lateral and one medial. I read studies and watched informative YouTube videos and began a gradual progression of walking, rehab movements, and bodyweight exercises. The rehab movements and exercise progressions were based on the excellent content from Mark Surdyka, DPT.
Slowly, I began to improve.
At the peak of my pain, I made an appointment with an orthopedic surgeon who specializes in hips. He’s a team physician for an NHL franchise and a Big Ten university. Even though I was improving, I went to the appointment in mid-May.
He ordered x-rays and immediately diagnosed severe osteoarthritis in my left hip. He said I needed a total hip replacement and that he would refer me to the best surgeon, since he doesn’t do hip replacements himself.
I was shocked — and also unwilling to accept his diagnosis. Mostly because I didn’t want it to be true. But I was also skeptical of how quickly he attributed the cause of my pain to something seen on an image. He hadn’t heard my history or even manipulated my hip before making his diagnosis and saying I needed a replacement.
I knew that in other areas, symptoms and images may not align. For example, a meta-analysis of over 3,000 individuals without back pain found that 88% of 60-year-olds showed disk degeneration on imaging, and 69% had bulges. Even at age 40, 68% of asymptomatic individuals showed disk degeneration and 50% had a bulge. Nevermind that I was symptomatic, not asymptomatic, and that study was about backs, not hips!
I was also resistant to the diagnosis because the symptoms accelerated so quickly. Less than five months earlier, I’d felt totally fine. I thought osteoarthritis was a slow, gradual process, with symptoms beginning mildly and worsening over a long period of time.
So despite the confident diagnosis from an expert physician, I clung to my hope that I was experiencing tendinopathies and that the osteoarthritis seen on the x-rays was incidental. I pushed for an MRI, which unfortunately delivered even worse news.
The MRI revealed a large area on my acetabulum where the cartilage was completely worn away, with the underlying, exposed bone swollen and cystic. I also had a large labral tear and bone spurs around the rim of my acetabulum. There was significant inflammation and swelling in the joint itself. In addition, the radiologist noted that I have a bony “cam” deformity, a known risk factor for developing both labral tears and osteoarthritis (more on that in a later post).
Even after the MRI report, I was resistant to the idea of a hip replacement. After I stopped running and lifting, my pain was decreasing and my function improving. Optimistically, I shifted to the idea that perhaps the labral tear (which, in my mind, might have occurred during my sprint session in mid-March) was the primary source of my pain, rather than osteoarthritis. Perhaps if I continued to go easy, I could become asymptomatic again.
I didn’t think for a minute that my labrum would magically heal itself or that my osteoarthritis would reverse. But years ago, I tore the meniscus in one of my knees, never had it repaired, and it ultimately became a non-issue. So I thought maybe the same could happen with my hip: if I let it settle down and then gradually build up capacity, maybe things will be okay. I had been pushing my hip pretty hard prior to the initial onset of pain. Perhaps if I dialed things way back, I could get back to a state where I could still do most of the things I loved, just not as frequently or intensely, without having to have my hip replaced.
I’m not saying any of this was rational or evidence-based. But that’s what was going on in my mind.
Much of what I was hoping for did come true. My walking distance improved. I worked my way back to full-depth squats and then slowly added weight.
Since being told in May that I need a hip replacement, I’ve done a 10-mile hike with over 3,000 feet of elevation gain and loss. I’ve front-squatted 210 lb, snatched 160 lb, and clean & jerked 200 lb — all at a bodyweight of 150 lb. I routinely do 100 burpee pull-ups. I did the CrossFit workout “Murph” in 50 minutes, walking rather than running (but completing all 300 squats to full depth and doing strict, rather than kipping, pull-ups).
Surprisingly, the lifting was and continues to be almost entirely pain-free. The hiking and long walks, not so much — especially by the end. Running has remained completely out of the question. Even jogging across the street is excruciating.
Over time, I have come to accept that the source of my pain is intra-articular, rather than tendinopathies. But I still wonder whether it’s primarily from my osteoarthritis or my labral tear. As far as treatment options, it doesn’t really matter. Arthroscopic surgery to repair my labrum is out of the question, given the severity of my osteoarthritis. My only surgical option is a total hip replacement, which will address both.
Most of the above was written several months ago. It’s now been 13 months since the onset of pain. A few weeks ago, I settled on a surgeon and scheduled a total hip replacement. It was a tough decision, which I began second-guessing immediately.
On the one hand, I can still do pretty much everything in the gym that I enjoy: squats, burpees, the Olympic lifts. For some reason, those are still mostly pain-free. It’s hard to believe that I need a new hip when I can still box-jump and snatch.
On the other hand, walking has become more painful and much less enjoyable. Flashes of intense pain are not uncommon. Often, I want to just stop and sit.
My hip is too unreliable for me to do anything but train in the gym and walk or hike in short loops or radials, never straying too far from my home or car. I’m tethered. I don’t have the confidence for a long out-and-back hike, to plan a vacation exploring a city, or even to stroll around a museum for a day.
The hope, of course, is that the surgery will restore my ability to walk and hike long distances. And the sooner I have the surgery, the sooner my freedom will be restored.
The flip-side is that having the surgery will likely be the end of my heavy barbell lifts and perhaps other gym movements as well. I realize that some people lift heavy with artificial hips, but I doubt I’ll ever try a max-effort full-depth snatch again in my life — which (weirdly, perhaps) makes me very sad.
Similarly, I don’t think surgery will restore my ability to run. I think that’s gone forever. Again, I understand that many people run after a total hip replacement, and perhaps I will too. But right now, that’s not my plan. In a later post, I’ll dig into the evidence regarding the risks of various post-surgery activities. For now, I’ll just mention that I’m not thinking only of my new artificial hip: giving up running, heavy squats, and the Olympic lifts will almost certainly benefit my right hip, which also shows signs of mild to moderate osteoarthritis.
I’m a week out from surgery and there’s no more indecision. My pain has now reached the point where I’m looking forward to the surgery 100%. I feel very fortunate that I’m already scheduled, since my surgeon is booked three months out. It would really suck to have to wait that long for surgery at this point.
I’ll probably start a separate post about recovery, but I wanted to include something here.
The post-op pathology report came back on my excised femoral head: "The articular surface has about 90% eburnation." Eburnation? I had to look that up. Eburnation, I learned, isn't just exposed bone completely devoid of cartilage — it's polished bone, which only occurs by rubbing on other bone. Combined with the labral damage, it's a wonder I was functional for so long.
As I mentioned above, I'd already moved past second-guessing my decision to have surgery. But that pathology report 100% validates my decision. Had I waited, I could have ended up in a world of hurt very soon.
- - -