Hello Doctors,
I had a personal training consult with a potential new client who recently had his hip replaced. He is 75 years old and would like to return to strength training post op. He has been released to exercise however was told by his doctor / surgeon not to strength train his lower body because they have diagnosed him with heterotypic ossification (in and around the damaged hip joint). He said that they told him strength training (resistance training as he put it) his lower body would exasperate this condition. Because of my scope of practice ( and lack of information on this condition)I did not question their orders. However for my own knowledge, I was wondering what your thoughts might be regarding their position. Since I feel there are few situations where reducing or stopping resistance training would be a protocol to follow, I felt inclined to see if you have an opinion regarding the topic. Possibly there might be some literature you could direct me to for more information about this condition you could pass along? Thanks!
Adam,
Thanks for the post!
Heterotypic Ossification (HO) is the formation of bone in surrounding soft tissue. It is not uncommon in those who have had hip replacements and can be graded based on severity as you can read about in this summary review here: Heterotopic Ossification: A Comprehensive Review - PMC
As far as resistance training or non-passive ROM exercise and HO go, we don’t really know if they improve or worsen HO signs or symptoms. It is not unusual for docs to recommend against RT in HO, as it is thought that vigorous exercise might make it worse, though there’s no data to support this.
On the one hand, the benefits for meeting the current exercise guidelines (which includes RT) is well established-especially in an elderly population. On the other hand, the risks for exercising with HO are relatively unknown. I think this ends up being a judgement call. While I don’t feel comfortable advising you (or the potential client) in this specific case, I think it’s reasonable to consider engaging in RT to meet the current guidelines using an autoregulated, progressively overloaded training program that is modified/changed based on symptoms.
Let us know how this turns out 
-Jordan
Thank you for the thoughtful response, Jordan. I really appreciate your feedback. I will report back if feel there is anything useful to share
I coach a 75 y/o male who had a left hip replacement 2 years previous to beginning training.
He didn’t mention the condition that your client has been diagnosed with, but he does have a bit less external rotation on that hip compared to the other. That hip was giving him a sever limp and a constant ache prior to beginning training.
Despite mobility issues in his shoulders, which i assume os due to arthritis, he can get in a low bar position with a modified grip.
We progressed slowly from 5lb goblet squats, performed in a LBBS fashion, to a recent PR 5x3@125. His limp is all but gone and he no longer has any pain in that hip. He has put on about 9lbs of lean body mass in 8 months, despite being stubborn about eating enough and not being interested in HRT. His quality of life has improved dramatically and most days he is completely pain free.
Hope this helps!