Jan 29, 2015
Hip To Be Smooth

By R.J. Anderson

Nearly a year and a half after undergoing Birmingham Hip Resurfacing surgery, elite endurance athlete Robyn Benincasa is back at the top of her game. The procedure has helped Benincasa overcome a painful battle with osteoarthritis, and she is again conquering adventure racing courses all over the world.
A sport that requires competitors to walk, run, climb, bike, and paddle across 400 to 600 miles of rugged, mountainous terrain over seven to 10 days, adventure racing has taught Benincasa about enduring through nagging injuries. But for a year and a half from 2005-07, that suffering started ratcheting up until it became almost unbearable.

Though she was still winning races and performing well, Benincasa was also blocking out right hip pain, which would later be diagnosed as osteoarthritis. What started out as an annoying but tolerable discomfort turned out to be a degenerative condition. In May 2007, Benincasa’s pain peaked, and during the adventure racing world championships in Scotland she labored like never before.

“It was day four and I was really struggling–I had to use my hands to pick up my leg and drag it every step, and my three teammates had to carry all my gear,” says Benincasa, who is also a firefighter in San Diego. “That’s when I knew something was seriously wrong. We made it through and finished the race, but I knew it was time to get checked out.”

An x-ray revealed that Benincasa had a large cartilage deficit, leaving bone-on-bone contact in her hip. Benincasa’s physician diagnosed her as having Level 4 osteoarthritis, a genetic impingement that had worn away her cartilage over a number of years. He explained that the longer she allowed her hip to degenerate, the quicker she would run out of surgical options. But if Benincasa acted soon, she would be a candidate for a relatively new procedure that could prolong her career.

An alternative to total hip replacement, the Birmingham Hip Resurfacing (BHR) procedure, which was introduced in England in 1997, preserves more of the patient’s hip joint. Instead of removing and replacing the femoral ball, the BHR involves smoothing the femoral ball and capping it with durable high-carbide cobalt chrome. In addition, the pelvic socket or acetabulum is lined with a metal cup, creating a smoothed metal-on-metal joint that conserves the patient’s bone structure, giving them more options for future procedures than if they have a total hip replacement.

Benincasa elected to have the surgery, and in July she went under the knife. Michael Kimball, MD, an orthopedic surgeon at Girard Orthopedic Surgeons in San Diego, performed the procedure, which was a success.

Benincasa’s post-surgery instructions called for a two-week non-weight bearing phase. But once that period was completed, Kimball turned her loose to resume her training and explained that the repair was virtually indestructible. He encouraged her to trust the training instincts she had developed as a veteran athlete: start slow and let pain be her guide during her recovery. If it hurt, scale back on the activity–but otherwise, do whatever her body would allow.

Two weeks post-surgery, Benincasa was back on her road bike for short rides and hiking in the hills around San Diego. Kimball told her to focus on performing movements that emphasized repetitive driving off her toes and pushing her knee upward, which would strengthen the muscles around the surgical site.

Benincasa says pain was minimal, but it was still a frustrating time for her. “There were a couple of weeks when there was a disconnect between my brain and my leg in terms of making it do what I wanted it to,” she says. “There was a lack of function and strength. Then about four weeks post-surgery, it really started responding.”

Two weeks later, Benincasa received her first real test when she went back to work. Her return corresponded with some of the worst wildfires in recent San Diego County history. With adrenaline masking her discomfort, Benincasa climbed on and off a fire engine ladder as her crew raced from neighborhood to neighborhood attempting to save houses from the flames.

“I didn’t have too much time to think about the pain,” she says. “But when the ordeal was over, it did give me a lot of confidence knowing that hip would hold up under duress.”

Soon after, Benincasa was able to strap on her running shoes and begin light roadwork. She started with short 10-minute jogs that quickly increased to runs lasting 15 and 20 minutes. Four months post-surgery, she competed in her first marathon. “It was a run, walk, run, walk,” she says. “It got pretty painful about halfway through, but I kept going and crossed the finish line shedding tears of joy.”

In June 2008, 10 months after her surgery, Benincasa returned to adventure racing, competing in the Primal Quest, a six-day, 500-mile race in Montana’s Gallatin National Forest. With over 100,000 feet of cumulative elevation gain, the course included advanced whitewater paddling, mountain biking, running, hiking, orienteering, and rock climbing. It is commonly referred to as the “Super Bowl of adventure racing.” Team Merrell/Zanfel Adventure Racing, a four-person team that Benincasa captains, finished second of 60 teams.

“I was still a little slow,” says Benincasa. “But I really started getting my confidence back and was happy with how well I felt.”

So what’s next for Benincasa? Thanks to the surgery, not only has Benincasa’s racing career been saved, it’s been revitalized. “I want to get all this cool stuff done while I still can,” she says. “Since getting this ‘new toy’ I’ve actually increased my adventure racing schedule. We’re doing three big races this year, where in previous years, I had to cut back to shorter and shorter races, and I’m not as good at those distances.” The shorter events Benincasa is referring to are Ironman triathlons–races consisting of a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run.

In addition to adventure racing, Benincasa competes in ultramarathon events, which are generally about 50 to 100 miles in length, as well as long-distance paddling and cycling events. “I just like going out and competing for a really long time,” she says. “BHR has given that all back to me.”

Appreciative of the second chance she’s been given, Benincasa is working hard to pay her good fortune forward. Shortly after having her hip resurfaced, she helped found Project Athena, a group whose mission is to “help women with breast cancer and other medical or traumatic setbacks live their athletic and adventurous dreams.”

Benincasa and the Project Athena team recently took a two-time breast cancer survivor to Costa Rica for a four-day, 155-mile rainforest run. They also helped a breast cancer survivor hike to the bottom of the Grand Canyon, and are working to send a woman with a degenerative spinal condition to run a marathon on the Great Wall of China.

“Our goal is to use adventure to provide other women like us with the hope of brighter days ahead as they battle through the dark times,” Benincasa says. “Hope is a stronger healing force than just about any medicine on earth.”

R.J. Anderson is Online Editor at Training & Conditioning.

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