hip replacement

The Hip Replacement Training Plan: Returning to Cycling and Sport after Total Hip Arthroplasty

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Throughout a lifetime as an athlete, I’ve had my share of injuries, surgeries, and comebacks. On December 27, 2021 I had my left hip replaced and started a 3-month return-to-training process that culminated in coaching on the bike at a week-long cycling camp in March 2022. As I’ve shared my journey, many athletes have inquired about the training, nutrition, and pain management strategies I used. I have tried to put together the details of my hip replacement cycling training plan to help other athletes and active individuals in similar circumstances.

Please note, I am not a physician nor a registered dietitian. I have been an endurance athlete for more than 50 years and professional endurance coach for more than 30. I followed my orthopedic surgeon and physical therapist’s directions. In the process I applied proven principles of training and sports nutrition to my recovery, and experienced remarkable results. Although everyone and every surgery is different, I hope sharing my experience can inform and enhance yours.

Background: Why I needed a hip replacement

Back in 1986 I raced for the 7-Eleven Pro Cycling Team, including the Tour de France. That winter, I broke my right femur in a cross-country skiing accident. It was a bad break that split my femur at the knee, between the medial and lateral epicondyles. The resulting surgeries cost me an inch of leg length on my right side. Although I returned to professional cycling, I never fully regained my previous form.

After a few seasons and subsequent knee surgeries, I retired. Shortly thereafter I started my coaching career in 1990. In the decades since, I have worn lifts in my right shoe – cycling and lifestyle shoes – to compensate for the leg length difference. Generally speaking, I did quite well for a long time. In my late 50s, however, I experienced progressively increasing pain in my right knee. By my 60th birthday it was clear I needed a total knee replacement.

I put off my knee surgery through 2020 and most of 2021. However, during the summer and fall of 2021, the pain in my left hip superseded the pain in my right knee. For years, I figured the aching in my left hip was just from my left leg compensating for the shorter right femur. I didn’t realize, however, that the imbalance put so much strain on my left hip that I’d worn away all the cartilage in the joint and was down to bone-on-bone.

Within a span of 8 weeks in the fall of 2021, the pain and stiffness in my left hip increased to the point I could barely climb or descend stairs. It was keeping me up at night, and I was just barely able to control the pain with a combination of acetaminophen, Celebrex, and CBDa soft gels from Planetarie.

The Hip Replacement Surgery

After discussing my options with my orthopedic surgeon – Dr. Jepson of Colorado Springs Orthopedic Group – we decided to prioritize the hip replacement and move the knee replacement to a later date. I contacted my 7-Eleven teammate and eminent orthopedic surgeon, Dr. Eric Heiden, for his advice as well. Initially, I wanted him to perform the surgery. After the joy and suffering we shared in the pro peloton, I have unbreakable trust and confidence my teammates have my back. The only reason I wasn’t Dr. Heiden’s patient was that I couldn’t spend 3-4 weeks in Utah after the surgery.

Anterior vs. Posterior

The two most common ways to approach a hip replacement (total hip arthroplasty) are through the front (anterior) or the rear (posterior) of the hip. The posterior approach is a more established procedure and more surgeons have more experience with it. The anterior approach has shorter recovery times, but the surgery is more complex. As an athlete, I favored the anterior approach because the surgeon moves muscles out of the way rather than cutting them. This means fewer restrictions during recovery. If you choose the anterior approach, just know it is less common and therefore it is important to find a surgeon who has a lot of experience with the technique.

hip replacement

My new hip!

Surgery and Immediate Post-Op

The day of my surgery was uneventful (thankfully). I had the surgery at Colorado Springs Orthopaedic Group’s Orthopaedic and Spine Center of Southern Colorado in the late afternoon. I stayed overnight after the surgery and was awakened every few hours to walk around the recovery floor. I had a nerve block for pain management, which lasts for about 24 hours. As such, those nighttime walks were awkward but not painful. I was home by mid-day the next day, after less than 24 hours in the surgery center.

post-op hip replacement

Hip Replacement Training Plan

Day 1:

“Puttering around” is the best way to describe my first day home with a new hip. Every two hours or so, I’d get up from the couch and use a walker to cross the room and get food, water, or medication from the kitchen, or go to the bathroom. For the first day I took an opioid pain killer every four hours, as prescribed. As the nerve block was wearing off, I wanted to make sure I was staying ahead of the pain. I was also instructed to take Aspirin for the first four weeks, to reduce the risk for blood clots.

Having used opioid pain killers after previous surgeries, my top hydration and nutrition goal was avoiding constipation. I purposely drank more water than normal and a combination of protein and lots of fruit and vegetables. I wanted the protein for recovery and the fiber from the fruit and vegetables for regularity.

Day 2:

After puttering around the house, Day 2 was my first venture outdoors. I slowly walked to the end of the driveway 3-4 times during the day – about 5 minutes each walk. Although I didn’t feel like I was at much of a risk for losing my balance, I used the walker because I couldn’t have caught myself if I had tripped.

I continued with my diet of primarily protein, fruit, and vegetables, and lots of water. I had to track my food intake and remind myself to eat when I wasn’t hungry because my appetite was suppressed. For pain management I cut the opioid pain killer from every 4 hours to every 8 hours. I was also taking Tylenol, Celebrex, and Aspirin.

Day 3:

I wanted to get away from opioid pain killers as fast as possible, so by Day 3 I was completely off them. I continued with Tylenol, Celebrex, and Aspirin, and today added back CBDa soft gels from Planetarie. Today I ventured beyond my own driveway and walked about a block around a small park near my house. I repeated that one-block route three times: morning, afternoon, evening.

Day 4:

Day 4 was the start of what I’d call the training plan. Up until this point, I had been just getting through the trauma and immediate post-op pain. Today I repeated the exact same routine as the day before, including the diet, pain management, and three separate walks around the block.

The general format of the training plan was to repeat a given volume of walking for two days, then extend and repeat. So, I did three walks around the block for two back-to-back days, then aimed to extend the walking distance/duration for Day 5.

Day 5:

Instead of three individual laps around the block, I walked two laps at once and completed that twice during the day – or that was the plan. On my afternoon walk, another 7-Eleven teammate – Jeff Pierce, who won the final stage of the 1987 Tour de France – joined me. ‘Pepe’ lives three houses down from me, and after about a mile of walking I told him I thought I was done. His response was reflective of the whole team’s attitude then and now. “Kidd, it isn’t worth kittin’ up for such a baby walk,” he said. I replied, “Pep, you realize some people out there would consider hip replacement kind of a significant surgery.” Pep shot back, “Save that for someone who cares. Let’s go, it is getting late.” Like always, he pushed me to dig deeper, so we went around the block again.

Hip replacement

With Jeff Pierce and my walker.

Day 6:

Repeat of Day 5, almost verbatim. The total distance for the day was a little more than 1 mile.

Day 7 and Week 1 Summary:

I was crushed after the increased distances on Day 5 and Day 6. I took a day off to just putter around the house again. Through the first week, I noticed I was sleeping a lot more than normal. I typically sleep about 8 hours per night and I go to sleep around 9:00pm. Due to the energy expenditure from healing, perhaps lower caloric intake from suppressed appetite, and the fatigue from walking, I was wiped out by evening. A few nights in the first week I went to bed before 7:00pm and woke around my normal time of 5:30am.

Week 2:

I dropped the walker in the second week but continued to use a walking stick for stability. Mainly, I wanted to avoid falling because I was still recovering from the trauma of surgery. The incision was still closing and the muscles that were separated and cut were still healing. The hip itself was secure and safe; the doctors assured me the hip wasn’t going anywhere and that I could walk as much as I could tolerate from a pain standpoint.

During the first two weeks I lost weight, despite trying to be conscious about consuming enough calories to support healing and energy needs. I think the suppressed appetite was a major factor, along with the energy needed for repair and recovery.

From an exercise standpoint, I continued extending and repeating walks. At the beginning of the second week I was walking .6-.75 miles twice a day. By the end of the week, I was completing two 1-mile walks per day. I have been a big fan of double-days in training, whether during post-injury recovery or during event-oriented training. Double days are a good way to get more volume or intensity.

Weeks 3-4:

Between January 11 and January 18, I went from doing three one-mile repeats (walking) to completing a single 3.5-mile walk. At this point I also started incorporating hills. Through the first three weeks or so, my walks were on flat ground and smooth surfaces. I was purposely conservative on terrain because I wanted consistency and duration. That means reducing the risk of falling.

During weeks 3-4 I was also doing more strength work that was prescribed by my physical therapist. The exercises were pretty basic, including glute bridges, isometric contractions of various leg muscles, and a little bit of work on internal and external hip rotation.

By Week 4 I was walking 3+ miles at a time and needed to get outside my immediate neighborhood. That meant climbing and descending a steep hill, which added to the challenge. I finished the first month of my hip replacement training plan by hiking 4 miles on groomed trails. Nothing technical, and I wasn’t going very fast, but I was back in the woods!

Month 2:

On January 29 I ventured out on my first post-surgery bike ride. Walking is the best rehabilitation exercise following a total hip replacement. And, of course, there’s concern people might fall off a bicycle. I’ve been riding for so long I’m more likely to trip over my feet than crash on my bike. Nevertheless, my surgeon was not thrilled I insisted on riding outdoors instead of inside. My first ride was 18 miles in Santa Ynez, California. I spent a week or so out there, riding 14-25 miles/day and hiking 3-4 miles in the evenings.

When I returned to Colorado in the second week of February, I continued riding and hiking. By this point, my pain management routine was down to Celebrex (prescribed for the knee pain, mostly), Aspirin, and CBDa. I’ve been taking CBDa in a soft gel or drop form in the evenings before bed, and I use Planetaire’s Muscle Rub on my legs – particularly my still pre-op right knee. I can definitely tell a difference if I miss a day of the CBDa: the swelling and pain from my knee flares up and I don’t sleep as well.

For the majority of February I aimed to ride 18-30 miles per ride – mostly road riding with a few gravel rides. I rode 10 times in the first 15 days of February, and walked 1-3 miles/day each day. For the second half of the month, the mileage increased to 30-35 miles/ride and I closed out the month with a 50-mile ride on February 27 – 2 months after a total hip replacement.

I finished the month of February with 444 miles covered (between walks and rides) in 35.5 total hours.

Return to Training Camp

I reached my goal of coaching at the CTS Santa Ynez Cycling Camp from March 14-20, 2022. I’ve been running spring training camps in the Santa Ynez Valley since 2000. I missed a year in 2020 due to COVID, but I didn’t want to miss this year. We had a great group of riders and completed some big rides, including “Manny’s Ride” – an 80-mile round trip from Santa Ynez to Jalama Beach – and the 4,000-foot climb and descent of Figueroa Mountain.

For the month of March, I increased my time and mileage on the bike and reduced my walking time and distance – but I’m still walking nearly every day. In total, I covered 466 miles in March in 36.25 hours.

hip replacement return to cycling

Jalama Beach during “Manny’s Ride” at March 2022 CTS Cycling Camp.

Summary and Take Aways

I approached my recovery from a total hip replacement almost the exact way I approach training for a major endurance athletic goal. I was conservative in the modes of exercise I used and kept my activities simple. Walking is the best exercise for hip surgery rehabilitation, so I walked. I didn’t complicate it with extraneous activities that increased risk without adding much benefit.

I stayed very consistent with the frequency of activity, my sleep schedule, and my diet. You can see the progression of my training volume on my Strava profile. There were days when I was tired, or when I wanted a heaping mass of pasta instead of lean protein, vegetables, and fruit. But I kept with the simple and consistent steps because the overall effect is greater than the sum of the parts.

I was patient with myself and kept my eyes on the prize, which was successfully completing big rides and being an effective coach on the bike during the March Santa Ynez Cycling Camp. When I started to feel good, I didn’t push my luck or try to test myself before I was ready. I trusted the process, stuck with the plan, and stayed right on track.

There was absolutely some luck involved in my process. I didn’t get an infection, nor did I have any complications with the incision site. I was able to manage the pain effectively with Tylenol, Celebrex, Aspirin, and CBDa. And I had a wonderful support system with my doctors, my partner Sarah, and my teammates, kids, and staff at CTS. If you have a hip replacement in your future, I can’t guarantee you’ll have the same experience I had. But, I hope you can learn from my journey, have a successful return-to-training, and join me for a ride sometimes soon!


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Comments 29

  1. Great article. Very inspiring and hopeful for me. But caution: I’m was 56 and a fit female cyclist (12-15 hrs per week on bike). I was thrilled to find this article and began a modified version of Chris’ comeback plan and really suffered with a setback. At 6 weeks it was way too much to walk one mile a day and ride a stationary trainer no resistance working up to 40 minutes (I started spinning at week 4). Doc said cementless implants are not osseo-integrated for 8-12 weeks. The risk of non integration was not worth the drive I had to start being active again. I’m still suffering a great deal of pain that started at 6 weeks forcing me to stop everything for several weeks. So my experience is a tale of caution. I hope I do not suffer any permanent damage by “doing too much” too soon. Only time will tell. Best wishes for a healthy recovery to all my fellow “hippy” cyclists!!!

  2. Just wanted to ad mention of the dual mobility implant which is suppose to provide better post-op mobility for more active patients. My hip arthritis manifested itself as knee pain that was unbearable after hour or so of even doubles tennis. My orthopedic surgeon suggested anterior approach and the dual mobility implant which has two balls that can move independently of each other for better range of motion. I am writing this 17 days after surgery and with just one Tylenol I can manage the pain to less than a 1 out of 10. Witching 10 days I was back at cross training doing somewhat mortified exercises and avoiding running, box jumps etc. but still going hard on push ups, sit ups, etc.

    I feel way better than before and the challenge is not to do too much as I feel great. Glad to see this forum as most information about THP recovery seems to be written from the perspective of inactive adults recovery. I agree with Chris’s advice, but my surgeon was adamant that while posterior is done most often as it has the longest history, anterior would give me the best outcome and dual mobility (not talked about enough) was far superior implant for athletic adults seeking better range of motion and fewer risks of dislocation (small ball inside a bigger one closer to size of original)! Good luck Everyone!

  3. Thanks for sharing your recovery,
    I’m 58 and just had my left hip replaced, I thought I had a good recovery plan in place until my sister sent me your article,my plan was more aggressive but since reading the article I have now changed my recovery to a less aggressive plan.
    I’ve been road racing and mtn bike racing since 1980.
    I’ve been dealing with this pain that I thought was a groin pull for about 4 years,I got to the point that I couldn’t walk 50 feet without stopping to make sure I could take another step,stairs were another nightmare.
    I quit riding and working out pain too severe to enjoy doing what I loved to do,after almost a year of not doing anything for my fitness, I bit the bullet and started riding my road bike and working out to get ready for surgery, I did a lot of leg work.
    Surgery a success and I can’t believe how great I feel ,looking forward to getting back to training.sorry for rambling on.thanks for the article

  4. thanks for the great article…after having 2 hips replaced over a five year time frame, my only wish would be that I’d done it sooner. I’m again enjoying pain free riding. When considering a replacement, take into account your age, how long the implanted replacement will last and understand that you may have significant pain during post op and rehab.
    One of the best pieces of information I can state is, find a PT that cycles, follow their advice to do “no more than told to do, no less than told to do” and results will follow.

  5. Great article Chris! Considering knee surgery, but worried about the time off the bike and swimming, age 75??
    Best of luck to you Chris.

  6. I’m 4 month post THR. I went anterior and yes the adductor muscles hurt for a long tome, but it is good now. I may have been less patient than you on the recovery. You do not mention any use of ice? I overlooked this and paid dearly for it on week three. I iced a lot after that and it settled down well. I would recommend anyone who gets it done to ice like crazy right away, like 6-8 hrs a day the first week.

  7. Had to comment since there was a lot of info left out that would be helpful to anyone who needs a total hip replacement. Both of my hips have been replaced – left in Dec., 2017 (age 66) and right in March, 2021 (age 69). No injuries were responsible, only bad genetics causing arthritis that necessitated the hip replacements. I started bicycle racing in 2006, so I had and continue to have great physical conditioning. First of all, I would recommend that everyone needs to do their homework regarding the surgical technique to be used. Both of my hips were done using the antero-lateral procedure which is considered to be the least invasive and DOES NOT cut any muscle. My doctor is a highly-regarded surgeon for joint replacements and is a member of a prestigious group of joint replacement surgeons. Next, with regard to pain management, Tramadol is a synthetic opioid that is not addictive. I refused the other opioid pain meds and used Tramadol occasionally during the first 2 weeks post-surgery, primarily to be able to sleep at night. Tylenol worked fine the rest of the time. Something for all to consider! Something that was not mentioned was physical therapy. Until I was able to drive (3 weeks), I received home physical therapy and then went to outside physical therapy for a couple of months. Chris, you didn’t say anything about the loss of muscle strength in the hip muscles of the affected hip due to joint deterioration and the surgery? Because I was concerned about the leg strength imbalance I rode the trainer, beginning in the 3rd week, until I felt confident about each leg’s strength. I could go on and on, but won’t. Regardless of what ‘Pepe’ says, total hip replacement surgery is MAJOR SURGERY! No, I didn’t baby myself (competed successfully in the Masters’ Road Race Championship 20k time trial only 4 1/2 months after the right hip was replaced), pushed myself to the edge but not over in training, but I respected the assault on my body and what I needed to do to bring my body back.
    Yes, everyone’s body will respond differently with regard to the need for a joint replacement and recovery from the surgery. The best advice is to inform oneself with as much info as possible!

    1. The largest misconception about Tramadol is that it is not an opioid and not addictive. This is just not true. The drug contains a synthetic opioid that is metabolized into an opioid in the body and acts on the opioid centers of the brain, just like other opioids.

  8. Welcome to the club Chris; some club, ha! I’ll be 56 in August, but back in my early 30s out of the blue my right hip would get very stiff after a long run; After many months of misdiagnosis, local good ortho told me that I have hip joints of an 80 year old man and to stop my competitive tennis and running; Long story short, no one wanted to place “new” hips into me due to my age, so the goal was to wait and wait, which was no option for me; found an article on hip resurfacing, and one of the 2 Docs doing it experimentally in the US is in SC. Upon visit, he told me that both of my hips are done and he can do them bilaterally due to my age. Mon was right, Wed was left and I was home on Saturday; apparently, bad genes, heavy-duty tennis and new love of long-distance running chew up all the cartilage in there. Things were very good for 2 years where I was able to return to running (not as fast, however) and tennis; Then, my left resurface failed (avascular necrosis) and THR took place; right resurface failed five years later and THR took place; I continued with running and tennis, but cycling became interesting and over the years I moved away from running and into more cycling and tennis; Tennis scholarship brought me to this beautiful country and it is my 1st love, so can’t shake it off, which costs me to become a faster cyclist, but that is a decision I can live with.

  9. I’m getting left THA this Wednesday and your write-up was just sent to me by a good friend. Excellent timing!
    I like the gradual, but consistent approach you used in adding activity throughout your recovery. It is always a good idea to temper progress with patience.
    Thank you for your words of experience and wisdom!

  10. Great write-up Chris. I’m in the midst of shoulder replacement rehab, which of course is a slightly different animal. Thanks for being an exemplar of grit & tenacity.

  11. Chris –

    Awesome…congratulations.

    A word about medication…in 2000, I did a cross-USA bike trip on two bad knees (the right one thrice surgically repaired). The only thing that kept me in the game was a Celebrex in the morning to ward off the inflammation of a 100-plus-mile ride and a DarvoCet at bedtime to help me sleep. Lather, rinse, repeat for 25 days. I never…before or since…felt better.

    Since the demise of DarvoCet, I’ve switched to Tramadol and eliminated Celebrex (on the advice of my cardiologist). It’s just not the same…even allowing for 22 years of aging.

    Blessings on your continued recovery…good luck with the knee replacement (my Spousal Unit needs one as well)…and until we cross paths out on the road…

    Rock On!!!

    Jeff Sipos
    Strongsville, Ohio
    John 16:33

  12. You where riding like a man possessed…..only three months after a hip replacement at the March camp…..glad your bionics are healing up…..now on to the knee and another 20 watts!!!

  13. Chris, thanks for sharing. It seems as if your plan and approach have led to a successful recovery in the shortest time possible. I’m going to keep this plan on file for when I need to go through it!

  14. Great article. Great recovery. You are the best. I took a climbing camp from you and your people some years ago. It was a great experience.

  15. Thank you for sharing this journey. I am 72 with necrosis of left hip from a break 18 years ago and have been holding off on the replacement surgery. I just don’t want to lose the time on the bike. This story has encouraged me to train for the surgery and have a post surgery plan in place.

    1. Janelle,
      Just do it😀…with the thousands of patients that I rehabbed s/p knee or hip replacement, the 1st and most common response I received from patients was “I wish I had done it years ago”…I did a bilateral TKR(knee replacement), and was back on bike, indoor, on day #30 and they still feel great 14 years later…do it now👍🙏

    2. Do it now. I had necrosis from prior fracture with pins for repair. Pain was slowly increasing but nothing I couldn’t live with but I was getting weaker riding and walking. Was told the longer necrosis progressed, the more chance of more serious fracture. I had THR on 12/20. I’m back on bike. I’m 64, no super athlete but like to stay active hiking and biking. Already had TKR. I’m thankful I didn’t wait. Feel so much better. Go for it!

  16. Chris,

    I had the same experience. Left hip was done 2/8/22 so I am 8weeks post op. My doc just released me to ride my road bike. I have been riding the recumbent at the gym which really has helped with endurance and strength. Looking forward to getting out there on the road starting Monday.

    D.J.

  17. Thanks for sharing Chris. I am having a TKR in 5 weeks so it was great reading about your recovery. Would love to hear more about TKR recovery and training if CTS has any experience with that.

  18. Congratulations on ur recovery that’s great!!!!
    I’m having my left hip replaced April 11th
    My right one was replaced 10 years ago and it does great! My replacements are do to arithmetic and bone spurs. I have a real physical job and I ride bikes and go to to gym regularly. Waited a little while to get bike on my road bike. I ready to get back to my riding bought a new cannondale last year haven’t been riding last month cause of the pain. I appreciate your article. I just turned 59 and ready to try this new hip out thanks again

  19. Chris, after having the pleasure of riding a hard week with you in the late fall before this surgery, and in March following – I was pretty stunned! Your recovery and fitness gains are really remarkable. Thank you for sharing your journey. It’s motivating and inspiring.

    These lessons of consistency and long term focus apply to everything in endurance sport (and really, life.)

  20. Congrats on your successful surgery/recovery. I had a total left hip replacement on January 21, 2022. Due to Covid, the surgery was done as single day. Surgery started at 7:30 AM, I woke up in post op at 8:50 AM and I walked out of the hospital at 1:30 PM. Mine was anterior. On the advice of an OT, and consent from my surgeon, I started walking the next day on a treadmill … 1 mile, very, very slow pace … 40 MPM. Still walking every day, mileage and pace have increased. Started back on an indoor trainer on 10th day, post-surgery and rode at least every other day. I waited till cleared after my 30-day checkup before venturing outdoors.

    Although I was bone on bone in the hip, all of my pain manifested itself in left knee pain when walking (none while biking, if seated) and severe pain in second digit on left foot, at all times. Both of these were due to nerve impingement created from being bone on bone in the left hip.

    With modern joint replacement techniques, surgery and post-surgery can go well. As stated in other posts though, there is no replacement for the benefit of going into the surgery as fit as possible. And after surgery there is no replacement for keeping the joint moving.

  21. Congrats on a nice recovery. Your story speaks to a large % of us “Active Agers” who have had joint replacement and want to keep cycling. I have had Hip replacement 2 years ago, and two knee replacements this year (whew!). Had LTKR 12 weeks ago, and RTKR 4 weeks ago. The recovery for both is going well. Can’t wait to get outside on my road bike. Stationary cycling at this point is my only choice. With good Physical Therapy along with my own researched routine at home, I’ll be out in no time.
    Considering this active age group (welcome!) who are avid cyclists, would be great if more articles could focus on comebacks following joint replacement. I would love to hear from others!

  22. I’m wondering if there are any exercises you currently do for strengthening and joint mobility. I’m a few years out from bilateral hip replacements and find myself starting to tighten up.

  23. Chris, glad to hear you are recovering well. The most interesting thing you shared for me was that you chose posterior over anterior. These days, it seems that everyone who goes thru these procedures is encouraged to have the anterior surgery. Great perspective. Heal well my friend.

  24. Nice work Chris, I unfortunately had to have 2, plus a revision, similar plan, but had upper body trx sessions ( in front of mash reruns ) everyday. Being body weight exercise I didn’t fear over training, plus kept my “athlete” mind from the ugh mode. I also got off the drugs asap, ice was my best friend. My advice to anyone having to go through it, get in good shape before, it makes a difference.

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