Hip resurfacing offers options to boomers' aging joints

Jul 12 2007

Joe Mitchell always assumed his chronic leg pain was due to tight muscles, but as the pain became more intense in recent years, his physicians uncovered the culprit: an arthritic hip. He explored treatment options, and was dismayed to learn that he was not an immediate candidate for the main treatment for arthritic hips: hip replacement surgery.

“Hip replacements are meant to last 10 to 20 years at the maximum. After that, the revision surgeries are not as successful, so surgeons shy away from doing total hip replacements on people younger than 60,” said Mitchell.

Mitchell is not alone. Like the 54-year-old attorney, who always led a fit and active lifestyle, hundreds of thousands of active baby boomers are now dealing with worn-out joints - and the pain - at a much earlier age than their more sedentary parents. Many, like Mitchell, are considered too young for total hip replacements, face years of painful waiting until they “come of age,” and often balk at the prospect of limiting their activity level once the artificial joint is in place.

But that’s beginning to change, thanks to a procedure called hip resurfacing, which was approved by the Food and Drug Administration last May.

“Hip resurfacing is an interim solution for younger patients who face significant pain and disability due to damaged hip joints,” said Christopher Drinkwater, M.D., assistant professor of Orthopaedics at the University of Rochester Medical Center, who performs about two hip resurfacing procedures a week at the Evarts Joint Center in Highland Hospital. “It allows us to fix the problem causing the pain, but in a way that preserves enough bone so that a patient can safely proceed to a total hip replacement down the road if it’s needed.”

Other benefits of hip resurfacing surgery include the ability to maintain impact activities, like running or karate, and having a more natural feel of the hip after surgery, including increased range of motion and stability.

In total hip replacement surgery, both the pelvis socket and the top of the femur, or thigh bone, are replaced with artificial devices which allow a natural gliding motion of the joint. A socket is implanted into the pelvic bone, while a metal ball attached to a metal stem is driven deep into the center of the thigh bone. It is the anchoring of the metal stem that often leaves too little solid bone to make a follow-up replacement procedure feasible.

In hip resurfacing, the socket is still implanted into the pelvic area, but the head of femur is only shaved to fit a metal cap, which is anchored by bone cement.

For all of its benefits, Drinkwater cautions that hip resurfacing is still a major surgical procedure, and takes about the same time as a total hip replacement.

“In fact, the surgery itself is more demanding on the surgeon because a more extensive dissection is required to place the socket without removing the femoral head. Younger patients overall tend to recover a little faster, though initial recovery can be just as difficult," Drinkwater said.

Not everyone is a candidate for hip resurfacing, either. Men must be under 65 and women under 55, due to concerns over bone density levels. Drinkwater requires all patients to meet minimum levels of bone density before doing the surgery.

Joe Mitchell doesn’t mind though. He had the surgery Jan. 26, 2007, and today is doing exactly what he wants to - biking and weight lifting - but pain-free now.

http://www.urmc.rochester.edu