05:16 PM EDT on Friday, June 22, 2007
By Felice J. Freyer Journal Medical Writer
The guys wanted it. Guys in their 40s and 50s, who once spent hours playing tennis or doing karate, and who, now hobbled by arthritis, poured their energy into finding a solution to the pain in their hips.
They came to Dr. Robert C. Marchand, printouts in hand, minds made up, and said, I want this. What they wanted was hip resurfacing — a new alternative to total hip replacement that preserves more bone, and is reputed to last longer, withstand impact and allow a greater range of motion. Perhaps allowing for more years of karate kicks.
Marchand, who is with South County Orthopedics, had observed a hip resurfacing procedure in his wife’s native Germany. In Europe, he says, people are running marathons with hip-resurfacing implants. He thought his patients were on to something, and resolved to give them what they wanted.
He took a course last year in hip resurfacing in Boston and went to New
York to train with a surgeon there. After persuading South County
Hospital to buy the necessary equipment, he began doing the procedure
last fall. So far, he has completed about 45 resurfacing procedures in
people age 20 to 71.
And he remains the only doctor in Rhode Island who will do it…
In the traditional treatment for arthritic hips, called total hip
replacement, the surgeon saws off the top of the thigh bone, hollows it
out and inserts a metal implant topped by a metal or ceramic ball, which
rests inside a plastic cup implanted in the hip socket.
In hip resurfacing, instead of sawing off the top of the thigh bone,
surgeons reshape it, preserving most of the natural ball. Then they
cement a metal cap over the ball, which slides inside a metal cup
pressed into the hip socket. Both are made of cobalt chrome.
Some think this metal-on-metal construction will last longer and
withstand high-impact activities such as running. More bone is
preserved, so that even if the implant does break down, the patient can
then get a total hip replacement. Also, the ball is bigger, thought to
be less likely to dislocate from the hip socket, and affording a greater
range of motion.
All this makes the procedures especially popular with active
baby-boomers. “They come in at six weeks [after surgery], cross their
legs and put on their shoes,” Marchand says. “They say, ‘I haven’t done
this in a year.’ ”
…EVEN AS patients exult, the debate continues among doctors. Dr. Scott
Rubinstein, a Chicago orthopedist who favors hip resurfacing for
appropriate patients, says many are discouraged from it by surgeons who
don’t do the procedure.
“If someone’s interested in getting this done, they need to be evaluated
by someone who does them,” Rubinstein said. “It’s certainly not
appropriate for everyone. You need to look at this as one way to have
your hip done. Like any surgery, there’s no right answer for everyone.”
In looking at the evidence, it may come down to a question of whether
one sees the glass as half-empty or half-full. Rubinstein, like
Marchand, finds the 10 years of data from Europe convincing. “I don’t
think it’s going to be any worse than the other stuff. I personally
think it’s going to be better,” he says. “It’s one of these
time-will-tell kind of things.”
…Dr. John A. Froehlich, of University Orthopedics, who specializes in
sports medicine and reconstructive surgery and practices at Rhode Island
Hospital, also says he’s not ready for that bandwagon.
But he points out that patients are not facing a simple choice between
old-fashioned total hip replacement and brand-new hip resurfacing. The
traditional hip replacement technology has also been advancing, with
procedures that preserve more bone, more durable materials, and smaller
He’s pleased with the results he’s getting with the latest versions of
hip replacement. “I think I can give people a more predictable result
the way I’m doing it,” Froehlich said.
With people now living into their 80s, and getting sore hips in their
50s, anyone who gets hip surgery is going to have to have it redone,
perhaps multiple times, Froehlich adds. “No matter what they’re made of,
they will loosen and wear. That is something that is not recognized by
the public,” he says.
“There is no panacea.”