By Nancy K. Crevier
Don Sweeney of South Salem, N.Y., and Albert Viscio of Redding are both men in their mid-fifties. Running, tennis, basketball, and even mountain climbing are activities they enjoy.
But about ten years ago, both men began to experience the discomfort that comes with osteoarthritis of the hip.
“The arthritis progressively became worse,” said Mr Viscio, “and I found I had to reduce some of my activities.”
Mr Sweeney developed increased mobility issues along with significant pain in his hips, until it became apparent a little over a year ago that he would have to take action, or face a debilitated future. Hip replacement surgery was performed on his left hip in 2005, and he then was told that his right hip would be a candidate for surgery in the near future.
When Mr Viscio had to cut short a climb to the summit of Mount Kilimanjaro in Tanzania in December of 2006 due to intense hip discomfort, he realized he had pushed his limits. “I knew it was time to address the problem,” he said.
Both men were candidates for hip surgery, joining the ranks of nearly 500,000 people in the United States who undergo the knife for reconstruction of hips damaged by arthritis. And both men were ideal candidates – relatively young, in good physical condition, and active – for a newly FDA approved hip resurfacing technique.
…For younger hip surgery patients, hip replacement is an operation that will probably be repeated in their lifetimes.
That is why Drs Sanjay Gupta and Robert Deveney, both affiliated with Danbury Hospital, are pleased to provide the hip resurfacing procedure, approved by the FDA just six months ago. Rather than completely removing the head of the femur as in hip replacement surgery, hip resurfacing preserves the femur head, reshaping it to save more bone. During surgery, a chromium cobalt metal cap is fit over the patient’s hip ball and a metal cup, also made of chromium cobalt metal, is set into the pelvic socket.
Why It Works
The metal-on-metal construction of the replacement parts means less friction and longer life to the prosethic parts. Hip resurfacing preserves more bone than when traditional hip surgery is performed, an important factor if hip replacement surgery is required in the future.
Dr Gupta has been certified to perform this surgery in the United States since the FDA approved the procedure, but having practiced as a medical resident in the United Kingdom where hip resurfacing has been embraced for the past ten years, he was very familiar with the procedure. He participated in more than 25 surgeries while a fellow at The Hospital for Special Surgeries in Manhattan after coming to the United States, and has already performed two hip resurfacing surgeries since joining Orthopaedic Specialists of Connecticut in Brookfield in September 2006.
Beyond bone preservation, there are other advantages to hip resurfacing, said Dr Gupta. By preserving more of the femoral head, hip dislocation is less likely.
“Hip resurfacing gives patients a better quality of life,” said Dr Gupta, “especially if they have a more active lifestyle.”
With hip resurfacing, patients spend approximately three to six weeks on crutches to allow the bone to bond to the metal cap on the femur head, said Dr Gupta.
“Then they can do whatever they want, except contact sports, running, and jumping for one year. After that, I tell them they are free to do everything,” he said. That is a far cry from the restrictions that come with hip replacement, when activities like jogging, gymnastics, and dancing are severely curtailed.
“This is a good choice for a very active person, someone under the age of 65 usually, who has good bone quality,” Dr Gupta said…
Dr Devany’s R&D
The procedure was modified over the years in the United Kingdom, though, until the present metal-on-metal design became a positive option highly regarded there for the past ten years.
In 2006, Dr Deveney traveled to Canada to study the newest hip resurfacing techniques with Ronan Treacy, a colleague of Derek McMinn, the developer of the Birmingham Resurfacing technique that is most widely used. The changes he observed since his initial experiences with hip resurfacing were primarily in the design of the prosthetic, rather than the surgical technique itself.
“What is so exciting is that hip resurfacing is preserving the femoral head, allowing patients to function at a high level. Their range of motion is greater, and there is a lower risk of hip dislocation than with traditional hip replacement,” Dr Deveney said. “What is really appealing to patients is the activity level and recovery level that is faster due to improved surgical techniques, rehabilitation, and the improved designs. We have people up and walking the same day as surgery. They are often in outpatient therapy by the fourth day, and I tell them that they can drive whenever they feel comfortable.”
Previous to newer developments, initial recovery often meant a time period of three to five months before patients were comfortable returning to daily routines.
“Now, I would say that many patients are back to their normal routines, back to work, three to four weeks after surgery,” Dr Deveney said.
There is an extremely low wear rate with the new metal-on-metal ball and joint construction used in hip resurfacing, and that means that the surgery has the potential of lasting much longer than the ten- to 15- year life expectancy of the plastic and ceramic metal combination used in conventional hip replacement surgery. The longevity of the metal replacement parts means that many hip resurfacing patients may never face hip surgery again.