Hip resurfacing is all the rage in the orthopedic community these days. In fact, I had four different hospitals pitch me stories on it in the last year, independent of one another.
But is it right for everyone with chronic, debilitating hip problems? NYMD News panelist Dr. William Macaulay, attending orthopedic surgeon at New York Presbyterian Hospital/Columbia and director of Columbia’s Center for Hip and Knee Replacement, has the answers below and after the break.
By William Macaulay, M.D.
You just turned 40 or 50. Your mind tells you you’re younger, but you
feel older because you have real hip pain that won’t quit. You limp
everyday. You do a little research and come across a new procedure
called total hip resurfacing. Then you wonder: Is this the right
procedure for me?
I hear the same story over and over from
my patients. Looking for a solution to their hip pain, they have
stumbled upon total hip resurfacing, which was approved for use in the U.S. in May of 2006. While many patients are ideal candidates for resurfacing, often I must inform them that hip resurfacing is not for everyone.
resurfacing is not a new concept. Older, less successful versions of
hip resurfacing came and went between the 1930s and 1980s, which
included materials such as glass, plastic and stainless steel. These
implants eventually failed under normal activity requirements. Advances
in metallurgy and refinements in surgical technique have brought
resurfacing back to the foreground of hip surgery.
total hip replacement remains the gold standard, especially for patients
over the age of 60 or 65 with severe, debilitating arthritis of the
hip. However, for the younger and more active hip arthritis patient, the
long-term success of THR remains a concern. Scandinavian hip registries (the U.S. does
not yet have one) have shown that active total hip replacement patients
under the age of 55 have a 15% to 20% chance of requiring a
re-operation within 10 years.
As a 40 or 50 year old with
severe hip pain, arriving at surgical intervention as your last resort,
which option do you choose? As with most things, there are pros and cons
The benefit of hip resurfacing is suggested by
its name. The top of the thigh bone is preserved by reshaping and
capping with metal (Figure 1) instead of replaced, as is the case with
traditional hip replacements with a metal spike driven down the inside
of the thigh bone …