Hip Surgery With a Future
By BARNABY J. FEDER Published: April 14, 2007
An interim approach to total hip replacement is offering an alternative that still leaves open the possibility of successfully receiving an artificial hip later in life.
Hip replacement, an operation that about 300,000 Americans undergo each year, is one of the great success stories of modern medicine.
But woe to those who outlive their artificial hips, which typically cannot be counted on to last more than 20 years or so.
Because it is difficult to extract and replace a worn-out or defective artificial hip, doctors routinely advise patients to put off hip replacement as long as possible. For middle-aged or younger people whose hips have been damaged by disease or injury, that typically means a punishing waiting game.
Now, though, an alternative to total hip replacement can offer an interim solution to many younger patients.
The alternative, called hip resurfacing, usually yields at least as many short-term benefits as a total replacement. It costs about the same and is typically covered by insurance.
And though many patients can expect to outlive the treatment’s effectiveness, hip resurfacing has the advantage of preserving enough healthy bone to allow for a future total hip implant.
“It’s nice to know that down the road, if necessary, it will be an original total hip — not a revision,” said Keith McDonald, a 54-year-old air traffic controller from Melville, N.Y., whose right hip was resurfaced late last month. This past Tuesday, just 15 days after the operation — and at least a week earlier than doctors would recommend — Mr. McDonald drove his car. “Every day I do more,” he said.
Tens of thousands of patients around the world have had hips resurfaced in the past decade. That includes some Americans who went overseas before the Food and Drug Administration started allowing it to be done in this country last May.
“The demand from patients and surgeons is tremendous,” said Brian Austin, of Smith & Nephew, the British maker of the F.D.A.-approved resurfacing system.
More than 400 surgeons in the United States have now been trained to use Smith & Nephew’s product, which is known as the Birmingham Hip System. Competing devices already sold overseas are expected to begin arriving in this country later this year.
For all its potential advantages, hip resurfacing surgery is actually no easier for the patient or doctor than hip replacement. And the recuperation may not be any quicker. While many activities can be resumed within weeks, complete healing can take six months or longer.