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Not so hip anymore? Surgery aims at the active boomer

By ASSOCIATED PRESS
Published January 30, 2007

WASHINGTON - Doctors are beginning to offer an alternative to hip replacement aimed at younger, athletic baby boomers who have worn out their joints too soon.

It's called hip resurfacing. The procedure covers a damaged hip's ball and socket with smooth metal rather than cutting away worn bone and replacing it.

The operation hit the U.S. market last spring with Food and Drug Administration approval of the British-designed Birmingham Hip Resurfacing System. Competitors are in clinical trials and are expected to clear the FDA this year.

Dr. Stephen Raterman, chief of staff at University Community Health in Tampa, has been performing the procedure since June. He was one of 50 U.S. surgeons trained for the system and one of three in Florida, said Phoebe Ochman, University Community Health spokeswoman.

Raterman has conducted more than 50 procedures, which allows him to train other physicians in the procedure, Ochman said.

Miami and Sarasota are the other two locations where resurfacing is available in Florida.

It's not the first time orthopedic surgeons have tried resurfacing worn-out hips. But where earlier attempts failed, data from Europe suggest this latest approach uses longer-lasting materials - with the additional promise of a joint that may hold up to the recreation of today's 40- and 50-somethings better than traditional hip implants.

"I do have people that call me and say, 'My father had hip resurfacing in 1970 and it didn't work. Why are we doing that now?' " said Dr. Michael Anderson, an orthopedic surgeon in Milwaukee who estimates that 15 percent of his hip implants now are resurfacings.

His response: Comparing today's resurfacing with yesteryear's is like comparing a modern car to a Model T.

Not everyone's a good candidate, specialists caution. Resurfacing isn't for patients with thinning bones - part of the joint could break - or those who have poorly functioning kidneys that can't eliminate microscopic metal particles produced when the joint's reinforced pieces rub together.

Moreover, while patients typically recover quickly, resurfacing is harder to perform than a hip replacement.

But interest is growing along with the demand for hip repair from ever-younger patients.

Until now, "you might have told someone to soldier on for as long as you possibly can," because a standard hip replacement before age 60 is likely to wear out, explained Dr. Scott Rubinstein of the Illinois Bone and Joint Institute and spokesman for the American Academy of Orthopaedic Surgeons.

With the resurfacing option, "people may be a little more aggressive" in treating younger creaky joints, he said.

More than 400,000 total or partial hip replacements are performed each year.

Typically, surgeons replace a hip by cutting off the femoral head, the joint's ball, and replacing it with a metal ball mounted on a rod implanted deep in the thigh bone. A plastic socket replaces the original. Those artificial hips can bring tremendous relief to people crippled by hip pain.

But the metal-on-plastic friction means the implants can begin wearing out in about 15 years, sooner if sports or other activities increase pressure on the joint.

Enter resurfacing. Surgeons lightly shave the damaged femoral ball and fit a metal ball snugly over it. That ball rolls in a metal cup reinforcing the socket. The idea: Metal-on-metal shouldn't wear out as fast, and if patients do need another replacement in 15 to 20 years, the thigh bone is largely intact.

"This resurfacing initiative has interest because we're sparing bone," said Dr. Mitchell Sheinkop of Chicago, a hip replacement pioneer.

Doctors differ on what age is the cutoff for resurfacing, between 60 and 65, largely dependent on the patient's bone strength. Nor do all insurers cover it. The implant costs about 20 percent more than a standard artificial hip, adding to the $35,000 tab.

Complicating the choice is that surgeons call newer artificial hips - ceramic-on-ceramic balls and sockets, or tougher plastic designs - good options for even the most active person just turning 60.

So resurfacing is emerging as a niche for the younger sports enthusiast. Dr. Marc Wiener, a Chicago-area internist, chose resurfacing when his own hip degenerated in his 40s, because it came with few restrictions on activity. He exercised before surgery to be in prime condition for physical therapy afterward - and played 18 holes of golf a month after his resurfacing, hit the basketball court at seven weeks and the tennis courts in three months.

Milwaukee's Anderson cautions that average patients shouldn't expect as much.

[Last modified January 30, 2007, 00:48:09]