So you’re an active baby boomer, or even younger, and you’ve found that one of your hips is either becoming very painful, curtailing your activities, or not responding to medications.
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You’ve exhausted the drugstore shelf dedicated to arthritis, and various muscle and joint aches.
Perhaps you’ve already seen your doctor, had an examination that proves you’ve lost some range of motion, and/or had an x-ray made that shows “arthritis”. The next step is most likely a visit to your friendly orthopedist. Here, you’ve been given the news! And the news is-that your problem, should you wish it to be definitively solved, involves major surgery. Major in the sense that the surgical procedure is medically so considered; Major in that it will require a lot of time and attention from you; Major in that it is a serious option you must face. And so you begin to consider- a total hip replacement or a hip resurfacing.
You’ve heard that the conventional total hip replacement has an average survival life of 15 years, after which it may have to be replaced-the so called surgical ‘re-do’. But now you learn too, there is an alternate procedure designed for younger, active patients of somewhere between 40 and 60, called a hip resurfacing. The ‘Resurf’, can give you 10, 15, or even more years before it may be required to be converted into a total tip replacement (the figures on life expectancy of a Resurf are not entirely fixed yet) As the experience is still too young for the studies in medical literature to be more definite.
A little basic anatomic information may help explain the difference between these two procedures. In essence the hip is a ball and socket joint. In both procedures the socket is revised and replaced. But the resurf, doesn’t replace all the bone of the ball part of the hip joint-particularly the part that anchors it in the femoral or thigh bone. Hence more anatomy is left intact.
The resurf procedure being offered to younger patients with enthusiasm by the orthopedic surgical community has some decidedly positive advantages if you’re a member of this younger group of patients.
- Quicker recovery time
- Greater safe range of hip motion,
- Earlier rehab(generally)
- Preservation of more bone stock
All of these things make a hip resurfacing by an experienced surgeon desirable for the younger patient.
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But just like this year’s newer better car model, the resurf is not without glitches. The following have produced lots of material for the professional literature and it is as well that candidates for the resurf procedure get in the know.
The learning curve for the performing surgeon is extremely steep. I personally would require that my surgeon do a minimum of 30 plus resurfs a year.
There is a noticeable incidence of femoral neck fractures following resurf. This is especially true for pre or peri-menopausal women, or any patient with Osteopenia (a diminished presence of calcium in the body’s bones- seen on x-ray or detected by bone density tests).
It is not the safest procedure for the obese (those whose body Mass index is over 30), or for those whose hip anatomy is significantly irregular or distorted.
Many of the implanted resurfs have been of a metal-on-metal construction, and are subject to the same metal particle shedding problems, and therefore to the same recall as the metal-on-metal total hips.
Of the two procedures, the total hip replacement has a more solid success percentage, and is less demanding of surgical technique.
What I am saying is, if you need a new hip, you need a new hip, but consider the matter carefully before you opt for this year’s model (the hip resurfacing) and take advantage of it only after knowing fully its risks.
Dr. Mary Ellen Hecht is an orthopedic surgeon and author of a new book, “A Practical Guide to Hip Surgery”. This concise handbook augments pamphlets or videos supplied in your surgeon’s office. The book as well as this article is written in user friendly English, but has the gravitas of thirty-five years of medical practice directly from an orthopedic surgeon who has performed countless hip surgeries and undergone a double hip replacement herself!