Hip resurfacing
By Dr. Myron Stachniw M.D.
I am writing to you to give you some information about hip
resurfacing. The resurfacing procedure is a way of doing a hip replacement, but
it is less invasive. In a standard hip replacement, the ball of the
ball-and-socket joint is cut out and an artificial socket is placed in the
pelvis, a stem is placed down the femur and there is a metal ball. In a hip
resurfacing, a socket is put in but the ball is not cut out. It is reshaped and
has a metal cap put on it. The advantages of this are threefold. There is less
bone loss. If the resurfacing should loosen, then the surgeon can go back and
perform a standard hip replacement and no bridges have been burned. Secondly, a
resurfacing arthroplasty has a metal ball in a metal socket and this does not
wear out as quickly as the standard hip replacement and could possibly last the
patient a whole lifetime. The other advantage is that the hip resurfacing
recreates the normal anatomy of the hip. It is very difficult to dislocate and
patients that have had a hip resurfacing can resume normal activities such as
tennis, golf, skiing, etc. I even have a patient who is a professional calf
roper at a rodeo and is able to do this because of the hip resurfacing. I have
performed approximately 370 hip resurfacings over the last 6 years. The big
changes that have occurred, are in the instruments used in performing the
procedure.
In the 6 years that I have been performing these, I have had
patients come from every corner of the country; from Florida, Maine, the state
of Washington, California and most states in between. I have even had a patient
come from Trinidad, West Indies.
Six years ago there were only 15-20 people on the North
American continent that performed this procedure and I was one of them. The hip
resurfacing has been approved by the FDA and now more surgeons are doing this,
but even so, only a small percentage of orthopedic surgeons choose to perform
the procedure as it is more difficult and demanding than a standard hip
replacement.
The FDA has already approved the Smith-Nephew prosthesis as
well as the Corin. The other prostheses have yet to get FDA approval. In order
to obtain approval, the company has to conduct a several year clinical trial
and submit the data for analysis.
I think that it is a successful procedure and there is a high
demand for it, particularly among the baby boomer generation. The baby boomers
want to stay active and participate in sports and a successful hip resurfacing
will allow them to do this.
As far as what is new in implants and prosthetics, the
materials that they are made of are improving. There are new ways to encourage
the bone to grow into the prosthesis. Also new, are better surgical techniques
that involve cutting less muscle and this provides a quicker rehabilitation for
patients. A person is a candidate for a minimally invasive procedure if he or
she is not significantly overweight. Other significant advances are those in
anesthesia, pain control and rehabilitation techniques.
The typical inpatient stay can be anywhere from 48 hours to 4
days. By 6 weeks, patients are usually walking unassisted and are steadily
increasing their activities.
There is an anticipated shortage of orthopedic surgeons. There
are 70 million baby boomers who will need orthopedic care and the training
programs have not increased the number of orthopedists that they train to keep
up with the demand. The malpractice insurance for orthopedics is slightly
higher than other specialties but not as high as neurosurgeons or OB/GYN
physicians. My personal malpractice premium is approximately $45,000 per year
and Knox County is a low risk area.
In the Chicago area, a colleague of mine is paying $120,000 to
$150,000 a year for similar coverage.
As far as somebody trying to hold out as long as possible, I do
not think that this is a good idea. Quality of life is important and for
somebody who could possibly be active with a joint replacement, to sit around
and become a hermit just to wait until he is old enough, would mean that he
would waste many good years. I would rather have a joint replacement, enjoy
life, even if I had to have a repeat operation. I do not feel that it is
necessary to put this off.
7/10/08