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