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Hip procedure preserves leg

Resurfacing is an alternative to replacement and might last longer

Resurfacing is an alternative to replacement and might last longer

November 26, 2007|By JULIE E. GREENE

Before John Britner's hip surgery in early October, walking was difficult and bending over to pick produce was painful for the Williamsport-area produce farmer.

During his 51 years, Britner's left hip had worn out and he was diagnosed with osteoarthritis in which joint cartilage breaks down causing pain with repetitive use of the joint.

Britner faced a decision - get a total hip replacement or try a procedure called hip resurfacing that is fairly new in the U.S. but has been done for years in Europe.

The deciding factor for Britner was thinking ahead to the possibility of needing a second hip operation. Several orthopedic experts believe the hip-resurfacing option could end up lasting longer than a total hip replacement, said Dr. Ralph T. Salvagno, orthopedic surgeon at the Center for Joint Surgery & Sports Medicine at Robinwood Medical Center.

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Britner could always get the total hip replacement later, but he preferred the hip-resurfacing option, which preserves more of the femur than does hip replacement.

Hip resurfacing

Hip resurfacing is an alternative suitable for active women who are 60 or younger and men who are 65 or younger because of their bone strength, active lifestyle and the expected life span of the implants, Salvagno said.

The key is the strength of the femur. As people get older, they tend to get osteoporosis, resulting in weaker bones and a higher risk that the femoral neck - the thin top of the femur bone - could snap off, Salvagno said.

Salvagno tells all his patients that the femoral neck breaking is a risk during surgery and during the first three months of recovery. If that happens, the patient will need a total hip replacement, in which the stem of the metal ball is longer so it goes further into the femur than hip-resurfacing implants.

The risk of the procedure failing - of the femoral neck cracking - is twice as high in women, though it's still a small percentage, Salvagno said. The risk of failure in women is about 2 out of 100 cases.

Even if a patient opts for hip resurfacing, if the surgeon discovers during the procedure that the bone is not in good enough shape, a total hip replacement would be done instead, Salvagno said.

With hip resurfacing, the neck of the femur is reshaped and capped with a metal ball, creating a new ball for the joint. The socket in the hip bone is cleaned out, and a metal socket is inserted.

Once you have a total hip replacement, you can't have resurfacing done because there isn't enough bone left.

History of resurfacing

Hip resurfacing dates back to about the early 1950s and became further refined in the mid-1970s, according to the Joint Replacement Institute's Web site.

Dr. Harlan Amstutz, who is founding director of the Joint Replacement Institute in Los Angeles, did some pioneering work in the 1970s, but Salvagno said other surgeons had difficulty duplicating Amstutz's work.

The implants Salvagno uses for his patients, including Britner, are called the Birmingham Hip Resurfacing System, named for the place in England where work was done on the components manufactured by Smith & Nephew.

The U.S. Food and Drug Administration approved the Birmingham Hip Resurfacing System in May 2006, though the FDA had approved resurfacing procedures for the shoulder several years ago, Salvagno said.

The FDA approved the Cormet Hip Resurfacing System, applied for by Corin USA, in July 2007, according to the FDA's Web site.

Salvagno started offering Birmingham Hip Resurfacing this past spring after working with Dr. Ronan Treacy in England, who had been doing the procedure for about 10 years.

Salvagno said he was skeptical of hip resurfacing before his trip because hip resurfacings done by doctors other than Amstutz hadn't lasted as long as Amstutz's.

His skepticism was alleviated during his trip when he determined the Birmingham technique was reproducible. So far he has done three Birmingham hip resurfacings, all on men.

Thinking long-term

Like John Britner, Williamsport-area resident Bill Rhodes also considered the longevity of hip resurfacing and the possibility of needing a future hip procedure when considering his options for his left hip.

Rhodes' hip had deteriorated due to an old motorcycle injury and arthritis.

His thinking was if he had a total hip replacement and needed another in 10 years, he'd be handicapped by age 63 if his femur wasn't strong enough to sustain another hip replacement.

Rhodes, 43 and a carpenter, decided to go with the resurfacing.

British studies of the Birmingham Hip Replacement System show there is an 85 percent survival rate for resurfacing components implanted for eight to 10 years, Salvagno said. If they fail, it's usually early because the femoral neck breaks.

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