For decades, people whose severe hip pain did not improve with painkillers and/or physical therapy had only one option-a hip replacement.

Now: A procedure that "resurfaces" worn-out hip joints rather than replacing them is available in the US. Known as hip resurfacing, the technique can be as durable as hip replacement with less pain during recovery and greater longterm mobility. Originally introduced in England in 1997, the Birmingham Hip System one of the products used for hip resurfacing) was approved by the FDA in May 2006.

Do You Need A Better Hip?

Osteoarthritis of the hip is the most common reason for hip pain. This disease occurs when the cartilage covering joint surfaces begins to wear out, causing pain and stiffness that can be so severe that sufferers limp and have difficulty climbing stairs, walking, standing and even sitting. Other causes of hip pain include rheumatoid arthritis and serious hip injury.

If you suffer from hip pain that does not improve with pain medication and physical therapy...interferes with activities that you enjoy, such as gardening or brisk walking...and/or disturbs your sleep, you may want to consider one of several surgical options.

A Breakthrough Approach

For several years, Americans who wanted to try an alternative to hip replacement have traveled to England, India or one of the other countries that have offered hip resurfacing, Now this procedure is available at more than 100 medical centers throughout the US.

With hip resurfacing, the round head of the femur (thighbone) is reshaped and covered with a metal cap about the same size as the natural femoral head. The reshaped head moves within a smooth metal socket that is implanted into the pelvic bone. Enough bone is left in place to allow for a future hip replacement, if necessary.

Hip resurfacing is a good option for patients age 55 and younger...people of any age who have relatively healthy bones or who are highly active.

Hip resurfacing may take slightly longer than the hour to hour-and-a-half required for a standard hip replacement surgery. The incision is often two to three inches longer than the sixto 12-inch incision required for conventional hip replacement, due in part to the limited maneuverability the surgeon has with most of the thighbone left in place. As with traditional hip replacement, a two-to three-day hospital stay is usually required following hip resurfacing, and healing is more than 90% complete within six to eight weeks. The procedure typically costs about $25,000 and is usually covered by insurance.

Hip Replacement Options

If you are not a candidate for hip resurfacing (due to age, osteoporosis or bone weakness), total bip replacement is an option. During this procedure, the surgeon makes an incision, removes the femoral head and replaces the ball-and-socket mechanism with an artificial implant that functions much like a natural joint.

A significant amount of bone is removed with hip replacement in order to insert a metal stem that attaches the synthetic ball-and-socket mechanism to the femur. If any part of the implant loosens in the future, this loss of bone makes a follow-up surgery more difficult.

Traditional hip replacement as described above) is usually recommended for patients who are obese or very muscular. Recovery time is the same as that for hip resurfacing.

With a newer minimally invasive approach, the surgeon uses specially designed surgical instruments to place the hip implant. Minimally invasive hip replacement generally takes one-and-a-half hours, uses one-and-a-half- to three-inch incisions and requires a one-to two-day hospital stay. It is usually recommended for people who are thin. The recovery period is comparable to that for hip resurfacing and a traditional hip replacement. However, the minimally invasive procedure is controversial, because it has been associated with significant complications in some studies.

The same type of artificial implant is used with both procedures. Each procedure costs about $25,000, which usually is covered by health insurance.

Installing Hip Implants

More than 300 types of hip implants are now available, as well as dozens of different techniques for installing them. Main choices…

  • Cemented. The implant is attached to the bone of the thigh with an acrylic cement. The cement gives immediate strength and is extremely durable.

Recommended for: Patients with less-than-healthy bone, such as those with osteoporosis or osteoarthritis.

  • Uncemented. The joint implants have a porous surface that allows the patient's natural bone to surround and grow into the implant.

Recommended for: Active patients with normal bone metabolism.

  • Metal/ceramic-on-plastic. A metal or ceramic femoral ball (prosthetic head) is mated with a hard plastic (polyethylene) socket. It's one of the older configurations-proven to be durable and reliable.

Recommended for: Any patient.

Risks And Recovery

The main cause of hip-replacement failure is aseptic loosening (when normal bone loss occurs around the implant, causing the joint to separate). In this case, the hip replacement must be repeated. Other risks…

  • Deep vein thrombosis. Blood clots can form in the leg veins—a life-threatening complication if a clot travels to the lungs. After the procedure, most patients are treated with blood thinners, such as warfarin (Coumadin), and advised to move their ankles up and down frequently (about 10 times at least three times daily), which helps prevent clots.
  • Uneven leg lengths. In some cases, the leg on the side that was operated on will be slightly longer than the other leg. When this happens, a patient may need to wear a shoe with a slightly raised heel

Important: Postsurgical exercise, including low-impact activities, such as walking or using an elliptical trainer, are among the best ways to stabilize the joint and maintain hip strength and/or flexibility.

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