The innovative procedure, called hip resurfacing, restores joint function and mobility by shaving and capping (rather than removing) the top portion of the thighbone that fits into the hip socket. Other advantages for suitable candidates include a lower risk of dislocation and a better chance of walking with natural ease when compared to total hip replacement (THR). Resurfacing implants are expected to wear well, perhaps even for a lifetime suggest some investigators.

Risks of the relatively new procedure (first approved for use in the US in 2006) are similar to those posed by standard THR.

Ten years after hip resurfacing, Beth Barney completed a triathlon at age 32, placing first in her age group. She is currently expecting her fifth child.Photo courtesy of Beth Barney

What should you look for in an orthopedic surgeon if you are exploring hip resurfacing? Expertise matters, of course—and the more resurfacing procedures that a surgeon has done the better, says Post writer Unmesh Kher in the 2006 article “Joint Decisions: Hip Resurfacing.”

Depending on the patient’s bones and goals, orthopedic surgeons in the U.S. now have several hip resurfacing devices to consider, including the:

Conserve ® Plus Total Resurfacing Hip System (Wright Medical Technology)

Birmingham Hip* Resurfacing System (Smith and Nephew)

Cormet Hip Resurfacing System (Stryker)

Two years after both his hips were resurfaced, Michael Carroll, currently 52, resumed his career as a Navy Seal Officer and later served in Iraq. Carroll now trains Navy Seals in San Diego.Photo courtesy of Michael Carroll

ReCap Femoral Resurfacing System (Biomet).

Beth Barney (pictured above, right) and Mike Carroll (at left) were treated at the Joint Replacement Institute, St. Vincent Medical Center, Los Angeles, California, founded by hip resurfacing pioneer and developer of the Conserve Plus device, Dr. Harlan Amstutz.

Hip resurfacing may not be an option for people with poor bone quality, osteoporosis, or osteonecrosis (bone death that occurs due to lack of blood supply), among other conditions.

Hip Resurfacing The Saturday Evening Post

Hand in Hand for RA

Nearly 75 percent of people with RA are looking for ways to be more active and give back to their communities, according to a 2009 online survey of 501 men and women with the condition. In addition, about 30 percent of the respondents report volunteer work helps them better manage their RA symptoms.

Debbie McGrady, diagnosed with rheumatoid arthritis about 10 years ago, knows from personal experience that helping others is good medicine for one’s own health challenges, too.

Having a serious illness prompted the Indiana resident to reassess her life goals and priorities. As a result of her personal “revolution,” the mother of two let go of self-imposed physical limitations and began to connect with others in new ways. Today she works part time, drives seniors to their doctor’s appointments, and remains committed to staying fit.

Click here http://www.handinhandforra.com/ to read more about McGrady and other inspiring volunteers who are living well with RA. The Web site, sponsored by advocacy group CreakyJoints http://www.creakyjoints.org/ and drug companies Genentech and Biogen Idec, also provides a list of suggested volunteer activities that are easy on the joints in addition to tips for managing the disease. 

New Way RA

Now in its second season, Deborah Norville’s online talk show, New Way RA, http://www.newwayra.com/ features panelists Amye Leong, RA advocate and spokesperson for the United Nations Bone and Joint Decade, and Sara Nash, author of the RA blog The Single Gal’s Guide to Rheumatoid Arthritis <http://singlegalsguidetora.typepad.com/>.  

Monthly episodes will offer information and advice about diagnosing RA, connecting with a rheumatologist, and easy-to-wear looks for everyday style. Registration is free, but required to view current and past episodes.

For more Post coverage on living with RA, including foods to reduce inflammation, click here.

Rheumatoid Arthritis The Saturday Evening Post

Helen Z.

Iowa

A cyst filled with lubricating synovial fluid from the knee joint causes Baker’s knee pain and can be treated or removed.

“A Baker’s cyst is usually caused by a problem within the knee joint, most commonly a torn meniscus or cartilage,” explains Dr. Eddie McDevitt, an orthopaedic surgeon who specializes in sports medicine. “Fluid from the knee joint escapes through the tear in the meniscus and accumulates 
in soft tissues behind the knee, causing swelling and pain especially when the person squats or bends.”

Ultrasound and MRI scans help diagnose a Baker’s cyst and rule out more serious causes of knee swelling and pain such as blood clots.

Many Baker’s cysts don’t require treatment. But when 
they do, using a needle to remove the excess fluid may alleviate symptoms, and treating the underlying cause 
with knee arthroscopy may cause the cyst to disappear, according to Dr. McDevitt. Surgery to remove the cyst may cure persistent problems.

“A Baker’s cyst has nothing to do with baking,” notes

Dr. McDevitt, “but instead gets its name from the 19th century British physician William Baker, who described

the condition.”

Baker’s Knee Pain The Saturday Evening Post

Today, they also offer an alternative procedure: the hip resurfacing surgery. The main advantage of the procedure, practiced for years abroad and approved by the FDA in 2006, is that it involves virtually no loss of bone. This means that when the resurfacing prosthesis wears out, patients are eligible for a total hip replacement that can last an additional 15 to 20 years. On the other hand, not everyone is eligible for resurfacing.

“In general,” says Dr. Craig Della Valle, a specialist in joint reconstruction at Rush University Medical Center in Chicago, “the best candidates for the procedure are young, active men, which is great. Those are the same patients who are at highest risk for failure with a conventional hip replacement. It’s nice when things work out that way.”

In total hip replacement, the orthopedic surgeon lops off the bulbous head and angled neck of the femur and puts in its place a ball-like prosthesis that is secured by a spike inserted deep into the lower portion of the bone. Resurfacing, meanwhile, spares bone because it leaves the head and neck of the femur intact. The surgeon instead reshapes the head of the femur to fit a toadstool-shaped prosthesis — a metal cap that is snapped onto the femoral head and held in place via a relatively short stem that slips into the femoral neck. The surgeon then inserts a metal cup into the socket as well. No one is sure yet how long these prostheses last on average.

Time isn’t the only thing resurfacing buys. Proponents say that people with resurfaced joints are capable of more vigorous activity than those who get total joint replacements. They are also more likely to recover their natural gait and enjoy a greater range of motion with the resurfaced joint. But the conservation of bone is probably the greatest advantage offered by the newer procedure. Dr. William Macaulay, a professor of orthopedic surgery at Columbia University Medical Center who trains other surgeons in resurfacing, notes that the relatively short length of the pin used to secure the femoral cap also preserves marrow, which is the source of all blood cells, and is particularly abundant in the femur.

	Hip Resurfacing: Surgeons reshape the head of the femur (large thigh bone) where it connects to the hip socket, then place a metal cap on the femoral head, which is held in place by a short stem drilled into the femur.
	Total Hip Replacement: Damaged cartilage and bone, including the head and neck of the femur, are removed and replaced with a prosthetic ball and metal stem inserted into the femur bone and an artificial hip socket.
Images: © Edwards Lifesciences

Like any other procedure, resurfacing comes with its risks. For the most part, they’re identical to those that accompany total replacement. But there’s one major risk unique to resurfacing: the fracture of the femoral neck, a complication only remedied by a second surgery to perform a total hip replacement. To find out just how frequently this and other complications occur, Dr. Della Valle led a study of the outcomes of the first 537 hip resurfacing procedures performed in the United States since the resurfacing prosthetic devices won FDA approval. “This is something new, and it’s a pretty difficult procedure,” says Dr. Della Valle. “We wanted to make sure that the complication rate in adopting this technology wasn’t horrendous.”

The 89 orthopedic surgeons who conducted the procedures had varying degrees of experience in hip surgeries. Further, they had done resurfacings on average just six times. “These guys were your average orthopedic surgeons who were trying a new procedure,” says Dr. Della Valle. He and his colleagues reported in the December issue of Clinical Orthopaedics and Related Research that of the 32 serious complications they tallied, 10 were fractures of the femoral neck.

The details are revealing. Nine of those 10 fractures were in patients who were either female or were 55 or older when they received the implant. That underscores the importance of patient selection to the success of resurfacing: The ideal candidate needs to have relatively dense and strong bones to reduce the risk of femoral neck fractures. This requirement eliminates most postmenopausal women, and men over the age of 55 as candidates for the procedure.

Dr. Della Valle’s results confirm the findings of a study published in PLoS Medicine earlier this year of 76,576 replacement and resurfacing surgeries conducted in the U.K. between 2003 and 2006. The researchers found that 1.4 percent of the patients had to have surgeries within three years to repair failed hip procedures of both types. But the overall revision rate for resurfacing was almost twice as high, at 2.6 percent. Among women, it was even higher, at 3.7 percent, as opposed to just 1.9 percent of men.

Surgeons, however, stress that patients need to be assessed on a case-by-case basis — some women may in fact be perfect for resurfacing. Still, even experienced orthopedists can only be sure about any particular patient after inspecting the femoral head and socket directly. On the plus side, making that decision in midsurgery adds neither expense nor risk to the procedure, says Dr. Macaulay. The two surgeries, he says, can be started in essentially the same way.

The resurfacing procedure is, however, more technically demanding than total joint replacement. Retaining the neck and head of the femur, for instance, makes it much harder for the surgeon to expose the socket. Shaping the femoral head appropriately also takes practice — and if the surgeon does that poorly, the patient is far more likely to suffer a femoral neck fracture. Indeed, Dr. Della Valle and his colleagues found that eight of the 10 femoral neck fractures they counted were in patients whose surgeons had done fewer than 10 resurfacing surgeries.

So what should you look for in a surgeon if you’re shopping for a hip resurfacing?

Expertise matters, of course — and the more resurfacing procedures your surgeon has done the better. “I think the learning curve is somewhere around 50 cases,” says Dr. Macaulay. When you find one with at least that much experience, he says, it’s wise to ask to speak to some of the surgeon’s former patients. Finally, make sure that the surgeon is the sort who’s likely to pay attention to you both before and after the procedure. This is, after all, a major surgery.

“If they don’t have much time for you before the surgery, they’re going to have even less time for you after,” says Dr. Macaulay. “I would choose my surgeon at least partly on the basis of which one sits down with me for 20 or 30 minutes and explains all the risks and benefits.”

Remember, you can’t change your mind under anesthesia.

Joint Decisions: Hip Resurfacing The Saturday Evening Post