In a recent issue of The Johns Hopkins Arthritis Bulletin, Joan M. Bathon, M.D., director of the Johns Hopkins Arthritis Center, talked about the promise of hip resurfacing for patients suffering with the pain and disability of arthritis. Because many of our Arthritis Health Alerts subscribers have asked us about this still-experimental procedure, we include an excerpt of Dr. Bathon’s article for your information.
For those of you who don’t know about hip resurfacing, here’s how it differs from total hip replacement: Instead of removing the top of the thighbone and placing a metal stem into the femur to anchor a replacement for the femoral head, the surgeon sands down ("resurfaces”) the hip’s roughened and damaged ball-and-socket, inserts a metal cup into the hip socket, and then places a metal cap on top of a small stem that is inserted into the thighbone.
Since the implant closely matches the size of a patient’s natural femoral head, and is substantially larger than the femoral head of a traditional artificial hip, the patient may attain greater flexibility and range of motion with greater stability and less likelihood of dislocation (the ball slipping out of the cup) in the months and years following surgery.
Hip resurfacing allows the surgeon to preserve more of the patient’s natural bone structure and stability than is possible with minimally invasive hip replacement. With the femoral head and neck preserved, as well as bone from the femur, it is still possible to have a total hip replacement or some other newer technology or procedure in the future, if necessary.
At the third annual Medical Innovation Summit held at The Cleveland Clinic Foundation last year, Sir Christopher O’Donnell, the CEO of Smith & Nephew, the English medical device company that makes the Birmingham Hip Resurfacing system, was asked why hip resurfacing was so popular in Europe but had failed to be adopted in the U.S. as a viable option for people with hip arthritis.
"There were three problems when hip resurfacing was initially tried in the U.S. in the 1970s,” admitted Sir Christopher. (Hip resurfacing was tested in the U.S. three decades ago, but the outcomes were very poor.) "The initial designs were not as well developed as they are today, nor was the surgical technique. In some hospitals, the method of entering the implant wasn’t well developed and the patient selection wasn’t as strict as it should have been.” Sir Christopher noted that the ideal candidate for hip resurfacing would be under age 60, because the procedure requires that the patient’s bones still be strong.
The FDA has recently approved the Birmingham Hip Resurfacing system. It remains to be seen, though, how hip resurfacing will compare with total hip arthroplasty, which is the standard approach in the United States, and how rapidly U.S. surgeons will adopt the procedure.
"Long term results are not available for hip resurfacing procedures,” said Simon Mears, M.D., when contacted by The Johns Hopkins Arthritis Bulletin. Dr. Mears, an assistant professor of orthopedic surgery at Johns Hopkins and chief of total joint arthroplasty and trauma at the Johns Hopkins Bayview Medical Center, believes that hip resurfacing does present a risk of fracture of the femoral neck. Current reported results have shown higher failure rates for hip resurfacing than for contemporary total hip arthroplasty.
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