BHR

Why I Chose A Hip Resurfacing Instead Of A Total Hip Replacement
By Pat Walter

 

My hip hurt, my body hurt and I needed a new hip. I had fought hip pain for almost ten years because I just did not want "half my leg bone cut off" to get a new hip replacement. It just did not make sense to me that doctors were still sawing off a big hunk of a femur bone to replace a hip. We sent men to the moon, had nuclear power and every kind of electronic device imaginable, so why are our operations still old-fashioned?

 

I asked myself that question quite often. One evening while visiting our local tavern, I was telling a gentleman my feelings about total hip replacement. I am not sure how the conversation started, but perhaps I was complaining about my hip pain. To my surprise, he told me that they don't have to saw off part of your femur bone to replace a hip any more. I was shocked. I had been doing some internet searching, but had not found information about hip resurfacing yet.

 

He explained that he had his hip resurfaced with Dr. Schmalzried in California in 2005. With hip resurfacing, the surgeon reshapes the top of your femur bone to accept a cap that is the same size as your original bone, he explained. The cap has a small stem which is placed into a hole that is drilled in the top of the femur bone. A small amount of cement is used to hold the cap in place until new bone grows under the cap. A matching metal cup is placed in the acetabulum of your hip to provide a bearing surface for the cap on the femur bone. It becomes a perfect metal bearing which replaces your injured or arthritic hip joint.

 

Hip resurfacing is major surgery just as a total hip replacement is. The basic difference is that the doctor does not saw off a major portion of your femur bone and drill a long hole into it to accept the long stem of a total hip replacement device.

 

Hip resurfacing is bone conserving. The reason that hip resurfacing is a better choice than total hip replacement for many people is that at some time in the future, you could require a revision. The actual hip devices don't wear out since they are metal, but the bone holding the hip device often deteriorates. The hip device becomes lose and very painful. A revision is then necessary to replace the old hip device. If a person starts with a hip resurfacing and at some point later in life requires a revision, then they have a complete femur bone for the surgeon to work with. If a person starts with a total hip replacement, then the doctor has to break apart the femur bone to remove the long steam of the old total hip device. The femur bone must be wired back together when the new stem is in place. Hip resurfacing allows a much easier revision later in life if it is required.

 

The second advantage of a hip resurfacing is that the hip device, due to it's large size, allows a person to return to any of their favorite activities without restrictions or possibility of a dislocation. The old fashioned total hip replacement devices used a very small diameter ball as compared to size of your natural femur bone. The small size of the ball would allow a hip to dislocate easily. The size of the hip resurfacing device is matched very closely to the original size of your hip, so any movements you make are much less likely to cause a dislocation. The hip resurfacing device is acting the same way your natural hip use to function.

 

I was sixty-one and still felt young when I needed a hip replacement. I had always been very active during my life playing tennis, ice skating, bike riding and participating in other sports. I wanted to remain active and did not want to worry about dislocating a hip after a total hip replacement. I had sixteen dogs and often got on the floor to groom and cut nails. I needed to be as active as possible and the only solution for me was hip resurfacing.

 

I had my hip resurfaced with a Birmingham Hip Resurfacing, BHR, in March 2006 with Dr. De Smet in Belgium. I did not have health insurance and could not afford surgery in the United States. Dr. De Smet is one of the best hip surgeons in the world and had done over 2400 hip resurfacings when I went to him. My surgery and medical costs were $13,500. The complete trip for my husband and I to Belgium, including the medical costs, was about $17,000. I felt this was the best investment I ever made in my whole life, an investment in my own health and well being.

 

Birmingham Hip Resurfacing, BHR, was not FDA approved in the United States until May 2006. The BHR had been used world wide for over nine years. Younger, active people all over the world were offered hip resurfacing instead of a total hip replacement. Over 90,000 people world wide have hip resurfacings and now I am one of them. Hip resurfacing has allowed me to be as active as possible without worrying about a dislocation. If you have hip pain and need a new hip, be sure to ask your doctor about hip resurfacing. Although the BHR is FDA approved, many doctors are not trained to do the BHR surgery. It is a more difficult surgery than a THR and requires training and experience. There are many sources available to learn about hip resurfacing like the Surface Hippy Website, a Patient to Patient Guide About Hip Resurfacing, the Yahoo Surface Hippy Discussion Group and many doctor and medical equipment websites.

 

About the Author: Patricia Walter had her hip resurfaced in March 2006. She is the webmaster and owner of several Patient to Patient Websites about Hip Replacement.

 

Hip Resurfacing News Features Up to Date News about Hip Resurfacing

 

Hips for You is a Patient to Patient Guide to Total Hip Replacement

 

Surface Hippy

 

Article Source: http://EzineArticles.com/?expert=Pat_Walter
http://EzineArticles.com/?Why-I-Chose-A-Hip-Resurfacing-Instead-Of-A-Total-Hip-Replacement&id=710186

 

Keith McDonald Hip Resurfacing Video - Choosing a Hip Resurfacing - New York Times Video

 

VIEW VIDEO

Lynn Beyler's Hip Story Video featuring her hip reusrfacing surgery with Dr. De Smet in Belgium.

 

VEIW VIDEO

Hip Surgery in Belgium Video

 

VIEW VIDEO

You, Too, Can Have A Bionic Body

New materials and high-tech procedures are driving a surge in hip, knee and even ankle replacements.

Knee and hip replacements are serious surgeries, but increasingly, they're also a serious business. As the baby boomers' joints wear out, more of them are turning to orthopedic surgeons for the procedures. Docs now perform more than 450,000 knee replacements and 208,000 hip replacements a year, and rising numbers of them are done to boomers willing and able to pay $30,000 and up. By 2031, one study predicts, docs will perform more than 3.5 million knee replacements alone—a 673 percent increase from current numbers. It's as if an entire generation has taken Matthew 18:8 to heart: "If thy hand or thy foot offend thee, cut them off, and cast them from thee." And, apparently, sub in something better and keep going...

...Now, though, orthopedic surgeons can offer much better treatments. Most exciting is a strategy called "resurfacing," which has come to the United States within the last two years after proving successful in England. Well suited to ac-tive, younger patients, it holds back on replacing the entire joint (usually the hip), instead leaving a great deal of bone in place and covering it with a protective surface. "The pain relief is dramatic, even right away," says Moorman. And it doesn't require some types of traditional cement that can eat away at bone tissue, so it may be a more sustainable fix than a full replacement. Several new resurfacing devices are currently awaiting FDA approval...

READ COMPLETE ARTICLE

All About Hip Resurfacing

Hip resurfacing is all the rage in the orthopedic community these days. In fact, I had four different hospitals pitch me stories on it in the last year, independent of one another.

But is it right for everyone with chronic, debilitating hip problems? NYMD News panelist Dr. William Macaulay, attending orthopedic surgeon at New York Presbyterian Hospital/Columbia and director of Columbia's Center for Hip and Knee Replacement, has the answers below and after the break.

By William Macaulay, M.D.

You just turned 40 or 50. Your mind tells you you’re younger, but you feel older because you have real hip pain that won’t quit. You limp everyday. You do a little research and come across a new procedure called total hip resurfacing. Then you wonder: Is this the right procedure for me?

I hear the same story over and over from my patients. Looking for a solution to their hip pain, they have stumbled upon total hip resurfacing, which was approved for use in the U.S. in May of 2006. While many patients are ideal candidates for resurfacing, often I must inform them that hip resurfacing is not for everyone.

Hip Surgery With a Future

By Barnaby J. Feder

Correction Appended

Hip replacement, an operation that about 300,000 Americans undergo each year, is one of the great success stories of modern medicine.

But woe to those who outlive their artificial hips, which typically cannot be counted on to last more than 20 years or so.

Because it is difficult to extract and replace a worn-out or defective artificial hip, doctors routinely advise patients to put off hip replacement as long as possible. For middle-aged or younger people whose hips have been damaged by disease or injury, that typically means a punishing waiting game.

Now, though, an alternative to total hip replacement can offer an interim solution to many younger patients.

The alternative, called hip resurfacing, usually yields at least as many short-term benefits as a total replacement. It costs about the same and is typically covered by insurance.

And though many patients can expect to outlive the treatment’s effectiveness, hip resurfacing has the advantage of preserving enough healthy bone to allow for a future total hip implant.

“It’s nice to know that down the road, if necessary, it will be an original total hip — not a revision,” said Keith McDonald, a 54-year-old air traffic controller from Melville, N.Y., whose right hip was resurfaced late last month. This past Tuesday, just 15 days after the operation — and at least a week earlier than doctors would recommend — Mr. McDonald drove his car. “Every day I do more,” he said.

Tens of thousands of patients around the world have had hips resurfaced in the past decade. That includes some Americans who went overseas before the Food and Drug Administration started allowing it to be done in this country last May.

“The demand from patients and surgeons is tremendous,” said Brian Austin, of Smith & Nephew, the British maker of the F.D.A.-approved resurfacing system.

More than 400 surgeons in the United States have now been trained to use Smith & Nephew’s product, which is known as the Birmingham Hip System. Competing devices already sold overseas are expected to begin arriving in this country later this year...

...

“You should have pain every day before you even think about it,” said Dr. William B. Macaulay Jr., a Manhattan surgeon who performs hip resurfacing surgeries. “If you are doing it in people with moderate pain who just want to improve their tennis game, that’s crazy.”

Experts say that 10 percent to 15 percent of hip-replacement candidates may find hip resurfacing a viable alternative. But unless they are Web-savvy like Mr. McDonald, who learned about it only through his own Internet research, they may not have heard about the procedure...

READ COMPLETE ARTICLE

Margaret Swift's hip pain was so bad by age 40 that she gave up softball. She struggled to walk up hills on the golf course. She limped giving tours of Woodcliff Hotel & Spa in Perinton, where she works in marketing.

"I'd do one hour of yard work, and I'd come in the house in tears," says Swift, now 43, of Penfield. She eventually needed prescription painkillers to get through the day.

Her first orthopedic surgeon diagnosed degenerative bone disease but said that Swift was too young for hip replacement surgery. That's because an artificial hip could wear out after 15 or 20 years; redoing it is more difficult than first-time hip replacement and generally less successful. The surgeon recommended she use a cane as needed, lose weight to help her joints and switch to low-impact exercise such as swimming.

"I couldn't believe that was the answer," says Swift.

Eventually she met with Dr. Hubert F. Riegler, one of two Rochester-area surgeons offering a new alternative: hip resurfacing. The procedure, approved last year, is aimed at younger adults — typically women ages 45 to 55 and men ages 50 to 65, or younger. (The guideline is younger for women because they tend to develop osteoporosis; once bones weaken, they're not appropriate for resurfacing.)

After those ages, patients get the more conventional full hip replacement. That surgery removes the entire ball at the top of the thigh bone and replaces it with an artificial one.

Hip resurfacing is like capping a tooth. The ball is reshaped — not removed — and capped with a metal prosthesis secured by a small stem. This approach conserves more bone, making a full hip replacement easier if needed later.

Local orthopedic surgeons who don't offer hip resurfacing give three reasons. The parts are new enough that nobody can be sure how long they will last. It's a more demanding surgery than hip replacement (requiring up to twice the time, a longer incision and moving and cutting through more muscles and tendons). And there's some concern about metal ions produced when the metal parts rub together. The ions are absorbed into the bloodstream and eliminated by the kidneys, so resurfacing isn't recommended for women who may become pregnant or people with weak kidney function...

...Riegler, chief of orthopedics at Highland Hospital, has done about 28 resurfacings in the past two years. He maintains that about one-third of the full hip replacements don't turn out well in young, active people because they're more likely to wear out or loosen the artificial joint during their lifetime. Resurfacing allows a greater range of motion, and the joint is less likely to dislocate, so its results so far are better for people pursuing recreational sports...  

...The U.S. Food and Drug Administration approved Smith & Nephew's Birmingham metal hip resurfacing system in May 2006. Last month, the FDA approved a competitor, the Cormet 2000 hip resurfacing device from the British firm Corin Group, to be distributed in the United States this fall.

Of nearly 300,000 Americans who get hip replacements per year, 10 percent to 15 percent may be appropriate for resurfacing.

Resurfacing and total hip replacement are covered equally by health insurance, says Excellus BlueCross BlueShield. The costs for both differ by hospital, ranging from $12,300 to $22,000 in western New York, a spokesman says...

READ COMPLETE ARTICLE

Learning curve may be longer than thought for placing hip resurfacing components

 

It took surgeons 55 to 60 cases to get femoral components within ?5? of planned placement.

 

By Susan M. Rapp ORTHOPEDICS TODAY 2007; 27:12 May 2007

 

British and Australian researchers collaborating on a prospective study identified a longer-than-expected learning curve to accurately perform hip resurfacing arthroplasties.

 

Hip surgeons taking part in the study, all of whom had performed more than 1,000 hip surgeries, found they had to complete three-times more resurfacing surgeries than they expected in order to place the femoral hip resurfacing components within ?5? of the desired neck/head angle, said Diane L. Back, FRCS.

 

The surgeons had initially estimated their learning curve at 10 to 20 cases, Back told Orthopedics Today.

 

"The results actually showed that it took 55 to 60 cases for most of our surgeons to get the femoral component where they actually planned it," she said.

 

...Four surgeons participated Back and colleagues prospectively analyzed the first 100 hip resurfacing procedures of four consultant orthopedic surgeons, three from Australia and one from the United Kingdom.

 

They performed all procedures with the recently reintroduced Birmingham Hip Resurfacing System [Smith & Nephew]. The FDA approved the implant for sale in the United States last year.

 

All surgeons used standard instrumentation and a posterior approach. Investigators focused on femoral component position, but also analyzed notching and other complications.

 

To determine how accurately they placed the femoral components, surgeons first marked the ideal implantation site on preoperative radiographs. Investigators then calculated the corresponding neck/head angle.

 

...The longer-than-expected learning curve has huge implications for surgeons' success with this type of hip replacement, Back told Orthopedics Today.

 

"Hip resurfacing is good. I think that is well proven. You have to choose your right cases, but it does take you longer than you expect to learn. I think medico-legally it does have some implications."

 

For example, surgeons just learning the procedure should tell patients they are at the beginning of their learning curve and have not done many of the procedures, she said.

 

In the United States where orthopedists begin practicing after completing fewer hip replacements than surgeons in the United Kingdom or Australia, "It actually means their learning curve may take them 10 years to get out of," Back said.

 

Back said she wonders how, with the worldwide trend toward reduced orthopedic training hours, many new surgeons would be able to accrue enough cases to become proficient with the technique.

 

READ COMPLETE ARTICLE

Health Alert: New hip surgery available in Toledo

 

WTVG--August 17, 2007 - In today's health alert a cutting edge surgery is now available in Toledo. It's for younger patients in need of hip replacement surgery. Doctors say Birmingham hip resurfacing has a lot of advantages for patients, including quicker recovery, the preservation of more of the leg bone, and the ability to continue to live an active life.

 

It looks seem enough, but a stroll down the hall at the University of Toledo Medical Center is somewhat of a miracle for 50-year-old Rick Janicki. About three months ago, he says he couldn't walk or do just about anything without crippling hip pain shooting down his right leg and up his back. Normally a very active man, he says he felt useless.

 

In late May, Rick had surgery, not to replace his hip, but to resurface it. Doctor Haleem Chaudhary is one of the first surgeons in the entire country trained in the new Birmingham hip resurfacing technique. He capped the head of Rick's femur, like a dentist would cap a tooth.

 

More of the leg bone is preserved with resurfacing, as opposed to the traditional hip replacement, which requires sawing off the top of the femur.

 

Dr. Chaudhary says, "Additionally, it has a much larger head than a typical hip replacement and that gives the advantage of a higher range of motion."

 

And less of a chance of dislocation.

 

"After Birmingham's hip replacement and after the healing process is done, I don't really put any restrictions on patients, in terms of their activity or their range of motion."

 

The procedure lasts one to two hours and patients can return to normal activity by six weeks. Dr. Chaudhary spares the major muscles around the hip during surgery, which also helps patients recover faster. Rick goes to physical therapy. He says he feels good. In fact, at times, he says he forgets which hip was resurfaced. Dr. Chaudary says this surgery isn't for everyone. He says good candidates are under sixty-years-old, with a diagnosis of osteoarthritis, and good bone stock.

 

READ COMPLETE ARTICLE