BHR

Link http://alexianbrothershealth.org

June 25, 2007 - For Tony Wojtkowski the realization that he was facing a lifetime of living in pain came last Christmas while shopping with his wife. "I could barely walk around the mall," said the 45 year-old housing consultant from South Elgin. "I had to stop and rest every couple of minutes, the pain was unbearable."

Wojtkowski, like millions of individuals, suffers from hip pain caused by osteoarthritis, a joint disease that affects cartilage. Unfortunately, cortisone injections and painkillers provided only temporary relief of Wojtkowski's pain. He was further discouraged after doctors advised him against having hip replacement surgery because he was still relatively young, and would basically "wear out" the replacement implant much sooner than someone less active. "I explored every option available," said Wojtkowski. He eventually came to the conclusion that his constant pain would always interfere with his personal and professional life. "I mostly missed the simple things like being able to go on bike rides with my kids."

In January of 2007, Wojtkowski learned of a brand new procedure from Dr. Daniel Kuesis of Midwest Sports Medicine, an orthopedic surgeon with the Alexian Brothers Hospital Network in suburban Chicago. The procedure, called hip resurfacing, would give Wojtkowski hope for regaining a pain-free life. Dr. Kuesis is among the first surgeons in the country to be trained in the remarkable new Birmingham Hip Resurfacing (BHR) technique. Rather than replacing the entire hip joint, hip resurfacing simply shaves and caps a few centimeters of bone within the joint. The bone-conserving approach of the Birmingham Hip Resurfacing System preserves more of the patient's natural bone structures and stability, covering the joint's surfaces with an all-metal implant that more closely resembles a tooth cap than a hip implant. This approach reduces the post-operative risks of dislocation, and because the all-metal implant is made from tough, smooth cobalt chrome, it outlasts traditional hip implants.

Total hip replacement involves the removal of the entire femoral head and neck explained Dr. Kuesis. The Birmingham Hip resurfacing technique, however, leaves the head and neck untouched. It is this neck length and angle that determines the natural length of a patient's leg after surgery, and since it is not removed and replaced with an artificial device during the resurfacing procedure, there is a greater likelihood of maintaining accurate leg length, thus resumption of normal physical activities. "This is one of the most exciting procedures I've seen in years," said Kuesis. "I see hip resurfacing as the ideal solution for many of my young, active patients who suffer from hip pain. As my patients are getting younger and younger, and are staying physically active much later in life, I've needed an alternative to total hip replacement that accommodates their age and lifestyle.

The Birmingham Hip Resurfacing System is that alternative." Remarkably, an estimated two million Americans who suffer from hip osteoarthritis are under the age of 65. "There has always been that perception that hip surgery is for the elderly, but that's simply not the case anymore. We're seeing many patients in their 40s who are already experiencing severe osteoarthritis," explained Kuesis. Just one month after receiving his hip resurfacing, Wojtkowski is making remarkable progress, and can already tell a difference in both his mobility and function. "It is like a new lease on life," he continued. "I am so grateful for this technology and those who are making it available."

Link  http://news.uky.edu/news/display_article.php?artid=2299

LEXINGTON, Ky. (May 15, 2007) − At the young age of 33, Allen Harris already has had his first hip resurfacing procedure. Exactly one year ago, a car accident during the line of duty as a London police officer left him with a broken femur, crushed joints and a broken and dislocated hip. But thanks to a new procedure called the Birmingham Hip Resurfacing System, Harris, like many other active young people, was able to resume normal activities and an active lifestyle.

After his accident in May 2006, Harris had a procedure to reconstruct his hip. But he still had pain, and 70 percent of his ball joint had died. New to UK HealthCare, orthopaedic surgeon Dr. Mauro Giordani heard about Harris's hip issues and talked to him about the Birmingham Hip procedure. After discussing various surgical options with Giordani, Harris decided it was the best option available.

Thankfully, Giordani, who is among the first surgeons in the country trained to perform the Birmingham Hip Resurfacing procedure, was able to help Harris in his time of need. Harris knew he wanted to get back to his career. "I'd only been a police officer for six years, and I didn't want to retire too young," he said.

Later the same day as his procedure in November, Harris was up walking with crutches. After only two weeks, Harris said he was walking just fine. Giordani said the Birmingham Hip procedure is allowing young people like Harris to remain active and productive members of society.

"Dr. Giordani is one of the finest people I've come across," Harris said. "I'm glad he was there to help me."

After the accident, Harris was afraid he would have lifelong problems and never be able to work again. But now he says his life is back to normal, and that he has no pain in his hip.

Harris went back to work as a London police officer in January 2007. He said he feels good and is getting back in the swing of things. "I'm a pretty determined person," he said.

About the Birmingham Hip Resurfacing System

Link  http://www.provena.org/stjoes/body.cfm?id=353&action=detail&ref=287

09/20/2006

When Catherine (Cathy) Holbrook knew the pain in her hip was making daily life more difficult, she opted for a new procedure called the Birmingham Hip Resurfacing to help with her pain.

Her nephew Nathan, who works at Hinsdale Orthopaedics, suggested that she look into the new procedure being done by Robert Daley, MD. Although she lives in Bloomington, she felt the procedure was worth the drive. Since her oldest son was born at Provena Saint Joseph Medical Center, she was also familiar with the hospital and the area.

"I know Dr. Daley is a really good physician, who concentrates on hips and knees," says Holbrook. "I didn't like having constant hip pain hindering my daily life. My hip was bone on bone with bone spurs, so I had limited flexibility. I wanted the opportunity for less pain and better maneuverability."

"The BIRMINGHAM HIP Resurfacing System is a clinically proven alternative to total hip replacement for physically active patients who are under the age of 65 and suffer from hip arthritis," says Robert Daley, MD. "This includes osteoarthritis, hip dysplasia, rheumatoid arthritis, and avascular necrosis. We began performing this procedure at Provena Saint Joseph Medical Center in July."

According to Dr. Daley, hip resurfacing preserves more of the body's natural bone structures and stability. The benefits of the BIRMINGHAM Hip Resurfacing technique and implant are that the implant's head size, its bearing surfaces, and its bone-sparing technique make it a preferred choice for young active patients. While the implants rate of survivorship is comparable to standard total hip replacements after five years, these three key advantages set the resurfacing technique and implant apart from its total hip replacement counterparts.

"Usually people are around 70 when this happens," says Holbrook. "My hip caused enough pain at night that I had trouble sleeping. If I had to walk a long distance, I would use a cane to ease the pain. I couldn't bend to touch my foot, so I couldn't tie my shoe. At 51, I was feeling a lot older than I should be."

The hip resurfacing technique is less invasive than normal hip replacements as well. A total hip replacement requires the removal of the femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing on the other hand, preserves the femoral head and the femoral neck.

"During the procedure, the surgeon will only remove a few centimeters of bone around the femoral head, shaping it to fit tightly inside the BIRMINGHAM HIP Resurfacing implant," says Dr. Daley. "The surgeon will also prepare the hip socket for the metal cup that will form the socket portion of the ball-and-socket joint. While the resurfacing component slides over the top of the femoral head like a tooth cap, the
acetabular component is pressed into place much like a total hip replacement component would be."

"I'm currently going through physical therapy to help regain all the movement and strength of my hip," says Holbrook. "I know I made the right decision in having the procedure done, and that once my recovery is completed, I will be able to participate in activities that I haven't been able to do for the last couple of years."

"This is such a great opportunity for potential hip replacement patients," says Dr. Daley. "With the constant improvements in technology, I am proud to be able to offer, along with Provena Saint Joseph Medical Center, one of the most advanced treatments for hip replacement."

Link  http://www.reuters.com/article/healthNews/idUSCOL86004420070518?sp=true

Fri May 18, 2007

NEW YORK (Reuters Health) - A new study shows that many active people are able to get back into sports after having hip resurfacing, a less extensive alternative to total hip replacement.

Swiss researchers found that, at an average of two years following surgery, 98 percent of 112 hip resurfacing patients were exercising regularly, in activities ranging from cycling and walking to skiing and jogging.

Hip resurfacing is a relatively new procedure used to treat severe hip arthritis and other forms of hip degeneration.

It's primarily intended for younger, more active adults who want to defer total hip replacement, which doesn't last a life-time and is often less successful the second time around.

Like hip replacement, hip resurfacing is major surgery, but it leaves more of the patient's bone intact. A surgeon reshapes the head of the thigh bone and covers it with a metal cap; a metal cup is placed inside the hip socket to create a metal-on-metal joint.

In contrast, traditional hip replacements involve cutting away the head of the thigh bone and replacing it with a metal implant. A plastic implant is placed in the hip socket. Over time, the implants can wear and loosen, particularly if a person is physically active.

Younger, active patients may opt for hip resurfacing with the hope of returning to their vigorous lifestyle. But it's been unclear how often they actually do, according to Dr. Florian Naal and colleagues at the Schulthess Clinic in Zurich.

Of the 112 hip resurfacing patients they surveyed, 110 were back to their active lives, regularly engaging in four to five activities and sports, on average.

Many were still into vigorous activities like downhill skiing, tennis and contact sports, though the percentages were lower compared with before surgery. Overall, 85 percent said they felt "good" or "excellent" during their activities.

Naal's team reports the findings in the American Journal of Sports Medicine.

The results show that hip resurfacing patients can return to a high level of physical activity, according the researchers, and so far, none of the patients in the study has shown signs of implant loosening.

However, they add, it's not yet clear how well hip resurfacing implants hold up in the long term. "Only the future can reveal whether hip resurfacing arthroplasties will produce less wear over time than other implants," the researchers conclude.

SOURCE: American Journal of Sports Medicine, May 2007.

Link http://columbia-stmarys.com/NewsPressReleases.asp?PageID=WTN000194

Kathy Schmit is a wife, mother, an executive director of a non-profit organization, a runner - and a recent Columbia St. Mary’s patient for an innovative hip resurfacing procedure.

On most days, her role as a surgical patient slips her mind, particularly when she’s out enjoying a three-mile run. "It’s amazing. I’ve had no pain since the surgery. I feel wonderful," she said of the active lifestyle that she has regained since her surgery last fall.

Kathy credits Columbia
St. Mary’s surgeons and staff, the hospital’s Joint Camp program and her own determination for the positive outcome from her orthopaedic procedure - a procedure that offers patients an alternative to traditional total hip replacement surgery.

Kathy, 56, had been a dedicated runner for nearly three decades. Through years of training and running, and completing four marathons including the famed Boston Marathon, she had a runner’s mindset when it came to injuries. "They say runners are either tough, stubborn or in denial. I think I was all three," she said of her reluctance to back off on running when she began to feel pain in her left hip during her workouts. That was five years ago.

As time went on, the pain worsened. "Toughing it out," as Kathy put it, wasn’t working for her anymore. She went to see Dr. Richard Karr at Columbia St. Mary’s Hospital Ozaukee Campus, who diagnosed arthritis in her left hip. He prescribed an anti-inflammatory and told her to back off of running. Admittedly, she backed off "a bit."

Convinced that a total hip replacement would finish her running life, Kathy resisted that type of surgery. "Running was a big part of my life. It was my exercise -- my meditation. I wasn’t prepared to give that up," she said. But after four years of doing an end-run around her hip problem, Kathy was open to any solution. "By last summer the pain was so bad I couldn’t stand it. I walked with a noticeable limp and couldn’t sleep at night," she said. "I told Dr. Karr I’d do anything."

Understanding her passion for running, Dr. Karr recommended that she see Dr. Mike Anderson -- an orthopaedic surgeon at Columbia St. Mary’s who was specially trained in the latest technique of hip resurfacing. This technique gave Kathy the greatest chance to realize her goal to run again - pain free.

Dr. Anderson evaluated Kathy. He said she was a good candidate for the surgery because she was young, active, very motivated and had good bone density.

Kathy had done her research on the resurfacing technique and felt confident that the procedure was a good option. Although it still was surgery, the end of the femur bone would not be removed but reshaped and fitted with a metal cap, which fits into a metal lining in the pelvic bone. "It’s the metal-on-metal joint that gives you an advantage with fit and wear," she said.

Her surgery was scheduled for October 17, 2006. But first, Kathy went to Columbia St. Mary’s Joint Camp. "Columbia St. Mary’s does a great job preparing you and managing your expectations about surgery, recovery and rehab," she said. Joint Camp specifically addresses the needs and issues of joint replacement patients.

Kathy had surgery on Tuesday and went home on Thursday - a day ahead of schedule. Her pain was well managed and she was very motivated about her rehabilitation. "I can’t say enough about the Columbia St. Mary’s orthopaedic floor - incredible nursing care. They know exactly what to do," she said.

In less than a week after surgery, with the aid of crutches, she was walking to the end of her driveway. By the end of the third week, she didn’t use them at all. "I healed really well and progressed exactly the way Dr. Anderson said I would," she said.

Kathy started weight training in December to regain strength and balance. And around the first of the year she began a power-walking regimen. With a plan of a mid-April Arizona vacation with her husband Tom, Kathy adjusted her goal. The thought of running in the warm desert air was a powerful draw. "I went to see Dr. Anderson and he told me I could start jogging every other day," she said.

Kathy power walks and gets out on her usual five-mile route three times a week, although now she walks the first and last miles while jogging the three miles in between - all without pain. Although she prefers to be outside, Kathy also works out on her elliptical machine.

Kathy is grateful that the doctors and staff at Columbia St. Mary’s understood how important it was for her to run again and to regain the level of activity she once enjoyed. She also understands the importance of listening to your body. "Scheduling days off from your workout routine is an important part of maintaining your physical fitness," she said.

Link http://www.medcompare.com/litupdate.asp?ArticleID=14960&typeid=24

1/1/2008

Journal: Clinical Orthopaedics and Related Research

Citation: 465:71-79, December 2007.

Authors: Carolyn Anglin, PhD, PEng; Bassam A Masri, MD, FRCSC; Jérôme Tonetti, MD; Antony J Hodgson, PhD, PEng; Nelson V Greidanus, MD, FRCSC

Femoral neck fracture is the most common short-term concern after hip resurfacing arthroplasty. Currently, there is little basis to decide between neutral and valgus placement. We loaded 10 notched cadaveric femur pairs to failure; one side was implanted at 0[degrees] relative to the femoral neck and the other at 10[degrees] valgus. All 20 were dual-energy xray absorptiometry-scanned. Failure load correlated with bone mineral density. Valgus placement increased the fracture load by an average of 28% over neutral for specimens with normal bone mineral density but had no effect on fracture load in specimens with low bone mineral density. For specimens with normal bone mineral density (typical of patients undergoing resurfacing arthroplasty), neutral-valgus placement had a greater effect than bone mineral density, explaining 54% of the fracture load variance. Component placement greater than 10[degrees] valgus is likely undesirable because this can lead to an increase in component size and a greater likelihood of notching. To reduce fracture risk, we recommend placing the femoral component in valgus and selecting patients with higher bone mineral density.

Link http://www.urmc.rochester.edu/pr/news/story.cfm?id=1596

Joe Mitchell always assumed his chronic leg pain was due to tight muscles, but as the pain became more intense in recent years, his physicians uncovered the culprit: an arthritic hip. He explored treatment options, and was dismayed to learn that he was not an immediate candidate for the main treatment for arthritic hips: hip replacement surgery.

"Hip replacements are meant to last 10 to 20 years at the maximum. After that, the revision surgeries are not as successful, so surgeons shy away from doing total hip replacements on people younger than 60," said Mitchell.

Mitchell is not alone. Like the 54-year-old attorney, who always led a fit and active lifestyle, hundreds of thousands of active baby boomers are now dealing with worn-out joints - and the pain - at a much earlier age than their more sedentary parents. Many, like Mitchell, are considered too young for total hip replacements, face years of painful waiting until they "come of age," and often balk at the prospect of limiting their activity level once the artificial joint is in place.

But that's beginning to change, thanks to a procedure called hip resurfacing, which was approved by the Food and Drug Administration last May.

"Hip resurfacing is an interim solution for younger patients who face significant pain and disability due to damaged hip joints," said Christopher Drinkwater, M.D., assistant professor of Orthopaedics at the University of Rochester Medical Center, who performs about two hip resurfacing procedures a week at the Evarts Joint Center in Highland Hospital. "It allows us to fix the problem causing the pain, but in a way that preserves enough bone so that a patient can safely proceed to a total hip replacement down the road if it's needed."

Other benefits of hip resurfacing surgery include the ability to maintain impact activities, like running or karate, and having a more natural feel of the hip after surgery, including increased range of motion and stability.

In total hip replacement surgery, both the pelvis socket and the top of the femur, or thigh bone, are replaced with artificial devices which allow a natural gliding motion of the joint. A socket is implanted into the pelvic bone, while a metal ball attached to a metal stem is driven deep into the center of the thigh bone. It is the anchoring of the metal stem that often leaves too little solid bone to make a follow-up replacement procedure feasible.

In hip resurfacing, the socket is still implanted into the pelvic area, but the head of femur is only shaved to fit a metal cap, which is anchored by bone cement.

For all of its benefits, Drinkwater cautions that hip resurfacing is still a major surgical procedure, and takes about the same time as a total hip replacement.

"In fact, the surgery itself is more demanding on the surgeon because a more extensive dissection is required to place the socket without removing the femoral head. Younger patients overall tend to recover a little faster, though initial recovery can be just as difficult," Drinkwater said.

Not everyone is a candidate for hip resurfacing, either. Men must be under 65 and women under 55, due to concerns over bone density levels. Drinkwater requires all patients to meet minimum levels of bone density before doing the surgery.

Joe Mitchell doesn't mind though. He had the surgery Jan. 26, 2007, and today is doing exactly what he wants to - biking and weight lifting - but pain-free now.

Link  http://www.kalb.com/index.php/news/article/hip-resurfacing-technique/891/

 

By Renee Allen - Reporter/Anchor CBS/NBC

October 10 2007

What happens when someone is too young to have a hip replacement but too old to just put up with it? Well, there’s something called hip resurfacing. And there are two physicians in Central Louisiana who were among the first to be trained on how to do it.
NewsChannel 5’s Renee Allen introduces a patient who’s trying it on for size.

Billy Weatherford is 53 years old soon to be a retired fireman. He lives an active life even with the pain from the arthritis in his hip.

“There are some days I’ll be able to work for an hour, then take a break. I’ll take something for the pain and then in an hour I get up again and go a couple more hours.”

Weatherford was told he would need hip replacement surgery. Doctors told him it would be best to wait.

“He told me then I was too young for total hip. Years down the road you’re going to have need a total hip. As long as we can manage the pain we’ll wait until then.”

But then his doctor, Dr. David Pope, told him about an alternative for younger patients. It’s called Birmingham Hip Resurfacing (BHR). Dr. Pope and Dr. Jeffery Garrison of Orthopaedic & Sports Medicine located in Alexandria are among the first surgeons in the United States trained in this bone conserving technique.

“Younger patients are going to go hard on their hip. So you put a traditional replacement in they feel better they’re going to go hard on it.”

Hip resurfacing simply shaves and caps a few centimeters of bone within the joint. It has the potential to last longer than traditional hip implants and conserves bone stock that otherwise would have been lost.

“If this hip has to be revised, which is probably a good chance if it’s done primarily in a younger patient in the first place, it will actually make that revision somewhat easier to do because you preserve bone in the femur.”

Dr. Pope adds that hip resurfacing is a more stable hip and an ideal procedure for patients under age 60 who live an active lifestyle.

 

Bone-Smoothing Surgery Offers Promising Treatment For Debilitating Hip Osteoarthritis

NEW YORK, Oct. 9, 2007

Link  http://www.cbsnews.com/stories/2007/10/09/eveningnews/main3349954.shtml

(CBS) Fifty-one year old Buddy Garlasco is back in the game - and was beating CBS News contributing medical correspondent Dr. Sanjay Gupta on the racquetball court - though he’s recently had a hip repaired.

“This is where we play,” Garlasco said. And Gupta was ready to be schooled.

How long did it take for Garlasco to get back on the court after his surgery?

“Seven to eight weeks,” he said.

Over the years Garlasco’s right hip had developed arthritis - the result of his passion for racquetball and his job as a contractor.

“It was so bad that I really couldn't even walk up a set of stairs and it ... encompassed the whole hip,” he said.

A traditional hip replacement may have limited Garlasco’s activities, even after he healed. So his doctor, William Macaulay, gave him a new choice for Baby Boomers: hip resurfacing.

Resurfacing is just what it sounds like. Instead of removing the thigh bone, as is done with total hip replacement, think of it as adding a cap to the top of the thigh bone leaving most of the bone untouched.

The result? Solid metal on metal, rather than metal on plastic. The technique allows you to save more bone, which results in more mobility.

“The bone has grown nicely into it,” McCauley said.

It’s been done on more than 5,000 patients in the U.S.

Was this a difficult decision in any way for Garlasco to have hip resurfacing versus a hip replacement?

“It was a no-brainer,” Garlasco said.

It's slightly more expensive than total hip replacement and the recovery time is comparable. But hip resurfacing is controversial - so new, there is only about one year's worth of data measuring its success in the United States. And there is a small chance of fracturing the hip joint.

"People will say, 'you know what, Dr. McCauley, the total hip replacement works just fine. Just stick to that.' And you way what to that?" Gupta asked.

“At one year, we have a significant number of people who have done the resurfacing on and they are actually functioning higher with less pain,” McCauley said.

“I could tell two days after I was operated on that my hip felt better already,” Garlasco said.

In the long term, no one is quite sure how well Buddy's hip will hold up - MacCauley says about half the patients are likely to have to get their resurfacing re-done after 15 to 20 years.

But today, Buddy's hip took a pounding. And so did Gupta.
 

Friday, 3-Aug-2007

 

In the world of prosthetic hips, what was old is new again. A procedure known as hip resurfacing, once tried two to three decades ago, is experiencing a resurgence in the U.S., thanks to improved technology. The new technique has several advantages over standard total hip replacement (THR) and is an attractive alternative to many people, said Peter Brooks, M.D., a Cleveland Clinic orthopedic surgeon, according to Cleveland Clinic's Men's Health Advisor.

 

"I think it's probably preferable in the right patient," he said. "They absolutely love it. They love the concept."

 

However, the procedure isn't for people with weak bones or kidney problems, so it may not be ready to supplant THR as the gold standard in hip prostheses. What's the difference?

 

In hip resurfacing, a surgeon shaves the head of the femur (the large thigh bone) where it connects to the hip socket (acetabulum). A metallic cap covers the femoral head, guided by a small, short stem drilled into the bone. The capped bone fits into a metallic cup inserted into the acetabulum.

 

A THR requires the removal of the entire femoral head and neck, replaced with a metallic device with a ceramic or metallic head and a long, thick metal stem that's driven deep into the femur.

 

The hip resurfacing devices of the 1970s and early 1980s, which used a metallic femoral head and a thin plastic socket, had a high failure rate, and by the mid-1980s, hip resurfacing had largely fallen out of use. A new metal-on-metal resurfacing device has been used in tens of thousands of patients worldwide for more than a decade, but it received U.S. Food and Drug Administration approval only in May 2006. Other devices are awaiting FDA approval.

 

The advantages

 

Whereas THR replaces the entire femoral head and neck, resurfacing preserves bone and targets only the problem area: the arthritic surface of the femoral head and acetabulum.

 

The long stem of a THR alters the natural biomechanics of the hip, resulting in a gradual thinning of the bone at the top of the femur that makes a follow-up THR difficult. Resurfacing preserves the normal hip mechanics and femoral thickness, delays the need for a THR and can easily be converted to a THR should it fail, Dr. Brooks said.

 

The larger head of the hip resurfacing system makes it more difficult to dislocate, and resurfacing patients generally do not have to follow all the precautions-such as avoiding bending forward more than 90 degrees or crossing their legs-that their THR counterparts must do to prevent dislocation in the weeks after surgery.

Dr. Brooks' patients also have reported that resurfacing feels more natural than a THR.

 

"I have a number of patients who have a hip replacement on one side and hip resurfacing on the other, and they uniformly prefer the hip resurfacing," he said.

 

The disadvantages

 

Despite these pluses, resurfacing has drawbacks. In about 1 to 2 percent of cases, a fracture may develop at the femoral neck, just below where the new metal cap ends. The fractures, which usually occur within four months of surgery, sometimes can be repaired with pins, but a THR may be necessary if the fracture does not heal.

 

Because of the fracture risk, resurfacing is not recommended for the elderly or people with osteoporosis. Dr. Brooks, who has performed about 60 resurfacings, said the majority of his resurfacing patients are in their 40s and 50s, but some are in their 60s.

 

Additionally, the resurfacing device can produce potentially toxic metallic ions. Healthy kidneys excrete the metals from the body, but people with impaired kidney function may encounter problems and should not undergo resurfacing.
Finally, the resurfacing operation generally takes more time and is more difficult to perform than THR surgery, and it requires a slightly larger incision. The procedure is relatively new, and only 400 to 500 U.S. surgeons, including Dr. Brooks, are formally trained to perform it.

 

What to expect

 

Dr. Brooks' resurfacing patients take a few steps on crutches the day after surgery and usually can go home three days after the procedure. Most patients remain on crutches for six weeks, at which point they return for a check-up, and don't see the doctor again until the one-year mark.

 

Patients are allowed to do non-impact exercise-walking, biking and swimming-after six weeks, but they must avoid heavy lifting and impact activities such as jogging. After a year, they can do whatever exercise they're fit to handle, he said.

 

What you can do

 

• Seek an experienced surgeon, and ask your surgeon how many resurfacings he or she has done.
• Six weeks after your surgery, do only non-impact exercise-such as walking, biking and swimming-and avoid heavy lifting.
• Help maintain bone health by getting at least 1,200 mg of calcium-about two eight-ounce glasses of skim milk-a day if you're over 50, and at least 400-600 international units (IUs) of vitamin D daily, preferably from D-fortified skim milk and fatty fish such as salmon.