Hip Resurfacing News

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BENTONVILLE — John Hill has run several Boston Marathons over the years, but crossing the finish line in 2006 was anything but pleasant.

Hill, a Bentonville resident for more than a decade and an executive with Nestle in Rogers, was accustomed to tackling the 26. 22-mile marathon in Beantown in as little as three hours, 27 minutes. But on April 17, 2006, Hill’s time skyrocketed to just shy of six hours. And he was in excruciating pain on top of that.

“ The only way I even made it to the finish line was to stop every so often and put more ice in my shorts, ” Hill recalls. “ I knew the end was near. It was going to be over for me. I wasn’t going to be able to run anymore. ”

Once a confident long-distance runner, Hill had been diagnosed with osteoarthritis prior to legging out the 2006 Boston Marathon. And at 44 years old, the condition had nothing to do with age. Instead, an extra piece of bone on Hill’s hip was rubbing against cartilage in the right joint of his hip, causing the protective material to deteriorate at a much more rapid rate than usual. The only surgical procedure being prescribed was total hip replacement — and that would mean giving up running altogether.

While attempting to stomach the fact that part of his life would soon be erased, Hill stumbled upon a story about a new surgical procedure called hip resurfacing. The procedure was so new, in fact, that it was not yet approved by the Food and Drug Administration, few had been performed in the United States, and the majority of insurance companies were not covering the procedure. Still, a glimmer of hope was ignited that has led to Hill holding on to the life he has always known.

On April 21, Hill, now 46, will be among the more than 20, 000 runners from across the country competing in the Boston Marathon. More importantly, Hill, who underwent the hip-resurfacing procedure 14 short months ago, expects to run the world’s oldest and most popular marathon pain-free, and even has his eye on finishing in under four hours.

“ If I think about it too much, I get overcome with emotion, ” Hill said. “ A year ago, none of this would have been possible. It wasn’t even imaginable. When you get a second chance at life like I have, you can’t help but feel humbled. I had already been told to start developing my exit plan from running. And in a few weeks, I’ll be doing the Boston Marathon. ”

The hip-resurfacing procedure, performed on Hill by Dr. Robert Barrack in St. Louis on Jan. 23, 2007, has been practiced in Europe for several years but has just recently started to gain acceptance in the United States. Rather than removing the entire hip, the resurfacing procedure introduces a special metal into the hip joint where the cartilage once was. As a result, bone-on-bone contact, which causes arthritis, pain and disability, is replaced by metal on metal.

The realization that he would not have to lose his hip meant Hill could continue to run marathons. But, more importantly, he would remain the father and husband he had been to that point in his life.

“ I coach my 6-year-old daughter (Mary Lou’s ) softball team, and there was a time when I was having trouble getting from one end of the field to the other, let alone running, ” Hill explained. “ I have a 9-year-old daughter (Sophie ) and an 11-year-old son (Brody ) that run AAU. I’ve always been right there, running with them. I enjoy being involved. My family is a priority. When my doctor performed the surgery, that was the thing I told him. I said, ‘ Now I can play with my kids. ’ ”

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March 2008

SAN FRANCISCO -  A study indicates that having a metal-on-metal bearing surface and performing high-impact activities preoperatively may be positive predictors for participating in high-impact sports after total hip arthroplasty.

To determine which patients would participate in high-impact sports activity following total hip arthroplasty (THA) and to examine the factors linked to participation in these sports, David R. Marker, BS, and colleagues submitted pre- and postoperative questionnaires to 303 THA patients who had a mean follow-up of 3 years.

The investigators found that 30% of patients participated in at least one or more high-impact sport postoperatively for an average of 4.3 hours per week.

A regression analysis revealed that a preoperative high activity level and metal-on-metal bearing surface were the only statistically significant factors to predict participation in high-impact sports postoperatively. Moreover, while a comparison of patients participating in high- and low-impact sports revealed similar preoperative Harris Hip Scores, the investigators discovered that the high-impact sport participating patients had higher postop Harris Hip Scores.

"There are many patients participating in these high-impact sports, up to 30% in our cohort," Marker said during his presentation at the American Academy of Orthopaedic Surgeons 75th Annual Meeting, held here. "The preoperative participation, as well as the metal bearing surface, were found to be predictive of postoperative participation. We found [in] the short-term follow-up that the high-impact sports patients had similar and better outcomes."

For more information:

Marker DR, Seyler TM, Ulrich SD, et al. High-impact sports after THA: Is the bearing type and independent predictor of activity level? Paper #16. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.

April 2008

Using potent anticoagulants such as low-molecular-weight heparin to prevent pulmonary embolism in total hip or knee arthroplasty patients, as recommended by the Chest Physicians Consensus Statement, may actually increase the risk of all-cause mortality compared to multimodal prophylaxis measures, according to a systematic literature review published in Clinical Orthopaedics and Related Research.

"We believe the American College of Chest Physicians should reconsider their guidelines to reflect the fact that PE (pulmonary embolism) occurs despite the use of potent anticoagulants and may, in fact, expose patients to increased mortality after surgery," the authors said in the study.

Nigel E. Sharrock, BMedSci, MB, ChB, and colleagues at the Hospital for Special Surgery, New York, conducted the systematic review, which included 20 English language studies published during the last 9 years. The researchers focused on studies that involved patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) and divided publications into three categories based on the venous thromboembolism prophylaxis regimen.

Specifically, Group A included the use of low-molecular-weight heparin, ximelagatran, fondaparinux or rivaroxaban, Group B included the use of a multimodal prophylaxis, and Group C included the use of warfarin.

"Multimodal prophylaxis (Group B) was defined as a protocol consisting of intention to use regional anesthesia (epidural or spinal) with or without intraoperative heparin during surgery or pneumatic compression and aspirin after surgery," the study authors noted.

The researchers found that the lowest number of deaths occurred among patients in Group B. Patients in Groups A and C were more than two times as likely to die compared to those in Group B, with no significant difference between Group A and Group C.

Patients in Group A also had a 60% to 70% higher risk of nonfatal PE compared to patients in Group B.

Nonfatal PE occurred in 94 of 15,839 patients in Group A (0.6%) vs. 25 of 7,193 patients in Group B (0.35%), according to the study.

"We show clinical PE occurs despite the use of powerful anticoagulants. The rate of 0.6% is comparable to the rate of 1% previously described with warfarin and low-molecular-weight heparin in cohort studies.

"This literature cannot support the use of powerful anticoagulants to prevent PE, although they clearly reduce the risk of venographically evident deep vein thrombosis," the study authors wrote.

For more information:

Sharrock NE, Gonzalez Della Valle A, Go G, et al. Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res. 2008;466:714-721.