Link
http://www.timesonline.co.uk/tol/life_and_style/health/article3641322.ece
Baby boomers are competing for hip operations
with older people, and the pain and strain will
be felt by the health service
Martin Richards has been sports-mad all his
life, playing five-a-side football, tennis,
squash and badminton. At 50 he tried taking up
waterskiing but found that he couldn't crouch
down to pick up the tow handle; if he fell he
had difficulty getting up again. “I would lie
there like a beached whale,” he says.
He thought he probably had a groin injury,
but pain and difficulty moving got worse, he put
on weight and eventually X-rays showed advanced
osteoarthritis. “Your hips are shot,” a
consultant told him. “I went away, lost 2st
(12.7kg), then came back for the operation. A
year later I had the other hip done.”
Richards was soon back playing all his
favourite sports, fishing and camping. At 57,
five years after surgery, he says that he feels
fantastic: “It was a total life change. I feel
very lucky.”
Richards underwent a procedure called hip
resurfacing, invented ten years ago in
Birmingham by the orthopaedic surgeon Derek
McMinn and named the Birmingham Hip, though
there are now many imitations. Instead of
removing the head of the thigh bone and
replacing it with an artificial ball (hip
replacement) a hollow metal cap is fitted over
the head of the thigh bone, which corresponds
with a metal casing inside the hip socket. The
procedure is now recommended by the National
Institute for Health and Clinical Excellence
(NICE) for younger and more active patients
though not all orthopaedic surgeons agree about
its role. “Some see it as a holding operation,”
says Jane Tadman, of the Arthritis Research
Campaign, “postponing the day when a traditional
hip replacement will be needed. Others claim it
is a perfectly good - and less invasive -
procedure in its own right.”
Because resurfacing is a relatively new
technique, there is little data on outcomes,
though early reports suggest a success rate of
more than 95 per cent at five years after
surgery. In one trial, hip resurfacing performed
better in young active patients than total hip
replacement. But the materials used were
different - metal on metal for the resurfacings,
metal on polyethylene for the replacements - and
it may be that if the more expensive metal or
ceramic bearings were used, the replacement
would perform better.
“Hip resurfacing has been well marketed,”
says Tom Pollard, an orthopaedic specialist
registrar. “But it is not yet certain that it is
superior to total hip replacement using
comparable materials in the longer term.”
Martin Richards was told that his new hips
should last about ten years, though he admits he
probably does too much. “They may wear out
before then.” He says that it's important to be
a good weight before and after surgery, and you
have to work hard to regain fitness: “I couldn't
have done it without the support of
physiotherapists at my local hospital. If I can
get to 60 with these hips, swimming, playing
tennis and squash, I'll have had a good run.”
Richards may need total hip replacement if
his resurfacing fails, but one advantage of
resurfacing is that this is usually a
straightforward procedure compared with revision
of a primary total-hip replacement.
Helen Cotterell was only 42 when she began to
feel pain in her knee that increased in
intensity over the next six years and
osteoarthritis was diagnosed in her right hip.
“My GP told me: ‘Oh you're miles off a
replacement'.” A friend recommended her to see a
consultant privately who gave her a year before
she would need surgery. “When I went back, I'd
worn another quarter of an inch off the bone.”
Resurfacing was recommended because she was so
young: “He said it could stand one or possibly
even two revisions before I would need a full
replacement; he reckoned he could get me through
into my nineties.” Even so, Cotterell was
uncertain: “Do I really need this op?” she
asked. “You tell me,” said her consultant. “I
thought, yes, I want to climb mountains with my
kids, who were only 10 and 13 at the time, I
want to keep up Scottish reeling, I don't want
to limp down Oxford Street and sit in agony like
an old woman in Topshop while my daughter tries
on clothes.”
After a second operation on her other hip,
Cotterell went to a remedial masseuse: “She
taught me how to walk properly - swinging each
foot forward like a catwalk model rather than
waddling, which I'd got used to when the hips
hurt.” She has no idea why the disease struck
her so young: “My grandfather had a hip
replacement at 70 but he was crippled by then.
They were more stoic, that generation, weren't
they?”