The new hip-op generation

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?”