Resurfacing emerges as poss...

Resurfacing emerges as possible option to hip replacement
By Mary Jo Feldstein
ST. LOUIS POST-DISPATCH
05/07/2008

Read Complete Story Here

The procedure gives many patients the chance to relieve pain and stay active. Physicians caution their peers to select patients carefully and make sure they're capable of performing the complicated procedure.

"Patients should have a long discussion with their physician," said Dr. Jay Mabrey, chief of orthopedics at Baylor University in Dallas and chairman of the Food and Drug Administration panel that reviews orthopedic devices. "I spend more time in my practice talking people out of hip resurfacing than talking people into it."

Such restraint can be difficult as a few device makers put their marketing teams in gear to maximize this latest profit center.

Hip replacements typically only last two or three decades, leaving young recipients with few options for their golden years. Hip resurfacing, on the other hand, can preserve enough healthy bone for a hip replacement later on in life.

Here's the difference: During traditional hip replacement, both the head and neck of the femur, or thigh bone, are removed and replaced with metal or plastic implants. During hip resurfacing, the head of the femur is resurfaced with a metal hip "joint" and the rest of the thigh bone is left intact.

Patients who opt for hip resurfacing often return to some strenuous physical activity after surgery.

Goodman hasn't completed another marathon since his surgery a year ago, but he occasionally jogs shorter distances and he regularly attends high-energy spinning classes.

He isn't hip resurfacing's only cyclist. Professional cyclist Floyd Landis underwent the procedure before his contested Tour de France victory.

Resurfacing costs more than a traditional hip replacements, with a price tag of $10,000 to $12,000 versus about $8,000.

Patients, on average, have similar recovery times. Hip resurfacing patients who get better faster, generally do so because they were younger and healthier before the surgery than the average hip replacement patient, said Dr. Robert Barrack, an orthopedic surgeon with Washington University Orthopedics at Barnes-Jewish Hospital.

Hip resurfacing is not for everyone. Barnes-Jewish considers it ideal for active men and women under age 60. People with osteoporosis, diabetes and women who plan to have children are among the other classes of patients warned to stay away.

Patients also need to find a qualified physician. Since it was only approved by the Food and Drug Administration two years ago, few surgeons are proficient in performing the procedure, which is considered more difficult than hip replacement.

Barrack said it takes about 50 cases to consistently achieve the best results. Because only 10 percent of patients qualify for resurfacing, Barrack estimates a surgeon would have to see 500 patients to reach the threshold.

That's a high volume of patients for a physician outside of a large medical center, Barrack said. He is a paid consultant for Smith & Nephew, a maker of hip resurfacing products, though the expertise he provides the company is related to other products.

Smith & Nephew's Birmingham Hip was the first FDA approved hip resurfacing product in the United States. It's been a solid product for the British company, driving growth in revenue and profit. The hip replacement market is worth about $2 billion, but Smith & Nephew had controlled hip resurfacing's estimated $20 million slice of the pie. Now, as other device makers work through the approval process, Smith & Nephew is facing new competition.

A concern is whether efforts by device makers to increase the market will encourage physicians with less experience to perform the procedure or recommend it to the wrong patients.

Mabrey said he's keeping this procedure for the most active of patients. A recent example is a triathlete who completed an Ironman competition a few months after surgery.

"That's the kind of person I aim for," Mabrey said.