South County Doctor Local P...

South County doctor local pioneer in hip resurfacing 05:16 PM EDT on Friday, June 22, 2007 By Felice J. Freyer Journal Medical Writer

 

SOUTH KINGSTOWN

 

The guys wanted it. Guys in their 40s and 50s, who once spent hours playing tennis or doing karate, and who, now hobbled by arthritis, poured their energy into finding a solution to the pain in their hips.

 

They came to Dr. Robert C. Marchand, printouts in hand, minds made up, and said, I want this. What they wanted was hip resurfacing — a new alternative to total hip replacement that preserves more bone, and is reputed to last longer, withstand impact and allow a greater range of motion. Perhaps allowing for more years of karate kicks.

 

Marchand, who is with South County Orthopedics, had observed a hip resurfacing procedure in his wife’s native Germany. In Europe, he says, people are running marathons with hip-resurfacing implants. He thought his patients were on to something, and resolved to give them what they wanted.

 

He took a course last year in hip resurfacing in Boston and went to New York to train with a surgeon there. After persuading South County Hospital to buy the necessary equipment, he began doing the procedure last fall. So far, he has completed about 45 resurfacing procedures in people age 20 to 71. And he remains the only doctor in Rhode Island who will do it...

 

In the traditional treatment for arthritic hips, called total hip replacement, the surgeon saws off the top of the thigh bone, hollows it out and inserts a metal implant topped by a metal or ceramic ball, which rests inside a plastic cup implanted in the hip socket.

 

In hip resurfacing, instead of sawing off the top of the thigh bone, surgeons reshape it, preserving most of the natural ball. Then they cement a metal cap over the ball, which slides inside a metal cup pressed into the hip socket. Both are made of cobalt chrome.

 

Some think this metal-on-metal construction will last longer and withstand high-impact activities such as running. More bone is preserved, so that even if the implant does break down, the patient can then get a total hip replacement. Also, the ball is bigger, thought to be less likely to dislocate from the hip socket, and affording a greater range of motion.

 

All this makes the procedures especially popular with active baby-boomers. “They come in at six weeks [after surgery], cross their legs and put on their shoes,” Marchand says. “They say, ‘I haven’t done this in a year.’ ”

 

...EVEN AS patients exult, the debate continues among doctors. Dr. Scott Rubinstein, a Chicago orthopedist who favors hip resurfacing for appropriate patients, says many are discouraged from it by surgeons who don’t do the procedure.

 

“If someone’s interested in getting this done, they need to be evaluated by someone who does them,” Rubinstein said. “It’s certainly not appropriate for everyone. You need to look at this as one way to have your hip done. Like any surgery, there’s no right answer for everyone.”

 

In looking at the evidence, it may come down to a question of whether one sees the glass as half-empty or half-full. Rubinstein, like Marchand, finds the 10 years of data from Europe convincing. “I don’t think it’s going to be any worse than the other stuff. I personally think it’s going to be better,” he says. “It’s one of these time-will-tell kind of things.”

 

...Dr. John A. Froehlich, of University Orthopedics, who specializes in sports medicine and reconstructive surgery and practices at Rhode Island Hospital, also says he’s not ready for that bandwagon.

 

But he points out that patients are not facing a simple choice between old-fashioned total hip replacement and brand-new hip resurfacing. The traditional hip replacement technology has also been advancing, with procedures that preserve more bone, more durable materials, and smaller incisions.

 

He’s pleased with the results he’s getting with the latest versions of hip replacement. “I think I can give people a more predictable result the way I’m doing it,” Froehlich said.

 

With people now living into their 80s, and getting sore hips in their 50s, anyone who gets hip surgery is going to have to have it redone, perhaps multiple times, Froehlich adds. “No matter what they’re made of, they will loosen and wear. That is something that is not recognized by the public,” he says.

 

“There is no panacea.”

 

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