New Procedure Gives Middle ...

Margaret Swift's hip pain was so bad by age 40 that she gave up softball. She struggled to walk up hills on the golf course. She limped giving tours of Woodcliff Hotel & Spa in Perinton, where she works in marketing.

"I'd do one hour of yard work, and I'd come in the house in tears," says Swift, now 43, of Penfield. She eventually needed prescription painkillers to get through the day.

Her first orthopedic surgeon diagnosed degenerative bone disease but said that Swift was too young for hip replacement surgery. That's because an artificial hip could wear out after 15 or 20 years; redoing it is more difficult than first-time hip replacement and generally less successful. The surgeon recommended she use a cane as needed, lose weight to help her joints and switch to low-impact exercise such as swimming.

"I couldn't believe that was the answer," says Swift.

Eventually she met with Dr. Hubert F. Riegler, one of two Rochester-area surgeons offering a new alternative: hip resurfacing. The procedure, approved last year, is aimed at younger adults — typically women ages 45 to 55 and men ages 50 to 65, or younger. (The guideline is younger for women because they tend to develop osteoporosis; once bones weaken, they're not appropriate for resurfacing.)

After those ages, patients get the more conventional full hip replacement. That surgery removes the entire ball at the top of the thigh bone and replaces it with an artificial one.

Hip resurfacing is like capping a tooth. The ball is reshaped — not removed — and capped with a metal prosthesis secured by a small stem. This approach conserves more bone, making a full hip replacement easier if needed later.

Local orthopedic surgeons who don't offer hip resurfacing give three reasons. The parts are new enough that nobody can be sure how long they will last. It's a more demanding surgery than hip replacement (requiring up to twice the time, a longer incision and moving and cutting through more muscles and tendons). And there's some concern about metal ions produced when the metal parts rub together. The ions are absorbed into the bloodstream and eliminated by the kidneys, so resurfacing isn't recommended for women who may become pregnant or people with weak kidney function...

...Riegler, chief of orthopedics at Highland Hospital, has done about 28 resurfacings in the past two years. He maintains that about one-third of the full hip replacements don't turn out well in young, active people because they're more likely to wear out or loosen the artificial joint during their lifetime. Resurfacing allows a greater range of motion, and the joint is less likely to dislocate, so its results so far are better for people pursuing recreational sports...  

...The U.S. Food and Drug Administration approved Smith & Nephew's Birmingham metal hip resurfacing system in May 2006. Last month, the FDA approved a competitor, the Cormet 2000 hip resurfacing device from the British firm Corin Group, to be distributed in the United States this fall.

Of nearly 300,000 Americans who get hip replacements per year, 10 percent to 15 percent may be appropriate for resurfacing.

Resurfacing and total hip replacement are covered equally by health insurance, says Excellus BlueCross BlueShield. The costs for both differ by hospital, ranging from $12,300 to $22,000 in western New York, a spokesman says...

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