Personal HR Stories 2008

Don't Wait Too Long for a Hip Resurfacing - You Could Miss The Window of Opportunity

By Ian Munro

I am a retired 69 year old surgeon. For most of my life I had been super fit: competitive squash 5-6 times a week, heli-skiing, windsurfing, sailing, single handicap golf etc. I left it too late to have surgery and I find this is a common story (see Jimmy Connors, Jack Nicklaus, etc.) As there are now two options: BHR and THR, this has become important. Like most people, trouble started with discomfort in my right thigh on walking. Eventually I went to see an orthopaedic surgeon in Fiji. I was surprised when he examined me and then ordered hip X-rays. I had lost half the cartilage.

The thickness on the outer half of my right hip. As a surgeon working a lot with bone, I knew that the glucosamine and chondroitin sulphate, needed for cartilage formation, are formed by the body. I deluded myself into believing that taking them orally would help – they had no effect. I also believed that a lot of walking would stimulate cartilage formation - again deluding myself. Gradually the pain got worse, going from thigh to knee to leg to ankle. After 2 years I got a cane. This helped. Then I had to progressively increase to 200mg Celebrex a day, plus occasional Tylenol.

I am now a full time sailor going around the world with my wife. Maintenance and repairs are constant and require contortions of the hips into many awkward positions. Eventually I could no longer function in this life, so it was do something, or give up our life style. I was not afraid of surgery but I had never consciously realized that things could be so limiting that I had to get treatment. I started research and soon found BHR. Physiologically this was more logical and satisfying to me than a THR. I had excellent bone density, excellent muscle strength and I intended to live a physically active life for at least another 25 years!! A not unreasonable expectation as my mother died at 99!

I had been a surgeon in Dallas, so after due research, I found Kurt Rathjen and wrote to him. He replied personally saying he had learned BHR in England. He had installed 134 BHR and had 1 major infection. These were good enough statistics for me so I arranged to fly back to see Kurt and have surgery 1 week later.

Before leaving Malaysia, I had new X-rays taken of both hips, right knee, and both ankles ( a total cost of $85!). This was 3 years from my first X-ray showing trouble. I was appalled to find that I had no cartilage on the lateral side of the hip joint. It was not just bone on bone but disintegration and micro fractures of the femoral and acetabular surfaces. Kurt took further X-rays and this is when the bad news arrived. I had developed large cysts in the femoral head and acetabulum. Presumably the micro fractures had allowed the joint synovial lining to be forced into the bone. The synovium then expanded to form the synovial cysts.

Kurt and I discussed the possibilities. One (unrealistic) possibility would be to scrape out the cysts, insert cancellous bone grafts, wait for 3 months forming new bone, almost non-weight bearing, then have a BHR. Obviously stupid. Secondly, I could have a BHR, ignoring the cysts. However, as the cysts were so large, there would be a significant risk of femoral neck fractures and neither Kurt nor I were interested in taking the risk. This meant a THR was the only sensible option. One advantage of the BHR is the very large femoral head and an acetabular cup that covers 80% of this head. This decreases the chance of dislocation. The standard THR has been a small femoral head and an acetabular cup that covers 50% of the cup and thus a higher chance of dislocation. I was delighted to find that Kurt uses a prosthesis that is similar to the BHR with a metal head and acetabulam. Over long term metal on metal would be more durable if lubricated. Think of a car or boat engine with constant motion for thousands of hours, working beautifully if well lubricated. Fortunately, your body physiology means you do not have to change the oil every 100 hours!

So I had the THR, and expect it will me 25+ years. However, as yet, I am not sure that I will be able to reach the level of activity possible with a BHR.

The moral of the story is: Get yearly X-rays. Once the cartilage is almost gone, or sooner, get surgery. Do not wait until disintegration occurs and cysts develop. Although a BHR is a relatively new procedure, it is physiologically and theoretically more sound than a THR- if the majority of the femoral head and neck are normal healthy bone. Conceptually, it really irked me that Kurt had to remove all the good normal bone of my femoral head, neck and shaft. Also if there is a problem with a BHR you can still have a THR. The reverse is not true. DO NOT WAIT. I wasted a year and a half – progressively limiting activities of going ashore to explore, or go for walks, visit restaurants etc. We went to Flores to see the Komodo dragons. Instead of going for a 5-10K walk with the guide, I was limited to an slow, brief half hour only seeing the dragons around the camp (wild but indolent). If I had been having yearly X-rays, I would have been able to have a BHR before cysts appeared.

Don't Wait Too Long for a Hip Resurfacing - You Could Miss The Window of Opportunity
By Ian Munro

Modern surgery is safe in a good center and will get you back to a normal life. Some surgeons use minimalist exposure techniques with less muscle disruption resulting in a reputedly faster recovery. I had the standard approach but I am writing this 11 days post operatively and I am pain free all the time except for muscle ache during the three times daily exercise periods. I can see that within another week I will be pain free. Then mental discipline will have to take over in order to restrict activities. I have a non-cemented femoral stem and acetabular cup; in my opinion the only way to go. Progressively, over time, scar tissue will develop and adhere to the roughened outer surface of the prosthesis. By 6-8 weeks this starts to become significant. Over further time, the strength of the adhesion becomes stronger and stronger. If the periosteum of the femur was preserved at the time of bone removal, there is a good chance of developing bone adhesion to the prosthesis. This is more likely in a younger patient than myself. However, all joints of the body – normal or abnormal – are protected by the strength of the muscles around them. Prior to the onset of symptoms, I had enormous leg strength, balance and agility. All of this was lost by waiting so long. Beforehand I used to be able to jump from uneven rock to uneven rock along a seashore – even if slippery – knowing I would never fall. My muscle strength and balance meant I could always recover if I made an error. I wonder if I will ever get back to that again?

8/18/08

Like most people, you probably want to keep your body parts for as long as possible. Innovative hip and knee surgery at San Joaquin Community Hospital (SJCH) can help you do just that. It's called resurfacing, and it's life-changing.

Bakersfield, CA (eMediaWorld) August 18, 2008 -- Like most people, you probably want to keep your body parts for as long as possible. After all, God gave them to you for a reason. Innovative hip and knee surgery at San Joaquin Community Hospital (SJCH) can help you do just that. It's called resurfacing, and it's life-changing.

According to the Centers for Disease Control and Prevention, there were 383,500 hip replacements and 550,800 knee replacements in the United States in 2005, and the numbers are rising. You don't have to be one of them.

Birmingham Hip Resurfacing

Gary Shepard, a 56-year-old from Bakersfield, has been athletic most of his life. It took its toll. He's been in pain for countless years, limping and walking at a 45 degree slant. He couldn't even cross his legs, so in 2007 he had Birmingham Hip Resurfacing (BHR™).

"The change is dramatic. It feels like my own hips. I walk straight, I've grown two inches, and even my knees don't swell anymore. People can't believe it when they see me---I feel fantastic," says Shepard.

Your hip is a ball-and-socket joint that unites two separate bones---femur (thighbone) and pelvis. The femoral head is a ball that fits into the pelvis socket. In the standard total hip replacement (THR), ball and socket are completely removed and replaced. The femoral shaft (thighbone's long part) is hollowed out and a spike, which holds the ball, is pressed into the bone. The spike can loosen and cause bone wear.

It's completely different with resurfacing. The femoral shaft is never disturbed---there is no spike. A minimal amount of the ball is shaved and then fitted snuggly with a smooth metal cap. The socket is shaped to fit a polished metal cup that the bone naturally takes on as its own.

Resurfacing preserves bone, improves range of motion, and gives you freedom to have a highly active, normal life. And that's a great thing.

Resurfacing was available years ago; it didn't last long. Technology and metal implants were far less sophisticated than today. Patients can now expect superior results with new medically-advanced implants.

In 2007, BHR™ celebrated its 10th anniversary. It has been used in 26 countries with a worldwide success rate of 97.2 percent. The FDA approved its use in the United States in 2006.

"With BHR™, I remove a lot less bone than in hip replacement. Oftentimes it's only 10 percent of the femoral head," says Tom Ferro, MD, FAAOS, orthopedic surgeon. "Patients experience less pain and report that it feels like their own hip. Resurfacing patients appear to feel normal very quickly, frequently by the second day after surgery.

"Another huge advantage to preserving bone is that you have more to work with later if your hips are injured."

It's just a fact of life: once bone is removed, you can't put it back.

Ferro, the leader in BHR™, is one of approximately 50 surgeons nationwide who perform this procedure. It requires considerable expertise in resurfacing. Although his clinic, the Bone & Joint Center, is located in Arroyo Grande and San Luis Obispo, Ferro also performs BHR™ in Bakersfield but only at SJCH.

"The hospital is extremely receptive to state-of-the-art procedures, and they have the patient's best interests at heart. It's important that patients have the finest technology used by the best people and in a highly efficient system---that's San Joaquin," says Ferro.

This procedure is recommended for active people under 66 years of age with good bone quality. There are some exceptions. Always talk to a physician to identify your best options.

"After seeing the huge change in me, friends and relatives are considering this for themselves. My wife spent a lot of time researching BHR™. I highly recommend it, and you can't do much better than Dr. Ferro," says Shepard.
 

Link  http://www.star-telegram.com/376/story/822867.html

By RICKY TREON

Calf roping is no longer a young man's sport for Jeff Copenhaver.

It was, back when he was 9 and dreamed of being a world champion. Back when he went to his first national finals 13 years later, and when he competed in that prestigious event for the last time at 29.

But now, at 59 years young, Copenhaver has decided to return to calf roping competition, something he thought he'd given up long ago.

Copenhaver, who runs the Cowboy Church at Billy Bob's in Fort Worth and also works with kids, did win that world championship in 1975 and he continued to be one of calf roping's premier competitors and teachers for two more decades.

It seemed age had finally caught up with Copenhaver in 1995, when it became too painful to mount a horse. And at the time, not being able to practice calf roping in any capacity was something he could deal with.

"I really didn't think I had any more desire to do it," he said of the skill that he'd nearly perfected throughout his life. "I was just minding my own business in 2006. And then, bam, the desire came back."

Copenhaver said that desire was subtle at first. But in October 2006, he scheduled a double-hip resurfacing, a new procedure that allows less bone removal and more mobility than a total hip replacement. The hope was to eliminate the pain and regain the abilities he thought he'd lost forever.

Turns out he had to wait until the following August to finally have his surgery done by Dr. Theodore Crofford at Fort Worth's Texas Hip and Knee Center.

It was tough, waiting all that time, he said.

Copenhaver hasn't had any complications after the surgery last Aug. 27 and said he's feeling better physically than he did at age 36 when he'd last sat in a saddle.

"They know so much more about the body and how it works nowadays," Copenhaver said. "I'm just way more fit."

So fit that he wants to start competing again. Though it sounds like a pipe dream, Copenhaver is doing everything he can to make sure he doesn't end this comeback disappointed or hurt.

Riding a horse and roping a calf is hardly like riding a bike.

"It's going to take a certain length of time to get riding again with an edge," he said. "The hip is just now, at 11 1/2 months, starting to feel strong again"...
 

http://www.signonsandiego.com/uniontrib/20080715/news_1c15alivem.html

July 15, 2008 SAN DIEGO ALIVE

With more people in their 40s and early 50s being sidelined by severe osteoarthritis, a new technology – hip resurfacing as an alternative to hip replacement – is giving baby boomers a chance to stay active longer.