Hip Quotient

To repair or replace—that is the question.

At least a quarter-million older Americans are troubled by arthritic hips. The source of shooting pains or joint stiffness, the condition typically appears gradually, limiting activities like tennis, golf and relaxing weekend walks. Until recently, a new hip was the only real solution.

Illustration by Dav BordeleauIn terms of patient satisfaction, surgically replacing the arthritic joint with a prosthetic one remains one of the most successful operations in modern surgery. At the same time, when you consider what you’re replacing—a ball cradled perfectly in a smooth socket—you see why it’s also such a technically unforgiving procedure. In time, the new parts can show wear and tear, especially if they’re made of plastic. Both the stem and socket could come loose and become misaligned. Over the past decade or so, such factors have prompted some specialists to seek out alternatives to conventional hip-replacement surgery.

Dr. Chet Simmons Jr. of Chester County Orthopedic Associates specializes in hip resurfacing, a “21st-century approach” considered to be better suited to active lifestyles. Another more recent breakthrough is anterior hip replacement, which avoids the gluteal muscles that connect the pelvis and femur—an area prone to surgical trauma.

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Among the other tissue-preserving hip replacement procedures, Percutaneously Assisted Total Hip Arthroplasty (PATH) involves smaller skin incisions. It’s used on heavier patients and those with severe hip problems.

Alas, new developments have done nothing to address a phenomenon that’s changed the focus of many private practices: an increase in osteoarthritis cases. Also known as degenerative arthritis, it’s characterized by creaky joints, swelling, hotspots and joint pain. It typically gets worse later in the day.

“It may be that the rise in fitness activities we saw in the last decade—and the trend to keep fit—is finally catching up with us,” says Simmons. “What we’re seeing with the baby-boomer generation is more and more people developing hip arthritis. These are very active people.”

And repairs are far from cheap. A conventional hip replacement typically runs $30,000-$40,000 without insurance, or $3,000-$5,000 with a good plan.

Compared to the rest of the body, which has a remarkable capacity to repair itself, our joints are fragile. Once the cartilage that cushions bones wears away, it doesn’t grow back. Thinning cartilage is the cause of most cases of osteoarthritis.

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Years of perfecting his tennis serve may have contributed to the development of osteoarthritis in Mike Schnably’s hips. The 46-year-old banking executive, West Chester University tennis All-American and nationally ranked senior player has been involved in competitive tennis for decades. The thought of giving up the game was at the root of his reluctance to consider a conventional hip replacement.

But after severe hip pain nearly sidelined Schnably a few years ago, he went to Simmons, who suggested hip resurfacing. With this procedure, the joint is surgically dislocated, and the top of the thighbone (known as the femoral head) is shaped to accommodate a thin, cemented metal cap. The hip socket is lined with metal, making it more durable and unlikely to fracture during high-impact activity. Because the femoral bone isn’t replaced with a prosthesis, it leaves the patient open to further surgery down the road. Schnably spent two weeks on crutches and was back to playing tennis six months after surgery.

According to the American Academy of Orthopaedic Surgeons, hip resurfacing is meant for active patients between 55 and 75 who have a one-in-14 chance that they’ll need further surgery within a decade. (For those under 55, it’s one-in-seven.) Simply put, hip resurfacing saves enough bone to allow for other options down the road.

With hip resurfacing, there is a higher failure rate among women, because the thighbone is less likely to be strong enough to support the metal implant. A study out of England suggests that women are more likely to be hypersensitive to metal, and that a smaller surface area makes surgery more challenging.

Surgeons in Birmingham, England, were the first to use cobalt chrome. And since the FDA approved the Birmingham Hip Resurfacing system in 2006, others have followed—including the Cornet brand Simmons uses.

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These issues aside, British studies found that only 6 percent of patients suffered complications due to abnormal wear of the metal implant, and that after 10 years, 95 percent are still doing well.

Simmons’ patients generally undergo a series of X-rays to determine the level of deterioration that exists in the hip. “[But] the real criteria is their age and activity level,” he says. “[Patients] can be anywhere between 40 and 60, as long as they truly want to maintain their high level or active lifestyle.”

To learn more about hip-replacement surgery and the alternatives, visit aaomed.org or aaos.org.

5 Ways to Avoid Hip Trouble

1) Control your weight.
The more you weigh, the more pressure there is on your joints.

2) Switch to low-impact exercise. Run on a track or treadmill, and mix up your exercise schedule with low-impact options like biking and power-walking.

3) Avoid Injury. It’s not the easiest thing to do, but your chances of developing osteoarthritis increase if you suffer any injury that requires surgery.

4) Be aware. You can often avoid injury simply by observing your surroundings. Shy away from activities on hard pavement, and give up the weekend-warrior routine.

5) Get fit … and stay that way. Muscles around joints act like mini-shock-absorbers, so it makes sense to have a toned body. Stay with exercises proven to gradually build muscle, like moderate weight lifting, vinyasa yoga and swimming.

Hip Resurfacing: 6 Deal-Breakers

1. Multiple cysts or an active (or suspected) infection in or around the hip joint.
2. Extreme obesity or poor bone quality.
3. Metal allergies.
4. Anything but an extremely active lifestyle.
5. Women in their childbearing years.
6. Kidney problems or weak immune systems due to disease or certain medications.

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