Hip resurfacing was mentioned briefly in a previous issue of GeezerJock. Could you tell me more about the procedure?
The GeezerJock Doc responds:
A relatively new approach to the treatment of hip arthritis in the United States is a procedure named Birmingham Hip Resurfacing. The procedure is named for Birmingham, England, where it was pioneered by Derek McMinn and other orthopedic surgeons. This surgical procedure treats osteoarthritis in young, active patients who would otherwise need to undergo a traditional total hip replacement.
Hip resurfacing has been recently approved by the Food and Drug Administration; however at this time not all insurance carriers are paying for the procedure. Some not well-informed insurance carriers deem this to be an experimental procedure, even though it has been performed successfully in Europe for decades with excellent results.
The key difference between BHR and the traditional hip replacement is that it spares the bone to a greater degree. Surgeons remove only the bone immediately under the cartilage surface. The wearing of the cartilage surface is the arthritic area that needs to be removed.
In a traditional hip replacement the entire ball of the femur is removed and replaced by a prosthetic piece. With the hip resurfacing procedure, once the cartilage surface is replaced, a cap of bone is put in place that covers the end of the femur. The resurfaced femur is placed into a metal socket.
The bearing surfaces are also different than a traditional hip replacement. The BHR is a metal-on-metal device. Previous replacement surgery often had a metal-on-plastic bearing surface. The metal-on-plastic friction often leads to plastic wear which might lead to failure of the replacement.
The BHR procedure appears to deliver other advantages over traditional hip replacement surgery. There tends to be a lower dislocation rate of the prosthesis. Additionally, patients report less thigh pain after surgery. And if the new joint needs to be revised, the surgeon has almost normal bone to work with.
Researchers bel ieve that with resurfacing there is a more normal load transfer of the forces through the hip joint. The more natural load transfer, in turn, leads to a more normal feeling hip and better preservation of the underlying bone. These facts seem to help negate one problem associated with traditional total hip replacement procedures, which is that the bone below the prosthesis often became weak and demineralized.
The perfect candidates for BHR are healthy, active individuals below the age of 55, with arthritis that is not deforming and who want to proceed with their active lifestyles. Cyclist Floyd Landis and former major leaguer Albert Belle are among the athletes who have had the procedure. After BHR surgery many surgeons will allow their patients to resume all impact-loading activities, such as running, tennis and other activities that were discouraged after traditional total hip replacement. For further information visit www.birminghamhipresurfacing.com.
Ask the Doctor Written by orthopedic surgeon and Masters sprinter Allan Tissenbaum, M.D., GeezerJock Doc is a forum for your questions about injuries, exercise and getting older. Submit questions to geezerjockdoc@geezerjock.com or mail to GeezerJock Doc, 2033 W. Hutchinson St., Chicago, IL 60618.
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