Consider Your Age and Gender Before Choosing Hip
Resurfacing
Stick with conventional hip replacement if over 55 or
female
Nov.
4, 2008 If you doctor suggests the new hip resurfacing rather than a
conventional hip replacement, you may want to be sure he knows your age.
New research says testing of a hip resurfacing device recently approved
by the FDA has found that the majority of serious complications occurred
in women of all ages and men over the age of 55.
The most common complication, and the most serious,
was a fracture of the femoral neck, the slender area of bone just
beneath the head of the femur.
"The ideal patients for hip resurfacing are males
under the age of 55. They have the fewest, and the least serious,
complications," said Dr. Craig Della Valle, lead author and a specialist
in joint reconstruction at Rush University Medical Center.
"Patients may be eager to take advantage of
technological innovations, but for older individuals, a conventional hip
replacement is generally more appropriate."
The review of over 500 surgeries using hip
resurfacing was led by Rush University Medical Center. The results have
just been published online and will appear in the January 2009 issue of
Clinical Orthopaedics and Related Research.
The researchers analyzed data for the first 537 hip
resurfacing surgeries performed in the U.S. after the Birmingham Hip
Resurfacing implant, manufactured by Smith & Nephew, was approved by the
FDA in October 2006.
The majority of the patients suffered from severe
osteoarthritis.
All 89 orthopedic surgeons involved in the
procedures had undergone training required by the FDA before conducting
their first cases. Their level of experience with hip surgery varied.
Some were joint replacement specialists; others were general orthopedic
surgeons.
Serious complications occurred in 32 of the 537
cases, including 10 cases in which the femoral neck fractured after
surgery, a problem not seen with conventional hip replacements. Such
fractures require additional surgery.
Nine of the fractures in the study occurred in
patients who were either female or older than 55 at the time of the
implant. Eight of the fractures occurred when the surgeon was relatively
inexperienced with the procedure (within the surgeon's first 10 cases).
According to Della Valle, age and sex are probably
linked to the incidence of such fractures because of bone quality and
quantity.
"Patients who are older or who are female tend to
have softer bone," he said. "Also, men on average have larger bone
structures, with a greater surface area for securing the implant."
The study identified several other serious
complications, including nerve injury, joint dislocation, fracture of
the proximal femur (just below the femoral neck), loosening of the metal
component in the joint socket, and deep infection.
About Hip Replacement
Also called: Hip arthroplasty
Hip replacement is surgery for people with severe
hip damage. When you have a hip replacement, the surgeon removes damaged
cartilage and bone from your hip joint and replaces them with new,
man-made parts. This can relieve pain, help your hip joint work better,
and improve your walking and other movements. Your doctor may recommend
it if you have hip damage and pain, and physical therapy, medicines and
exercise don't help.
The most common problem after surgery is hip
dislocation. Because a man-made hip is smaller than the original joint,
the ball can come out of its socket. The surgery can also cause blood
clots and infections. After a hip replacement, you might need to avoid
certain activities, such as jogging and high-impact sports.
The BIRMINGHAM HIP* Resurfacing System (BHR*) is
the global market leading hip resurfacing system with over 70,000
implantations worldwide. Introduced in 1997, the BIRMINGHAM HIP
Resurfacing System was designed using knowledge gained from first
generation metal-on-metal total hips and a thorough understanding of hip
resurfacing principles.
This successful, bone conserving total hip system is well documented
through independent clinical and laboratory studies. Additional clinical
evidence supporting the BIRMINGHAM HIP Resurfacing System is published
in multiple registries.
This bone conserving procedure, combined with the
virtual elimination of dislocation and excellent survivorship make the
BIRMINGHAM HIP Resurfacing ideal for the active informed patient.
The rate of complications, however, was similar to
that found in other studies involving only orthopedic surgeons who had
extensive experience with hip resurfacing. As a result, the authors
concluded that the FDA-mandated training succeeded in teaching
generalists the skills needed to perform the technically challenging hip
resurfacing procedure, alerting them to possible complications and ways
to avoid those problems.
In a conventional total hip replacement, orthopedic
surgeons remove the head of the femur, or the ball of the hip joint, and
replace it with a metal stem inserted into the thigh bone. They fit the
socket of the joint with a metal shell that typically includes a plastic
liner. In hip resurfacing, the femoral head remains, but its surface is
reshaped to accept a rounded cap with a short stem that sits in the
femur. A thin metal cup is pressed into the hip socket. Both components
are made entirely of cobalt chrome, a metal.
Hip resurfacing is generally recommended for
younger, more active patients out of concern that the traditional
artificial hip might wear out during their lifetime and require a second
replacement, a far more complicated surgery.
"Hip resurfacing has certain advantages over the
conventional total hip replacement," said Della Valle. "It preserves
more bone because the head of the femur is retained. It enables the
patient to return to high-impact sports because the metal components of
the implant resist wear and tear and can withstand the forces associated
with activities like running. Some studies have also shown that hip
resurfacing carries a lower risk of dislocation because the size of the
ball component is larger."
"But despite its benefits, risks remain," Della
Valle added. "Our findings suggest that we need to be cautious. This
procedure is not ideal for everyone."
Background Information
Rush University Medical Center's orthopedics
program ranks tenth in the nation, according to U.S. News & World
Report. Physicians from Rush serve as the team physicians for the
Chicago Bulls and the Chicago White Sox. For more information on
orthopedics at Rush, visit
http://www.rush.edu/rumc/page-R11726.html or call (888) 352-RUSH.
Rush University Medical Center is an academic
medical center that encompasses the more than 600 staffed-bed hospital
(including Rush Children's Hospital), the Johnston R. Bowman Health
Center and Rush University. Rush University, with more than 1,270
students, is home to one of the first medical schools in the Midwest,
and one of the nation's top-ranked nursing colleges.
Rush University also offers graduate programs in
allied health and the basic sciences. Rush is noted for bringing
together clinical care and research to address major health problems,
including arthritis and orthopedic disorders, cancer, heart disease,
mental illness, neurological disorders and diseases associated with
aging.
Keep up with the latest news for senior citizens, baby
boomers
Nov.
4, 2008 If you doctor suggests the new hip resurfacing rather than a
conventional hip replacement, you may want to be sure he knows your age.
New research says testing of a hip resurfacing device recently approved
by the FDA has found that the majority of serious complications occurred
in women of all ages and men over the age of 55.