Device manufacturers are hoping to win regulatory approval of hip-resurfacing technology. The procedure is promoted as a less-invasive alternative to total hip replacement. It's approved for use in Britain. Now, a few dozen surgeons in the United States are offering resurfacing as part of an investigational trial.
"Clearly, the market for hip devices is growing. We are treating younger and more active people," says David Illingworth of Smith & Nephew Orthopedics.
Last year, a record 400,000 Americans had hip surgery. The vast majority had the traditional total hip replacement. But what his company is betting is that future patients will choose resurfacing.
The procedure caps the ball of the thighbone in metal and lines the socket of the hip with a metal plate.
"Once we get approval for the device, we're hoping to get very good penetration into the United States," says Illingworth.
Patients are attracted to the procedure because it spares the thighbone. "Patients are intrigued with and interested in an operation that preserves more of their own body," says Dr. Thomas Vail, director of Adult Reconstructive Surgery at Duke University.
Vail says to think about the hip joint as a ball and socket. Total hip replacement is like removing the ball and replacing it with a metal ball, whereas resurfacing is capping the ball.
Tracy Bogart , 58, of Chapel Hill, N.C., was diagnosed with an arthritic right hip two years ago. "The pain is debilitating, it's chronic. You can't sleep. It's a constant distraction," says Bogart. "I'm not feeling it because two weeks ago I had a steroid shot."
Bogart can only get a shot every few months, but the pain comes back much earlier. As a result, she's had to give up teaching yoga. And recently she learned that her insurance plan will not cover the costs of the investigational hip-resurfacing operation.
"I could pay out-of-pocket and have it done tomorrow, but it's a $40,000 operation. I could go to India and have it done tomorrow. But I have a daughter at home, and I have a business to run. I can't leave," says Bogart.
Vail supports Bogart's decision to appeal the insurance company's decision because she's a good candidate for the resurfacing surgery. Among the criteria he considers are age (under 60 is ideal), bone density and the shape of a person's hip. He also looks for cysts in the ball of the hip, which signal the bone might be too weak for capping.
Many patients that request hip resurfacing are convinced it's the best option. Many of the patients believe it's superior to traditional total hip replacement. Tracy
Bogart says she conducted a lot of her own research, and she read about a professional ballerina who was able to return to dancing after having the resurfacing operation.
"That's a gift, and it's worth waiting for," says Bogart.
Some surgeons are not convinced that resurfacing will prove to be superior to traditional hip-replacement operations. They'd like to see more evidence.
Dr. Michael Jacobs of Good Samaritan Hospital in Baltimore, Md., says resurfacing devices did not have a smooth beginning when they were introduced several decades ago.
"The devices failed because the sockets were made of plastic, and the plastic turned out to be the wrong material. It couldn't take the stress of the resurfacing device," says Jacobs.
The new devices seem to be working. Eight years of investigational studies have shown that the metal is holding up, and the surgeries are successful. But over a lifetime, the results are unknown.
"There's no good long-term follow-up on the current generation of metal-to-metal resurfacing," says Dr. Paul Lachiewicz, of the University of North Carolina, Chapel Hill.
There's little evidence to suggest that resurfacing gives hip patients a better range of motion over the long-term.
Lachiewicz says much of a person's recovery depends on how flexible and strong they are before having surgery, as well as how hard they work to recondition after surgery.
Surgeon Thomas Vail likes the results he's seeing with his resurfacing patients. Two years after the surgery, he finds resurfacing patients do have slightly more range of motion in their movements than his older patients who've undergone total hip replacement.
Vail advises patients who are not good candidates for hip resurfacing to pursue options for traditional surgery.
"There has been a real boom in technology. There are a lot of options," says Vail.