Resurfacing Procedure on Trial for Aging Hips Two companies have applied for FDA approval of their hip-resurfacing devices, and trials are under way. Resurfacing salvages the bone and is considered less invasive than total hip replacement. The technique is geared to patients younger than 60 who have strong bones.
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Resurfacing Procedure on Trial for Aging Hips

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Resurfacing Procedure on Trial for Aging Hips

Resurfacing Procedure on Trial for Aging Hips

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This is MORNING EDITION from NPR News. I'm John Ydstie.


And I'm Renee Montagne. In personal health today, a look at aging hips and a new way to fix them. Device manufacturers are hoping to win regulatory approval of hip resurfacing technology. Hip resurfacing is being promoted as a less invasive alternative to replacing hips, and it's already used in Britain. Now, a few dozen U.S. surgeons are offering resurfacing as part of a trial of the procedure. NPR's Allison Aubrey reports.


A pair of hips is a little bit like a pair of tires. Wearing them down isn't only a matter of age, it's also how they're used. Some baby boomers are learning this, as the wear and tear of active lifestyles catch up with them. The demand for hip surgery is escalating.

Mr. DAVID ILLINGWORTH (President, Smith & Nephew Orthopedics): Clearly, the market is growing. We are treating younger and more active people.

AUBREY: David Illingworth is president of Smith & Nephew Orthopedics, a British-based hip device manufacturer. He says, last year, a record 400,000 Americans had hip surgery; the vast majority had the traditional hip replacement. But what his company is betting is that future patients will choose the alternative, hip resurfacing, a procedure that caps the ball of the thigh bone in metal and lines the socket of the hip with a metal plate.

Mr. ILLINGWORTH: Once we get approval for the device, we're hoping to get very good penetration into the U.S.

AUBREY: Internet sites and chat rooms have helped to create a buzz about resurfacing. The attraction is that the procedure spares the thighbone from being sawed off.

Dr. THOMAS VAIL (Director, Reconstructive Surgery, Duke University): Patients are interested in the idea of an operation that preserves more of their own body, and that's really, I think, the basic difference between a hip resurfacing and a total hip. If you look at the picture of it on an X-ray, it looks more like your own hip.

AUBREY: Physician Thomas Vail directs reconstructive surgery at Duke University. He performs four hip resurfacing surgeries per month as part of the investigational trial.

Dr. VAIL: If you think about the hip joint as a ball and socket, and the total hip replacement as removing the ball and replacing it with a metal ball, you can consider the hip resurfacing as capping the ball.

AUBREY: One patient on Dr. Vail's waiting list is 58-year-old Tracy Bogart(ph). She was diagnosed with an arthritic hip two years ago.

Ms. TRACY BOGART: The pain is debilitating. It's chronic. You can't sleep because of it. It's a constant distraction. I mean, it's at its worse now, but I'm not feeling it because, two weeks ago, I had a steroid shot.

AUBREY: She can only get a shot every four months, but the pain comes back in a few weeks. So, Bogart says, she is out of commission. She has had to give up part of her livelihood teaching yoga. Now, she is spending her time appealing her insurance company's decision to deny coverage of the operation.

Ms. BOGART: I could pay out-of-pocket and have it done tomorrow. But it's a $40,000 operation. And I could go to India and have it done tomorrow, but I still have one daughter at home; I have a business to run; and I can't leave.

AUBREY: Surgeon Thomas Vail is supporting Tracy's efforts to appeal the decision, because, he says, she's a good candidate. Among the criteria he considers are age, under 60 is ideal; bone density; and the shape of a person's hip.

Dr. VAIL: In other words, would the hip-resurfacing device fit well onto this person? It has to do with whether there are holes in the bone, which we would refer to as cysts. Are there cysts on the ball of the hip?

AUBREY: That could make it too weak for capping. Vail says patients who come in asking for resurfacing are usually convinced it's the best option, superior to traditional hip replacement. For instance, patient Tracy Bogart got turned on to resurfacing after reading about a professional ballerina whose hips had gone bad. One season after the resurfacing procedure, the ballerina was back in her toe shoes performing.

Ms. BOGART: That's a gift, and it's worth waiting for.

AUBREY: But not all surgeons are so convinced that resurfacing will prove to be superior.

Dr. MICHAEL JACOBS (Orthopedic Surgeon, Good Samaritan Hospital, Baltimore): Like most things in life, it's an old idea. It's not a new idea.

AUBREY: Michael Jacobs is a surgeon at Good Samaritan Hospital in Baltimore. He says resurfacing devices were first used in patients several decades ago.

Dr. JACOBS: But, unfortunately, they all failed because the sockets were made out of plastic, and the plastic, as a material, turned out to be the wrong material and it could not take the stress of the resurfacing device.

AUBREY: Jacob says the new devices seem to be working. The metal is holding up, at least eight years out. But over a lifetime, the results are unknown.

Dr. PAUL LACHIEWICZ (Orthopedic Surgeon, University of North Carolina): There is no good long-term follow-up on the current generation of metal/metal resurfacing.

AUBREY: Paul Lachiewicz is a surgeon at the University of North Carolina. He says, contrary to the spin, there is little evidence to suggest that resurfacing gives hip patients a better range of motion over the long term. Much of a person's recovery, argues Lachiewicz, depends on how flexible and strong they are before having surgery, as well as how hard they work to recondition after surgery.

Thomas Vail doesn't disagree, but he says he does like the results he's seeing with resurfacing.

As for the patients who aren't good candidates or can't get insurance to pay for it…

Dr. VAIL: I really don't think someone in that situation should be disappointed, because there has been a real boom in technology. There are a lot of options.

AUBREY: Even less invasive total hip replacement. Vale says the one clear advantage younger patients have with resurfacing is a better second chance if, one day, they find additional hip surgeries they'll still have the bone in place that makes it feasible.

Allison Aubrey, NPR News, Washington.

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