Hip Resurfacing Helps Patients Stay Active
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New York Surgeon Introduces Unique Alternative To Total Hip Replacement
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Hip resurfacing helps patients stay active


(Original publication: April 27, 2007)

VALHALLA - The top of Brad Kenyon's thighbone was a large and, it can be said, rather bald orb.

The cartilage from the bone and from the hip socket in which it sits was all but missing, which is what brought Kenyon to an operating room at Westchester Medical Center recently.

"You hear that?" asked Dr. Steven Zelicof, an orthopedic surgeon, as he tapped on the naked femur. "That's just bone. That's like polished marble. That's what the guy's been walking on."

Kenyon, a 61-year-old management consultant from Sleepy Hollow, may have been a prime candidate for hip surgery, but he was not willing to trade in his active lifestyle for replacement parts.

In the past year, another option has become available for aging baby boomers and other active adults who need to repair achy hips without sacrificing mobility.

"In some ways, you're too young to have a replacement," said Zelicof, who heads the joint reconstruction service at the medical center. "In some ways, you're too young not to."

The procedure Kenyon had April 11 is called hip resurfacing, a revamped version of a technique that has been around for decades. This time, doctors expect that new materials will allow for greater success.

Much less bone is lost in the resurfacing compared with traditional hip replacement.

"Instead of replacing the whole ball of the hip, we're able to put a cap on it," Zelicof said. "It's much like capping your tooth."

Hips usually need to be replaced when arthritis causes cartilage to wear out or, in younger people, because of injuries or sometimes congenital conditions that may only become apparent in their 40s or 50s. About 474,000 people had a total or partial hip replacement in 2004, according to data from the American Academy of Orthopaedic Surgeons.

A standard hip replacement involves removing the head of the femur, or thighbone, and replacing it with a metal or ceramic ball that is anchored deep in the bone. In about half of the cases, the hip socket also is replaced with plastic.

Doctors sometimes tell younger patients to hold off as long as they can because the artificial joint eventually wears out, and replacing it is more difficult than the original operation.

Zelicof said newer artificial hips can last up to 20 years, and the operation works well for many people, but because the replacement ball is sometimes smaller than the original bone, motion may be limited. He said he usually advises patients who have had the surgery to avoid high-impact activities such as jogging and vigorous games of tennis.

Kenyon said his arthritic condition might have been genetic and might have been compounded by running marathons. He's done about 10 of the races.

He sought treatment for the pain in his right hip several years ago, and an X-ray determined he was missing cartilage. He tried physical therapy and massage, took dietary supplements and began researching surgical options. He said he was told by doctors that at some point, the pain would get in the way of his quality of life.

"And it did, as promised," he said.

But as someone who loves to swim, cycle and do yoga, a traditional hip replacement was not an attractive choice. Kenyon said his Internet research led him to hip resurfacing and to Zelicof.

Zelicof spent a week in Birmingham, England, to learn the technique from its developer. The device is called the Birmingham Hip Resurfacing System and was approved by the U.S. Food and Drug Administration in May 2006.

Zelicof has done more than 60 resurfacing operations, most involving just the placement of the metal cap and not the socket. He also operates at Sound Shore Medical Center of Westchester, in New Rochelle, where he is chief of orthopedic surgery.

In Kenyon's surgery, Zelicof first put in the metal cup that would serve as the new hip socket.

He then slightly reshaped the head of the femur and smoothed it. Zelicof used a small mixer to prepare the acrid-smelling cement that would help hold the cap in place.

"This is like the Food Network," he joked

Zelicof poured the cement into the metal cap, put it on Kenyon's bone and pounded it in place with a mallet. It is anchored with a short stem that sits in the bone.

Soon, Kenyon's right leg was lifted back into place, and the team was closing him up with the shiny cobalt chrome hardware inside. The entire operation took less than two hours.

The recovery wouldn't be much different than for a traditional hip replacement. Kenyon has been using crutches since the surgery and expects to start physical therapy today.

"Once you're recuperated, then you can usually go back to a lot higher level of activity and a lot more aggressive program of sports," Zelicof said.

He said the resurfacing was only for select patients, particularly those who are young and do sports that involve a great range of motion such as yoga or martial arts. It is the same surgery cyclist Floyd Landis had last year.

In older people, the bone may not be strong enough to hold the new cap in place. The device is not approved for women of child-bearing age because it is not known whether the metal ions released by the cap's contact with the socket cup can harm a fetus, the FDA said.

The metal-on-metal construction of the device is supposed to make it long-wearing. International data show it can last 12 years or longer, Zelicof said.

If the resurfacing wears out, a patient likely will need a traditional hip replacement.

Don Sweeney, a 56-year-old South Salem resident, has had both a traditional hip replacement and the resurfacing. The first operation was a year ago at Danbury (Conn.) Hospital, and during the winter, two days before he was to have the second hip replaced, his doctor called with some news. He told Sweeney he had just returned from learning the resurfacing technique in England and asked Sweeney if he would like to have that operation.

"I was excited that he called and told me because I wanted to do that originally," Sweeney said.

He said he was still recuperating, and it was too early to tell whether he could feel a difference between the two hips.

"I just want to be able to get out there and walk around without pain and be able to sleep through the night," said Sweeney, the operations manager at a tennis club.

Kenyon said he doubted he would ever train for marathons again, but he thought he might try running, something he has not done in three years.

Zelicof said his goal was that Kenyon forget he ever had surgery.

"My job is not to give him something new and improved," Zelicof said, "but to have him get to a point that he says, 'Which hip did I have replaced?' "