Hip Resurfacing: BEWARE!

Only in Research Stages with Known Failures and Unknown Long-Term Success

Hip resurfacing is a surgery getting a lot of press lately. If you do a Google search on the word hip resurfacing, the first sponsored advertisement is from a respected device manufacturer who proceeds to tell you all the "good" things about this operation.

They do not tell you the truth, though. They suspiciously compare the operation to hip replacement using older plastic techniques and cover over any of the serious complication that may loom. They tell you nothing of the range of research or potential negative aspects of the procedure.

This operation could be very dangerous for you. This operation could be very successful for you. Here is the problem: we really just don't know right now. The respected surgeons working on the implant should be applauded in that they are rigorously studying an alternative to hip replacement. The early advertising and "physician locator" features found on some advertisers' websites should be outright condemned.

Here are some of the projected problems associated with "hip resurfacing:"

This information is summarized from a superb review article in "Orthopaedic Clinics of North America." The article was written by a group from Melbourne, Australia. According to the data supplied by this respected journal, none of the authors were either investigators of the implant, reserved royalties for the development, or had any financial interest in the outcome of hip resurfacing.

1. There were serious problems with the older designs of hip resurfacing which has prompted this development of a new generation of hip resurfacing (the one in the above mentioned advertisement is an example of this new generation).
2. There are NO LONG TERM results available on this new generation of hip resurfacing.
3. The more of these hip resurfacing procedures that are being put in, especially by non-developers, the more the complications appear.
4. Fracture of the femur (the top of the hip bone) is a real and serious complication.
5. The fracture rate is 1-2 people every one hundred cases. That is high.
6. The ideal candidate to receive a hip resurfacing at all is unknown by any real data and is conjecture at best.
7. The metal-on-metal surface of hip resurfacing produces circulating metal in the bloodstream. These are cobalt and chromium levels. It is yet to be known what the negative effects of these circulating metals are. [My Note: given the choice of metal circulating through my liver, kidneys, lungs, and brain or not- I choose NOT]
8. The problem with metal ions can be removed if ceramic surfaces were used [My Note: Like in successful ceramic bearing in total hip replacement!]
9. There is a need for INDEPENDENT research to allow better guidance on this procedure.

That pretty much sums it up. When choosing hip replacement procedures, ask your surgeon real and serious questions.

In 2006 through 2007 the data supports a cementlesss titanium hip replacement of a ceramic head and modern cross-linked plastic cup, a ceramic head and a ceramic cup, or a metal head and a modern cross-linked plastic cup.

When hip resurfacing is compared for 10 years against all three of those models then it should be considered. It is not an operation for the general public now.

Dr. K.

Related Topics: WebMD Video: Joint Camp: Where Boomers Go , Is Less-Invasive Hip Replacement Best for You?

Technorati Tags: hip resurfacing, arthritis, hip replacement, Arthritis Center

Basic Knee Anatomy

On the WebMD message board the following post caught my eye:

"I have been hearing a scraping sound in my right knee every time I sit down or climb or go down stairs.... A couple years ago, I had alot of pain in that knee and had special x-rays done, and was told the meniscus was starting to wear down."

Here are a few anatomical tid-bits:

The knee joint is made up of 2 bones that ALWAYS touch each other: the femur (thigh bone) and the tibia (leg bone). The femur and tibia both have their ends covered with a 3/8" of cushion called cartilage. Cartilage is part of the femur and tibia so technically since the cartilage surface always rub against each other then the femur bone and the tibia bone technically rub against each other.

If this surface cartilage rubs away then the bone ends rub against each other. This sometimes causes pain, but not all the time.

The knee is unique in that there is a second type of cartilage that is there (just when you thought you knew it all...) This cartilage is called the meniscus cartilage. I tell my patients that it is called the "meniscus" cartilage. I do not call it a pancake cartilage as I have heard other refer to it because I cannot eat it and it tastes like crap with maple syrup. Also it does not look like a pancake, it looks like the letter C.

The meniscus cartilage sits on top of the tibia and is actually attached to the tibia. YOU DO NOT WALK ON THE MENISCUS CARTILAGE. There is a meniscus cartilage on the inside of your knee (the medial meniscus) and another on the outside (the lateral meniscus). Looking down on the tibia, one meniscus looks like a C and the other looks like a reverse C. When they come together they may an oval and effectively appears like a ring.

The meniscus cartilage therefore is more like a ring around the knee. It can be likened to a rubber gasket on a faucet. When you are sitting or standing with your knee straight the meniscus cartilages are hanging out around the edges of the ring, minding their own business. As you either bend your knee or twist it while walking the meniscus cartilages (the ring) engages and acts as a secondary support - just as you would expect from a ring support.

Sometime that meniscus ring can tear, just like a gasket on a faucet can tear. Since meniscus cartilage has NO NERVE ENDINGS it should not be painful. The problem is that when a meniscus tears in the center while there are no nerve endings there are many nerve endings at its attachment.

Think of it like a skin tag or earring. If you have a skin tag and look at it, it does not hurt. If you pull on it, ouch! Same with an earring. It looks nice, but pull on it -- WOW!. Based on this, the meniscus tears with a little tag of cartilage and when you walk or twist the tags gets caught between the femur and the tibia and pulls on the attachment. This causes pain and swelling.

This is why arthroscopic surgery is so successful for a meniscus tear. We have learned over the years that we only need to remove the torn "tag" part of the meniscus and we can leave the rest behind. This removes the pain almost immediately. More importantly, the more meniscus you can keep behind the less chance you have in developing arthritis at a later age. Removal of the entire meniscus leads to arthritis of that part of the joint eventually.

If you are interested in some excellent drawings about what I just explained you can go to www.walkandmove.com and click on the patient education section. This will take you to medical material produced by an excellent education company (Medical Multimedia Group). The material is called eOrthopod. You can easily access any of the material on my site for free.

Dr. K.

Related Topics: Is Chronic Knee Pain Limiting Your Life?, Common Knee Injury Strikes Women More than Men

Technorati Tags: meniscus, arthroscopic surgery, knee injury

Get Stroking Tiger

Return to Golf After Total Knee

A common question, expecially in Westchester County, NY, where there are more golf courses than there are Emergency Room beds, is when can a patient return to golf after a knee replacement. It really depends on a few things:

1. What type of knee replacement you received- Partial (uni) or total
2. Your response to healing
3. Your definition of a return to golf

As a serious, national proponent of partial, minimally invasive knee replacements (www.walkandmove.com) return to activity is a most persuasive argument for only replacing the part of the knee that is diseased.

A partial knee replacement allows you to maintain the important knee ligaments which are totally removed in a total knee replacement. Aside from a remarkably rapid return to function, the level of function in a partial knee is superior.

The function of total knee replacement is OK- like a Toyota Corolla. The function of a partial knee is superior- like a Lexus. That an analogy I use for my patients. Surgeons who generally do not recommend partial do that because they do not have the skill or experience to implant a partial. You need to see someone who performs both- REGULARLY.

Patients do heal at different rates. In reviewing my long term results of a consecutive series of over 225 partial knee replacements I performed (50 of the patients had bilateral partial knee replacements), I found that by 3 weeks, a high percentage were able to drive a car- not a 3 wood- this took close to 6 weeks. Total knee replacements took almost 3 -6 months.

If you define returning to golf as doing 9 holes, with a cart, non-competitive- you can return early- (3 weeks). If you are looking to be club champion- look to 4-6 months.

Dr. K.

Related Topics: Is Knee Pain Limiting Your Life?, (WebMD Video) Joint Camp: Where Boomers Get Knees, Hips Replaced

Technorati Tags: golf, knee replacement