April 9, 2007
The pain in Jeff Mapes’ hip had been coming on for years. But through 2006, it was approaching unbearable.
“It’s been coming on for years and it really got bad within the last year,” Mapes said. “It would always hurt to one degree or another. I was eating (the over-the-counter painkiller) Aleve like mints and it wasn’t even touching it anymore.”
He was having trouble sleeping, because the slightest stir would wake his brain up enough to remember his body was in pain.
“It was a quality of life issue. I just was in pain,” Mapes said. “I wasn’t having a good time. I just had enough.”
But at 52, he was too young for a traditional hip replacement, in which the hip joint is replaced with a synthetic implant. The new components of the joint often fit together less than perfectly, which often causes dislocated hips and addition wear that may require additional procedures later in life.
Mapes enjoyed a fairly active lifestyle walking and riding his motorcycle in down time from his job with a trucking company. He discovered he would be a good candidate for a hip resurfacing procedure, a new type of artificial joint used in cases of arthritis or hip damage.
These systems consist of a socket in the shape of a shallow cup, and a cap in the form of a ball head. The cup replaces the damaged surface of your hip socket and the cap covers the ball-shaped bone at the top of your thigh, according to the Food and Drug Administration’s Web site.
The cap has a small stem that is inserted into the top of your thighbone, which is much smaller than the metal rod on traditional replacements.
Both the cap and the cup are made from high carbide cobalt chrome, which creates less friction and 98 percent less wear on the artificial joint that traditional implants.
Dr. Joel Wallskog resurfaced Mapes’ hip in December 2006. In February 2007, Gov. Jim Doyle had a similar procedure performed in Madison.
“A hip resurfacing like Doyle had is a femoral head and a cup. It’s a ball and a socket resurfacing,” said Wallskog, who is among a dozen Wisconsin surgeons certified to install Smith & Nephew’s Birmingham Hip Resurfacing System. For the last year, the British company has provided the only FDA-approved resurfacing system, although a handful of other corporations have devices in the approval process.
“First of all it’s bone preserving – you’re not removing the bone of the hip socket,” said Wallskog“It allows for a greater range of motion, and a lower risk of dislocation – that is a lower risk of the ball popping out of the socket. They rehab in half the time of a standard hip replacement. For young active people, or for people who work as laborers, it’s a great option.”
Hip resurfacing also does not limit future options. A person could still get a traditional ceramic hip replacement surgery 20 or 30 years later. Men older than age 65 and women older than 55 are typically poor candidates for resurfacing, because the system requires a patient have good bone density. People in their 40s and 50s were often told they were too young for a standard hip replacement, because ceramic systems often dislocated. New materials and designs in resurfacing systems fit together and stand up to wear better.
“Bo Jackson was trying to play professional sports on a traditional hip replacement, and he went through three hips in five years,” Wallskog said of the multi-sport athlete of the 1990s. Conversely Floyd Landis, winner of the 2006 Tour de France, famously postponed resurfacing his ailing hip until after the July race. In September, he had the Smith & Nephew system installed, and in January 2007 was cleared to resume his full training schedule.
The recovery time for hip resurfacing is much quicker and less painful than a traditional replacement, because less work is done on the bones. The incision made to access the joint is actually larger.
“The hardest part is exposure,” Wallskog said during a resurfacing surgery in Hartford in February. In a standard hip replacement, he said, the top of the femur would be sawed off, leaving a large space to work inside the leg.
He peeled back layers of tissue to expose the white knob of bone at the top of the femur.
“The incision is not smaller. In fact, it’s a little larger,” he said. But the recovery times are still vastly quicker because less is done to the actual bones. In old systems, the top of the femur would be cut off, and the stem of an artificial femoral head would be inserted into the bone.
Wallskog has had patients walking on their new hip a few hours after a procedure. Mapes said he spent about two weeks on crutches, and used a cane for another couple of weeks. He was back to work a little more than two weeks after his procedure.
Hip resurfacing is a relatively new procedure, so it’s hard to tell how long the systems will last. Data from a study of the Birmingham hip showed 90 to 95 percent of the systems were still working fine after 10 years.
“It’s definitely possible that it could last their whole life, although if you’re talking about a 40-year-old person it’s probably a bridge to keep them active,” Wallskog said. “If these implants last for 10 to 20 years, I would be very happy with them. But the true goal of this implant and this operation is really trying to get patients back quick and back to a higher level of function than they would have with a standard hip replacement.”
Mapes said he believes his resurfacing will could last for 15 or 20 years.
“I’d just like to recommend to anyone who is a good candidate. I wouldn’t be afraid to do it,” Mapes said. “I’m to the point that I don’t think about whatever way I’m stepping — I’ll just take off.”