New idea: resurface hip with metal

WASHINGTON — Doctors are beginning to offer a new alternative to hip replacement — one aimed at younger, athletic baby boomers who've worn out their joints too soon. Now they no longer have to wait until they hit their 60s for a fix.

It's called hip resurfacing, covering a damaged hip's ball and socket with smooth metal rather than cutting away worn bone and replacing it.

The operation hit the U.S. market last spring with Food and Drug Administration approval of the British-designed Birmingham Hip Resurfacing System. Competitors are in clinical trials here, and expected to clear FDA later this year.

It's not the first time orthopedic surgeons have tried resurfacing worn-out hips. But where earlier attempts failed, data from Europe suggest this latest approach uses longer-lasting materials — with the additional promise of a joint that may hold up to the heavy recreation of today's 40- and 50-somethings better than traditional hip implants.

"I do have people that call me and say, 'My father had hip resurfacing in 1970 and it didn't work. Why are we doing that now?'" says Dr. Michael J. Anderson, an orthopedic surgeon in Milwaukee who estimates that about 15 percent of his hip implants now are resurfacings.

His response: Comparing today's resurfacing with yesteryear's is like comparing a modern car to a Model T.

Not everyone's a good candidate, specialists caution. Resurfacing isn't for patients with thinning bones — part of the joint could break — or those who have poorly functioning kidneys that can't eliminate microscopic metal particles produced when the joint's reinforced pieces rub together.

Moreover, while patients typically recover quickly, resurfacing is harder to perform than a hip replacement, and only a small fraction of the nation's orthopedic surgeons so far are trained to do it.

But interest is growing, as evidenced by a focus on hip resurfacing at next month's annual meeting of the American Academy of Orthopaedic Surgeons — and a growing demand for hip repair from ever-younger patients.

Until now, "you might have told someone to soldier on for as long as you possibly can," because a standard hip replacement before age 60 is itself likely to wear out, explains academy spokesman Dr. Scott Rubinstein, of the Illinois Bone and Joint Institute.

With the new resurfacing option, "people may be a little more aggressive" in treating younger creaky joints, he adds.