LITTLE ROCK – A new surgical technique, seen as an alternative to a total hip replacement for younger, more active patients, was performed for the first time in Arkansas on Wednesday by joint replacement specialist Richard Evans, M.D., at the University of Arkansas for Medical Sciences (UAMS).
The patient, Joannie Cayce of Thornton, is in good condition at UAMS Medical Center and continues to recover from the procedure, known as hip resurfacing. Rather than replacing the entire hip joint, hip resurfacing simply shaves a few millimeters of bone and places a metal cap and socket over the two joint surfaces.
Evans, director of the UAMS Center for Hip and Knee Surgery, performed the surgery on Cayce, who is in her 40s. He said the procedure will most benefit patients age 60 or younger who lead a more active lifestyle. For those patients, there is a high chance that a total replacement will wear out during their lifetime, requiring another replacement operation, he said.
“Hip resurfacing offers us an alternative to a total hip replacement, which is good for a younger patient with joint problems who will be able to delay a total hip replacement,” said Evans, also an associate professor in the Department of Orthopaedic Surgery at the UAMS College of Medicine. “A total replacement usually lasts 15 to 20 years before another replacement surgery is often needed. With so much bone already removed in the first operation, joint function after the second operation is often not as good.”
During the hip resurfacing procedure, the head or ball at the top of the thigh bone (femur) is mostly retained, but shaped to accept a metal sphere. The hip joint itself is not removed as in a total hip replacement. In addition, there is no large metal stem going down the central part of the femur to hold a completely new ball in place. Instead, the surface of the acetabulum, the portion of the pelvic bone that is the socket, is replaced with a metal implant.
Evans said the bone-saving approach reduces the post-operative risks of dislocation and inaccurate leg length since having more natural bone makes the joint more stable. Since the all-metal components, called the Birmingham Hip Resurfacing System by maker Smith & Nephew, are made from smooth cobalt chrome and designed for low friction, it has the potential to last longer than traditional hip implants, he said.
The hip resurfacing technique has been used in Europe since 1997. It was approved in 2006 by the U.S. Food and Drug Administration for use in this country. Although 30,000 have been done worldwide, few have been done in the United States.
Cayce was diagnosed with avascular necrosis, which Evans compared to a “heart attack in the bone.” The condition leads to the death of tissue or bone due to a loss of blood supply. The hip surgery became necessary when the hip joint became arthritic and failed, Evans said.
The hip resurfacing implant is intended for patients suffering from hip pain due to osteoarthritis, dysplasia (abnormal bone development) or avascular necrosis, and for whom total hip replacement may not be appropriate due to their increased level of physical activity.
UAMS is the state’s only comprehensive academic health center, with five colleges, a graduate school, a medical center, and six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state’s largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children’s Hospital, the VA Medical Center and UAMS’ Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. For more information, visit www.uams.edu.
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