Hip alternative

As with many people who aren't of retirement age, Linda McKenzie was in shock after hearing the news that she needed a total hip replacement.

It all started about eight years ago. In her mid-30s, the Mount Pleasant-based personal trainer began having hip pain, especially after running.

She chalked it up to tight muscles. But by 2008, at 42, it was becoming a major issue in her life.

"I wasn't in major pain, but it was nagging and persistent,”

recalls the Londonborn McKenzie. “I couldn’t run or power walk. I couldn’t walk my dogs. I couldn’t do lunges or squats. As a fulltime personal trainer, I was faced with not being able to do my job. But it was more than that. It (being active) was my life.”

Added to that, the pain started to affect her personality.

It made her grumpy and depressed.

Still, the experience didn’t prepare her for an orthopedic surgeon telling her that she had severe osteoarthritis and needed a total hip replacement.

In fact, she went to two more doctors for different opinions and didn’t get one. Knowing that a hip replacement would limit her active lifestyle at a still relatively young age, she held out and one day heard about Columbia-based Dr. Thomas Gross, who does “hip resurfacing,” an alternative to hip replacement.

She express-mailed her Xrays to him last summer. They consulted, and she scheduled an appointment. She had her surgery Sept. 28.

And while she still is in a six-month healing stage, she is back in the gym with limited activity and walking.

“The pain is gone, but the hip is weak. I can walk my dogs, work, do a little lower body training. I can sleep, and my mood has improved,” says McKenzie.

The procedure

Hip resurfacing is not new; it first emerged in the 1950s.

But advances made in England and Austria in the 1990s, as well as an evolution of materials and technique in the past 15 years, have made it an alternative for conventional hip replacements for middleage people who don’t want to sacrifice active lifestyles.

Hip replacement, as the name implies, replaces the ball of the hip with a metal or ceramic ball. With resurfacing, the damaged ball is reshaped and capped with a metal prosthesis, as is the hip socket.

Resurfacing leaves more of the bone intact, making it easier to perform a total hip replacement later, if needed, and may reduce the risk of dislocation.

According to the Mayo Clinic, hip resurfacing is technically more difficult and generally requires a larger incision than what is used for a conventional hip replacement.

And the risk of complications is slightly higher with hip resurfacing, even when controlling for factors such as a patient’s age, sex and activity levels.

Resurfacing isn’t suitable for everyone, such as older patients, those with osteoporosis, impaired kidney function, known metal hypersensitivities and large areas of dead bone.

Gross, one of three surgeons in the United States who have performed 2,000 or more resurfacing surgeries, has been performing the procedure for 10 years and advanced an “uncemented” version of resurfacing.

Patients have ranged in age from 11 to 75 years, but the average age is 48. Generally, he doesn’t offer it to people age 65 and older because the bone isn’t strong enough.

He’s frustrated that the United States, where less than 2 percent of the 300,000 annual hip joint surgeries are resurfacing, lags in acceptance of the procedure. Gross adds that about 9 percent of the surgeries in England are resurfacings.

“I think a lot of surgeons in the U.S. won’t do resurfacing because there’s a huge learning curve and because it’s more complicated than hip replacements,” says Gross.

“Younger patients should be offered this option, but in many cases, they are not.”

Marketing strategy?

Dr. Robert Lowery, an orthopedic surgeon in Charleston, says he’s concerned that the resurfacing procedure is driven by a marketing strategy: that it’s a “sports hip.”

He has other concerns about reactions to metal (in which case, the parts have to be removed) and fractures along the femoral neck. He adds that the surgery is more invasive than a hip replacement.

“It’s been a trendy surgery for the last three to four years,” said Lowery. “I personally think people, in fact, are better off with a state-of-the-art hip replacement.”

He contends that resurfacing will only result in the need to have a hip replacement in the future, while a ceramic hip replacement could last a lifetime.

“A lot of people would rather have one hip surgery than two,” he said.

Despite his doubts about the procedure, Lowery says hip resurfacing “has it’s place” for the right patient who simply won’t give up certain rigorous activities.

The right fit

Jimmy Hawk, a contractor who lives on James Island, has been playing competitive soccer all his life. A former Davidson varsity player, the 49-year-old plays on a team that won the premier league in the city of Charleston last fall. The league is made up mostly of guys in their 20s.

Hawk put that in perspective: “Basically, the only team better than us is the Charleston Battery.”

Hawk says that about nine years ago, he started having hip problems that stemmed from a bad recommendation from a doctor to wear a heel lift in his right shoe. The result was that he wore out the cartilage in his right hip.

In 2000, he was told he needed a total hip replacement. Yet he couldn’t give up soccer.

“I was in pain 24/7. I’d take an Advil before I started playing and took an hour to stretch and warm up before a game, but afterwards, I really hurt,” recalls Hawk.

On Sept. 10, 2007, he went in for resurfacing with Gross.

Six months and one day later, Hawk was back on the soccer field and has only one issue.

“The only time I have a problem is when it’s cold. Because when it’s cold on the outside,

it’s cold on the inside. Other than that, I’m good to go.”

How it works

In metal-on-metal hip resurfacing, metal implants cover the ball and socket of the hip, rather than replacing those parts.

The best candidate for resurfacing is a patient under 55 with severe osteoarthritis of the hip who has lost cartilage and is bone on bone, but who has lost less than 30 percent his femoral head bone stock.

Columbia-based Dr. Thomas Gross led the first successful FDA resurfacing study and was the developing surgeon for the BIOMET Recap and Magnum hip reconstruction systems, the world's first fully porous coated, "uncemented," femoral component for resurfacing.

Gross, who has been doing resurfacing surgeries since 1999, performs about 350 every year.

Reach David Quick at dquick@postandcourier.com.

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