An alternative to total hip replacement is an operation called hip resurfacing. Unlike the prostheses used in total hip replacement, which are made to replace the femoral head, resurfacing prosthesis designs allow the head to be preserved and reshaped. The resurfaced bone is then capped with a metal prosthesis. Like total hip replacement, the socket is fitted with a prosthesis.
In the United States, hip resurfacing is being conducted only in FDA-approved clinical studies. It is necessary for each manufacturer of a hip resurfacing device to collect clinical data on its resurfacing design. The data collected in these studies will be used to demonstrate whether each hip resurfacing design is safe and effective for market approval in the United States. Presently, no manufacturer has obtained FDA approval to market its hip resurfacing design.
Not everyone is a candidate for resurfacing; the femoral head may be too damaged to hold the resurfacing component. "Good bone stock is required," says Michael Mont, M.D., director of the Center for Joint Preservation and Reconstruction at Sinai Hospital in Baltimore.
James Puglisi considers himself fortunate to have good bone stock. Puglisi was 47 when he began limping because of a burning, aching pain in his hip that spread through his leg and into his knee and ankle. For this marathon runner and cyclist, just walking and standing became painful, and sometimes the pain was so intense that it would wake him up during the night.
Puglisi was diagnosed with osteoarthritis, brought on by an abnormally formed hip joint. He was advised by his orthopedic surgeon to wait as long as possible before getting a total hip replacement because it might wear out with his active lifestyle and require one or more revisions.
Revision surgery, which replaces both artificial parts and damaged bone, is more difficult than first-time surgery, says NIAMS. The outcome is generally not as good because bone is not as strong as when first operated on and the supporting ligaments may be damaged.
"But the pain was getting to the point where I needed to do something," says Puglisi.
Puglisi flew from his home in Amherst, N.Y., to Baltimore to take part in a study on hip resurfacing. Mont performed Puglisi's resurfacing operation in March 2003 and Puglisi returned home after a four-day stay at Sinai Hospital. Gradually putting more weight on his new hip, Puglisi was able to be full weight-bearing (walking without a cane or crutches) after three months. Now pain-free, the 50-year-old is back to cycling 200 miles a week and anticipates running again soon. "I'm so happy with the results," he says. "I had forgotten what it was like to have a pain-free life, and now I have it back. It feels as normal as my other hip."
Puglisi notes that different surgeons may have different recommendations. Another surgeon who saw Puglisi's X-rays told him he shouldn't run again. "But Dr. Mont was OK with it as long as I waited at least six months after surgery," says Puglisi. "He just told me I couldn't bungee jump or parachute!"
Mont advises the six-month waiting period to give a patient time to build strong muscles. He also says he doesn't "totally condone heavy sporting activities" after resurfacing. "You do it at your own risk," he says, adding that if the resurfaced hip ever fails, it can be converted to a total hip replacement.
Current hip resurfacing technology is too new to know how long the resurfaced hip will last. Puglisi has volunteered to return to Sinai Hospital for an annual checkup for the next 10 years to help clinical investigators gather long-term data on resurfaced hips.
"All You Need to Know About Joint Surgery," © 2002, Arthritis Foundation