Hip resurfacing rises as an alternative for younger patients

Jeff Stewart, 43, a house painter and former high school and college athlete, remembers the exact moment his hip gave out: Valentine's Day 2006. "I bent down to paint something low. When I got up, my hip never stopped hurting until I woke up from surgery in January 2007," he said.

The pain, due to an anatomical abnormality made worse by years of wear and tear, was so bad that sometimes all he could do was lie on his recliner and watch TV: "When you are in so much pain, your life is reduced to that."

But like a growing number of young, active people, Stewart eschewed the gold-standard treatment -- total hip replacement surgery -- in favor of a new procedure that, propelled by aggressive marketing featuring vigorous, youngish athletes, is sweeping the U.S.: hip resurfacing.

The main claim for hip resurfacing is that it can preserve more of the thigh bone, making any subsequent surgery more feasible if the initial repair wears out.

Stewart, who paid $30,000 for the procedure and follow-up care because it was not then covered by insurance, is delighted with the results. He can once again "paint million-dollar houses by myself and jump up on roofs."

But many orthopedic surgeons, including the one who did Stewart's surgery, Dr. Carl Talmo at New England Baptist Hospital, are worried about the rate at which doctors, most of whom are still on a steep learning curve for this technically demanding procedure, are jumping to do it.

Resurfacing is so new that statistics on the number of people who have gotten it won't be available until next year, according to the American Academy of Orthopaedic Surgeons.

"I'm encouraged, but I also harbor a healthy skepticism toward resurfacing," said Talmo, who added that Stewart was his first -- carefully selected -- patient. "There's tremendous potential for young, active adults," he said, "but we need to be cautious because there is also the potential for this to be over-utilized in the wrong patients.

"Every objective study of hip resurfacing anywhere in the world demonstrates slightly higher failure rates in the first one to five years than total hip replacement," Talmo added.

How the surgery works

In hip resurfacing, surgeons shave down the tip of the thigh bone, capping it with metal, and then scrape out the hip socket into which the cap fits and line the socket with metal. The surgery and recovery with resurfacing can take just as long as with standard replacement surgery and often requires a bigger incision.