Thanks, Tracy, but today we're talking about hip resurfacing, not oil painting. A while back, we had a guest post from Dr Robert Roman discussing a new hip surgery technique. Recently, I had the opportunity to speak with Bob about another hip procedure, this one aimed primarily at "young actives."
By the way, "young actives" are those folks aged 55 or so who enjoy an active lifestyle, and don't want to be sidelined because of a bum joint.
Typically, a hip replacement involves cutting a piece of bone, and then attaching a new piece (or three). There's usually a pretty significant waiting period before one's able to get back to one's accustomed lifestyle, whether that's mall-walking or a round of golf. Another downside is that the replacement parts have a finite (and known) lifespan. This is a problem, because no one really wants to have such an operation at age 57, and then again at 72.
And that's where this (relatively) new technique comes in. Called the Birmingham Hip Resurfacing System, this process, developed by Smith & Nephew, holds a lot of promise for those "young actives." As Dr Roman explains, it involves much less bone resection, and patients can expect to get back to their pre-surgical activity level much faster than with a traditional hip replacement. In fact, according to Dr Roman, some 87% of folks who undergo the resurfacing process are back to their pre-surgical levels of participation in sports activities, and in past series some 22% of these athletes participate in contact sports.
[ed: Actually, Dr Roman may be understating the benefits of the Birmingham approach; according to this study, almost half again as many folks who had the surgery were able to participate in sports post-op, and "a significant proportion of patients who did not do any sports before surgery are able to take part in sports after surgery." ]
This procedure also lends itself nicely to the anterior approach (where the patient is prone and the surgeon proceeds from the front, rather than the traditional posterior - or lateral - approach). It's less invasive than traditional replacement surgery, which means a faster recovery time, but Dr Roman also warned that's it's more labor intensive for the surgeon. Another benefit is that the "Birmingham method" is a self-lubricating, metal-on-metal bearing surface, so there is much slower wear and tear.
Hunh?
This simply means that there's greater longevity in comparison to a traditional metal-on-plastic bearing, and so less likelihood of additional replacement procedures down the road.
Let's step back and look at how "a Birmingham" works: the surgeon make an incision, and then trims the "knob" at the top of the leg bone where it joins with the "cup" of the hip, and adds a little ball (much like the ones we used to put on car antennas). He then adds a metal "liner" inside that cup; there's a very small channel where the new ball and the newly-lined cup meet. The body's own, natural lubricants fill in that space, creating a self-lubricating system.
Very cool.
[ed: Click here for a short video showing the difference]
Of course, we also need to consider both the cost and the insurance aspects of this procedure, especially in contrast with the traditional replacement method. As Dr Roman explained it, the Birmingham is a bit more expensive (at least initially), but that cost differential is minimal. The surgeon's fee is generally set by either Medicare (if applicable) or one's insurer, so it tends to be the same as a full replacement. So at least from the outset, there's no tangible cost-savings. Of course, if there are fewer complications, then longer-term costs are likely to be lower. It's really a lifestyle, rather than a financial, calculus.
From the insurer's perspective, this has become just another procedure, not considered experimental. Again, fees are dependent on procedure codes, but carriers seem to be okay with it. In fact, it's generally the same code as a full replacement, and reimbursed the same way. And providers like it because it gives them an additional marketing tool: "hey, we've got the latest tech and processes, and can get you back on the courts and courses faster."
So what are the downsides? Well, as Dr Roman points out, the anterior method we discussed previously, while continuing to gain steam, faces some obstacles. For one thing, many hospitals are a bit skittish about the $80,000 capital investment for the new, specialized equipment. For another, surgeon's who have had reasonable success with traditional replacement techniques often take the "if it ain't broke, don't fix it" route. Still, these are not insurmountable obstacles, and Dr Roman is confident that this technique will become relatively commonplace in the near future.
Thanks again to Dr Robert Roman for helping us to enlighten our readers. If you have any questions, please feel free to pose them in the comments, or drop us a line.
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