A Joint Venture Is the New Hip Thing

Wall Street Journal—May 1, 2009

By JAMES TARANTO
Warwick, England

In 2007 I saw the doctor for a mild but persistent pain in my thigh. After two months of physical therapy, my hip was so stiff that I could barely bend over. An MRI revealed avascular necrosis, a localized degenerative condition in which an insufficiency of blood causes bone loss and eventually arthritis. Friedrich Boettner, an orthopedic surgeon at New York's Hospital for Special Surgery, informed me ominously that X-rays of my femoral head -- the ball of the hip joint -- showed "signs of collapse," meaning that my hip was too far gone to save. Before the advent of joint replacement, this condition would have meant a lifetime of worsening pain. As it was, within eight months of the diagnosis, I needed a cane and struggled to walk a few city blocks.

A decade earlier, I would have had a total hip replacement, which entails amputating the head and neck of the femur and inserting a stem into what's left of the bone. This is a proven therapy, but it is problematic for younger patients. Most total hip replacements use a plastic socket, which works very well at first but tends to wear out within a decade or two. To slow the socket's deterioration, the ball is smaller than a natural hip, but that poses a risk of dislocation. Total-hip patients are ambulatory and pain-free, but if they are young -- I was in my early 40s -- they face restrictions on their physical activity and the likelihood that they will outlive the prosthesis and need more surgery.

Now there is an alternative with none of these drawbacks: the Birmingham Hip Resurfacing, named for England's second city, where inventor Derek McMinn practices orthopedic surgery. More than 100,000 BHRs have been implanted world-wide since 1997, with an overall failure rate of less than 4%. Because the BHR preserves most of the femur, it is easier to replace with a total-hip implant if it does fail. Dr. McMinn tells me that among his patients who were under 55 at the time of surgery, "92% play sport, and 62% play impact sport."

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When Dr. Boettner decided last May that I was ready for surgery, I had to wait only until he was available to perform it. I received my new hip July 18, and it was the best medical experience of my life. The pain was gone immediately. I was walking on crutches the next morning and using my cane 11 days later. By the last week of August, I was striding unassisted through Denver, where I had gone to cover the Democratic National Convention. The implant sets off airport metal detectors, but otherwise my life is back to normal. Being born in America was a lucky break after all.

Mr. Taranto is a member of The Wall Street Journal's editorial board.

Read the full story at wsj.com.

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