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A Whole New You Don’t live with the pain just because getting a replacement makes you feel old. Here’s what you need to know about joint replacement 
Suffering chronic pain in his left hip due to severe arthritis, George Devanney was told in 2006 he would “just know” when it was time for hip replacement surgery. Given his age, he thought his hip should last for a few more years, though he’d been limping for months. Then while skiing the following winter, his hip gave out and he started somersaulting. “I remember it like it was yesterday. I got up and said, ‘I have to get my hip replaced.’” He was 44 and neither old nor frail. Devanney, now 48 and living in Berkeley Heights, N.J., is one of a growing number of middle-aged people who have undergone hip-replacement surgery, challenging the idea that 60 on up is a more age-appropriate time for the procedure. “I had the perception that hip replacement was something for 70-year-olds,” Devanney says. “Now, I believe the younger and the faster you get it done, the more ability you have to live life to its fullest.” Not long ago, physicians advised patients to wait until their 70s to consider joint replacement. “Now in their 40s and 50s, we don’t tell them to wait. Patients have higher quality-of-life expectations and want to get back to the activities they enjoy,” says Devanney’s surgeon, Dr. Calin Moucha of the Mount Sinai Medical Center in New York. “Plus, there are new materials and methods that last a long time. Hip replacements used to be fixed to the bone with cement, and the cement would eventually fail if you put it in at an early age.” Prosthetic joints generally are made of metal, plastic or both. Some are ceramic, but those are more likely to break, Moucha says. The joint can either be cemented into place or implanted, so the bone grows into it. An uncemented joint is often recommended for younger, more active people with strong, healthy bones. “The implant really becomes part of the bone and lasts a lot longer,” perhaps even forever, Moucha says. Other prosthetic hip joints consist of a metal ball and a metal socket, but when metal rubs against metal, ions enter the bloodstream. Whether this should concern patients is up for debate, but Moucha recommends metal-on-plastic joints instead. Where the bones come together at the joint, a plastic liner provides cushioning between the two metal components. The downside is the plastic might not outlast the patient. “I tell all people below 70 there is a chance they may need to have the plastic liner changed sometime in their lifetime,” Moucha says. 
Two fairly recent innovations include anterior hip replacement and hip resurfacing. Anterior hip replacement switches out the entire joint, but it differs from traditional hip replacement because no major muscles are cut. Using a special operating table, surgeons gain access to the joint through a four-inch incision on the front of the hip as opposed to a 10- to 12-inch incision on the patient’s side or posterior. A smaller incision means less blood loss, and with less trauma to the muscles patients recover and resume normal activities sooner. Hip resurfacing, an alternative to total hip replacement, is specifically designed for patients under 60. Instead of replacing the damaged ball of the hip joint, the surgeon smoothes and caps it with metal. Then, a metal cup is fitted into the hip socket. The principal advantage of hip resurfacing is that it conserves bone, says orthopedic surgeon Dr. Daniel Snyder, Newton, Mass. Active men between the ages of 40 and 60 who have good bone quality are the best candidates for hip resurfacing, while women’s success rates are lower due in part to their smaller stature. “You’re relying on bone to support the metal cap. The bigger the head on the bone, the better result, so size matters,” Snyder says. Anterior hip replacement and hip resurfacing are both technically difficult procedures, so in choosing a surgeon, patients should ask how many the doctor has performed. For hip resurfacing, it’s safest to find a surgeon who has chalked up 100 or more successes, Snyder recommends. Moucha advises against hip resurfacing because the implants are metal-on-metal and the risk of complications are greater. “I think it’s a fad that’s on its way out,” he says. Patients should keep in mind that while new procedures are available, traditional total hip replacement surgery has an outstanding track record, especially with the newer materials. “Metal on plastic is the tried and true,” Moucha says. Hip replacement surgery does not signal the onset of old age and inertia. “These days, we’re letting patients do a lot more after the surgery. We used to say no skiing” or other strenuous pursuits, Moucha says. That’s a good thing, because nine months after his surgery, Devanney was back on the slopes feeling as strong as ever, other than a little pressure in his new hip that has since gone away. The following autumn, he trekked to the base camp of Mt. Everest as part of a personal challenge to raise cancer awareness and conquer a new sport. This year, he’s climbing Mt. Fuji. “Without question the new hip has made things far, far better,” he says. “Not only has it helped me get back to the things I enjoy, but it also opened up a whole new door for me with the trekking.” Devanney certainly isn’t taking it easy or babying his new hip, though he realizes the plastic liner is likely to wear out before he does. “I don’t know how long the hip replacement will last,” he says. “But I want to see how long I can go and how far I can push it.” |
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