Jewish World Review May 28, 2003 / 26 Iyar, 5763


New artificial hip will last longer for younger, more active patients

http://www.NewsAndOpinion.com | (KRT) As the pain spread from her hip to her lower back to her groin and down her left leg to her shin, Shelly VanderArk knew her arthritic hip was getting worse.

Steroid injections eased the pain for a few years, but even those had stopped working about a year ago.

It reached the point that every step she took brought great pain.

She had a last option: hip replacement surgery.

But at 34, the labor and delivery nurse at Akron City Hospital was told she was too young. Artificial hips can wear out in 10 to 15 years, leaving young sufferers such as VanderArk two choices: delay the surgery and endure the pain for another decade or longer, or choose surgery, knowing that they'll probably face at least two more major hip surgeries in their lives.

Not anymore.

In February, the U.S. Food and Drug Administration approved a new artificial hip that its manufacturer - Stryker Howmedica Osteonics - says will last longer and wear better than traditional hip implants.

In fact, Dr. Kenneth Greene - an orthopedic surgeon with Summa Health System and a member of Howmedica's design team - expects the new hip can last a lifetime in most patients, even someone as young as VanderArk.

"She was told by another surgeon, `Sorry, you're too young,' but what's she supposed to do? Wait 10 or 15 years?" Greene said. "Those years between 34 and 44 should be the best years of her life."

VanderArk certainly hopes so, but just one week after her surgery, it's hard for her to know how well the new hip will serve her.

She suspects her snow skiing days are over, although her goals are much simpler. She would just like to be able to keep up with her three children: 11-year-old Ella, 1 year-old Libby and 4-year-old Carson, who has asked his mom whether her new hip will allow her to go on "adventures" to a stream near their home with him.

Greene has no doubt the answer is yes.

The new hip, known as the Trident Ceramic Acetabular Insert, is different from current models because it uses a ceramic-on-ceramic design instead of the usual metal-on-plastic design.

For some patients - those who are older and less active - the metal-on-plastic design can work fine, Greene said.

But in young, active patients, the plastic tends to wear out, Greene said. That can lead to hip dislocation and worse: Plastic particles cause the body's immune system to attack, resulting in significant bone loss in some patients.

Green was the first surgeon in the nation to implant the new ceramic hip, before it was approved by the FDA. He did so by obtaining the agency's OK of "compassionate use" of the device.

His first patient, 52-year-old Karl Schwarzinger of Stow, Ohio, has been an athlete all his life. Greene knew that the metal-on-plastic hip wouldn't last for him. But as the FDA approval process dragged on, Schwarzinger's hip got worse.

Schwarzinger, who sells artificial joints (including the ceramic hip) for Stryker Howmedica Osteonics, had surgery in October.

"Four days post-op, I was completely pain-free," he said. "I have no limp, no pain. I can pretty much do anything."

Not anything, actually. He has had to give up basketball, competitive tennis and running, but he can still swim, lift weights and play golf.

Schwarzinger knew he felt better physically after the surgery. But his co-workers noted that he also seemed happier.

"People actually said to me, `Your wrinkles are gone,'" he said. "When the pain's gone, your whole attitude changes. You get that vigor back."

This isn't the first time that ceramic has been used in implants. In 2001, the FDA recalled implants that had been given to as many as 9,000 people because the ceramic was fracturing at an unacceptably high rate.

The recalled hips used a ceramic called zirconia. The new hip uses a different kind, called alumina. Doctors say the only material harder than alumina is a diamond.

As is often the case with new medical products, the ceramic hips are more expensive, Greene said. Surgery costs about $11,000, compared with $3,800 with conventional artificial hips.

"The big issue is that we've got a new technology here that can last a lifetime," he said, "but people may not be able to afford it."

In the long run, Greene said, the new hips should save money by sparing patients follow-up surgeries to replace worn-out parts 10 or 15 years later.

"Where we're at now with insurance companies, they don't care where you're at in 10 years," Greene said. "I'm not sure they see the advantage of doing it right the first time The reality is you probably won't be their patient in 10 years."

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