A Great Birth day Present

By Dr. W. Gifford Jones

February 19, 1994

"What do you want for your birthday?" Ask your children or friends this question and you'll get a variety of answers. But recently one of my colleagues told me he gave himself a birthday present, a total hip replacement (THR).

He said, "I'm tired of being able to walk only short distances. I'm fed up with the pain. Now I'm ready to accept the risk of surgery."

We've come a long way since Dr. Austin Moore performed the first hip replacement in the U.S. 40 years ago. Since then 900,000 THR's have been performed in North America. Last year over 120,000 of these operations were done in the U.S.

Human bodies are like old cars. Some parts wear out quicker than others. Since the hip is one of the hardest working joints it tends to fails sooner and more often than others.

The most common cause of hip failure is osteoarthritis, the wear and tear disease. This condition results in gradual deterioration of the cartilage that cushions the bones within a joint. And without this padding the surfaces of the joint become irregular and inflamed.

The long term use of cortisone like drugs may also result in a damaged hip joint. And alcoholics are more likely to develop this condition.

Worn out hips are replaced with plastic and stainless steel ball©and©socket joints. The surgeon cuts off the top of the thigh bone and drills out a hole about six and a half inches (16 cm) deep. The long shaft of the prosthesis is then driven into the reamed out thigh bone.

The ball at the top of the shaft fits into a cup©shaped socket made of plastic usually encased in metal. A type of acrylic cement is used to attach the prosthesis to the thigh and pelvic bones.

Surgeons have discovered however, that artificial hips can also wear out. But about 85 per cent of patients fitted with this type of prosthesis continue to walk after 15 years of use.

One of the post©surgical problems has been eventual cracking of the cement. This results in a loose©fitting joint. To circumvent this problem researchers developed a cementless joint in the early 1980's.

This new prosthesis has a rough, unpolished, penetrable surface. This allows bone to grow into and around the prosthesis providing a natural supporting structure.

These joints can also loosen, it appears, with continued wear and tear. Debris collects in the joint causing renewed pain.

New techniques are being developed to make cemented hips more durable. For instance, surgeons can mix the cement in a vacuum to make the adhesive stronger. Then insert the cement under pressure.

The type of hip chosen for an individual depends on several factors. In general, cementless joints are used in younger patients where natural bone growth is more likely to occur. Moreover cement is unable to withstand the more strenuous activity of younger patients. Patients over 70 are more often given a cemented hip.

How close can surgeons get to developing the perfect hip? In the past patients between 50 and 70 years of age have often been given a "halfbreed" type. In this case the shaft of the prosthesis is cemented into the thigh bone and the ball and socket left to nature to secure.

A panel of experts who gathered recently at the National Institute of Health in Bethesda, Maryland, said this type may become the "gold standard".

These experts reported other good news. They claim that 90 to 93 per cent of all artificial joints never have to be replaced or revised. And that some day artificial joints will last up to 30 years. In effect a lifetime for those who receive one.

Remember that hip replacement is not minor surgery. Following the operation infection can occur or a blood clot can travel to the lungs. There's also a danger for about 10 weeks that a new hip can become dislocated. This complication requires returning to hospital and possibly several weeks in traction.

We've come a long way from the prolonged bed rest that used to be required. Now the hospital stay is reduced to a few days followed by physical therapy.

Due to these new improved techniques more than 90 per cent of patients experience a smooth recovery from this operation. There's no doubt that the development of artificial hips has been one of the major surgical triumphs. It gives a new lease on life for those disabled by a frozen painful hip.

But remember to use common sense after this operation. No one suggested that Bo Jackson play baseball after his surgery. If that's sound advice for an athlete who has bone stock like granite, it's sound advice for us all.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod