Dr. Gold's Orthopedic Surgery Blog

Often times, my patients experiencing severe hip pain appropriately ask me, “Are there any alternatives to hip replacement surgery?” This is a great questions which requires a meaningful discussion. As many of you know, I believe surgery should only be considered once the alternatives are researched and evaluated.

A partial or total hip replacement may be the best solution for some patients. However, there are alternatives that each patient might wish to explore prior to opting for the surgery. Individuals should review the possibilities with their physicians since every case is different. In general, surgery should only be considered if traditional treatments such as medications and physical therapy have not been successful.

If the pain is due to a misalignment of the joint known as hip dysplasia, a femoral osteotomy might be a suitable alternative. The procedure requires a patient whose weight-bearing hip area is capable of being broadened. The surgeon cuts the femur to realign it in its proper position. Recovery may be lengthy and is often longer than the recovery following hip replacement surgery.

Arthodesis is a procedure to fuse the femur head to the acetabulum. During surgery, a plate is normally screwed into place and some patients will need a cast to immobilize the joint while it heals. Arthrodesis is basically hip fusion, and therefore it eliminates the joint’s ability to move and leaves the patient with a limp. Because the patient’s back will have to compensate for lost hip movement, ideal candidates must not suffer from back pain or immobility. The procedure is not widely performed exempt in younger patients whose livelihoods depend on their ability to perform heavy labor.

With hip resurfacing the surgeon inserts a cap on top of the femur. This conserves the bone, and since he does not need to insert a stem into the femur. As the patient’s bone must be of good quality, patients with osteoporosis or similar conditions are not ideal candidates for the procedure. Many patients have been able to return to an active lifestyle, including running, after a hip resurfacing.

If the patient has a severe, uncontrollable infection or a physical condition that precludes normal walking, a resection arthroplasty may be performed

. In this procedure, the surgeon removes the bone surrounding the hip joint. Scar tissue will eventually fill the space. Almost all patients undergoing the procedure will need to use some type of walking aid on a permanent basis.

I hope this helped you better understand hip replacement alternatives.

Until next time,
Stuart

In August 2010, Johnson and Johnson issued a recall for hip replacement systems sold by DePuy Orthopaedics, one of its divisions. The two systems involved in this recall were the ASR-XL Acetabular System and the ASR Hip Resurfacing System. Since introducing the devices in 2003, DePuy reportedly sold more than 90,000 of these two systems worldwide.

Johnson & Johnson Hip Replacement Recall

Statistically, it is expected that no more than 5 percent of patients who undergo this type of surgery will need a corrective operation within five years. However, data revealed that between twelve and thirteen percent of patients receiving the ASR systems needed additional surgery within that five-year time span. Surgery to revise a hip replacement is more difficult and the patient’s recovery may take longer than after the initial surgery.

Patients involved in the Johnson and Johnson hip replacement recall typically complained of swelling, pain, and difficulty in walking. If not corrected, these issues can lead to more serious complications. The implant may loosen or dislocate, or the bone may fracture, and falls can result. The devices can also release toxic metals into the patient’s bloodstream.

The Federal Drug Administration granted DePuy permission to forego clinical trials and begin marketing the devices in 2003. In 2008, researchers from the United Kingdom began conducting tests on the prosthesis. They reported that the joint, which placed two pieces of metal in contact with each other, was eroding and leaching metals into the blood.

Early in 2009, DePuy began marketing a new head for their implants, stating that it “reduced associated ion release” significantly when compared to conventional devices that used metal-on-metal construction. There might have been a Johnson and Johnson hip replacement recall at that point, but the company did not act. They did, however, discontinue the ASR devices later in the year, but they never issued a recall or notified the public of potential problems from the implants.

The issue came to a head in 2010, when the UK’s equivalent of the FDA issued alert-advising physicians to monitor patients who had received the devices for cobalt and chromium toxicity. Soon after, the state of Alaska, through its Department of Health and Human Services, recommended that physicians develop a plan to monitor patients for toxicity and the need for additional surgery.

The Johnson and Johnson hip replacement recall announcement stated that the company would cover customary, reasonable costs for treatment, including additional surgery if required. No mention was made of lost wages or compensation for pain or suffering. However, some patients have sued and been awarded settlements

.

Until next time,

Stuart