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Oct. 1, 2011 – Jack Sirard contributing writer

With Americans living longer and longer, it comes as no surprise that some of their individual parts will give out long before they do.

Take hips, for instance. With adults being more and more active later in life, their hip joints often take a beating and need to be replaced.

In fact, hip replacement surgery is becoming quite fashionable among those in the senior set. But while the surgery most often provides a new lease on life, it is not without its critics.

Recent national reports have pointed out that the federal government has received a surge in complaints about failed hip replacements, particularly those that are known as metal-on-metal hips.

Tom Imming, who plays for the 65 Major Game On and the 70 Major Thousand Oaks Panthers, says not only did he have a hip replacement, but the device that was used was on the recall list.

“I had a bunch of lawyers call me after the reports came out, but I told them that I’m doing just fine. In fact, I never felt better,” says Imming who lives in Arroyo Grande, Calif.

He notes that he had his right hip replaced three years ago when he was 67 “and you wouldn’t know that I ever had anything done other than a small two-inch scar that is gradually fading away.”

Imming notes that his surgeon discovered that he had a small birth defect in his hip that he had not been aware of. “My doctor found that my hip socket was at least one-third flat and not curved as it should have been. As a result the hip ball didn’t set in as well as it should have and had less than two-thirds of the cartilage that it needed. But he was able to carve out a socket in the pelvic area and gave me a larger hip ball that gives me more mobility and it will last longer.”

For Imming, mobility is extremely important because not only does he compete in senior softball, but he is an active participant in track and field. At age 70 he competes in the long jump, triple jump, high jump and pole vault and has been awarded USA Track & Field status in all four events.

Imming says after the hip replacement surgery he was up and walking the next day and walking three miles a day in two weeks. Three to four weeks later, he was back out on the softball diamond hitting balls but not going full tilt for another few weeks.

He says he’s paid close attention to the reports of trouble with the hip replacement surgery and adds that his doctor called him immediately after the report came out. “My doctor has done more than 400 or these surgeries and has only had problems with two of them. My understanding is that the problem is that the patient’s bone doesn’t adhere to the metals, but that wasn’t the case with me.”

The American Association of Orthopaedic Surgeons said in August that “ongoing reports may heighten concerns among patients about joint replacements using metal-on-metal bearing devices. The group noted that any concerns — before or after surgery — should be addressed with a patient’s orthopedic surgeon. “Nearly 400,000 hip replacement surgeries are performed each year, and the overwhelming majority are uneventful procedures that restore mobility and enhance quality of life for patients,” the AAOS said.

The AAOS reports that “after you and your surgeon have determined you are a candidate for hip replacement surgery, your surgeon will select a hip replacement device for you based on your body structure, medical history and lifestyle.”

Dr. William R. Gallivan Jr., a Santa Barbara, Calif., orthopedic surgeon, says that the knee, hip and shoulder replacement surgeries are becoming more and more common.

“We do about 400,000 hip surgeries a year in the United States now, but by the year 2030, it is expected to be as high as 3.5 million a year.”

“The beauty of the surgery is that it absolutely improves a person’s quality of life, getting them back to where they want to be to do what they want comfortably.”

He notes that most of the surgeries “are what I call time and gravity related” as an individual’s joints wear down with age. “And if there is a significant predisposition to arthritis, we can expect to see a need for the surgery in time,” he adds.

He points out that there are always risks with any surgery such as infection. “But we see that less than 1 percent of the time. For the ultimate risk of death, I like to say that the surgery is safer than riding in a car. For patients, the scariest thing is their ride to the hospital, not the surgery.”

He says that hip replacement can take as little as an hour and 15 minutes. “Surgery and recovery is much faster than it used to be because of the tools we have are better and more refined and using computer navigation we can be more accurate.”

He points our that the principal reason some patients have to have their surgery redone is that “there has been a biological failure of the implant and the bone not growing together correctly.”

The AAOS notes that many different types of designs and materials are used in artificial hip joints. All of them consist of two basic components: the ball component (made of a highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic/polyethylene, ceramic, or metal). Sometimes, the socket is made of a different material than the ball, or is lined with a different material, and sometimes the ball and socket are made of the same material.

“All hip implant devices — no matter what type — can have complications. The most common complications include implant dislocation and device wear,” the AAOS says.

Bone loss, or osteolysis, is also a known complication. When the ball component moves against the cup, the surface begins to wear away and small debris particles are given off. The debris remains around the joint and over time can cause the bone around the implant to thin and weaken. As a result, the implant components can loosen and additional surgery may be necessary, the AAOS reports.

Metal-on-metal implants have been used because they avoid the complication of debris wear from implants made of plastic/polyethylene, the association says.

“However, recent information about the wear of certain metal-on-metal devices has raised concerns about their use. Like polyethylene, metal surfaces give off small particles of debris. In addition, metal surfaces can corrode, giving off metal ions. Metal debris (ions and particles) can enter the space around the implant, as well as enter the bloodstream. This can cause a reaction in some patients, such as pain or swelling around the hip, osteolysis, and very rarely symptoms in other parts of the body.”

Although the vast majority of patients have not had any problems with metal on metal implants, orthopedic surgeons and the U.S. Food and Drug Administration are concerned because cases have been reported in which patients have local hip symptoms (pain and swelling). Manufacturers of metal-on-metal hip implants have orders from the FDA to further study the safety of metal-on-metal devices.

In addition to hip replacement surgery, there is a procedure called hip resurfacing.

Barbara Fischetti, age 58 of Bethel, Conn., had this done one year ago with the goal of allowing her to continue to play competitive sports.

And as she plays softball five to seven times a week in addition to competitive racquetball, mobility is important for her.

“I had bad arthritis in my hip and the joint was virtually down to bone on bone. But after talking to my doctor we decided that hip resurfacing worked best for me,” she says.

She notes that a standard hip replacement replaces the acetabulum (hip socket) and the places a femoral component inside the femur (thigh bone). Hip resurfacing replaces the acetabulum in the same way but resurfaces the femoral head. This means the femoral head has some or very little bone removed that is replaced with the metal component. This spares the femoral canal. She said her doctor calls it a more conservative and less traumatic alternative to total hip replacement.

Fischetti says she took her physical therapy very seriously and was able to return to the playing fields in just six months. “I now have a great range of motion and really enjoy playing with the Connecticut Senior Moments and the New York Metros.

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