New Options for Hip Surgery

The artificial hip is indeed a medical miracle, but the joint replacement surgery usually lasts only 20 years or so. Each year about 300,000 Americans undergo hip joint replacement surgery. As younger patients avail themselves of this type of hip surgery, the problem of “outliving” the joint replacement must be faced.

Middle-aged or younger people with hips damaged by disease or injury are often cautioned to put the surgery off as long as possible. In the meantime, many are plagued with pain and disability.

Now, an alternative surgical procedure may make the waiting game a thing of the past. Because extracting and replacing a worn-out or defective artificial hip is difficult, more surgeons are turning to hip resurfacing. Surgeons using this procedure preserve enough of the healthy bone to allow for a future total hip implant when benefits of hip resurfacing wear out.

In the past decade, tens of thousand of patients worldwide have undergone hip resurfacing. Many U.S. “medical tourists” had the procedure done overseas, where doctors are experienced in the technique and costs are lower. Popular destinations are Britain, Belgium or India, where costs may be half what they are in the U.S.

Hip resurfacing surgery is no easier for the patient or physician than hip replacement, and the incision is usually larger than with a total joint replacement. Complete healing can take six months or longer. The advantage is that the patient will still be eligible for a total hip replacement using an entirely new artificial joint rather than having a revision of the old one.

Hip resurfacing and total hip replacements both involve implanting a metal cup in the pelvic socket. The difference is mainly the way each procedure treats the top of the femur, the long thigh bone that fits into the socket. In resurfacing, the femur is shaved to a rounded shape and covered with a metal cap, with a spike that is cemented into a small hole drilled into the center of the femur.

With total hip replacement, surgeons saw off the entire head of the femur and replace it with a larger, hemispherical device that is anchored with a much longer spike and driven deeper into the femur. This procedure leaves too little strong bone to allow for follow-up with an entirely new total hip replacement if this joint wears out.

Hip resurfacing is not minor surgery. It requires a highly skilled surgeon, and the operation usually takes a bit longer than the three or four hours of total hip replacement. In addition, patients lose more blood, although transfusions are rarely needed.

With either procedure, problems can occur, but they are unlikely. Complications that are possible with either surgery include infections or fractures. Since hip resurfacing is so new, we are unlikely to know how durable the resurfaced hips are until the 20-year mark is reached in the earliest patients.

Doctors advise patients, especially younger ones, not to even think about either procedure unless they are in pain every day. Most people won’t want to take on the risks of either type of surgery, and the complications that could arise, just to improve their golf game or to be able to resume jogging.

Source:  New York Times

Add comment April 16th, 2007

New Breast Screening Information Is Confusing to Women

This spring, new information came out about breast cancer screening, much of it perplexing to women. Past guidelines for annual mammograms included women in their 40s. Now, a major medical group disputes the need to screen women between the ages of 40 and 49.

The American College of Physicians has issued new and controversial guidelines. Their rationale is that for every 10,000 women screened in their 40s, perhaps six might avoid death from breast cancer. In addition, a high percentage of false positives could lead to unnecessary biopsies, increased costs, and potential for injury. Younger women receiving annual screenings might also incur a tiny risk of cancer developing from radiation used in mammograms.

All medical groups and experts agree that women 50 and over should get regular annual mammograms. Some women are known to have a very high risk of developing breast cancer — based on a strong family history or genetic testing showing defective BRCA1 and BRCA2 genes. The American Cancer Society recommends screening mammograms and MRI imaging for these women, beginning at age 30. Sonograms are also used for more definitive imaging in high-risk young women whose breasts are quite dense.

Recently, a new study found that MRI scans can detect tumors mammograms missed in about 3% of women. This sensitive technology, not available in all hospitals, often picks up suspicious but harmless growths that need to be biopsied. The result can be costly procedures that might cause unnecessary alarm in women. For those few in whom cancer is found at an early stage, MRI can prove valuable and, hopefully, life-saving.

Another controversial subject is a computer-assisted program designed to help radiologists identify small cancers on mammograms. This system has proved to be no more effective than traditional mammography read by an experienced radiologist. The technology also has led to many false alarms requiring needless biopsies. About 30% of mammography centers use computer-assisted technology, and no clear medical benefits have been found. Government and private insurers may be re-evaluating whether these expensive systems are worth the price.

The best advice in the screening controversy is to assess your risks carefully with your physician and determine what is right for you. If you are very high risk for breast cancer, use all available technologies at an early age. Early detection is still the best strategy.

Source:   New York Times

Add comment April 7th, 2007