Media briefing covers hip treatments in young, active

This year, the oldest of the baby boomers — those born between 1946 and 1964 — will turn 60. Many in this generation want to continue their previous participation level in exercise and recreational sports, which may lead to earlier cases of hip arthritis, injury and disease.

At a media briefing held Thursday, a panel of orthopaedic surgeons who specialize in total joint replacement examined this trend. The experts discussed advances in detection, evaluation, treatment and surgical and non-surgical options for musculoskeletal conditions affecting younger patients’ hips.

“We are seeing an increasing patient base of adults in their 20s and 30s — as well as those in their 40s, 50s and 60s — who lead extremely active lifestyles and put very high demands on their hip joints,” explained Joseph C. McCarthy, MD, president of the American Association of Hip and Knee Surgeons.

If patients have hip arthritis, they should first be offered non-surgical options, such as weight management, anti-inflammatory medication and gentle physical therapy, according to Robert T. Trousdale, MD, of Rochester, Minn. Because there are many different causes of hip arthritis, an orthopaedic surgeon should first pinpoint the source of the pain and detect it on x-rays to determine the most appropriate treatment, he advised.

“One of the latest advances for detecting damaged or torn cartilage, cartilage loss or loose bodies within the hip is through a gadolinium-arthrogram magnetic resonance image (MRI),” said Dr. McCarthy. “In this procedure, contrast material is injected into the hip joint, allowing for specific views and sequencing.” This is currently the most accurate non-surgical method available to evaluate hip pain that is not apparent on plain x-rays, conventional MRI or computerized tomography (CT) scans.

When surgery is necessary, some patients may qualify for less invasive total hip arthroplasty and hip resurfacing. An biologic alternative to total hip replacement, hip arthroscopy is performed to smooth out the hip, repair a labral cartilage tear or remove a loose body. “These less-invasive procedures may offer less risk; a faster rehabilitation to return to work and an active lifestyle; and less long-term activity restrictions, in select patients,” said Dr. McCarthy. Selecting the proper procedure for a patient centers on the question of whether the additional risks of these less-invasive techniques are worth the benefits. Not all patients are candidates for these types of surgery, depending on the type of injury and the patient’s overall health.

“Hip resurfacing is best utilized in patients who are at risk for a failure of total hip replacement,” said panelist Thomas P. Schmalzried, MD, of Los Angeles. “In general, these are young and active patients with good bone in the proximal femur, or the top of the thigh bone.”

With regard to types of implants, the experts explained the wear rate for ceramics is slightly less than the metal on metal, but both are extremely low. “Ceramic implants are most frequently used in younger, active people, where the replacements will theoretically last longer throughout the course of their lives,” Dr. McCarthy said.

Most patients who have undergone hip replacement can remain physically active, as long as they adhere to certain restrictions as recommended by their orthopaedic surgeon. “For total hip arthroplasty, regardless of the bearing surface — such as ceramic, plastic or metal — we recommend patients avoid high-impact sports, such as competitive running, due to the risk of accelerated bearing wear,” explained Dr. McCarthy.

According to Dr. Schmalzried, there have been important improvements in the functional capacities in total joint replacement, but the exact longevity of the current generation of devices is not available. “The longevity of a joint replacement could be compared to the lifetime of set of tires,” he explained, “because it’s more a matter of how much use the joint gets, rather than a function of time.”

In addition to implant components that wear much better than those used in previous generations, Dr. Trousdale noted surgeons have perfected the technical care of soft tissue to enhance patients’ recovery. “Hopefully we can advance patients’ quality of life with a combination of improved techniques and access to the newest and safest products to provide maximum durability,” he said. Dr. McCarthy added that research is currently being done to assess the efficacy of partial surface replacement, biological cartilage repair and artificial cartilage replacement — all of which hold promise for extending the mobility of active patients in years to come.

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