HEALTH & FITNESS technology It's Hip! New technology makes orthopedic surgery less traumatic. Ilene Wolff Special to the Jewish News T hey're good for balancing a baby or a bag of groceries, mastering the yoga lotus pose and keeping your upper body connected to your lower body. What are they? Your hips! Unfortunately, the ball-and-socket con- struction of hips can wear out. This can cause pain, affect a person's balance and movement and may keep one from per- forming activities of daily living or pursu- ing physical activities such as dancing and sports. Fortunately, orthopedic surgeons at Royal Oak-based Beaumont Hospitals offer traditional hip replacement surgery in addition to several alternatives for those whose hips are in less than optimal condi- tion. Not Yet, Doctor Ira Zaltz, M.D., "looks" inside the hips with magnetic resonance imaging and ultra- sound to guide him in reconstructing the hip joint, which can delay or eliminate the need for hip replacement. Using minimally invasive surgery, he can repair cartilage and can move and reshape the hip socket and the head of the femur, the long bone that makes up a person's thigh. "About 80 percent of hip arthritis is caused by abnormal anatomy. Either the socket is too shallow, leading to abnormal stress in the joint; or the femoral head impinges on the rim of the socket, lead- ing to cartilage damage and tears;' says Zaltz. "What I do at Beaumont are differ- ent surgical procedures to normalize the hip mechanics in order to relieve pain, improve function and slow or stop the arthritic process This procedure is good for those in their teens to early 40s. If people that young had a hip replacement, it would wear out and then have to be redone in about 10-20 years. This limits a surgeon's options to create a smoothly functioning hip joint. It would also require significant changes in a person's lifestyle, limiting his activities. Keep Moving For those younger than 60, who are physi- cally active and have healthy bone, James Verner, M.D., offers a procedure known as hip resurfacing. He implants a dome- A38 July 31 2008 shaped insert into the hip's socket portion and reshapes the head of the femur to accept an anatomically sized metal sphere. The head of the femur is retained and there is no large stem to insert into the femur itself as there is in hip replacement. "One advantage to hip resurfacing is that we can still do a hip replacement later if necessary because we still have a lot of bone to work with,"Verner saysAnother advantage of resurfacing over traditional hip replacement surgery is that patients can resume unrestricted activities once they are healed. "For younger patients with excellent bone strength — most often men under 60 — the resurfacing eventually enables them to return to high-impact activities such as running and other sports." There is good range-of-motion because the socket is larger and the ball can move more freely than with a hip replacement. These benefits come at a price though: The procedure is technically difficult because the surgeon is trying to preserve most of the joint and is working in a small area. A Kinder Cut To those for whom a hip replacement is the best option, Perry Greene, M.D., offers a minimally invasive procedure. He makes a 3- to 4-inch incision instead of 12-14 inches as in traditional hip replacement. "My experience is that patients with minimally invasive hip replacement sur- gery are more comfortable and active in the first month afterward than those who have the traditional approach;' says Greene. "The only contraindication to minimally invasive hip replacement is pre- vious surgery on the legs!' The advantages to minimally invasive hip replacement are that there is less trau- ma to the bone and surrounding tissue and less postoperative pain, which leads to a reduced need for pain medications. Patients usually go home one day sooner than those having traditional hip replace- ment surgery. And they usually are more comfortable and active within a month after surgery. Poor Bones The average hip replacement lasts 10-20 years, depending mostly on a person's activity level and size and some underly- Perry Greene, M.D., James Verner, M.D., Michael Hubers, M.D., Ira Zaltz, M.D. and Chairman Harry Herkowitz, M.D., all of the Department of Orthopaedic Surgery at Beaumont Hospital, Royal Oak. ing health condition such as osteoporosis, kidney disease and steroid use. If a per- son's hip replacement wears out, Michael Hubers, M.D., offers an option that can be used even in those who have lost signifi- cant bone — due to either age, reaction to wear, fracture or previous infection — whose hip replacement revision would be complex. Hubers is able to offer this option due to a replacement hip socket that's made out of an extremely porous metal, tantalum. It was initially used in the construction of submarines and shares many physical and mechanical properties with bone. Because tantalum is so porous and scratchy, it allows bone to grow into its open spaces, creating a stronger bond between bone and replacement. "In patients with severe bone loss, the hip wasn't easily rebuildable before says Hubers. "Now we can rebuild it without bone grafts, that often fail!' Revising a hip replacement with this technology is faster and easier, resulting in less time under anesthesia and decreased blood loss. Beaumont Hospital in Royal Oak has been recognized as fourth in the United States and tops in Michigan for the num- ber of Medicare patients receiving hip replacement surgeries, according to the Orthopedic Network News. "Being ranked among the national lead- ers on this list for hip replacement proce- dures reinforces our surgeons' expertise, dedication and specialization in these areas;' says Harry Herkowitz, M.D., chair- man of Orthopaedic Surgery at Beaumont Hospital, Royal Oak. "Volume and experience equate with high quality and better outcomes and allow us to provide specialized nursing care units and operating rooms exclusively for joint replacement surgery" Beaumont also offers rehabilitation ser- vices that will help patients improve their ability to move and perform functional activities in their daily lives after hip replacement surgery. ❑ Ilene Wolff is a marketing specialist with Royal Oak-based Beaumont Hospitals.