My surgeon says I'm over the age limit to be considered for a hip joint resurfacing procedure. I really hate the thought of having a total hip replacement when I could have something less dramatic. Would another doctor consent or is this age thing really set in stone?
The current thinking on this subject is that older patients don't have the bone strength and density to hold up under joint resurfacing. The danger of a femoral neck fracture is too high. And older adults who are less active don't need resurfacing. They can get a total joint replacement that will last them the rest of their lives.
But there really isn't much evidence to support any of these arguments. A recent study compared results of hip resurfacing between two age groups. The first group was 60 years old or older. The second (larger) group was younger than 60 (between 18 and 59 years old).
Patients in both groups were operated on by the same surgeon during the same time period. They all received the same type of metal-on-metal resurfacing implant. Both the femoral and acetabular components were resurfaced. Results were measured using clinical outcomes such as pain and function, as well as comparing X-rays and complications.
The results were very similar for both groups. Recovery time was the same regardless of age. X-rays showed equal angles for the cup placement and femoral head and neck. These angles indicate accurate placement of the components needed for good results.
And the number of problems that occurred after the surgeries was also very similar between the two groups. The results of this study support the use of joint resurfacing for older adults. This is consistent with the few other studies that have also been published.
Failure rates and poor function of hip joint resurfacing is the same in older adults compared with younger adults. Quality of bone and deformity of the femoral head and neck are the major risk factors for poor outcomes. And at least from this most recent study, these are not necessarily linked with age.
Adults are living longer and staying more active suggesting the need for treatment alternatives such as joint resurfacing. Age alone should not be the sole determining factor of whether or not someone could benefit from this procedure.
The authors do point out that their results only extend for three years, so more time is needed to judge the final results. In time, you may see a more routine use of this procedure with all age groups.
Mike S. McGrath, MD, et al. Total Hip Resurfacing in Patients Who Are Sixty Years of Age or Older. In The Journal of Bone and Joint Surgery. Supplement 2008. vol. 90-A. No. 8. Pp. 27-31.
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