I've heard that only male athletes are being given the new hip joints where they resurface rather than replace the joint. Is this really true?
There is some truth to your statement but not for reasons of gender discrimination. Hip resurfacing is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement.
Special powered instruments are used to shape the bone of the femoral head so that the new metal cap will fit snugly on top of the bone. The cap is held in place with a small peg that fits down into the bone.
The acetabulum (hip socket) may remain unchanged. But more often it is replaced with a thin metal cup. The acetabular component is pressed into place in the socket. Friction holds the metal liner in place until bone grows into the holes in the surface and attaches the metal to the bone.
The patient must have enough healthy bone to support the cap. That is the real heart of the issue. Many women do not have strong enough bones to qualify for this surgery. Any sign of osteopenia (decreased bone density) or osteoporosis (brittle bones) excludes them from this approach.
The reason for this is that too many patients suffered from a femoral neck fracture within the first six months after joint resurfacing. They ended up with revision surgery to replace the resurfacing with a total hip replacement. Some men were affected, too. They were usually older, small-boned males.
The new joint resurfacing has made it possible for older adults who are active but hampered by arthritis to remain active. Some can return to work or sports participation pain free and functional for many more years.
It's probably only a matter of time before researchers are able to find a way to include all patient groups in this treatment alternative. This will include men and women of all sizes and shapes.
Michael A. Mont, MD, and Thomas P. Schmalzried, MD. Modern Metal-On-Metal Hip Resurfacing: Important Observations From the First Ten Years. In The Journal of Bone and Joint Surgery. Supplement 2008. Vol. 90-A. No. 3. Pp. 3-11.
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