Hip to be spared...

This post is a bit nontech, but perhaps many people will be interested in what I am experiencing. I left Tokyo on 14 October for NYC, and will remain in NYC a few weeks. I'm getting my hip joint fixed.

I've always been physically active in my adult life, but had to stop nearly everything 2 years ago because my right hip was giving me problems. This meant the end of biking, running, hiking, basketball, raquetball, and my passion - ultimate frisbee. It was a hard pill to swallow, but the pain and the diagnosis by a Japanese doctor indicated the hip joint was failing. I was told to lose weight and bike or swim to keep in shape, and hope to delay joint replacement until my 50s (I was 41 at the time).

Well, in the two years that followed I couldn't do much exercise because of the excruciating pain. Biking was impossible. Swimming was OK, but the distance I had to walk to do it was often difficult. And with my job standing and lecturing, as well as use of trains for my commute - things deteriorated. Adding a few pounds didn't help either.

In May of this year, the pain was so bad I went to a nearby clinic to see an orthopedist, and he told me the joint was in its 'terminal' phase, and that my left one was not in good shape either. You can see the Xray at right, bad hip is on the left side of the photo.

I started looking for local solutions to my problem - in Japan. I went to a reputable orthopedic hospital in Shinjuku and was told they could do total hip replacement (THR), and use a ceramic joint fitting. Unfortunately, THR is very destructive, basically cutting off the entire top quarter of the femur. And THR's may only last 10-15 years, with revisions requiring more bone destruction. Usual candidates for THR are in their late 50s or 60s, but for someone my age I just couldn't see whacking off so much bone. Unfortunately, this is the only technique readily available and in common practice in Japan.

You can see a THR example below left. This image is from Dr. Edward Prince, M.D.

Fortunately, there are other alternatives to THR, namely a relatively new technique called 'joint resurfacing' that was tried (and failed) in the 1970's, then completely revamped
about 10 years ago. The original successful version of joint resurfacing is the Birmingham Hip Resurfacing System (or BHR) developed by Derek McMinn in Birmingham, England. BHR was in use in England from 1997, and was FDA approved for use in the US in May, 2006. There have been other similar systems developed (Cormet, e.g.), but BHR seems to be the most commonly used. The advantage of BHR is very clear for younger patients: less bone loss, more future options, higher potential levels of activity. You can see from the below right BHR photo (from Orthoworks, UK), that the implant size is considerably less - a femoral cap over or replacing the ball and a matching cup inserted into the pelvis. There are reports of many athletes having this surgery, including Floyd Landis, and they are able to continue their activities at similar or higher levels.

Of course, there are potential problems with BHR, and with only 10 years of supporting data - there are a lot of questions that remain unanswered. The first of these is longevity. We just don't know the lower or upper limits of lifespan of BHR implants. The other issue is the potential problems from metal on metal joints releasing ions into the bloodstream. BHR uses Chromium Cobalt, and there isn't enough long term info to determine its effect. Another risk involves stress on the femur neck. Therefore, the placement of the implant is critical. The angles must be carefully worked out so that stress doesn't exceed the bone's capacity. This also means that the patient needs to have good bone mass to support this implant, compared to THR.

Fortunately, I meet all the criteria for BHR and am at the young end of the spectrum (average age is 48 years). Unfortunately, I had to look outside of Japan. Yes, there were a few places offering BHR in Japan, but the replicates of BHR performed were very small by those surgeons. Given the importance of positioning the implant correctly, a surgeon's number of BHR surgeries (as well as successes) is critical. BHR is relatively common in Europe, with Dr. Smet in Belgium having the most experience. There are actually two or three UK trained surgeons in India performing BHR (Dr. Bose in Chennai the most senior of these), and the cost of doing that surgery is very low compared to the US. Medical tourism to India is very popular, as a result of such low costs.

Given that US surgeons have only had limited time for BHR, only a few have had much experience, including the trials leading to FDA acceptance. Since my insurance was willing to pay for nearly all expenses, I decided to look for surgeon in the US with experience. When I combined this with a comparison of the best hospitals for orthopedic surgery, I came up with one particular choice: Hospital for Special Surgery (HSS) in New York City, and Dr. Edwin Su. HSS has the lowest infection rate in the country, as well as the highest ranking by US News and World Report. Dr. Su has nearly 400 BHR cases to his credit, and I liked the fact that he is publishing research papers on his surgical work. Plus, I was able to find and email him directly - and he answered me in short order. So, about 2 months ago I began making arrangements to come to NYC for my surgery. There have been many hurdles, but Dr. Su's office staff made many efforts to help me out. The hardest part for me has been separating from my 11 month old daughter and wife for a few weeks. But after meeting Dr. Su and the hospital staff, I know that I made the right choice. I'm in very good hands. These are quality people.

So, I go under the knife on Oct 19th, and will probably stay in NYC for at least 2 weeks after for rehab. I'll probably post more of my experience in the future. In the mean time, I will try to see some of NYC.