Surgeon offers modern repair technique for young people

By CANDACE CHASE

The Daily Inter Lake

Orthopedic surgeon Dr. Lawrence Iwersen at Flathead Orthopedic Center offers the hippest new procedure designed specifically for younger adults plagued by chronic hip pain.

Called the Birmingham Hip Resurfacing System, the surgery removes less of patients' bones and less of their post-surgery lifestyles compared with total hip replacements.

"The amazing thing is it looks like you can go back to an active lifestyle," Iwersen said. "I talked to someone who ran a marathon after this operation, although we don't like impact sports."

Because of the recent approval by the Food and Drug Administration, long-term studies haven't been completed. But Iwersen said English surgeons have performed the procedure for about 10 years.

"They've have very good results," he said. "Generally, it's an operation for very active younger adults."

In the orthopedic world, "younger adults" translates to people younger than 60. Iwersen said the average age of total-hip-replacement patients is about 70, though that age is dropping as new options emerge.

He explained that a total hip operation removes the femoral head and neck. The resurfacing shaves off just a few centimeters of the head to reshape the bone to accept a mushroom-shaped implant. The femoral neck and head refer to the angled bone (neck) with a knob (head) off the top of the thigh (femur) bone. The knob fits into the hip socket.

Iwersen said the cup side that receives the implant is the same as the total hip replacement.

"We preserve the femoral neck so it can be converted to a total hip at any time," he said. "We haven't burned that bridge."

Iwersen said a patient must have "good bone stock" with no osteoporosis or osteopenia to qualify for the resurfacing. Patients take a density test to confirm their bone quality before the procedure.

Active people generally have very good bones, because exercise keeps osteoporosis at bay, Iwersen said. Their hip problems may stem from bad accidents, genetics or hard poundings from athletics.

Athletics don't account for the majority of early hip failures, he said. Arthritis, genetics and accidents take a greater toll.

As an example, Iwersen said motorcycle accidents often dislocate hips, leading to avascular necrosis, a devastating condition caused by poor blood supply to the bone.

"Then the ball on the femoral bone dies," Iwersen said. "That's what happened to Bo Jackson."

Alcoholism and corticosteroids (steroid hormones) cause even more cases of avascular necrosis in young to middle-aged adults.

Hip deterioration from all causes develops gradually, Iwersen said. Most people start with conservative treatments to decrease the inflammation and pain radiating from the hip joint.

Physicians recommend lifestyle modifications, such as weight loss and avoiding long periods of walking or standing to relieve stress on the hip.

"They can use a cane, but it's amazing how people fight that," Iwersen said with a laugh. "They'll use one after surgery because that's short term."

Exercise, physical therapy and medications also provide relief for many people. Surgical intervention comes when these measures no longer help.

Previously, options were limited for younger people, because total hip replacements might not last for their lifetimes. The Birminghamresurfacing fills that gap while providing excellent range of motion and good stability.

"People get their strength back because they're young," Iwersen said.

He said the procedure may involve a longer recovery time but younger, active people typically are highly motivated and in good shape. Iwersen said the recent winner of the Tour de France, Floyd Landis, had this procedure and returned to bicycle racing.

After the FDA approved hip resurfacing, Iwersen began training in the operation.

"For years, I've been interested in this," he said. "It's actually an old procedure. But, as with many things in these surgeries, the materials are getting better and better."

Iwersen the stability of the metals has improved, allowing for a larger ball that prevents the implant from popping out of the cup. He said this was an improvement because larger ball experienced greater wear.

Along with better metallurgy, technology has produced better materials to fix implants into the bone. Studies show 98.5 percent implant survival at the five-year mark, comparable to the rate for total hip replacement in patients younger than 60.

Iwersen said his training included performing the procedure with the surgeon who developed it. He learned about appropriate candidates and challenges that may arise.

kkellogg 5/16/07 He performed the first two in the Flathead in January. One patient was in his early 40s and the other was in his early 50s, but they both decided it was time for surgery.

"They were in a lot of pain," Iwersen said.

He said people make the decision to go forward when they can't put on their shoes and socks, get in and out of cars or sleep at night. Both patients had excellent outcomes.

The operation requires an incision averaging 6-8 inches. Iwersen said the surgery takes about 20 minutes longer than a total hip replacement.

Patients spend between two and four days in the hospital. One of Iwersen's first two patients left the hospital in just two days.

"It's a three-month recovery," he said, similar to a total hip replacement.

One patient enrolled in rehabilitation; the other didn't. Iwersen said he doesn't insist that all patients take formal rehabilitation if they think they can do it alone.

Iwersen said patients return to their previous active lifestyles after about a year. He said he recently had a follow-up with one of the patients.

"He's doing fantastic," Iwersen said.

Because the procedure is relatively new, the operation costs more than a total hip replacement. Since FDA approval, insurance companies are cover the procedure.

According to Iwersen, quite a few people in the valley had the operation before the FDA approved it a year ago. He referred patients to participate in studies under way in Los Angeles.

"Those physicians came here [to the clinic] to follow-up those patients," Iwersen said. "They're doing well."

People interested in the operation should call Flathead Orthopedic Center at 752-7900.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.