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Hip Resurfacing Article from Star Tribune
This article is from the
Startribune.com
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Tale of a 'surface hippy'
Josephine Marcotty, Star Tribune
December 14, 2005
Susan Anderson wouldn't know until she woke up whether she'd
be able to dance again. But as the sweet-talking nurse in
the hot pink scrubs wheeled her into the operating room,
Anderson could finally let go. It was up to the surgeon now.
For 10 years the Minneapolis woman had been limping through
life and putting off the surgery that would halt crippling
pain from advanced osteoarthritis. But a total hip
replacement meant she'd have to give up the cha-cha, salsa
and tango dancing that had inspired her online moniker, "susanjoyful."
She waited for a better treatment to come along.
Nine months earlier, a friend had told her about a procedure
called hip resurfacing that promised to free her from pain
and allow her to dance to her heart's content. The catch: It
wasn't approved by the Food and Drug Administration,
probably wouldn't be covered by her insurance and was rarely
done in the United States.
As she faded into unconsciousness on the gurney, neither
Anderson nor her surgeon knew whether she was a candidate
for hip resurfacing. He had to see her bones for himself.
Still, for Anderson it was over. She had been on a journey
that had taught her about the intricacies of bones and
joints and brought her to an unexpectedly rich support group
of fellow "surface hippies" on the Internet. What drove her
was the unbearable pain in her hip. But what's remarkable is
how a middle-aged music teacher who loved to dance took
charge of her own health care -- and her life.
Dancing in pain
The pain began 10 years ago, just before Christmas. Her hip
ached when she walked the malls looking for Christmas
presents for her sisters and two daughters. "Every night
when I'd go to bed it would hurt," she said. "The next day
it would hurt."
X-rays revealed advanced osteoarthritis in her left hip. She
would need a total hip replacement, doctors told her. But
because she was so young, she should put it off for as long
as possible. (Anderson declined to reveal her current age.)
She started doing water aerobics and a regular stretching
regimen to manage the pain, but over the years it got worse.
Cleaning the house took two days because she had to stop and
rest so often. She couldn't walk around Lake Harriet in
south Minneapolis, near her house. Still, she knew she was
pretty lucky.
"I didn't have the pain that a lot of people have," she
said.
In 2002, when her sister was undergoing chemotherapy for
breast cancer, she went to a salsa class at the Social Dance
Studio in Minneapolis. For an hour she was happy.
"It was a present, like a gift that this could happen to
me," she said. She started going to dance class twice a week
-- sometimes three times a week. Then she added the cha-cha
and, finally, the Argentine tango.
She loved the slow, dramatic moves of the tango, but the
dance requires crossing the left leg over the right. And
that hurt.
"I was never good at tango because I was always trying to
get to my right leg right away," she said.
She often had to sit down on the floor during classes and
dance events to rest. As her hip pain worsened, she gave up
tango. Then, a year ago, she stopped dancing altogether. But
by then she'd already started on her quest for a different
sort of ending. Anderson had begun studying her options in
August. She kept notes in a little pink book labeled "hip
stuff."
She didn't want a total hip replacement because the surgeon
would have to remove the top of her leg bone, leaving few
options later in life if she needed another one. And most
hip replacements are done with a small ball on the end of
the leg bone that makes the whole thing prone to dislocation
with too much activity -- like dancing the tango.
The key difference with a hip resurfacing is that she would
not lose any bone. Surgeons essentially re-shape the ball on
the end of the leg bone, and top it with a round metal cap.
That meant a second replacement years down the road would be
much easier, because her bone would remain intact.
Hip surgery of choice abroad
Hip resurfacing is not for everyone. Research has shown that
the neck of the leg bone fractures in 1.5 percent of cases,
said Dr. Robert Trousdale, an orthopedic surgeon at the Mayo
Clinic in Rochester. And the metal-on-metal joint produces
metal ions in the body. There is no evidence that such ions
are harmful, but there's not much data either, said Dr.
Edward Cheng, a professor of orthopedic surgery at the
University of Minnesota. Because of the unknown risk, he
does not recommend hip resurfacing for women of childbearing
age or people with kidney problems.
Resurfacing is rarely done in the United States because the
FDA has yet to approve any of the artificial body parts that
it requires. But applications from several manufacturers are
pending. Some surgeons such as Cheng and Trousdale do it by
using artificial joint parts approved by the FDA for other
purposes, but they say it's unknown whether hip resurfacing
is better or lasts longer than total hip replacements.
However, it is the hip surgery of choice for middle-aged and
young adults in Australia, England and other countries in
Europe.
By early April, Anderson had learned all she could from her
research and from others on the Yahoo support group website.
A doctor friend checked it all out and told her to go for
it. She contacted a surgeon in Ghent, Belgium, a leader in
the field whom many others on the Yahoo website had used.
Send your X-rays, the surgeon said.
Two weeks later she got an answer.
"Hi everyone," she wrote on the website. "[The doctor] just
sent me an e-mail to say he is sorry, but I am not a
candidate for resurfacing," she wrote. She had a
malformation of the hip that made it too risky, she said.
Instead, the doctor recommended she get a new type of total
hip replacement that uses a larger ball. But she would still
lose the top of her leg bone.
"I have to start over at square one," she wrote. "Anyone
have any ideas for me?"
Yes, they responded, try Dr. Thomas Gross in South Carolina,
one of the few surgeons in the United States who routinely
did hip resurfacing. She sent off her X-rays, and five days
later, around 10 at night, he called her at home.
"We talked for an hour," Anderson said. "And we set a date."
June 22. But she didn't know what kind of hip she would get
because he wouldn't know until he could see for himself the
condition of her joint and bone. She might get a
resurfacing, she might get a big-ball total hip replacement,
or the more traditional small ball. She wouldn't know until
she woke up from the surgery.
She also didn't know if her insurance would cover the
procedure, but she decided she would use her own retirement
funds if she had to. She recruited two dancing friends to go
to South Carolina with her -- they could check out the local
clubs while she was in the hospital.
The day before they left Minneapolis she posted a note on
the Yahoo website.
"Thanks to all of you for your support ... through my bad
times in April. ... What a support group! And we don't even
really know each other."
A date with Dr. Gorgeous
After she met Gross, she was at peace with whatever was
about to happen. She was certain that Gross, whom her
friends referred to as Dr. Gorgeous, would make the choice
that was right for her. The next day she woke up in the
surgical recovery room and, groggily, asked a nurse what
kind of surgery she had. The nurse looked at her chart.
"A total hip replacement," the nurse said.
Anderson was stoic. Well, so be it, she thought to herself.
But when Anderson's friends came in, they said, "Isn't it
great?"
"I said, 'No, I got a total hip,' " Anderson said. But they
had spoken with Gross after the surgery, and finally they
convinced her. She had the hip she wanted.
"It was magic," Anderson said. "It was like when I first
held my adopted daughters in my arms."
Nine weeks after the surgery she made her last entry in the
pink notebook marking her first complete walk around Lake
Harriet without a cane. She has resumed her dance lessons --
though Gross told her she had to wait six months before
attempting the cross-step in the tango.
In November, her insurance notified her that it would pay
for the surgery. And 12 days ago she was back near full form
at the monthly salsa extravaganza at the Cinema Ballroom in
St. Paul.
It took her 10 years to get her hip fixed. "But I'm so glad
I waited," she said.
Josephine Marcotty
Copyright 2005 Star Tribune. All rights reserved
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