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Surgeon performs country's first FDA-approved hip resurfacing procedure

Washington University In St Louis : 21 July, 2006  (Company News)
The U.S. Food and Drug Administration has approved a surgical procedure that helps resurface worn out hip joints rather than completely replacing them, and the first approved procedure in the U.S. was performed by a Washington University orthopaedic surgeon at Barnes-Jewish Hospital in St. Louis.
The FDA approved the Birmingham Hip resurfacing system last month, and last week Robert L. Barrack, M.D., became the first U.S. surgeon to implant the system since its approval. Barrack is the Charles F. and Joanne Knight Distinguished Professor of Orthopaedic Surgery at Washington University School of Medicine, chief of service for orthopaedic surgery at Barnes-Jewish Hospital and chief of the Adult Reconstructive Surgery Service for the Department of Orthopaedic Surgery.

He was assisted by Derek McMinn, M.D., one of the developers of the system. McMinn and colleague Ronan Treacy, M.D., developed the Birmingham Hip system, which was first introduced in July 1997 in the United Kingdom. It has since been implanted in more than 60,000 patients in 26 countries.

Hip resurfacing is an alternative to total hip replacement for patients with hip abnormalities, including osteoarthritis. The system is designed to preserve more of a patient's own bone than a traditional hip replacement. During traditional hip replacement, both the head and neck of the femur, or thighbone, are removed and replaced with metal or plastic implants. During hip resurfacing, the head of the femur is resurfaced with a metal hip 'joint,' and the rest of the thighbone is left intact.

By preserving more bone, the developers sought to eliminate pain while preserving greater mobility and function. In Europe and Canada, many younger, active patients have opted for hip resurfacing rather than total hip replacement.

'There's a perception that the patient population for hip replacement surgery is elderly, but that's not always the case,' Barrack says. 'We often see patients in their 40s and 50s who already are experiencing severe osteoarthritis.'

Barrack believes hip resurfacing may have advantages for certain patients, especially younger, more active patients. He says many 'baby boomers' hope to remain active well into their 70s, but the pain of osteoarthritis can force them to severely limit daily activities such as jogging, biking, gardening and even walking. Hip resurfacing may help some of the patients with osteoarthritis in the hip to return to activities that have been severely limited or impossible due to pain.

'It used to just be sore and it didn't keep me from doing anything, but last fall the pain was so bad I struggled throwing a football in the yard with my son,' says Jones, a high school teacher at Cahokia High School and Belleville West High School.

When Jones met with Barrack earlier this year, he was told the FDA might soon approve the new procedure and that he would be a strong candidate.

'I'm active, I like to play with my kids, and as I looked into this option more and more, it looked better and better,' says Jones. In fact, Jones followed the FDA website regularly until approval was finalized.

'If I had to wait another six months I would have,' he says.

Nearly one in four Americans has some form of arthritis, and the number of men under the age of 65 with hip osteoarthritis is estimated to be over 44,000. Because traditional hip replacement implants have a limited life-span, Barrack says in addition to preserving the patient's own bone, the hip resurfacing technique may be able to provide a more permanent solution for those younger patients.

'Some implants used in traditional hip replacement surgery are smaller than the bone that they replace,' Barrack says. 'This new system is designed to more closely match the size of the head of the femur bone, and we hope that will create greater stability and decrease the chances of dislocation, which is one of the most common complications of total hip replacement surgery.'

Patients who have had previous hip replacement surgery are ineligible because the previous surgery required that they have too much of their femurs removed.

More than 300,000 Americans had hip replacement surgery in 2003, and some demographers predict that as the U.S. population ages, the number of hip replacement procedures could increase by as much as 80 percent in the next 25 years.
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