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Metal-On-Metal Hip Replacement to Debut Here
Orthopedic Surgeon Plans Procedure at Holy Family, Foresees Wide Applicability
By Kim Crompton
A Spokane orthopedic surgeon plans shortly to begin using a newly approved "meta-on-metal" hip-replacement procedure here involving the precision-machined product in early October at Holy Family Hospital. The recipient will be Norma Younker, a 53-year-old Otis Orchards woman who has worn out an artificial hip joint she received just six years ago.
Younker says she is enthused by what she's heard about the durability of the new implant she's going to receive, and hopes her surgery "encourages more people to go ahead with it, because it definitely is a good thing."
Scott says he expects eventually to be installing 50 to 100 of the metal-on-metal prostheses a year because of their advantages over current implants and because they're appropriate for a broad range of people who need hip replacements.
"It's basically a lifetime component for any age patient," he asserts.
Hip-joint replacement surgery is a big market in the U.S., estimated at 300,000 procedures, costing $800 million, annually. The Spokane area, with a large elderly population, would seem likely to have strong demand for improvements in hip-replacement technology.
Scott says a majority of the people who seek hip replacements are at least 60 years old and suffer from age-related arthritis, or joint inflammation, and that demand from elderly patients is expected to grow as life expectancies increase. However, he adds, "Clearly younger and younger patients are becoming candidates" as longer-lasting implants are developed. Those younger patients often suffer from congenital or traumatic arthritis, due partly in the latter case to active lifestyles and sports-related injuries, he says.
Most hip-replacement systems currently include a combination of a metal head, or ball, that moves around inside a polyethylene cup, or socket. The problem with polyethylene is that it wears over time. Thousands of microscopic particles can break off and settle in tissue around the implant. The body's immune system rejects the debris, but its defensive reaction causes a condition that dissolves bone.
The bone loss can cause the implant to become loose and work improperly. The patient then must undergo major surgery once again to replace the implant. Many hip implants last only 10 to 15 years before having to be replaced, and some - such as the one that Younker received earlier - don't last even that long.
"Total (artificial) hips are really quite sophisticated these days, and this is really the last major problem that limits longevity," Scott says.
The patented Metasul metal-on-metal prosthesis, developed by Swiss-based Sulzer Medica, seeks to eliminate that deficiency by reinforcing the earlier developed polyethylene cup with a wear-resistant metal liner. The liner and the artificial femur head with which it couples both are made of a special metal alloy and are machined to tolerances of one one-thousandth of a millimeter to ensure smooth movement and minimal wear. The body's natural fluids lubricate the metal surfaces.
"We like to call it the Rolex watch of total hip replacements - Swiss precision," Scott says.
Metal-on-metal hip replacements were used in the U.S. in the mid-1900s, but had faded by the late 1960's due to poor results. Sulzer again took up the idea in the early 1980's with the goal of improving on the original design.
The Metasul implant was approved by the FDA just last month after three years of clinical trials, but has been used outside the U.S. since 1988. In all, more than 80,000 of the implants have been sold, and they've shown excellent wear results in European studies, Scott says. Sulzer is so confident in its patented product that it has taken the extremely unusual step of offering a limited lifetime warranty on the device, which it sells for $1,000 to $1,200, he says.
For the patient, the approximately $20,000 hip replacement procedure is no different with the metal-on-metal prosthesis than with other implants, and the cost isn't significantly greater. Scott says the procedure takes between about 90 minutes and two hours to do. The patient can begin walking the next day and within six weeks shouldn't need crutches or a cane, he says. Because of the debilitating effects of arthritis, however, the patient may need as long as three to six months to return to a normal gait, he says.
Younker, the Otis Orchards woman on whom Scott will be performing the first metal-on-metal hip replacement procedure here, says she's excited to be a beneficiary of the new technology.
"For an active person like me, it's a plus because of the (implant's) ability to last so much longer. I just think it's awesome. I'm really thrilled," she says. "I'll be able to exercise again and do the things I used to do."
Although she was only about 47 when she received her first artificial hip, which seems young to be needing such a procedure, she says she worked on commercial fishing boats in Alaska with her now-deceased husband for almost 20 years, which took a physical toll, and also raced motorcycles for a time.
"I have a small bone structure, but I thought I had the power of King Kong," she says. "I just kind of abused my bones. I don't know how to put it more simply. I've lived a pretty physical life. I've always been a pretty physical person."
She says her earlier hip-joint replacement surgery improved her mobility and gave her relief from pain, but since then she has "totally worn the Teflon out" of her current implant and has begun experiencing problems with it.
She now owns a boarding stable, and she says, "If I get this help, I'll be able to start riding again."
Scott and two other orthopedic surgeons - his wife, Dr. Amaryllis J. Scott, and Dr. Antoine Tohmeh - recently formed a new orthopedic group, called Orthopaedic Specialty Clinic of Spokane PLLC, to serve Spokane's North Side. They formerly had been with the Spokane Orthopedic & Fracture Clinic.
The new group, located in the Northpointe Medical Building, at 9631 N. Nevada, will cover all areas of orthopedics, with focus in neck and back problems, arthritis surgery and joint replacement, sports medicine and arthroscopy, and shoulder and knee problems.
Scott says he believes the new orthopedic group is the only one in Spokane in which all of the physicians are fellowship-trained, which means they spent a year of additional, unrequired training in a chosen subspecialty.
He completed his orthopedic residency in New York City, followed by a fellowship in adult reconstruction at the University of Utah in Salt Lake City in 1997.
He specializes in arthritis surgery with a focus on adult reconstruction and joint replacement.
His wife also completed her orthopedic residency in New York City, followed by two subspecialty fellowships - shoulder reconstruction surgery at the Hospital for Joint Diseases Orthopaedic Institute in New York in 1996, and sports medicine at the University of Utah in 1997. She specializes in shoulder and knee problems, arthroscopy, and ligament reconstruction of the knee.
Dr. Tohmeh completed his orthopedic residency in Baltimore, followed by a spine fellowship at the University of Maryland in 1998. He specializes in treatment of neck and back disorders, including disc herniations, sciatica, and scoliosis.
Aricle from the Journal of Business.