Thursday, April 24, 2003
By HILARY WALDMAN
udging by his family history, Michael Taylor has a chance of living well into his 80s or 90s and he'd like his hip joints to take the ride along with him.
Unfortunately, his hips already have proved they do not share his potential for longevity.
So when the Storrs, Conn., lawyer needed a hip-replacement operation two years ago, he went looking for an implant that would last as long as he would and be able to withstand the hiking, bicycling and skiing he pursues with passion.
Conventional hip implants can wear out in as little as 10 years, although most last longer without wear and tear. Taylor is 58 and hopes his active lifetime will be longer than that of a conventional hip.
"If I don't walk in front of a car and I'm lucky, I could live through three or four hip replacements," Taylor said.
Instead of risking multiple surgeries, he chose to take part in a study at Waterbury (Conn.) Hospital of the safety and effectiveness of a new ceramic lining for artificial hip joints.
The ceramic promises to last up to 50 years even in an active person, without breaking down and causing the risk of blood contamination posed by conventional implants, said Dr. Kristaps J. Keggi, the Waterbury orthopedic surgeon who participated in the trial.
Based on the experience of Taylor and more than 1,000 patients like him across the country, the U.S. Food and Drug Administration has approved ceramic-on-ceramic hips for general use.
"If I had to have my own hip done today, I would definitely want a ceramic hip," said Keggi, a 69-year-old innovator in joint replacement surgery.
One drawback of the ceramic hip is its cost. While a hip implant made of titanium with a plastic liner costs $1,500, the ceramic-lined titanium hip can cost $4,500, Keggi said.
And for the less-active person, the additional cost probably is not worth it. In a fairly sedentary person, a conventional, plastic-lined implant will eliminate pain from arthritis and can last 10 to 20 years, often the rest of a lifetime, Keggi said.
But for younger active people, such as Taylor and Gavin Adamson, of New Milford, the ceramic replacement offers several benefits.
Adamson, 45, destroyed his left hip through a series of youthful indiscretions, including several motorcycle accidents and rough hockey and rugby play in high school and college.
By the time he agreed to a hip replacement he no longer could bend down to tie his shoes. He could not swing his left leg over the saddle of his motorcycle. Working as a traveling salesman was agony because it hurt so much to get in and out of his car.
Keggi installed Adamson's new hip through two fairly small incisions, one at just about the location of the hip pocket in a pair of blue jeans, the other a bit lower on the thigh. The smaller incisions, which have become a trend in joint replacement surgery, allow for quicker recovery because they reduce blood loss and do not damage major muscles.
Keggi said his patients are generally out of bed the morning after surgery and leave the hospital within four days, walking with the help of a cane.
Before his surgery, Taylor said he felt as if his life was "beginning to close." He and his wife had dreamed of hiking the Great Wall of China, but pain from arthritic degeneration in his hip was making that seem impossible.
Now, he is back on the slopes with the ski patrol at Stratton Mountain in Vermont and bicycling hundreds of miles on his international vacations. He said he looks forward to outliving his father, who died at 96 after a workout and a swim.
Keggi predicted that the ceramic hip will last as long as Taylor does.
"Ceramic wears much less and when it does wear, the particles it gives off are so small -- microscopic, they are carried away from the area by the blood," Keggi said. Larger particles that flake off plastic implant liners can cause bone to dissolve over time, he said.
Keggi predicted that the cost of ceramic eventually would drop and that it would become the implant material of choice.
"I think over time more people are going to want ceramic," he said.