As the pain spread from her hip to her lower back to her groin
and down her left leg to her shin, Shelly VanderArk knew her
arthritic hip was getting worse.
Steroid injections eased the pain for a few years, but even those
had stopped working about a year ago.
It reached the point that every step she took brought great
pain.
She had a last option: hip replacement surgery.
But at 34, the labor and delivery nurse at Akron City Hospital
was told she was too young. Artificial hips can wear out in 10 to 15
years, leaving young sufferers such as VanderArk two choices: delay
the surgery and endure the pain for another decade or longer, or
choose surgery, knowing that they'll probably face at least two more
major hip surgeries in their lives.
Not anymore.
In February, the U.S. Food and Drug Administration approved a new
artificial hip that its manufacturer -- Stryker Howmedica Osteonics
-- says will last longer and wear better than traditional hip
implants.
In fact, Dr. Kenneth Greene -- an orthopedic surgeon with Summa
Health System and a member of Howmedica's design team -- expects the
new hip can last a lifetime in most patients, even someone as young
asVanderArk.
``She was told by another surgeon, `Sorry, you're too young,' but
what's she supposed to do? Wait 10 or 15 years?'' Greene said.
``Those years between 34 and 44 should be the best years of her
life.''
VanderArk certainly hopes so, but just one week after her
surgery, it's hard for her to know how well the new hip will serve
her.
She suspects her snow skiing days are over, although her goals
are much simpler. She would just like to be able to keep up with her
three children: 11-year-old Ella, 1 year-old Libby and 4-year-old
Carson, who has asked his mom whether her new hip will allow her to
go on ``adventures'' to a stream near their home with him.
Greene has no doubt the answer is yes.
The new hip, known as the Trident Ceramic Acetabular Insert, is
different from current models because it uses aceramic-on-ceramic
design instead of the usual metal-on-plastic design.
For some patients -- those who are older and less active -- the
metal-on-plastic design can work fine, Greene said.
But in young, active patients, the plastic tends to wear out,
Greene said. That can lead to hip dislocation and worse: Plastic
particles cause the body's immune system to attack, resulting in
significant bone loss in some patients.
Green was the first surgeon in the nation to implant the new
ceramic hip, before it was approved by the FDA. He did so by
obtaining the agency's OK of ``compassionate use'' of the
device.
His first patient, 52-year-old Karl Schwarzinger of Stow, has
been an athlete all his life. Greene knew that the metal-on-plastic
hip wouldn't last for him. But as the FDA approval process dragged
on, Schwarzinger's hip got worse.
Schwarzinger, who sells artificial joints (including the ceramic
hip) for Stryker Howmedica Osteonics, had surgery in October.
``Four days post-op, I was completely pain-free,'' he said. ``I
have no limp, no pain. I can pretty much do anything.''
Not anything, actually. He has had to give up basketball,
competitive tennis and running, but he can still swim, lift weights
and play golf.
Schwarzinger knew he felt better physically after the surgery.
But his co-workers noted that he also seemed happier.
``People actually said to me, `Your wrinkles are gone,' '' he
said. ``When the pain's gone, your whole attitude changes. You get
that vigor back.''
This isn't the first time that ceramic has been used in implants.
In 2001, the FDA recalled implants that had been given to as many as
9,000 people because the ceramic was fracturing at an unacceptably
high rate.
The recalled hips used a ceramic called zirconia. The new hip
uses a different kind, called alumina. Doctors say the only material
harder than alumina is a diamond.
As is often the case with new medical products, the ceramic hips
are more expensive, Greene said. Surgery costs about $11,000,
compared with $3,800 with conventional artificial hips.
``The big issue is that we've got a new technology here that can
last a lifetime,'' he said, ``but people may not be able to afford
it.''
In the long run, Greene said, the new hips should save money by
sparing patients follow-up surgeries to replace worn-out parts 10 or
15 years later.
``Where we're at now with insurance companies, they don't care
where you're at in 10 years,'' Greene said. ``I'm not sure they see
the advantage of doing it right the first time... The reality is you
probably won't be their patient in 10 years.''