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Putting Metal to Metal STORY BY

Meredith Raine

Vincent was only a teen-ager when a rare form of arthritis began to slow him down.

By the time he was 21, he walked like a man at least three times his age. Sometimes he had to use a walker or crutches just to get from the living room to the kitchen. Other times, he couldn’t move at all.

The crippling disease, called ankylosing spondylitis, destroyed the cartilage in both his hips, causing pain when the bones scraped together.

Pain medications and anti-inflammatory drugs didn’t do much for the once-active college student’s condition. Finally, Vincent, at the advice of doctors, he decided that surgery to replace his hips was the only viable option for improving his quality of life.

In the past, patients Vincent’s age weren’t considered good candidates for total hip replacement because the device was only expected to last about 10 years. Plastic parts wore down over time, and patients likely would have to undergo at least one more surgery during their lifetime to replace the device.

New generation, very "hip"

"Dr. Terry Clyburn, assistant professor of orthopedic surgery at The University of Texas Medical School at Houston, said a new generation of all-metal hip replacements lessens the possibility of repeated hip-replacement surgeries.

The M2A device, manufactured by Biomet, Inc., consists of two major parts. There is a stem, which is designed to fit securely in to the femur. At the top of the stem is a chrome ball that fits into the metal socket.

Surgeon, Dr. Terry Clyburn holding M2A device. Photo by: Meredith Raine

The surface of each part is porous, allowing surrounding bone to grow in to the device, making it stronger and eliminating the need for cement to hold it in to place.

Clyburn, director of Total Joint Research at the medical school, said the new metal device offers numerous advantages for patients with hip arthritis.

“This technology shows promise, and it is our implant of choice for many patients,” Clyburn said.

30 years of pedal to metal

Preliminary results show that the metal hip replacements could last 30 years or more. The ball that fits in to the metal socket also is larger than older-generation devices. “This reduces risk of hip dislocation, and it also provides for greater range of motion,” Clyburn said.

In addition, experienced surgeons can perform minimally-invasive surgery to implant the metal-on-metal device. “In the past, we had to make very large incisions,” Clyburn said. “With improved technology, we can implant this device through a three-inch incision.”

The surgery for one hip replacement takes less than two hours. The next day, the patient is up and walking. Generally, Clyburn said, formal rehabilitation isn’t necessary. Patients simply can walk the road to recovery.

As with any surgery, Clyburn advised, there are risks, and patients should consult with their doctors to fully understand potential complications, such as infection. Also, the metal-on-metal hip replacement may not be appropriate for all patients.

Double hip in double time

For Vincent, it proved to be the best option. Because the hip arthritis was so severe, he had both joints replaced at the same time. Just a few days after surgery, he was home, slowly making his way around.

Because pain from his arthritis had gotten progressively worse in the past two years, Vincent said was unable to walk much. “I was out of practice,” he said. “There was a time when I thought I might not be able to walk again.”

He chose a four-week physical therapy program to help speed up his recovery and get him back on his feet.

Clyburn says that he is healing nicely and that physical therapy should have Vincent walking and acting like a normal 21-year-old in no time at all.

Last Updated:3-06-2003