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Six months after surgeon Myron Stachniw began performing an alternative to total hip replacement called resurfacing in U.S. clinical trials, he reached a conclusion: He wanted the procedure himself. "I had severe arthritis in both hips, which was really limiting my activities," says Stachniw, 57, of Galesburg, Ill. "When I saw how well my patients were doing after resurfacing, it didn’t take too long before I figured out, ‘This is for me.’ "

Two years later, with two resurfaced hips of his own, Stachniw climbs in and out of the light plane he pilots, rides horses and generally maintains a level of activity that he believes would have been difficult with traditional replacements. Stories like his explain the buzz about resurfacing among patients and within the medical establishment. Candidates for the procedure have been traveling to Canada and Europe for operations and then filling Internet message boards with testimonials of running, yoga, even rock climbing. The Food and Drug Administration’s first approval is anticipated, possibly within a few months.

Unlike traditional hip replacement, resurfacing does not require removing the head of the femur (the bone in the upper leg) to replace it with an artificial ball. Instead, the head is reshaped and capped with a prosthetic that, as in the traditional procedure, fits into a man-made lining in the socket. Resurfacing uses a bigger ball, which makes dislocation less likely and gives the joint the ability to handle greater stress. Preserving the top of the femur is also an advantage if the hip requires subsequent work, which becomes more likely as the average age of hip patients, many of them quite active and determined to stay that way, falls.

New Materials

Resurfacing emerged in the 1970s but fell completely out of favor because of problems with the polyethylene parts used at the time. A new generation of cobalt chrome caps and socket linings, approved in Europe and manufactured for FDA-approved clinical trials by Wright Medical and Corin USA, has led to the renaissance.

More than 2,000 resurfacings have been performed in four years of U.S. trials, and many more thousands have been done in other countries. The number of operations is still small compared with total hip replacements, which in the United States numbered 193,000 in 2002, according to the most recent data from the National Center for Health Statistics.

The surgical costs of the resurfacing and replacement procedures are comparable: about $25,000. The resurfacing procedure lasts 90 minutes on average, Stachniw says, and as long as three hours. Recovery time is six weeks to three months, not the three- to six-month recovery time of hip replacement. "It’s still major surgery," he says, which requires making a large incision and dislocating the hip.

Is This for You?

With the final results of the trials pending, medical experts urge caution. "There’s no data that a resurfacing has greater functional capacity than an up-to-date replacement," says Tom Schmalzried, a surgeon at the Joint Replacement Institute at Orthopaedic Hospital in Los Angeles. "The modern conventional total hip replacement is a very good operation."

Stachniw agrees the data need to be analyzed, particularly long-term results. Also, resurfacing isn’t for everyone; the average age of patients in resurfacing trials is under 50, while the average age of hip replacement patients is 68. Resurfacing requires strong bones, so people with bone disease are less likely candidates. But he is impressed with the results of the 82 procedures he has performed. Barbara Bullen of Port Hadlock, Wash., was 52 and disabled by her arthritic hips when she went to Stachniw. Pain-free after a double resurfacing, she has resumed work as a UPS driver and taken up strenuous exercise.

"I was 52 going on 80," she says. "This operation has given me back whatever youth I have left."

Reed Karaim is a freelance writer in Tucson, Ariz.