Younger patients now candidates for hip replacement

New materials and new techniques have led to a surge in hip replacements, both for seniors and for active weekend warriors.

Rob Ashurst has always been an active guy. Into sports and exercise all his life, the 40-year old recently started doing a rigorous cross-fit program at a local fitness club with some office mates. One evening, after a hard workout, he felt a tweak in his hip. That tweak was his first indication he had a degenerative condition known as avascular necrosis, a disruption in the blood supply to the hip joint, causing the head of femur to die. That led to osteoarthritis and pain that worsened by the month.

Ashurst came to University of Alabama at Birmingham orthopedic surgeon Herrick Siegel, M.D., who told him that he was a candidate for hip replacement, largely because new advances in materials and techniques mean surgeons are now able to offer hip replacement to younger patients.

“There is growing need for joint replacement in general, especially in the baby boomers and the weekend warriors,” said Siegel, as associate professor of surgery in the Division of Orthopedic Surgery. “We’ve improved the surgical process and increased the lifespan of the implants to a point where it’s now viable for a younger population and for older patients who previously were not candidates due to other medical issues.”

“Modern hip replacements are not the same hips that were put in in the 1980s and 1990s. These are hips that have the potential to last a lifetime in most patients.”

-Herrick Siegel, M.D.

One factor is better materials for the hip implants. Aluminum ceramic and highly cross-linked polyethylene provide harder, smoother surfaces that cause less wear and last longer than more traditional plastic materials. Other new materials help bone grow into the implant, providing additional strength.

“Modern hip replacements are not the same hips that were put in in the 1980s and 1990s,” said Siegel. “These are hips that have the potential to last a lifetime in most patients.”

Rob Ashurst hopes so. Three months after his hip replacement he was back at the gym. He took the hard-core fitness introductory class again and, to his surprise, scored better with his new hip than with his old one.

“I really figured I’d be one of the slowest in the class,” said Ashurst, “but I beat everyone in the class the first day.”

Siegel says that in some patients, the new hip implants could last 40 years. He also touts another advance, operating from the front of the leg rather than the back. The anterior approach, as it’s called, means a shorter recovery time

“We come in from the front so we are dividing muscles rather than cutting through them,” Siegel said. “It produces an earlier return to full function.”

The anterior approach is best performed on a special operating table. UAB has two and considering getting a third. First developed for hip and hip joint fracture cases, the table allows surgeons to manipulate the patient’s hip to provide the access needed to use the anterior approach.

The bottom line is faster recovery, fewer complications and a quicker return to the lifestyle that many younger patients - and the baby boomers – are demanding.

“When I first saw Dr. Siegel, he said the point is to get you back to living the lifestyle that you want to live,” said Ashurst. “It’s like getting up in front of the class when you have to give a presentation. You either go first or last but either way you are going to have to do it. I’m glad I was able to do the hip transplant now, so I can live the rest of my life pain free.”

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