MILWAUKEE – For three years, Jim Nord came up with simple solutions to deal with the excruciating pain in his right hip.

When he could no longer walk the golf course with his friends, he started riding in the cart. And when the pain worsened, he tried using stronger over-the-counter painkillers to get some temporary relief.

But once the 52-year-old Wisconsin man learned that the cartilage in his hip was severely damaged, he knew he’d have to have surgery in order to maintain his active lifestyle.

Nord, who continued to work and referee high school basketball games despite having difficulty walking, opted for a revised hip repair surgery geared toward younger patients.

On Nov. 14, Nord had his hip resurfaced using the Birmingham Hip Resurfacing System, a metal-on-metal resurfacing artificial hip replacement system.

During the procedure, orthopedic surgeons shaved and capped a few centimeters of bone within his hip joint.

The Birmingham system is the only one approved by the Food and Drug Administration.

Within two days, Nord was using crutches to maneuver down the hospital corridor. He is looking forward to playing golf in Phoenix in March.

“I feel the pain from the incision, but I don’t feel pain in the joint,” he said. “I expect to be able to play in about three months, but golfing in February in Wisconsin just isn’t ideal.”

Surgery is the last resort for people who have received little or no relief from hip pain by taking medication or changing their daily activities.

Though the materials used for hip surgery should last a lifetime, the normal wear and tear of the body may mean some patients have a second surgery.

Hip resurfacing is a bone-conserving technique that is becoming an increasingly popular alternative to total hip replacement.

The technique was first introduced in July 1997 in the United Kingdom. The hip resurfacing system has been used in more than 70,000 patients worldwide, with 5,000 of those in the United States since it was approved in May, said Victor Rocha, spokesman for Smith and Nephew Inc., manufacturer of the Birmingham system.

About 193,000 hip replacements are done every year.

About 150 surgeons in the U.S. have been trained to perform the procedure, Rocha said, which is generally covered by insurance.

Hip resurfacing preserves more of the bone structure and has a lower risk of dislocation and inaccurate leg length than total hip replacement.

The all-metal implant is made from cobalt chrome, which resists deterioration. This means the implant has the potential to last longer than traditional hip implants.

“This is going to become one of the standards of care,” said Timothy Schultz, an orthopedic surgeon who has performed the procedure since August.

“You still have the base of your own femur bone, so if the procedure ever needs revision, you simply go back and remove the ball as you would in a hip replacement procedure,” he said.

A normal hip consists of two parts: a femoral head, or ball, at the top of the thighbone (the femur); and the acetabulum, or rounded socket in the pelvis. Bands of tissue, or ligaments, connect the ball to the socket and provide stability.

In a hip replacement, surgeons must dislocate the hip to remove damaged cartilage and bone. The ball is replaced by a strong metal attachment and the socket by a durable plastic cup housed in a metal shell.

A special cement may be used to fill the gap between the prosthesis and remaining bone to secure the artificial joint.

During hip resurfacing, the surgeon uses specialized tools to prepare the bone for resurfacing after dislocating the hip.

The head of the femur is prepared to receive the resurfacing component, while the socket is shaped to accept the new surfacing cup.

After careful manipulation, the socket is placed to allow bone to grow around it, providing further stability, and the component is fixed into position on femural head using bone cement.

The procedure takes about two hours, slightly longer than a traditional hip replacement because of the care used while shaving, said Michael Anderson, the orthopedic surgeon who did Nord’s procedure.

But the procedure is not for everyone.

Anderson said candidates include those who are active, younger than 60 and those who have no bone deformity or kidney impairment (metal ion concentration in the bloodstream could cause renal failure).


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