| Sam Whiting
Sunday, July 30, 2006
Arthritis has eaten away all the cartilage on Frank
Stonich’s left hip, so he was pleased to hear he’d be the
first person in California to receive the ball-and-socket
being introduced by Dr. Robert Gilbert of California Pacific
Orthopaedics & Sports Medicine.
The device, called the Birmingham Hip Resurfacing System, (BHR)
is less invasive than total hip replacement because it saves
the knob at the top of the thigh bone. Instead of being
sawed off, the head of the femur is shaved to fit under a
shiny hat that looks like a mushroom. Approved by the FDA on
May 10, resurfacing has been shown to have a faster recovery
and leave a greater range of motion than replacement, “Wow.
It’s kind of neat and kind of scary at the same time,”
Stonich, 58, was saying an hour or two before being wheeled
into surgery on the third floor of the California Street
Campus of California Pacific Medical Center. This being the
last day he could complain about his old hip, he didn’t mind
piling it on. “I can’t sit or walk for any kind of length. I
can’t go upstairs, can’t do anything,” he says. “It’s
messing up my spine. Its messing up my knee and it’s
shortened my leg.”
While Stonich is in getting prepped, Gilbert, 65, explains
that resurfacing was common in the early 1980s, involving a
ball on the femur and a cup in the socket attached to the
pelvis. Back then the socket was plastic, and
metal-on-plastic either didn’t work or wore out. Gilbert did
29 of these before abandoning the procedure.
It took another 20 years for him to return to resurfacing.
What convinced him was the highly polished Cobalt Chrome.
“Now that we have metal-on-metal articulations we can go
back to it,” Gilbert says, “because metal-on-metal works.”
As proof, he cites 60,000 BHR surgeries done since 1997,
when it was perfected by its inventor Derek McMinn,
operating in Birmingham, England. McMinn has done 3,000
himself, and Gilbert went over to Birmingham to train with
McMinn last March.
They call orthopedic surgery “human carpentry,” and for his
first BHR Gilbert has brought along some muscle. First there
is his partner in surgery, Dr. Peter Callander, 41. Next to
him is Dr. Marc Thomas, an Australian rugby player and
surgeon, who has gone over to the other side and now
represents Smith & Nephew Orthopaedics, manufacturers of the
BHR, based in Memphis.
“It’s the premiere device in hips, no doubt,” says Thomas,
who has been in on 1,000 of these operations, though in
British-style understatement, says, “I’ve done a few.”
Backing up Thomas is Matt Bouza, who played eight years in
the NFL and is Northern California Sales Director for Smith
& Nephew.
The patient, Stonich, is bigger than either ex-athlete at
6-feet 4 inches and 240 pounds. He’ll be up to 241 when
these metal parts are sewn into him.
To begin the hip resurfacing surgery, Stonich is given
regional anesthetic, below the waist. Then he’s turned on
his right side with his left knee up. Once opened up, the
soft tissue is released to expose the hip-joint capsule.
Then the hip is dislocated. Callander, throws the gimp leg
over his right shoulder, then his left, so the femoral head
pops out. The leg will flop in any old direction, once
disconnected from the pelvis.
A year ago, Stonich had arthroscopic surgery to clean out
arthritis and bone spurs. The hope was that new cartilage
would grow back, but it didn’t.
“He’s horrible,” observes Gilbert. “He’s got no cartilage,
just bone-on-bone arthritis.”
A prosthetic hip works without cartilage. One problem with
the total replacement, he says, is that the ball has to be
smaller because it fits on a narrower part of the femur,
leaving a higher risk of dislocation.
“This one almost never dislocates, so it’s very good for
athletic people, who want to hike, climb mountains.” Thomas
adds to that “downhill ski, continue to play tennis, rugby.”
Continuing rugby, is that a good thing? “No. Probably not.
But when it’s in your blood. . .”
Stonich played football at Sacred Heart, class of ’66, then
played semi-pro baseball for the San Jose Bees. But at this
point he’d be happy just to get around a golf course. For 18
years he made his living on the stocking crew at grocery
stores, loading pallets and lugging them down the aisles.
When his hip went bad he switched to the crew on the
Presidio Golf Course, until he had to quit that three years
ago.
In testing, his femur was strong enough to support a
resurfaced hip, a strict requirement. Thomas says out of 10
candidates, maybe one will be right for the BHR. Because
doctors choose only active, and usually young patients with
normal anatomy and good bone stock, the device has had a 98
percent survival rate in the eight years since it was
introduced.
Once the hip is exposed, Gilbert goes to his tool bench,
which consists of two tables of metal mallets, power drills,
wrenches and saws, plus bone cement and a mixer. It takes an
ortho-technician just to keep them all lined up in working
order, and wipe the blood off after use.
After trimming away bone spurs, caused by the arthritis,
Gilbert takes a power reamer to shape the acetabulum — the
cup-shaped cavity at the base of the hip bone. The metal cup
has a taper-fit, coated in hydroxyapatite, the bone salt
that gives compressional strength. It is pounded on with 35
whacks of a metal hammer. No screws required.
The finish carpentry is in carving the head of the femur to
fit under the artificial ball joint. The BHR comes in 20
sizes, increasing in 2-millimeter increments, each in a
sterilized box.
After measuring the top of Stonich’s hip bone, Gilbert grabs
the reamer and changes the bit, which he applies to the
exposed hip bone to mold it to the under-surface of the cup.
It works like a cheese grater. Curly shavings of white bone
fly off it as he molds a perfect sphere.
“You’re preserving as much bone as possible,” Callander
says, “and shaving it in order to have a perfect fit for the
hat.”
Using a drill bit, he augers down through the center of the
femur. The stem of the hat is then pounded into the femoral
canal — 50 whacks.
“I didn’t count them but I could feel he was hitting on it
pretty good,” says Stonich the next day. During surgery he
was awake but feeling no pain. “It was cool. I liked it.”
The end is near when the bone cement gets mixed. “That’s the
smell of victory,” says Thomas, absorbing the aroma. The
shiny new hip joint is then connected. A nurse counts the
sponges to make sure none have been left behind.
Stonich heard that part too. “I thought, ‘good,’ ” he says
later. “That means they’re double-checking.” Then he is sewn
up. End to end it takes about three hours.
A day after surgery, Stonich was lifting and bending the
leg. The pain was a 2 on a scale of 10. Before surgery it
was an 11, he says, already looking forward to getting the
Birmingham Hip Resurfacing on his right side, in a year.
That hip has cartilage.
“I think it’s phenomenal,” he says, planning his next tee
time. “I think I’ll be able to shoot in the ’70s, take some
money away from my grandson.”
E-mail Sam Whiting at swhiting@ sfchronicle.com
This article appeared on page CM – 4 of the
San Francisco Chronicle |
