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Thursday, March 9, 2000

Problems of the hip:

X-ray courtesy of Dr. Jay Marumoto,
Helen Alronn with cane by Ken Sakamoto,
Photo composite by Dean Sensui, Star-Bulletin

An X-ray image of Helen Altonn's hip shows the
cobalt-chromium prosthesis embedded in her femur.
Helen Altonn walks with her cane and new hip.

Pivotal technology

Doctors predict more replacement
surgeries as the population ages

Mountaineer had surgery, then climbed Yosemite peak
Education and preparation shortened recovery

By Helen Altonn


THEY'RE called "hip celebrities" and include such names as Elizabeth Taylor, Jack Nicklaus, Bo Jackson, Queen Elizabeth, Pope John Paul II, Charlton Heston, Mike Ditka and Pavarotti.

For varied reasons ranging from sports injuries to arthritis, each has had a hip replacement on one or both sides.

Osteoarthritis, called "wear and tear arthritis," is the most common cause of hip degeneration, although many conditions may lead to the same result.

Hip replacements are "very, very common," said Dr. Jay Marumoto, an orthoscopic, reconstructive, orthopedic and sports medicine surgeon.


"Hundreds of thousands of hip replacements are done every year, most for arthritis," he said.

In the case of osteoarthritis, Marumoto said, "cartilage in the hip wears thin until it gets to the point where bone is rubbing on bone."

This causes damage to both the ball and the socket, both of which must be replaced -- a total hip replacement, he said.

Hip fractures also lead to hip surgery, and they're expected to increase because of osteoporosis as the population grows and ages, Marumoto said.

"Osteoporosis in and of itself doesn't mean you need a hip replacement," but that could be one consequence, he said.

The National Osteoporosis Foundation estimates more than 10 million Americans have osteoporosis of the hip and nearly 19 million more have low hip-bone mass, putting them at increased risk for osteoporosis and fractures.

The number of hip fractures in the United States is expected to climb from 238,000 per year to 840,000 by 2040, according to Clinical Orthopedics 1990.

For those suffering from hip arthritis, a hip replacement is "a big step in a positive direction," Marumoto said. The number of replacements is "only going to go up," he said.

Photo courtesy of Dr. Jay Marumoto, Special to the Star-Bulletin
Reporter Helen Altonn is wheeled into surgery for a hip replacement.

For someone with a normal hip who must have hip surgery for a fracture, he said, "it's a much different animal."

That patient, who had no pain before the fracture, "has to work up out of this valley," he said. "It's a big dip."

Surgeons tend to put uncemented stems into people younger than 50, Marumoto said.

They do what's called "a press fit" -- "meaning we use the appropriate size of the stem so it fits very, very snugly into the inner side of the thigh bone, and the bone will actually grow onto the metal stem."

Patients with uncemented stems aren't allowed to put weight on their legs for six to eight weeks while that's going on, he said.

"A young person can get around without putting weight on the leg for several weeks after replacement," Marumoto said. "It's difficult, almost impossible, for older people not to put weight on one leg."

There's a higher chance of the hip wearing out before the patient dies but it's easier to do the procedure again if the stem isn't cemented, he said.

"If it wears out, you take out the metal stem and that's it. You can put in another one."

Special to the Star-Bulletin
UH professor Charles Hardy at Yosemite National
Park a few months after hip surgery.

Hardy mountaineer had
surgery, then climbed Yosemite
peak 6 months later

By Helen Altonn


CHARLES Hardy set an ambitious goal after having a total hip replacement: to climb a mountain within six months.

And that's what he did.

Hardy, 77, a University of Hawaii faculty member in maternal and child health, had a hip replacement in 1972 because the cartilage had worn out completely on his right side.

"There was no indication in my history of why that should have happened," he said.

He thinks that side may have been weakened by polio when he was 15, although he said doctors discounted that.

He said his right side hurt and got steadily worse about six or seven years before he had surgery.

A one-eighth difference in the length of his legs had given him a listing stride, he said. "You wouldn't think one-eighth of a difference would make that much difference."

His now-retired surgeon, Dr. Robert Lindberg at Straub Clinic and Hospital, "got both legs the same length again," he said.

"I had to learn to walk again," he said. "Mine was a correction of something in existence 50-plus years. It took a long time to get my strength back up."

However, he went on a strict physical-therapy regimen and met his six-month goal to hike 9,500-foot Lembert Dome at Yosemite National Park in California.

"I put in 250 hours with weights on that ankle, moving my leg around one way, that way and every other way.

"I think that was responsible for my complete recovery. At six months, there was no difference between the two legs."

Hardy said he normally walks two or three miles a day. "I think all that helps."

He and his wife, Charmion, had hiked the Sierras for about 25 years and he thought Lembert was "a reasonable goal," he said. "It's a stiff hike, but that's all it is. No Tetons."

His wife and grandson, Scott Hardy, accompanied him. Only about the last half mile involved climbing, he said. "There is a great view up there, incidentally."

Hardy said he travels extensively and has had no problems with his hip replacement.

He has a "muscle sensation ... a sensation that I'm carrying a flashlight in my hip pocket. It's a presence, nothing to do with the (hip) joint."

Otherwise, he said, "Things go along beautifully. It's a terrific operation."

Education and preparation
boosted her confidence,
shortened recovery time

By Helen Altonn


DOROTHY Bicks decided in January 1999 to have a hip replacement, then spent six months preparing for it.

A clinical nurse specialist in orthopedics at the Queen's Medical Center, she said she had suffered 10 years with osteoarthritis of her right hip joint.

She believes it was genetic, noting both parents had the same problem. "It was kind of like breakdown of the cartilage that lines the head of the femur, plus the joint space."

Bicks, 60, said she gradually lost range of motion on her right side. "The first thing I noticed, I couldn't turn it inward to shave my leg. I couldn't see that side of my leg. It was very painful to turn it inward."

She said she had several episodes of inflammation in the joint, which cleared with anti-inflammatory medication, but the pain increased in her right hip, thigh and knee.

She fell twice due to lack of muscle strength in her right thigh and it was difficult to sleep and get in and out of a chair, she said. She also was walking with a noticeable limp.

As a nursing specialist in total joint replacement, Bicks said she had advantages going into surgery in May 1999.

Still, she had "the same fears, concerns and unknowns of anyone else going through major surgery," she said.

She overcame them with a series of pre-surgery actions:

She built up her strength with physical therapy. She talked to many people to gain courage and support. She had "healing touch" treatments to keep calm and focused. And she cared for her dental, vision and other health needs.

"Being healthy gave me confidence going into this big surgery," she said.

She bought a new straight-backed chair with a recline feature that "definitely was and is my comfort to this day," she said.

And her sister stayed with her for 10 days after she left the hospital to handle household chores and chauffeuring.

Bicks joined a "hippie club" of recent and former hip replacement co-workers, who offered encouragement.

Her orthopedic surgeon, Thomas Kane, "was wonderfully supportive and educational," she said, "sharing X-ray results, describing how surgery was to be done, the type of prosthesis he would use and why."

Because of her preparations, Bicks said she had "what seems to be a magical recovery."

Within a month, she was walking with crutches and "felt I could jump in the car and go grocery shopping and drive the car myself."

About 90 percent of the healing after a hip replacement occurs in three months, Bicks said. "The rest takes nine months. I'm trying to identify what 'the rest' of it means."

Her experience wasn't "as devastating and prohibitive as they tell you," she said. Her advice to those facing such surgery: "Your focus should be more on enabling and not so prohibitive."

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