A monthly guide to your health, wellness and prevention

Aging Joints - New hips for the not-so old
Original Publication:  June 10, 2003

Younger, active adults are turning to joint replacement surgery for relief

Between them, Gino D'Ippolito and Gerald Fischoff have been refereeing soccer games in Westchester for more than 60 years.

While all that running up and down the field has been good for their hearts, it has taken a toll on their joints: Both men needed hip replacement surgery last year.

"I felt pain and discomfort around four years ago," says Fischoff, a 59-year-old Scarsdale resident. "It was diagnosed as arthritis. It got to the point where I could hardly walk."

So last July 22, Fischoff underwent total hip replacement surgery on his right leg at Phelps Memorial Hospital Center in Sleepy Hollow.

Weeks later, friend and fellow referee D'Ippolito realized his aching leg pain probably meant he had the same problem. His hunch was right: X-rays of his right leg showed a frayed, arthritic hip joint, similar to Fischoff's pre-surgery X-rays.

So in December, D'Ippolito, of Yonkers, had hip replacement surgery. "Same problem, same operation, same doctor," D'Ippolito, 68, says.

It's probably not too often that two longtime friends and soccer referees both need hip replacements in the same year, for the same leg. But as more baby boomers age - and develop degenerative diseases like arthritis - hip replacements become more common for adults now in their 50s and 60s.

Technological advances also mean that surgery and recovery is safer and shorter than years ago, says Dr. Robert Seebacher, the Orthopedic surgeon who performed Fischoff's and D'Ippolito's surgeries.

Still, surgery is surgery, and it's only done when the problem is serious, says Seebacher. He looks for these red flags in his patients: pain, difficulty moving the joint and an abnormal X-ray. Either one or both joints may need to be replaced, and both hips can be replaced during one surgery.

"And, first, they should have tried other treatments, like weight loss, (or) pills to reduce arthritic inflammation, Seebacher says. He points out that many of his patients are overweight, which adds stress to the knee and hip joints.

For younger, more active people, Orthopedic surgeons usually recommend a "non-cemented" hip replacement. The top of the thigh bone, which has a round nubby end, is cut off by the surgeon. Then the surgeon sinks a porous metal ball and stem into the hollowed-out thigh bone.

As the patient heals, the bone grows firmly around the metal stem, creating a strong bond. The socket, in the pelvic bone, is also replaced with a metal cup-like device that fuses naturally with the pelvic bone. The concave surface of the socket is lined with plastic to allow the ball of the joint to move smoothly in the socket.

Since D'Ippolito and Fischoff have no immediate plans to retire from soccer refereeing, Seebacher gave them both non-cemented joints.

Older or weaker patients' bones are usually too frail to form a strong fuse with the metal joints, so surgeons use a cemented procedure. In that case, the bone cavity is filled with cement before the metal stem is sunk into the the thigh bone, since weak bones can crack.

Unfortunately, patients who have either procedure may need a repeat surgery about 15 years later. That's because the plastic lining of the socket can wear down, says Dr. Steven Stuchin, an Orthopedic surgeon and professor with New York University's Hospital for Joint Diseases.

"I tell patients, 'You will always have to come back every year and see the doctor and get an X-ray'," he says. "We want to change the plastic before it's worn all the way through. It's like driving around on a flat tire. (Eventually,) you're going to damage the rim."

Newer artificial joint materials like medical-grade ceramics or smooth metal alloys may replace the need for a plastic inlay on the socket. Both have their disadvantages, though. While ceramic joints, are strong, they can still break. Additionally, installation of metal joints, increasing the overall amount of metal in the body, can raise nickel and cobalt levels in the urine, although the levels may remain within acceptable ranges.

These problems seem to occur rarely, so more doctors are beginning to use the new materials, Stuchin says.

No matter what materials are used during surgery, the after-care will probably always require intensive physical therapy. For example, patients have to relearn skills lost years ago because of arthritis, such as reaching down to tie shoelaces, crossing their legs or stepping over a high bathtub.

Patients are encouraged to get out of bed the day after surgery, says physical medicine specialist Dr. Joseph Annichiarico of Phelps Memorial. Standing up helps circulation and digestion.

Over several weeks, patients progress from basic walking skills to more advanced exercises. One of the final tests requires a patient to stand with one foot on a small trampoline and toss a ball to another person, which tests for balance.

"Each day, the patient feels better and better," Annichiarico says.

Fischoff and D'Ippolito, the soccer referees, both were impatient after surgery and ready to return to soccer. After a few months of crutches and physical therapy, both were able to do so.

"The important thing was getting back on the field," says D'Ippolito, who, at the peak of his career, refereed soccer star Pele's last game. "That's what I do - get out with the kids and enjoy the fresh air."