"My doctor told me I would need a hip replacement when I was older and I should endure the limping," recalled Doyle, an active exerciser. "I was living on ibuprofen."

Unsatisfied with the diagnosis, Doyle sought the help of Dr. Mitchell Sheinkop, professor of orthopedic surgery at Rush University Medical Center and director of the joint replacement program at the Neurosurgical and Orthopedic Institute of Chicago.

Sheinkop examined Doyle and realized she was a perfect candidate for a state-of-the-art procedure called hip resurfacing,  in which just a few centimeters of the head of the thighbone are resurfaced, or shaved, the arthritic cysts are removed and the remainder stays intact. In traditional surgeries, the head of the bone is removed and replaced with an artificial ball.

A good analogy: "If you go to dentist with a cavity in your tooth, you could have your tooth pulled and an artificial tooth put in or have the cavity removed and a crown put on," Sheinkop described. Resurfacing is akin to the crown.

Sheinkop is one of a small number of U.S. surgeons trained to do the resurfacing procedure, which was approved by the Food and Drug Administration last summer.

"According to the American Academy of Arthritis, 350,000 to 400,000 hips will be replaced due to arthritis every year," he said. "With Baby Boomers and the activity demand of the American lifestyle, by 2015, [that may be] up to 600,000."

Traditionally, the most successful, reliable treatment had been hip replacement.

"The problem is survivorship," he said--of the implant, not the person. In a standard hip replacement, the pelvic shell has a plastic lining that acts as gliding surface. When the metal ball of the hip moves round and round through the years, wear on the plastic lining causes foreign particles to be released and dispersed throughout the body.

"In trying to eliminate the foreign debris, the body attacks the bone, resulting in bone thinning," Sheinkop explained. This led to a search for a better procedure with a tougher, metal-on-metal prosthetic.

In resurfacing, once the head of the leg bone is reshaped, it is topped with a cobalt chrome cap (think surgical stainless steel), which fits neatly into a round metallic shell that has been attached to the pelvis. There is no plastic lining. The result of this bone preservation: faster postsurgical rehab--six weeks to three months versus three to six months for hip replacement--and a more complete return to full function.

For instance, in late September, Floyd Landis, the cyclist accused of doping on the way to his Tour de France victory in July, underwent right hip resurfacing with a return to low-level cycling within weeks, a virtual impossibility with hip replacement. Also, because the top of the femur is not removed in hip resurfacing, future work can be done on the same hip many years later if needed; specifically, full hip replacement.

Anecdotally, Sheinkop's patients have had great results, he said: "The most functional outcome imaginable with return to unrestricted activity, short of running." He just resurfaced the hip of a fellow physician, age 47, who was able to walk out of the hospital with a cane the same day and return to work two days later. With standard hip replacement, such a quick recovery would be "absolutely unimaginable," according to Sheinkop.

As for Doyle, who had the procedure in July, she also was standing that night and walking up stairs the next day. "I have not had one ounce of pain since I opened my eyes," she said of the operation. "I do the elliptical machine, I Rollerblade. The only thing I can't do is run."

Besides not being able to break into a jog, there are a few other downsides to hip resurfacing--age, for one thing.

Dr. Michael J. Anderson, an orthopedic surgeon at Blount Orthopaedic Clinic/Columbia-St. Mary's Hospital in Milwaukee, said the best candidates are younger and physically active, with good bone quality.

"We have to remember that regular hip replacement works extremely well in 95 percent of the cases," Anderson said. "I don't want everyone to think they need hip resurfacing. This would be more ideal for the younger patient."

Also, insurance carriers may not cover the new procedure, so be sure to check  For instance, although Anderson's patients have not had problems getting their hip resurfacing covered, Doyle is fighting to have her insurance company cover the $24,000 parts (insurance did cover her two night hospital stay).

And in what Sheinkop called an "unknown entity," the metal-on-metal contact may liberate ions into the bloodstream. In a healthy patient, these should be cleared through the kidneys, but if an individual has poor kidney function, hip resurfacing may not be the best choice

Still, despite the potential $24,000 price tag, Doyle couldn't be happier. She called the operation a "piece of cake" and said she "would recommend it to anyone."
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