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Eastern Idaho

Spring/Summer 2013

EIRMCs new pediatric intensive care unit offers community unique service

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Hip resurfacing procedure saves bone, gets patients back to what they love

By Ainsley Despain For Medical Guide

his practice, Ravalli Orthopedics & Sports Medicine, P.C. n 2006 the FDA approved Long-term goals of hip the Birmingham Hip reresurfacing are to provide surfacing procedure, a pain relief, restore normal bone-saving alternative to activities of daily living, and hip replacement. enhance overall quality of The BHR has since swept life. the nation in success. Over 95 percent of the Dr. Gregory M. Behm, time the cause is arthritis, Dr. Gregory M. MD has been with Steele Behm said. On occasion Memorial Medical Center its a hip dislocation due to a Behm, MD in Salmon, Idaho since 2010 car accident or similar type and has performed this operation an of trauma. Some patients will have conaverage of 25-40 times every year since genital anomalies which made their hip 2007 when he added the procedure to go bad sooner. Other causes like those

or avascular necrosis are much less common. The difference between the total hip replacement and the BHR is on the femur side. Instead of replacing the entire ball portion of the ball-andsocket joint, the resurfacing procedure shaves down the arthritis which allows the metal to be attached to the healthy bone. The BHR is more of what I call a step-change in what we can offer young patients with hip arthritis, Behm said. Particularly for those who are in their 30s and 40s who are runners or snowboarders or involved with high impact, high demand sports or work. They have

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awful hips and want to go back to the active lifestyle they had. When comparing the BHR to total hip replacement, Behm said the recovery is different but not necessarily a faster process. Both surgeries require anywhere between 1 to 6 months to recover mobility. Patients can get back to activities such as yoga and skiing; they can do what they want, Behm said. After a year they can go back to high intensity activities like tennis, jump aerobics, or a triathlon. With a standard hip replacement high impact activities like running, racquetball, tennis, etc., can lead to early failure and are usually not recommended. He was recently told by the manufacturers of the implant that his practice ranks in the top 50 in numbers of BHRs done by any particular surgeon in the U.S. When we started coming to SMMC in 2010, we brought that service to this hospital, Behm said. The new SMMC hospital is only eight years old and is a state of the art facility for a small, rural hospital. Behm said his wife is the one who had the vision that the BHR would be something that would develop into a substan-

tial part of their practice. Dr. Behm specializes in orthopedics which focuses on the musculoskeletal system of the body. He primarily treats ACL and other ligament tears, cartilage tears, dislocations, fractures, sprains and arthritis. They serve

After a year they can go back to high intensity activities like tennis, jump aerobics, or a triathlon. With a standard hip replacement high impact activities like running, racquetball, tennis, etc., can lead to early failure and are usually not recommended.
Dr. Gregory Behm, MD
patients who come from Billings, northern Idaho, Missoula, Bozeman, Great Falls and Helena. I really love patient care and surgery. Its rewarding to meet someone who is in pain and be able to offer them something that fixes that problem, Behm said. They come from

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hundreds of miles and almost without exception they are thrilled with the care that they get at SMMC. The BHR procedure was invented by Dr. McMinn and Dr. Treacy in Birmingham, England which is where it gets its name. They were able to expand the use of their implant from England to Canada, Australia, and India and later to the U.S. British Sir John Charly tried hip resurfacing in the 1950s using Teflon-on-Teflon bearings but they wore out in 2 years. The metal ball-andsocket mechanism used today is made of cobalt chromium steel. The large metal on metal joint reduces the risk of post-surgery dislocation by 10-20 times. This also leads to a reduced need for follow-up surgery. Today, completely new procedures are uncommon, Behm said. Instead, there are usually many small improvements that make treatments either more effective or easier to perform. In other words, the improvements made in medicine today are in

Unlike with standard hip replacement, patients with BHR can get back to high-impact activities in about a year.

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the details of the procedure and in the tools used. The approval process to introduce a new device into the medical world is expensive and may contribute to the waiting period, among other things. The BHR was approved around the world in 1997 but the FDA did not approve it in the U.S. until 2006. Youre looking for someone who can spend the millions of dollars required to get the device approved, and hope to get

Behm said. Certain patients have had ups and downs but overall its been an excellent implant for the right patient. Where the FDA helps us is in situations like where there have been a few hip procedures in other countries that had 50 percent failure after only a few years. In those types of cases, I am glad the FDA takes its time and Im glad things like that didnt get approved. At the end of January this year the FDA issued a statement which reiterated the fact that the BHR had already met all the requirements for FDA approval and is still a reasonable and approved implant for the appropriate patient. Ravalli Orthopedics & Sports Medicine, P.C. is an independent practice. Dr. Behm and his wife have been working with SMMC since October of 2010. Their primary goal for the future at SMMC is to continue building the practice. We want to make our practice and this Dr. Gregory Behm, MD hospital somewhere that people come to have a very intimate and personal experience and it back. There is the good and the bad to the FDA, Behm said. go home and do well, Behm said. We want to make it a They are very slow moving, slow to approve new procedures. destination for patients who need help. There are things like the BHR that ideally should have been Patients who suffer hip pain due to rheumatoid arapproved much sooner. thritis, osteoarthritis, hip dysplasia or avascular necrosis Studies show that the 140,000 plus procedures done on should consult their physician about being considered for those who have had the BHR hips 15 years or later show the the BHR. vast majority of the people are still happy with it. For more information, go to www.BriminghamHipResIts extremely good. Survivability has been excellent, urfacing.com. n

I really love patient care and surgery. Its rewarding to meet someone who is in pain and be able to offer them something that fixes that problem.

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