It was a sunny day in 1998. Jennifer Rottenberg, then 28 years old, had just moved from New York to Los Angeles for a marketing job at a golf-course-management company. After two and a half years spent working hard – but rarely working out – in the Big Apple, she was ready to get back to a more active lifestyle that reflected her love of sports.
“I was so excited about living a healthier life in California,” Rottenberg says. “So shortly after I moved, I decided to go out for a run. But when I woke up the next day, I could hardly walk because my hip was so inflamed.”
She managed to get to the doctor’s office, where she received a shock: She had developed osteoarthritis, a gradual degeneration of the cartilage covering the ends of bones, in her right hip joint.
It turns out that although osteoarthritis is rare in people under 45, it’s not unheard of: An estimated 2 percent of Americans are diagnosed with the condition before their 45th birthday. But until age 55, more men develop osteoarthritis than women, which made Rottenberg’s condition even more mysterious to her. The disease’s causes range from prolonged, abnormal stress on weight-bearing joints, to sports injuries, to metabolic disorders.
Rottenberg’s doctors couldn’t tell her the cause of her premature degenerative arthritis, but whatever the reason – a childhood injury or some other factor – blood had long ago stopped reaching the head of her right femur and, over time, the structural integrity of the hip joint had disintegrated. The cartilage that protected the top of the femur from the pelvis socket had been damaged, so the bones were rubbing against each other, causing serious pain.
The doctors told her that eventually she’d need to have hip-replacement surgery, a procedure that involves the removal of damaged tissues and the insertion of a small prosthesis that mimics the natural mechanics of the hip.
“The initial consensus of the majority of my doctors was that these artificial hips are great and getting better all the time, but they have a life span of only 10 to 20 years,” Rottenberg recalls. And, the doctors warned, each time the hip underwent replacement, more bone would be excised and the risk of complications would increase.
Some implants can last up to 25 years, making the prospect of a second replacement unlikely for, say, a 65-year-old man. But because Rottenberg was so young, she was sure to need a second, if not a third, surgery to repair or replace the implant at some point in her life. Fearful of the implications, she spent the next several years in denial, even as the pain grew worse. “I held out the hope that I could fix it instead of replace it,” she says.
Eventually, however, her deteriorating quality of life made the surgery look like an attractive solution. “I was 32 years old and couldn’t do anything. I’d lost my range of motion, so I couldn’t even take a normal stride,” Rottenberg says. “My only activities consisted of riding a stationary bike and walking, but with a limp, and that kept getting worse.”
Rottenberg had grown up playing every sport she could, including soccer, basketball, volleyball, softball, track, tennis and swimming, so not being able to participate in any of the activities she loved became motivation enough to face her fears. “To be in your early 30s and not be able to go out and hike or play tennis or golf or go dancing with your friends – that’s hard,” she says. “I couldn’t do any of those things. I wanted to get my life back.”
At the suggestion of a friend, she contacted a prominent surgeon in Boston who dealt with hip replacements, Benjamin Bierbaum, MD, former chairman of orthopedic surgery at the New England Baptist Hospital and clinical professor of orthopedic surgery at Tufts University School of Medicine. Bierbaum outlined his methods, and Rottenberg extensively researched these, as well as other options. She found that there’s more than one way to replace a hip joint, each with its benefits and drawbacks.
The most common type of implant consists of a metal ball that fits into a polyethylene-lined cup. But such implants can have a serious side effect, according to Bierbaum, in that over time the plastic particles can wear off and enter the body, triggering an inflammatory response that then causes an additional loss of bone around the implant. The condition, called osteolysis, loosens the implant and results in the need for further surgery.
Through the years, biomedical engineers have experimented with other materials in an effort to build a perfect hip-replacement device. But the downsides of each material eventually emerged: A metal-on-metal implant might result in ground up metal particles entering the bloodstream. Ceramic-on-ceramic implants sometimes cracked.
But in February 2003, the Food and Drug Administration (FDA) approved an implant developed by the Stryker Corporation: the Trident Ceramic Hip System, a ball-and-socket device made of a new alumina ceramic. In clinical trials involving more than 1,100 patients, the product proved highly durable; plus, the new ceramic could withstand sudden, intense bursts of movement, as well as daily wear and tear. Occasionally, wear debris from the implant did enter the joint space, but it didn’t trigger an inflammatory response.
Bierbaum had participated in the FDA studies of the improved materials, and he recommended the use of this improved ceramic-on-ceramic implant for Rottenberg. “Regarding the proposed longevity of the new bearings, we predict that it will allow younger patients to be physically active without detrimental effects to the wearing of their joints,” Bierbaum says.
The possibility of returning to an active lifestyle enticed Rottenberg, as did Bierbaum’s expertise. “He does hundreds of ceramic implants a year,” she says. “He knows what he’s doing.” So finally, after suffering for five years, she decided to have her hip replaced.
The Gift of Mobility
In December 2003, Rottenberg traveled to Boston, where she had grown up, and where her parents still lived. Four days before Christmas, she entered the New England Baptist Hospital for her surgery. When she emerged from the procedure, she knew she’d received the best present ever.
Her incisions hurt and the soft tissues in her leg were sore, but it was an absence of hip pain she noticed most. “When I woke up,” Rottenberg recalls, “I had pain from the surgery, but I could already tell there was no pain in the hip joint.”
The next morning, she was up and walking with the aid of a walker. “Two days after that, I was walking up and down stairs with crutches and getting in and out of bed.” The day after Christmas, she was out of the hospital and at her parents’ house, where she stayed for a month, working with a physical therapist three days a week on an aggressive rehab program.
“Rehabilitation is critically important,” Bierbaum says. “Once patients go through the early phase of letting the soft tissue heal, they need to do flexibility training, cardio and strength training. When that’s completed, they should be able to do other physical activities.” After a month, Bierbaum said, Rottenberg had improved enough to return home to Los Angeles. She left the crutches behind, carrying only a cane.
Back in the sunshine, Rottenberg continued to do exercises prescribed by her physical therapist, which included walking, leg lifts and weight training. As she progressed, she worked on squats, balancing exercises and strengthening her hamstrings. After two months, she could walk without her cane, and she began exercising on a stationary bike and elliptical machine. Then, in summer 2004, she gave her hip joint a major test: She and her parents went on a vacation to Italy. “We did a lot of walking,” she says. “I never could have done that before the surgery.”
Low Impact, High Activity
Now, at 34, Rottenberg is still careful about how she exerts herself. Her implant will never be as stable as a healthy, natural hip joint, so she doesn’t participate in high-impact activities, such as one-on-one tennis matches and soccer games, which could damage or dislocate her implant. But she is back to a more active lifestyle, which suits her perfectly. She’s shooting basketballs and riding bikes, walking, hiking, golfing and swimming.
The new ceramic hasn’t been around long enough for doctors to know precisely how long it will last. Realistically, it’s likely that at some point Rottenberg will need another surgery. But today, that fact seems less like a daunting prospect than a decent tradeoff. “I feel better. I have more freedom to be a regular person,” she says.
Although, as with all major surgeries, hip replacements carry with them a small risk of serious complications, including infection, negative reactions to anesthesia and less-than-ideal recovery outcomes, there is no question in Rottenberg’s mind that the rewards are worth the risk, particularly given recent technological advances.
When she looks back at her own experience, what she most wants to pass along to others is a message of hope. “Once you have the surgery – once you get past that day – everything is going to be so much better,” she says. “Don’t be afraid to make it better.”