cartilage problems because the cushion can’t support the weight. Now while the aged osteoarthritis patients can go in for total hip replacement, youngsters have a problem.

In total hip replacement, surgeons replace a hip by cutting off the head of the thigh bone, the femur, and replace it with a metal ball mounted on a rod implanted deep in the thigh bone. A plastic socket replaces the original. Those artificial hips can bring tremendous relief to people crippled by hip pain.

But the metal-on-plastic friction means the implants can begin wearing out in about 15 years, sooner if sports or other activities increase pressure on the joint. For the average 65-year-old, that's no problem. But a 50-year-old, in contrast, could very well wear out an initial replacement and have little thigh bone left to fit another. Surgeons lightly shave the damaged femoral ball and fit a metal ball snugly over it. That ball rolls in a metal cup reinforcing the socket. The idea: Metal-on-metal shouldn't wear out as fast, and if patients do need another replacement in 15 or 20 years, the thigh bone is largely intact.

"This resurfacing initiative has interest because we're sparing bone,'' explains Sheinkop, a Rush University professor and joint replacement director of the Neurologic and Orthopedic Institute of Chicago.

The operation hit the U.S. market last spring with Food and Drug Administration approval of the British-designed Birmingham Hip Resurfacing System. Competitors are in clinical trials here, and expected to clear FDA later this year.

More than 400,000 total or partial hip replacements are performed each year, a number growing as the population ages.

Doctors differ on what age is the cutoff for resurfacing, somewhere between 60 and 65, largely dependent on the patient's bone strength. Nor do all insurers cover it. The implant costs about 20 per cent more than a standard artificial hip.

Some studies suggest
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