Hip procedure gets a soldier’s career back on track

Alternative to hip replacement makes one gentleman Army Strong
Oct. 28, 2015

Hip x-ray before resurfacingPat Jewell will soon start a new assignment with the Army as a Ranger instructor, thanks to a hip procedure at University of Colorado Hospital.

This X-ray taken before Jewell’s procedure shows severe deterioration at the ball of the head of the femur in the left hip.

An X-ray taken one year after the October 2014 hip resurfacing shows the resurfaced and capped femoral head.
In July 2011, Pat Jewell suffered a hip injury that sentenced him to three years of excruciating pain. For many of us, even such a setback wouldn’t be career-ending. But his is no ordinary career.

Jewell, 50, an Army staff sergeant, was on a tour of Afghanistan when a board in the roof he was standing on gave way. He jumped onto a rafter, but it also broke. Jewell fell about 10 feet, landing heavily on his left side. He says he initially felt only “aches and pains” in his lower back, but the discomfort steadily worsened with hours on patrol.

Hip X-ray after resurfacingDeployed a second time to Kuwait, Jewell struggled through hip pain so severe he couldn’t sleep. An X-ray ultimately revealed that the cartilage cushioning his left hip was gone, leaving bone rubbing on bone. He was told he needed a hip replacement. That would have effectively ended his career as a soldier, as the military will not assign individuals with hip replacements to any job that requires high-impact activities.

“I’d have had to reclassify to an office job or get a medical discharge,” Jewell said.

Second chance

Today, Jewell, who lives in Peyton, Colo., in El Paso County, is looking forward to starting a new assignment at U.S. Army Ranger Camp Frank D. Merrill in Dahlonega, Ga. It’s no desk job. He will prepare soldiers for the rigors of special operations combat. He runs 5 miles in about 40 minutes and has just completed a 6-mile road march with a 40-pound pack at a 15-minute-per-mile pace. That puts him halfway toward the Army’s requirement for a 12-mile walk in three hours or less with a 35-pound pack. He is on track to begin his three-to-four-year commitment in January.
Orthopedic surgeon Cecilia Pascual-GarridoCecilia Pascual-Garrido, MD, an orthopedic surgeon at UCH, performed the hip resurfacing that saved Jewell’s career.

The femoral head, exposed during the hip resurfacing procedure.

A procedure called hip resurfacing, performed by orthopedic surgeon Cecilia Pascual-Garrido, MD, at University of Colorado Hospital, rescued Jewell’s career and restored his quality of life. Resurfacing is an alternative to total hip replacement, which requires removing both the femoral head and acetabulum, which form the ball and socket, respectively, of the hip joint and implanting metal prostheses in their place.

In resurfacing, the surgeon keeps the femoral head, but trims off any damaged bone and fits a porous metal cap on top of it. After cleaning out the socket, the surgeon lines its surface with metal, inserts the repaired femoral head, and cements the components in place. The cap on the femoral head and the socket lining protect the bone, as natural cartilage would.

The procedure is aimed at people like Jewell who are relatively young and active, Pascual-Garrido said. Unlike a hip replacement, the resurfacing preserves the patient’s tissue and bone. That also makes it easier to perform a traditional hip replacement if the prostheses have to be removed because of wear or malfunction, she said.

Touch and go

Jewell said he was unaware that he even had another option after he received the “depressing” news that he would need a hip replacement. He discovered the hip resurfacing technique through his own research, watched a YouTube demonstration, and searched for providers who could perform it. He found that Pascual-Garrido is one of the very few surgeons in Colorado with experience in hip resurfacing, and set up a “meet and greet” with her at UCH.

When Pascual-Garrido met Jewell, he was in obvious pain and walking unevenly, but the decision to perform the resurfacing was far from a slam dunk because he had a large femoral cyst. If more than 30 percent of the femoral head was compromised, the procedure couldn’t take place, Pascual-Garrido said.

Unwilling to give up on his career, Jewell said he “begged and pleaded” with her to perform the procedure. He went to sleep in the OR in October 2014 not knowing if he would awaken with a resurfaced joint or a complete hip replacement. Pascual-Garrido was able to fill the cyst with bone cement, and determine during the procedure that Jewell was still a candidate for hip resurfacing.

Jewell spent three days recovering in the Orthopedics Unit at UCH. Although he had post-surgical pain, he could finally move his left leg without the throbbing agony caused by the original injury. After the surgery healed, Pascual-Garrido encouraged him to walk but also warned him to avoid running or engaging in any high-impact activities for six months. By August, Jewell was at full strength and had his orders to report as a Ranger instructor.

Wait and watch

The procedure is not without risk. Success relies on careful planning and measurement to ensure the capped femoral head is oriented to and fits precisely within the lined socket, Pascual-Garrido noted. Failing that, the prostheses will wear unevenly and place too much stress on the femoral neck, which connects the head to the femur.

In addition, Jewell has about a 4 percent risk of contracting an inflammatory reaction caused by metal-on-metal contact of the prostheses parts. That means annual blood testing to check the metal levels in his blood. If they are too high – greater than 20 mg – the device has to be removed, Pascual-Garrido said.

Four-plus years after his injury, Jewell is ready to get back to the active working life he had, and he credits Pascual-Garrido and the UCH team for helping him get there.

“The quality of care was outstanding,” he said. “They were very thorough and professional and any questions I had were promptly answered.” Pascual-Garrido, he added, gave him a straightforward message.

“She had an attitude of ‘You’re not limited, so it’s up to you to get better,’” he said. “That motivated me.”

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.