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Hip resurfacing is far more appealing to younger patients, because most of their natural bone is preserved. Instead of removing the top of the femur, the surgeon smooths out the hip's damaged ball joint and covers it with a metal cap, much as a dentist would cap a damaged tooth. Then the hip socket is cleared of worn cartilage and lined with a metal cup. When the resurfaced joint is replaced, the patient's range of motion is restored, pain free.

Risks and past trouble

But resurfacing isn't without risk. In up to 2 percent of patients, the short length of bone that attaches the ball joint to the femur snaps, requiring patients to have a hip replacement. Surgeons try to minimize the risk by resurfacing only patients with strong bones.

Resurfacing itself isn't new. It was introduced in the United States in the 1970s, but the first implants were made with a plastic socket lining that didn't wear well, and the procedure fell out of use in the 1980s. Modern implants use a metal or ceramic socket and are considered much more durable.

If the implant wears out and the patient opts for a hip replacement later, the surgeon has plenty of bone to work with, Vail said.

Vail, who helped design a resurfacing implant for a subsidiary of Johnson & Johnson, said treatments for hip pain are evolving to meet patients' changing needs. Traditionally, hip surgery was for older people, and it was mainly to help them walk without pain, he said. Today, people stay active longer and are unwilling to accept that their aging bodies aren't up to the rigors of snow skiing, tennis, hiking or salsa dancing.

"What's changed is people's expectations," Vail said. "We can't rely on the old technologies to meet their needs."

Market going abroad

Resurfacing's slowness to win FDA approval frustrates Vail, who knows many patients are desperate for help now.

"If the technology is worthwhile and proven, it should be offered in the U.S.," Vail said. 'It seems like it's time [for FDA approval], but it's not our call."

Vail doesn't like to see patients going halfway around the world for a surgery he has been doing for more than five years. But he knows many aren't prepared to wait.

Bennett, for example, has helped two other Triangle residents -- a man in Cary and a woman in Raleigh -- get appointments with her surgeon in India, where both ended up having their resurfacing surgeries.

Responding to questions via e-mail, Bose, the surgeon who operated on all three patients, said he now does hip resurfacing on up to 15 Americans each month. Business picked up considerably after the television news program "60 Minutes" aired a segment last spring on medical tourism that featured an interview with him. Before then, Bose operated on Americans only occasionally.

Active again

Franky McMahan, 62, the woman Bennett encouraged to contact Bose, said it would have been difficult for her to afford surgery at Duke. She and her husband lost their health insurance a few years ago after the company covering them quit doing business in North Carolina. They never replaced it with a new plan.

Like Bennett, McMahan was eager to avoid multiple hip replacements. She was also eager to get back to a more active lifestyle. McMahan said pain often caused her to lag behind friends and family when she accompanied them on outings.

"I was last in line," she said. "People would forget about me."

McMahan returned from India in early March. Her pain is gone, and she recently stopped using the crutch her Indian nurse sent home with her. She exercises daily to build her muscles. And she is looking forward to showing companions she can keep up.

"Maybe I'll even set the pace," McMahan teased.

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