But like a growing number of young, active people, Stewart eschewed the "gold standard" treatment - total hip replacement surgery - in favor of a new procedure that, propelled by aggressive marketing featuring pictures of vigorous, youngish athletes, is sweeping the United States: hip resurfacing.
The main claim for resurfacing is that it can preserve more of the thigh bone, making any subsequent surgery more feasible if the initial repair wears out.
Stewart, who paid $30,000 for the procedure and follow-up care because it was not then covered by insurance, is delighted with the results. He can once again "paint million-dollar houses by myself and jump up on roofs."
But many orthopedic surgeons, including the one who performed Stewart's surgery, Dr. Carl Talmo at New England Baptist Hospital, are worried about the rate at which doctors, most of whom are still on a steep learning curve for this technically demanding procedure, are jumping to do it. (Resurfacing is so new that statistics on the number of people who get it will not be available until next year, according to the American Academy of Orthopaedic Surgeons.)
"I'm encouraged, but I also harbor a healthy skepticism toward resurfacing," said Talmo, who added that Stewart was his first - carefully selected - patient. "There's tremendous potential for young, active adults," he said, "but we need to be cautious because there is also the potential for this to be overutilized in the wrong patients.
"Every objective study of hip resurfacing anywhere in the world demonstrates slightly higher failure rates in the first one to five years than total hip replacement," Talmo added.
In hip resurfacing, surgeons shave down the tip of the thigh bone, capping it with metal, and then scrape out the hip socket into which the cap fits and line the socket with metal. The surgery and recovery with resurfacing can take just as long as with the standard replacement operation, and it often requires a bigger incision.
Dr. Michael Millis, director of the adolescent and young adult hip unit at Children's Hospital Boston, put it more bluntly: "Resurfacing is very attractive because of its great stability. But it's a harder operation. There's more blood loss. And nobody has 20-year results."
