ACTIVE CARE

When the New York Yankees recently announced the news that Alex Rodriguez, All-Star third baseman and owner of the largest yearly salary in all of baseball, would undergo hip surgery for the second time in 5 years, it highlighted the evolving awareness and concern over injuries involving the hip joint.  The surgery, performed in January, will likely keep Rodriguez out of baseball for at least six months.

The sharp rise in the number of hip injuries and surgeries in professional baseball has been cause for increasing alarm among Major League Baseball teams.   As sports medicine professionals scramble to determine the cause for the increase in hip injuries, it is evident that no singular reason can explain the epidemic.  While media attention has focused on Alex Rodriguez and baseball’s stars, athletes of all ages, skill levels and sports have experienced the disturbing development of hip joint injury.

While arthroscopy, or the use of a less invasive camera guided device for joint surgery, has long been used for knee, ankle and shoulder surgery, it is only in the past decade that it has been utilized for hip surgeries.  During that period, the options available for the treatment of hip joint injuries have increased, most notably with the condition for which Alex Rodriguez had his surgery, FAI or femoro-acetabular-impingement.

The condition, in which a bump on the femur or leg bone collides with the soft-tissue structures of the hip joint, causes a characteristic pain in the front or groin area of the hip.  These repeated collisions can lead to tearing of the hip labrum and cartilage.  While it is commonly found in runners, cyclists, ballet dancers and baseball players, many are predisposed to the condition because of an anatomical difference in the structure of the hip.  It is the belief of many surgeons and sports medicine researchers that FAI is a leading cause of hip arthritis when left untreated.  However, as the sports medicine community has only been aware of the condition for the past 15 years it is difficult to conclusively connect FAI with any long term connection to hip arthritis.

Non-surgical treatment of the condition is often the best initial course of action.  Physical therapy treatment should focus on regaining hip and leg strength with an emphasis on the hip abductors or outer hip muscles.  The exercise program should be individualized based on activity level, sport, joint mobility and relative muscle strength.  Anti-inflammatories are often part of the initial treatment to reduce the bony or soft-tissue inflammation associated with the condition.

If a more conservative treatment plan is unsuccessful in returning an individual to a prior level of athletic activity or pain-free daily life, surgery is likely the next course of action.  If the FAI has not led to any cartilage damage, the surgery can be performed arthroscopically and focus on restoring normal mechanics by shaving down the bony bump on the femur.  Involvement of the hip labrum or cartilage of the hip joint usually requires a more significant surgery and rehabilitation.  It is possible that a more extensive surgery will not be performed arthroscopically but rather will require an open procedure.