New Hip Surgeries Boost Mobility, Fend off Arthritis

USA TODAY—July 20, 2009

Jasmine Caccamo talks about how she was not able to walk down a New York City block without having to stop several times and rest her sore hip. She is only 26 years old. Enough already, she thought. This is just decades too young for the jabbing pain in my groin.

In her quest to find out what was wrong, she went to six doctors in nine months, got three MRIs, a CAT scan, three sets of X-rays and several different diagnoses. It wasn't until she saw Dr. Struan Coleman at Hospital for Special Surgery in New York that she got the answer: She had a torn labrum (fibrous cartilage that seals and stabilizes the hip joint) and impingement.

More people are seeking treatment for the injury, says Coleman, head team physician for the New York Mets, partly because they hear how surgery has allowed the return to action this year of professional athletes such as Philadelphia Phillie Chase Utley.

"It's not unusual to see that many doctors," Coleman says. "The thing about hip injuries is it's complicated and one of the hardest things to diagnose. Making the diagnosis is 90% of the problem. If someone tears their ACL (knee) or rotator cuff (shoulder), those problems are much more easily indentified."

Coleman performed Caccamo's arthroscopy six weeks ago. Now she is getting physical therapy and can walk pain-free for several blocks at a time. She is not 100% yet, but she's hopeful.

"Luckily, I found the right doctor and he did a great job," Caccamo says. "I was hurting. Now I have pain from the surgery, but I'm told in three months that will also be gone."

Preserving hips is a rapidly growing field. Coleman and colleague Bryan Kelly, an associate team physician for the New York Giants, say diagnostic tools and the understanding of hip biomechanics have taken off in the past 10 years. They are opening a new branch of the hospital, the Center for Hip Preservation, this month.

Most of the early research on hips focused on replacement. Kelly says that's still a "perfectly good surgery" for end-stage arthritis. Coleman says the hope is that repairing pre-arthritic injuries or congenital abnormalities, if done early enough, can prevent cartilage damage and arthritis.

"It's a really exciting time right now," Coleman says. "We're helping people stay active longer, and we're helping professional athletes extend their careers."

An impingement results when the hip ball and socket don't fit together harmoniously. Either the ball or socket is misshapen or both have irregularities. During arthroscopy, irregular areas are shaved and torn labrums are repaired. This can be done with minimum effect on surrounding muscles and tendons because arthroscopy is done through a small incision with a scope.

In the past, Coleman says, impingements would end sports careers or stop people from being active because of the pain. Kelly says nerve endings in the labrum can stimulate pain fibers, causing pain sensations throughout the hip region, most often in the groin.

"I can't find enough time to see these hip problems," Kelly says. "We're booked out with surgeries through the end of August. I don't think it's that more people are having pain. It's just that more people are thinking, 'Well, maybe I don't have to live with this chronic pain' and they're looking for a solution."

It is not always a success. Kelly says progressive pain can occur after the surgery. Additional scoping might be required to repair tissue or reshape areas of bone.

Doctors learning more

"We can't give cartilage back," Coleman says, adding with a laugh, "It's on my list of things to work on, but once it's gone, it's gone."

And that is when arthritis cripples a joint.

For Caccamo, though, the prognosis is good. She says Coleman told her she will be able to run and lead an active life, although she's not expecting to run hurdles again, which she did for 12 years before college.

"He asked me if I want to run the NYC marathon and didn't know if that would be a possibility, but I told him I want to run a mile, kick the soccer ball around, do the treadmill. He said that was doable."

Read the full story at USAToday.com.

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