The Hip Option

Category: Tennis

Publish Date: 04-26-2010 11:53 AM -0400

In the May issue of TENNIS we have an article about a player who successfully came back to the court after traditional hip replacement. Frank Trulaske, a 61-year-old tennis lover, returned to his regular game nine months after his surgery, and two years later he’s still playing. It doesn’t go that well for everyone. With heavy use, traditional artificial hips can dislocate or wear out. That doesn’t bode well for patients in their 40s who need a solution for bad hips.�

�“It used to be that the people coming in for joint replacements were all in their 60s and 70s, but now with the baby boomers coming of age, we’re seeing a lot of younger people who’ve played a lot more sports and pounded their bodies a lot more,” says Dr. Chet Simmons, an orthopaedic surgeon at Chester County Orthopaedic Associates in West Chester, Pa. “They’re wearing out their joints sooner and sooner, so we’re seeing some people who need a replacement of some sort in their 40s sometimes.”

One solution for younger people with chronic hip pain is hip resurfacing, which is fairly new to the United States, but is popular in Europe. Instead of removing the ball of the joint and replacing it with a prosthesis, like in traditional hip replacement, a metal cap is put over the ball on top of the femur, which fits into a metal socket that’s placed in the pelvis. It’s usually only done in those who are younger because the patient needs strong bones to support it. “It has to sit on top of healthy bone or it can come loose or fracture,” Simmons says. “Older people typically have weaker bone and it may not support that structurally.” Simmons says there’s also concern about doing the procedure in women because of the prevalence of osteoporosis as they get older.

Hip resurfacing is the option Simmons’ patient Mike Schnably, a 45-year-old competitive tennis player, decided on. A Division II All-American for West Chester University, Schnably gave up playing competitively for about 20 years after college, but he took it up again in his 40s as a way to stay in shape and have fun. He rose quickly to No. 39 in the nation in the 40-and-over division, only to be brought down by chronic hip pain. At first he thought it was just a pulled muscle or a bruise, but it got progressively worse. “Eventually, end of the year 2008, it was baaad,” Schnably says. “I couldn’t even keep up with people playing golf. I couldn’t do anything. I mean, I could walk with a limp, but there was pain.” An X-ray revealed that he had no cartilage left in his hip. Bone was rubbing against bone.

�Schnably wanted the pain to go away, but he didn’t want to give up his lifestyle. As a young, active guy, he feared that a traditional hip replacement wouldn’t keep up with him and that it would wear down too quickly or dislocate. “Intense play would probably shorten the life of a traditional hip replacement significantly,” Simmons says. “There are lots of folks that will play kind of low-intensity tennis, and they can do that pretty well because they don’t have to run long distances or dig into the corner for a ball.”

A little less than a year ago, Schnably had a hip resurfacing with a product made of magnesium cobalt alloy. Six months after the surgery, he was back on court. Now, he’s ranked No. 5 nationally in the 45s and he has won three tournaments so far this year.�

Of course, not everyone has as much success as Schnably. A recent article in the New York Times questions the safety of metal-on-metal hip products. The concern is that the metal rubbing together releases tiny particles that can cause soft-tissue damage or even get into the blood stream, especially in poorly installed resurfacings. Only a small percentage of people have had problems like these, but they’re certainly a concern. “That’s a problem with any new surgery because you don’t have long-term follow-up yet,” Simmons says. The majority of people who’ve had this are doing well like Mike. But it’s something we always discuss.”

Now pain-free and playing as well as he was before, Schnably has been satisfied with his decision. “You can’t tell it’s there except when you go through the airport,” he says.

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