scopin’ it

Wednesday, March 11, 2009

The operation was a success and the good news continued for Alex Rodriguez. The cartilage tear in is hip was repaired and major arthritis changes weren’t found. Baseball’s highest paid player is ready to rehab and get ready to play again. It’s only fitting because not only is he the highest paid but also one of the most durable in the game.

Less than a decade ago, Rodriguez’s hip pain might have been the end of his career. Technology allowed doctors to use MRI to evaluate anatomy and look for injuries but that was as far as it went. There was no way to go inside and fix cartilage injuries or clean out arthritis changes. The usual recommendation was to rest, avoid activities that cause pain and wait until the patient was old enough to get a hip replacement. Then came hip arthroscopy and what was seen could be fixed.

Arthroscopy, the ability to look inside and repair joints is more than a generation old and standard operating procedure for the knee but other joints needed technology to advance. The knee is a hinge joint, meaning it moves in only one direction, and it is large. There is plenty of room to accommodate surgical instruments including arthroscopes, probes and other things used to prod, cut and paste tendons, cartilage and ligaments back together.

The hip is a more challenging joint technically for the arthroscope. It is a ball and socket joint and swivels in multiple directions. It is a smaller joint and is not located near the surface of the body, making access tougher. New instruments and technique needed to be developed to work inside such a small space. General anesthesia and paralysis is required to allow the large muscles of the leg and buttock to relax and allow traction pulling the leg away from the body. This made enough room to insert the scope and allow it to maneuver. Then it was up to the surgeon’s artistry and adventure to see what one could do in the joint.

The hip labral is a wide band of cartilage that helps stabilize the joint. Labral tears can cause catching sensations with range of motion and associated pain. This is often seen in twisting motion found in a golf or baseball swing or with the pounding that occurs with running. Arthritis can narrow the joint space just enough to pinch the labrum and cause symptoms. The arthroscope allows the surgeon to do some housekeeping by repairing any tears and by shaving off bony irregularities.

According to Dr. Philipon, Alex Rodriguez’s surgeon, the patient had both issues and he was happy to report that all went well. Rodriguez was cleared to start range of motion and strengthening exercises and should be good to go within a couple of months.

Timing is everything for Rodriguez on the field. Timing it seems is also his friend in medicine. Ten years ago, his career would be in jeopardy. Today, his injury becomes almost routine.

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