when it’s not so hip…

Monday, September 30, 2013

Joints are parts of the body that we take for granted when we’re young but as we age, they start to get stiff, take a while to warm up and get moving and become the focus of our body getting older. Sometimes, trauma and injury make our bodies get old in a hurry. A weekend of watching the NFL confirms that the body is not meant to be hit at a high rate of speed. Often the bodies bounce, but Jake Locker, the Tennessee quarterback was not as lucky as his hip buckled. As he was carried off the field, first for x-rays in the stadium and then to the hospital for more tests, the rumors regarding his status ran rampant. A day later and there is still uncertainty about what is going on deep within his hip joint.

The hip joint is pretty well designed ball and socket joint. The head of the femur, the ball, sits in a deep socket of the pelvis called the acetabulum that is made deeper by the labrum. This is a ring of cartilage that extends the joint but is also flexible to allow the hip to move more freely. There is also a fibrous capsule that encases the hip, plus large muscles of the buttock and thigh to add extra protection. While the cartilage can be damaged by overuse and arthritis, it takes a significant force to damage the hip joint with a single blow.

Dislocating the hip is a rare athletic injury and most often occurs as a consequence of a car wreck. If the bent knee is driven into the dashboard, the force causes the hip to dislocate posterior or through the back of the joint. Other types of dislocations can occur but are much more unlikely and require a different type of mechanism. Anterior hip dislocations occur when the leg is turned out and forced backward levering the femoral head out of the socket, but this is very unusual injury. As it turns out, care safety technology with better air bags, decrease the risk of hip dislocations, but they still happen and they are an orthopedic emergency.

The hip needs to be relocated as soon as possible to restore blood supply to the ball of the joint, the femoral head. The longer that is it out of place, the higher the chance of avascular necrosis, the term used to describe death of bone because of loss of blood supply. Othercomplicat8ions include damage to the sciatic nerve, the femoral nerve and the femoral artery, all structures that need to work to have a normally functioning leg. Even with prompt care, the prognosis is not great. Good hip function can be expected in about 50% of patients and potentially 70% will develop arthritis in the joint.

Then good news is that Jake Locker’s doctors don’t think that he had a hip dislocation. The bad news is that there is so much swelling in and around the hip that it obscures the labrum and the jury is out whether it is damaged. Patience is not a virtue for injured athletes, but Mr. Locker will have to wait for a few days before another MRI to look at the hip.

A torn labrum may or may not be a big deal. Small tears can be treated with rest, ice and anti-inflammatory medications and may heal nicely. However, the MRI often underestimates the damage that is seen when arthroscopic surgery looks directly inside the joint. The hip is a small joint and to fit the camera inside, the hip has to be distracted or partially dislocated. The labral tear can be fixed or trimmed but rehabilitation and recovery may take 6-12 weeks. It’s a reminder that all joints are not created equal since a pro athlete can be back on the field in a couple of weeks after knee arthroscopy.

No matter the short term outcome for Mr. Locker, the long term prognosis would favor him developing a chronically sore and arthritic hip as he ages. The question is whether his hip will age gradually with the rest of his body or whether it will get old before its time. A reminder that the body is not meant to be hit at high speed.

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