The Evolving Hip Surgery Patient
John Marshall, AP
The surgeon waved his arms like a puppeteer over the body of his 18-year-old patient, the sound of a heartbeat from a monitor giving way to the jarring noise of a saw grinding bone in her hip joint. The sedated college volleyball player agreed to the surgery, not knowing if her insurance would cover the expense but hopeful that it would allow her to again walk up stairs without collapsing in pain. And hovering over her was Dr. Marc Philippon, the surgeon at the epicenter of the fastest growing niche in orthopedics: hip arthroscopy.
“The goal, whether it's a professional athlete who earns a living with their body or a weekend athlete, is to get them back to an active lifestyle,” Philippon said. “This procedure allows them to do that.” Used minimally in the 1980s, hip arthroscopies have become much more popular. According to the Millennium Research Group, more than 30,000 hip arthroscopies were performed in 2008 and the number is expected to rise to 70,000 a year by 2013.
Philippon is well known for fixing the hips of Greg Norman, Mario Lemieux, Tara Lipinski, Marcus Camby, Kurt Warner and, perhaps most famously, Alex Rodriguez. His office inside the Steadman Clinic in this ski resort town is filled with autographed photos, posters, hockey sticks, footballs and basketballs.
Philippon has done hip surgeries on everyday people, too, more than 4,000 and counting. One of his recent patients, who agreed to let an Associated Press reporter watch her procedure, was Taylor Irwin, a college volleyball player from Pinedale, WY. She's one of the younger patients Philippon has worked on, but she has as much damage around her hip socket as someone three times her age.
Active in sports since she was little, Irwin started having hip problems while playing soccer and volleyball in high school. She has hip displaysia, causing her hips to go out of alignment, and the constant wear and tear of cutting, jumping and running led to a torn labrum.
After fighting through the pain of her hip popping out of place during her senior season in high school, Irwin couldn't take it anymore once she arrived at the University of Great Falls in Montana.
“My freshman year started and I realized I couldn't play through the pain,” Irwin said. “I'd get deep into a squat low to the ground and wouldn't be able to get back out of it. Even walking up the stairs to my dorm room, by the top I'd feel weakness in my legs, like I couldn't go one more step.”
Had it been 15 years earlier, Irwin probably would have been out of luck. But hip arthroscopy has made enormous advancements in recent years. Doctors learned better techniques for guiding an arthroscope into the awkward angles of the hip, past the tough ligaments and around the head of the femur. They've discovered labral tears and deformities in bone, progressing from cleaning out debris to restorative techniques.
“In the past, we didn't have a treatment for this,” Philippon said. “Now we have an approach, an arthroscopic approach that's very successful.”
Thing is, it's still so new, many insurance companies still don't recognize it as a required procedure. Irwin and her family went into surgery not knowing if their appeal to their insurance company would be approved. Long after the procedure, their insurer agreed to cover 85 percent of the cost.
Irwin's injury was similar, though a little more complicated, than A-Rod's famous hip. Irwin had a torn labrum and an impingement in the ball-and-socket joint, caused by a bone deformity. She also had what's commonly known as a snapping hip; one of the tendons at the front of her hip was too tight and would catch within the joint, causing sharp pain.
For the torn labrum, Philippon cleaned away the frayed edges, drilled holes in the bone for anchors and put a stitch around the labrum. He also whittled down the bone deformity, trimmed off the impingement and released the IT band with an incision to stretch it out.
Philippon later used a whirring ball of razors to notch two holes in the hip bone and had an assistant hammer in what looks like a wall anchor. The hip socket is filled with water during the surgery to better see the damage and clear out the debris. And while the area looks huge on the video screen, it's actually about the size of a tennis ball, the repairs to the labrum and bone less than 5 centimeters each.
The morning after surgery, Irwin was in physical therapy, gingerly riding a stationary bike to work on her range of motion and start building her strength. After returning from Vail, she went to physical therapy twice a day for two weeks, then once a day for about 12 more.
Four months after surgery, Irwin starting running with her teammates and participating in a few drills. At six months, she was pain-free, able to run, cut and do agility drills, though she wasn't able to play this past season. Irwin is expected to be fully healthy when practice starts again in the fall.
“I don't regret any of it,” she said. “The pain I feel now is nothing it was before. It was a sharp, shooting pain, but now it's more kind of soreness and not like it was before, which is reassuring.”
The bad news? Irwin's right hip is getting worse and she'll probably need the same surgery next year. At least she'll know what to expect.