Last Updated on Wednesday, 10 February 2016 16:19
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I am a 50-year-old who developed hip arthritis 18 months ago. I attempted to play through my injury for six months, but then I had to stop. After a thorough workup, I was sent to rehabilitation and now I have almost no pain. While I have hip stiffness and tightness and the decreased motion, I would like to try and skate again. Do you think this is possible?
Answer: In recent years, it has been recognized that hockey players have a much higher risk for development of hip arthritis. Even in youth hockey players, increased hours on the ice may lead to damage of the growth plate and the development of femoroacetabular impingement.
This condition is believed to be due to continued microinjury of the growth plate of the femoral neck, leading to a bony bump, which causes a tearing of the “bumper” of the hip, the labrum. The increased bone on the femoral neck and labral tears can lead to development of arthritis over time.The development of hip problems in ice hockey players is more common than in any other sport and significantly higher than in non-athletes.
Unfortunately, most hockey players do not have symptoms until the hip problem is well advanced. A thorough workup is necessary to diagnose hip arthritis including range of motion and strength testing, X-rays and an MRI scan to best define the problem.
In most hockey players with decreased hip motion and hip pain, surgery to decrease the size of the bony bump and to repair the labrum can be quite effective. However, a large percentage of these athletes also have some underlying arthritis, which is very difficult to treat.
In your circumstance, it appears that the arthritis has progressed to such a degree that arthroscopic hip surgery would not be beneficial. Several studies have shown that athletes with have less than 2 mm of joint space (as often occurs with arthritis) do poorly with hip arthroscopy. In fact, a large number of these athletes will total hip replacements within a few years.
I would certainly recommend that you continue on a low-impact exercise program. While improving your range of motion may not be possible due to the extra bone overgrowth on your hip, it is important to stretch daily to make sure that your range of motion does not become worse. In addition, participation in low-impact activities, such as cycling, swimming and walking can be very effective. Focus on hip-specific exercises that activate hip flexion, adduction, abduction, extension and other movements to improve overall strength, decrease symptoms and increase function.
Finally, attempting to return to playing ice hockey may be beneficial if it is used as part of your rehabilitation program. However, if you experience any significant pain, swelling or stiffness, it may be necessary to cut back on your on-ice activities or avoid skating because this could lead to further progression of your arthritis.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to editor@letsplayhockey.com.
