Putting Your Best Hip Forward
Chris Ritrievi decided to get a total hip replacement the night his wife Stephanie watched him struggle with his socks and shoes. “When you can’t do that any longer,” she said, “I’m not going to do it for you.”
Ritrievi, 51, is the Associate Athletic Director at the University of Utah. His life revolves around sports. Ritrievi broke his left hip nine years ago while skiing. He went under the knife at 42, woke up with three pins holding the bone together, and, after recovery, resumed anactive life. A typical year found him on the links for 48 rounds and on the slopes for 40 days, many of which he spent as a certified ski instructor at Park City Mountain Resort.
The socks-and-shoes incident was one of a few gradual yet unmistakable aggravations since the accident. His gait stiffened; his lower back developed a nagging pain. He rode the golf cart rather than walk the course. In addition, when he fell on his left side skiing, he would roll over onto his right to get up. Other wise, he needed a helping hand.
Despite his middle age, he knew it was time for intervention. Fortunately, hip replacement is no longer reserved for old folks who have “fallen and can’t get up”. Ritrievi had a solution to what ailed him.
“When hip replacement began in the 70s, it was for those who had stopped walking,” says Chris Peters, M.D., an adult reconstruction specialist at the University Orthopaedic Center at theUniversity of Utah. “Today, someone who has pain which prevents activity doesn’t have to tolerate [the condition until full failure].” Peters replaced Ritrievi’s hip in late April, 2008.
Though cases like Ritrievi’s may seem to have an obvious cause and remedy, what actually leads to hip replacement is up for debate. The problem could have developed long before a significant event like that ski accident. Some doctors, including David Petron, M.D., the U’s team physician, say you could have had a minor sports-related injury as far back as grade school. “The injury itself sets up a cascade of events that leads too steoarthritis,” says Petron. Also known as degenerative arthritis, osteoarthritis is the wearing out of cartilage in the joints.
Still other doctors like Peters, have additional theories; like hip dysplasia. “There is mounting evidence that the vast majority of people under 55 who exhibit degeneration in the hip joint have underlying anatomical abnormalities,” he says. “Manyfeel like the on set of symptoms started with a football injury or bad fallskiing. I think the cards probably have already been played, so to speak.”
Based on this belief that it’s not an injury per sebut genetics that mess with joints, Peters’ perfected an acclaimed procedure known as “hip preservation”. Designed to keep the natural hip intact and delay a total hip replacement, hip preservation usually entails reshaping either the hip socket or the hip’sfemoral head. In contrast, a total hip replacement exchanges the natural balland socket joint of the hip for an artificial set- a procedure that requires cutting off the top of the femur (your thigh bone).
No matter the cause, it’s tough to predict who will need a hip replaced and when. “There are so many variables,” says Peters.“Statistics say if you live over the age of 65, 8 out of 10 people will have some sort of joint problem.” But not all activities will lead to arthritis and joint replacement. “Being athletic puts you at risk for trauma,” says Petron.“But there are a lot of marathon runners that put a lot of mileage on their joints and they don’t get arthritis.”
And hip replacement is more of a last resort. “Once we see cartilage damage, we try to protect what remains by reducing activity, ”Petron says. Next, comes hip preservation and ultimately, if necessary, the hip replacement.
“We are performing hip replacements more frequently in younger people because they’re wearing things out faster, but you want to be asold as you can be when you have your first,” says Jill Erickson, a Physician’s Assistant who works along side Petron and Peters. The reason is that no matter the initial procedure, you’re bound to need another one. A total hip replacement might last 15 years, it might last 20 years—but it won’t last forever. The service life of a hip preservation is even less, but it’s done to delay the replacement.
“The goal isn’t to replace a joint and get someone back to a high impact activity like running,” Petron says. “The goal is to get them pain free and back to an active lifestyle.”
Let’s say you decide to proceed with hip preservation or a total hip replacement. What happens after the anesthesia wears off? A typical total replacement recovery might require four weeks while those recovering from hip preservation usually spend about six weeks on crutches and a cane. In either procedure, Peters says most patients resume activities after about two months of rebuilding strength and stamina. Seeing a physical therapist usually is not necessary, though competitive athletes commonly do. Follow- up office visits occur at two weeks, six weeks, six months, 12 months, and every two years there after.
Once recovered, just how much activity a patient can resume depends upon prior activity and age. High-impact sports such as running, basketball, and racquetball are discouraged, but most other sports are easily resumed— including downhill, backcountry, and cross-country skiing. “We have close to 100 patients who ski more than 20 days a year on the Wasatch front, ”Peters says. “In 20 years we haven’t seen any revisions due to this activity.”
Within six weeks of his operation, Ritrievi dumped the crutches. He returned to the gym every other day, using the elliptical trainer, gradually increasing the speed and resistance. Most every night now he walks around the block near his home, accompanied by Stephanie and their dogs. The only pain, he says, is the normal muscle aches from a typical workout. His hipsare pain free.
“My expectations are high,” says Ritrievi, whose goal is to play 18 holes by July 4th weekend.“I don’t expect to play 48 rounds of golf this summer, but I’d like to play 30. And I expect to teach skiing next winter.” After all, he says, “The artificial hip is better than what they tookout.”
Story by John Blodgett
