Hip surgery no longer game, set, match
Injury often used to be a career-ender, but men benefit from advances
WIMBLEDON, England — The modern men’s tennis game has not been kind to hips.
Few players have come back from hip surgery to make an impact on the ATP World Tour. For some, it was a direct path to retirement. For others, it was a post-operative condition from which they never recovered.
The list of players whose careers were cut short or irreparably diminished is notable — from former No. 2 Magnus Norman of Sweden to three-time French Open champion Gustavo Kuerten of Brazil to multiple Olympic medalist Fernando Gonzalez of Chile.
“They just didn’t really know how to do it back then,” says American doubles specialist Mike Bryan, who was urged by doctors to go under the knife for a hip problem in 2004 but chose instead cortisone shots and rehab. “It was a career-ender.”
Hip surgery, however, might no longer be the occupational hazard it once was. Consider Brian Baker. When the 27-year-old American qualifier plays his first Wimbledon main-draw match against Portugal’s Rui Machado on Tuesday, it will mark another page in an extraordinary comeback story, not the least of which are his three hip surgeries.
“My hips won’t be 100%, but they are night and day better,” Baker said.
Tommy Haas of Germany is another player making a case for post-hip surgery success.
Eight days ago, the 34-yearold German upended Roger Federer to win a grass-court tuneup in Halle, Germany.
“Technology is getting better and better,” said Haas, who had surgery on his right hip in February 2010. “Doctors are getting better and better. I’m very hap- py and excited for Brian to see that comeback after five, six years away. I can relate.”
Until about 15 years ago, hip injuries were often misdiagnosed (as groin problems) or misunderstood.
Doctors have since discovered that many issues stem from a deeper structural problem in the joint itself — a condition sometimes exacerbated and accelerated by the repetitive wear-andtear of world-class athletics.
“The hip has been the weak link in the system,” said Thomas Byrd, a leading orthopedic surgeon who pioneered the technique for performing arthroscopic surgery on the hip. Nashville-based Byrd has operated on dozens of athletes, including Baker, Norman and Kuerten.
“It’s been a kind of black box, a mystery,” he adds when compared to knees, shoulders and backs.
For tennis players, the most common injury occurs when the bone that runs from the knee to the hip chafes against the socket excessively, either because there is an excess of bone at the head or because the socket is less than round.
The condition, called femoro ace tabular impingement, or FAI, appears to have a genetic component that affects men more than women, which explains the much higher incidence in male players.
Untreated, it can scrape the bone inside the joint and damage cartilage. That, in turn, can lead to early arthritis and hip replacement.
“It’s like the front end of a car being out of alignment,” Byrd said. “You get uneven wear.”
Doctors see similar impingement across many sports, from baseball to hockey to soccer.
Baseball’s Alex Rodriguez, golfer Greg Norman and NHL goalie Jean-Sebastien Giguere have all had surgery to fix impingement. Diagnosis and treatment of hip injuries have improved vastly in the last decade, increasing the likelihood of durable return to action.
A number of factors have helped turn the tide: increased awareness of structural pathology in the joint; earlier treatment; better diagnostic tools such as magnetic resonance imaging; and improved surgical in- struments and techniques.
Kuerten, for one, said he and Norman were unfortunate. He thinks he might have prolonged his career at a higher level with today’s knowledge and techniques.
“Definitely,” said Kuerten, who retired in 2008 primarily because of hip pain. “The response is a hundred times more efficient than before.”
Recovery often takes longer (four to six months) than in years past, but players such as Baker, Haas, Lleyton Hewitt and David Nalbandian — all hip surgery casualties competing here — have a better chance of coming back to full capacity for a longer time.
Some blame the increased torque, speed and power of the modern game for a perceived uptick in hip injuries. The force of any stroke travels up from the legs through the hip to the torso.
Gary Windler, an orthopedic surgeon based in Charleston, S.C., who serves as a medical adviser to the ATP Tour, said it would be premature to draw that conclusion.
“We surmise it, but we don’t have enough numbers yet,” cautioned Windler, also a member of the U.S. Tennis Association’s sport science committee.
An equal number of players with similar hip problems might have competed in years past but also experienced less discomfort because of the slower speed and less-violent stroke mechanics, Windler said.
Windler suspects such injuries could become less debilitating as knowledge and techniques advance.
As for 126th-ranked Baker, it’s too early to know if his body will hold up, though he’s made a promising start, jumping 330 ranking places since the start of the year. Each case is individual.
“Brian seems to be doing well, but is that because he had a minimal problem or because the surgeon did an unbelievable job or that he heals well?” Windler said. Kuerten is not so ambivalent. “If I talk to him,” the former No. 1 laughed in reference to Baker, “perhaps I can come back next year.”