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Monday, December 3, 2012
A-Rod faces another hip surgery


The New York Yankees announced Monday that third baseman Alex Rodriguez will undergo arthroscopic surgery on his left hip in January to "repair a torn labrum, bone impingement and the correction of a cyst." The team has initially projected a four- to six-month recovery, which would have him returning to baseball sometime between May and July.

Is this déjà vu all over again?

Alex Rodriguez
Alex Rodrgiuez has not played more than 140 games in a season since 2007.

Rodriguez underwent surgery on his right hip in 2009 for a similar condition. While the Yankees have indicated the upcoming surgery "will be similar but not identical" to the procedure he underwent nearly four years ago, it is a good basis for comparison. After all, when Rodriguez first had hip trouble in 2009, the initial culprit that was identified was a soft tissue cyst. At that time, Rodriguez had fluid withdrawn from the cyst and the hope initially was that he might avoid surgery. Ultimately, surgery was required to address a torn labrum and Rodriguez had a delayed start to the season.

Although a cyst such as this can lead to weakness, stiffness or tightness of the surrounding hip muscles (and occasionally pain), it is actually a secondary problem. These cysts tend to form as a consequence of irritation in the joint, which is often caused by a torn labrum (hence the term paralabral cyst). In pitchers, the repetitive trauma that can damage the labrum of the shoulder can lead to similar cysts. The labrum is a ring of cartilage that adds depth and stability to a joint and labral tears of the hip are not uncommon in power hitters. The repetitive trauma induced by high-speed torsion of the hips while swinging a bat is thought to contribute to the breakdown of the labrum.

Additionally, femoroacetabular impingement or FAI (the "bony impingement" referred to in the Yankees' statement) is associated with labral tears of the hip. In basic terms, FAI is a condition in which the femur (thigh bone) and the acetabulum (the bone that forms the hip "socket" for the femur) repeatedly come into abnormal contact in certain hip positions as a result of the athlete's particular anatomy combined with the demands of his sport. That repeated abnormal contact causes a "pinching" (impingement) that can result in spurring of the bone and damage to the labrum, as well as the cartilage surface, over time. During surgery to repair or resect the labrum, reshaping of the bony surface will also be addressed. The bone can be remodeled to eliminate the presence of impingement, but the bone is more delicate initially after this procedure and the rehab is slowed accordingly to allow proper healing. The extent of work involved on the bone will impact the total rehab time. If the cartilage is defective, a microfracture procedure can also be performed, although this has not been hinted at in the case of Rodriguez.

Following surgery, the athlete is required to go through a "protective" phase of rehab in which the amount of weight bearing is limited to allow the tissue to heal, and range of motion and strengthening exercises are gradually increased. The athlete is returned to weight bearing incrementally and the vigor of exercise is upgraded. Ultimately there is a return to sports-specific drills and eventually return to play.

The timetable for Rodriguez seems reasonable given the information released regarding the planned procedure, but it is worth keeping in mind that things can always change when the surgeon has the opportunity to directly visualize the athlete's anatomy. The surgery will be performed by Dr. Bryan Kelly at the Hospital for Special Surgery in New York. Kelly is renowned for his expertise in this area and has performed similar procedures on other professional athletes, including Philadelphia Phillies second baseman Chase Utley and former Red Sox third baseman Mike Lowell.