Hip Preservation Surgery Puts Tom Cummings Back in the Race
By Pat Schrepf
Tom Cummings, 41, has been competing in triathlons for many years. He loves the challenge and intensity of the sport, and it’s a great way to relieve stress from his work as a Sales Excellence team member for Microsoft.
But he started having problems with pain while training for Ironman France in the fall of 2009.
The symptoms varied between deep bone aches and a stabbing pain in his right hip that prevented Tom from putting weight on his leg. A sports medicine doctor at another organization diagnosed an overuse injury, but Tom continued training. “It was only after the race, when training volumes subsided and the symptoms persisted,” recalls Tom, “that I was sure overuse was an incorrect diagnosis.”
He was referred to Cara Beth Lee, MD, a board-certified orthopedic surgeon with specialized training in hip preservation surgery. Dr. Lee started Virginia Mason’s Hip Preservation Program, which is the only one in the Pacific Northwest to offer these advanced hip surgery options in combination with a research focus that tracks the long-term results of treatment.
After examination and testing, Dr. Lee diagnosed femoroacetabular impingement (FAI). “That means the hip’s ball and socket don’t fit together properly,” says Dr. Lee. “Sometimes the ball (head of the femur, or thigh bone) is misshapen or the socket is too deep, often due to the overgrowth of bone. These can restrict or alter hip movement such that the ball does not roll smoothly in the socket. In Tom’s case, it not only caused pain but can wear down the joint cartilage. The damage can eventually lead to osteoarthritis.”
While hip disease and its treatment are commonly associated with aging, the truth is that many hip disorders begin much earlier in life. Variations in hip anatomy are relatively common and can lead to premature wear and tear, even in young adults. Hip preservation procedures aim, as the name implies, to preserve hip function by correcting bony deformities that can cause pain. In the long term, the hope is this approach may also decrease the risk of osteoarthritis (OA) and help patients delay or avoid hip replacement.
“Very active people and athletes in particular are susceptible to degenerative hip disease brought on by an underlying abnormality,” says Dr. Lee. “If initial joint disorders aren’t diagnosed and treated, OA can strike relatively early; the more serious the joint abnormality, the sooner symptoms will affect quality of life.”
Expert diagnosis is critical to identifying hip dysfunction while it’s still in its most treatable phase. General X-rays reveal the presence of the bony deformity causing joint dysfunction, while MRIs are effective for showing more detailed information about the health of the cartilage and soft tissue.
Surgical Treatment Options for Hip Preservation
Fortunately for Tom and others, specialized surgical services can correct mechanical dysfunction, reducing the risk of degenerative disease in hip joints. Dr. Lee works with a team of program clinicians, including Kirsten Nygaard, PA-C, to provide a continuum of care, from evaluation and diagnosis to surgery and rehabilitation. The team has a number of surgical solutions available for hip preservation, depending on the situation, from arthroscopic outpatient surgery to the use of open procedures for more complex deformities.
Tom underwent hip arthroscopy in which Dr. Lee used two small incisions to access the joint and introduce a small camera and specialized instruments. Dr. Lee shaved and shaped the excess bone and repaired tears in the cartilage. Tom had two separate surgeries about six month apart, one on each hip. The surgery took several hours. He went home the same day.
Tom says the procedures and recoveries went smoothly: “I was up and riding my stationary bike within 72 hours of the surgery. Over the longer term, I would make significant gains, then push a little too hard in my activities and experience discomfort that resulted in a scaling back of effort. I was able to train somewhat seriously at about six months.
“These days I have absolutely no side effects or limitations linked to the surgery,” Tom says. “In fact, I completed a half-ironman race in October 2012 and cut my time by over 30 minutes, right at my goal. I believe that, without the hip preservation surgery, I was seriously looking at hip replacement.”
Tom says his care under Dr. Lee was as close to perfect as it gets. “In meeting Dr. Lee it became clear very quickly that she is a master of her trade,” says Tom. “Her bedside manner and ability to explain everything meant I was getting the best care available.”
The Virginia Mason Hip Preservation Program engages the Team Medicine approach through collaboration with experts in sports medicine, musculoskeletal radiology, anesthesiology, physical therapy and other disciplines to provide state-of-the-art care. It is the first in the Pacific Northwest to offer the most advanced hip surgery options available today, while monitoring outcomes and conducting research in an effort to prevent degenerative hip disease.
Pat Schrepf, communications program manager, wrote this story for the Virginia Mason 2012 Annual Report.