Hi Everyone,
I'm new to this site & forum. I was encouraged to read some of the posts here in the tennis section. I'd like to share my story and ask for your feedback, opinion, advice, shared experiences, etc. Starting with the bottom line up front: I'm trying to decide among several options (or a combination of these options): Hip Arthroscopy, THR, HR, some regenerative methods: (Stem Cell injections, PRP injections, chondrocyte grafting, collagen type-2 supplements, glucosamin/chontroiton supplements, etc.) and have even considered just waiting a few years to do anything in the chance that better options emerge within the next 5 years.
My story:
My name is Chris and I'm a 48-year old male who is (was) a very active recreational tennis player. Since I was 21, I've played mostly mens singles but also some doubles and mixed doubles with my wife. I'm a 3.5 - 4.0 player. So not a great player, not a professional player, but a fanatical player who loved the process of improving my game. For the past 25 years, I've spent many hours at the baseline practicing my serve and being run all over the court by my ball machine. And loving every minute of it. I was usually enrolled in 2-3 leagues per season -translating into 2-4 hours on the court per day 5 days a week.
Two years ago my left knee started getting cranky but I persisted in playing on it anyway (used cortisone injections once or twice over two years). At first, I was told the knee uneven wear and mild arthritis in the knee was due to muscular imbalance (tight IT band, weak VMO muscles). So I did VMO physical therapy. That helped after 6 weeks. Then - last September (2013), I developed the classic symptoms of cam-type FAI in my left hip (groin pain, hip pain, and referred pain down to the left knee). My last two matches it became painfully obvious that moving laterally or doing any kind of start/stop was too painful. So off to the doctors I went. After comprehensive diagnostic tests (xrays, 3D CT Scans, MRIs with dye/arthrogram), I was told I have mild to moderate osteoarthritis in the left knee and hip (I'm a righty and I strongly suspect that serving 600 serves a day for 25 years just may have something to do with why my left leg has so much more wear and tear than my right leg - imagine my left leg as a piston repeatedly collapsing and explosively expanding over and over again). To sum up what my three orthopaedic surgeons told me: the first two told me that I should quit tennis, take up swimming, and take 2 advil a day until I'm 65 at which point I should have a THR. I asked them about hip arthroscopy for FAI (hip impingement) - they both said at my stage of articular cartilage degeneration, arthroscopy would be like closing the barn door after the cows got out - useless since the damage to the articular cartilage is too extensive and irreversible at this point. The third believes there is a 70% chance that hip arthroscopy will buy me a few more years until either a THR or a HR is needed. The third also believes it's better to take advantage of what is available now in order to keep doing what I love - play tennis - rather than sit on the side lines for the rest of my days. Which I see the logic in but am not sure I agree with for the following drawbacks which worry me about each surgical solution:
1) Hip Arthroscopy - I don't mind being on crutches for a month and having to rehab for another 5 months because I've been doing constant physical therapy for the past 7 months. And I like the idea of preserving my natural hip as long as possible. BUT - it sounds like there is a large possibility (based on other hip scope patients) that for my condition, the scope will not provide any benefit (other than removing the cam lesion which tore up my cartilage to begin with and repairing some labral damage). I am also worried that having the scope might take the HR option off the table. Does anyone know if having a scope removes or delays the possibility of having a HR?
2) THR - frankly - this "procedure" seems barbaric and straight out of the Middle Ages to me. And despite all the risks (dislocation, blood clot, infection, uneven leg length) - the real problem with this "solution" is that it does not solve the problem because I was told by my surgeons not to play tennis on a THR because I'll wear through it in 5 years, only be able to have one more after that, and then they'll have to amputate my leg when I wear through that one. just great. So this "solution" which leaves me with one leg by the time I'm 58 (unless I am happy to put it off until I am 65) does not appeal to me. Please correct me if I am wrong in this assumption - does anyone know someone who has successfully maintained an active tennis life with a THR?
3) When I learned about resurfacing I was thrilled - finally the perfect solution for me: "appropriate for the adult under age 60 who wants to remain active." Then I started to read about some nasty potential outcomes: "necrosis, metalosis, femoral head fracture, every step you take creates millions of ions as debris which poison your surrounding bone, tissue, and blood." So I am now leery about what I thought was going to be my savior.
4) Regenerative techniques - supposedly they are growing cartilage in the labs at Duke University, in France, and in Sweden from stem cells, fat tissue, and healthy cartilage pieces using chondrocyte grafting. And they can even form these cartilages in the shape and size needed - much like you would use a jello mold.
5) What about artificial cartilage? Don't laugh - I had a vertebral disk fusion in my neck due to a bad disc herniation (also caused by excessive tennis and having been born with a vertebral fusion to begin with). While that operation was very successful back in 1997 - I remember asking my dr. "can't they replace the bad disc with an artificial one?" No was his answer. No such thing. Guess what - some very clever scientists in Germany created an artificial disk back and "artificial disk replacement" is available in the US as of 2007. Experimental but available. My point being - if they can create an artificial disc and implant it, why can't we do the same with cartilage? If not today, why not someday within the next 10 years? Doesn't it seem that either an artificial or regenerated cartilage are possibilities.
So my current plan is to possibly try to buy more time with the arthroscopy, keep an eye on regenerative breakthroughs, and fall back on a hip resurfacing if/when my hip becomes too painful or dysfunctional to get through my day.
Regarding hip resurfacing - I've been told everything from "you can play tennis 2 months after" to "you have to wait a year for the femoral head bone to fuse to the the metal covering" to "you don't have to wait because they cement the metal covering on to the femoral head and you're good to go." What's the truth on this matter? does anyone know?
And to finish with the question I started with - do these BHRs really last 17 years? And can I really (at some point post-op) play tennis on a resurfaced hip? Or am I just asking for serious problems if I do?
Thanks so much for enduring this walk through my confused mind with me. Any advice, experience, opinions, insights are greatly appreciated and welcome. I'd really like to stop limping around and to even be able to play tennis again. It is one of things my wife & I really enjoyed doing together. But there is so much conflicting information out there - I find it hard to feel confident about going forward with any currently-available surgical options.
Sincerely,
Chris