Carlos Delgado felt the pain in his right side and figured he'd pulled something - a groin, most likely. Maybe a strained hip flexor. Something nagging, but not needing surgery.
Turns out, Delgado didn't know what he was dealing with. Luckily for him and a growing list of pro athletes, there were doctors who did know. And Delgado, expected to return to the sagging Mets this month, may have a new lease on his career thanks to the diagnosis of a torn hip labrum and the wonderful new world of arthroscopic hip surgery.
"Everybody I've talked to will tell me that if I had the injury 10 years ago, they say, 'You can't play no more, come back in 20 years and you'll get a hip replacement,' " Delgado said. "I guess it's getting diagnosed more accurately these days. I'm surprised. You figure in the year 2009, with all the technology and they operate on everything, but they didn't have a great scope surgery for your hip until 6-7 years ago."
The two orthopedic surgeons leading the way to prolonging the careers of New York athletes such as Delgado, Alex Rodriguez, Rick DiPietro, Michael Boley and Marian Gaborik are the pioneers in this delicate surgery.
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Dr. Marc Philippon practices at the Steadman-Hawkins Clinic in Vail, Colo.; Dr. Bryan Kelly practices of the Hospital for Special Surgery in New York. The two worked together at the University of Pittsburgh in 2003, learning the components of a surgery that had rarely, if ever, been tried before.
"The hip is a little bit different than other joints in that it's a highly structured joint," said Kelly, who went from a fellowship studying with Philippon six years ago to now performing 350 of these surgeries a year in New York. "It's supposed to be a perfect ball-bearing joint. When there are changes in the morphology of the hip, the labrum is the first thing that gets damaged."
Bony growths inside the hip socket can chafe at the labrum, the cartilage that surrounds the socket, causing a tear. Kelly and Philippon repair the torn labrum and shave down the growths to re-establish the smooth articulation of the joint. That's the good news once a player gets the diagnosis of a torn labrum - femoroacetabular impingement, in medical terms.
But simply getting to that point, even with so many high-profile names getting their hips done, hasn't been easy. "It's not a new injury," Kelly said, "there's simply a lot of confusion about it."
Kelly cited a recent study that found the average time for a patient to receive an accurate diagnosis of a torn labrum was 21 months; the number of experts seen by a patient in the study averaged 3.3. For a pro athlete, that's enough time to disappear from a roster.
Team trainers are taught to look for deeper causes of soft-tissue injuries such as strained groins and hip flexors and even sports hernias, which is a relatively new diagnosis. But looking for underlying hip issues had never been the thing to do until recently.
"Now we have a red flag. It's exciting," said Ronnie Barnes, the Giants' head trainer for the last 30 years. "The focus on the labrum and its importance, it just wasn't there."
The newness of the surgery has also raised a red flag for performance-enhancing drug hounds who believe that it's no coincidence that A-Rod had his torn labrum fixed by Philippon shortly after revealing his prior steroid use.
"There may be some PEDs that have a direct effect on the cartilage and joints, but I don't think in this case it's true," Kelly said. "The main issue with this injury is simply the bigger impacts, the bigger axial rotation on the hips. Athletes are just bigger now."
And the surgery simply wasn't there a decade ago. "It's like going back 30 years ago and nobody's had a 'Tommy John,' " Delgado said of the elbow surgery that saved the former All-Star pitcher's career. "Now, everybody's had a 'Tommy John.' And they save their career."
The goal for the future is not only faster recovery from the surgery, but on prevention of the injury. Kelly said studies have shown that participation in contact sports in formative years, from ages 11-16, can lead to problems because the joints aren't fully formed then.
For the pros, it's about staying in the game longer. Barnes didn't believe that players would be forced into retirement by a torn labrum, but "they're having relatively pain-free careers now as a result [of the surgery]."
The players are wising up, too. Rodriguez called Gaborik, the new Ranger who played for the Minnesota Wild, to find out about recovery time. Philippon repaired both of Gaborik's hips last year. Delgado called the Phillies' Chase Utley, who had the surgery last November.
"We're all doing quite a bit of learning," Barnes said. "We used to treat a strain or a pull with some rehab, a course of anti-inflammatories and you feel the injury would get better. We know what to look for first now."