Flyers defenceman Andreas Lilja had left hip surgery July 2012, and is expected back in late October or early November. Well that is the predicted time frame from GM Paul Holmgren, Lilja has said more like December. It is never a good sign when player and GM don’t agree with the return time table, remember Kesler (@Ryan_Kesler).
After doing a little reading it has become apparent that Lilja has had this hip degeneration issue for a couple of seasons. What is disappointing for me is had Lilja taken the proper precautions when it started to hurt, he could have avoided this surgery.
Arthritis means "joint inflammation". It causes pain and swelling in the body's joints; one location is the hip. There are many type of arthritis, but osteoarthritis is the most common type. Also known as degenerative joint disease, osteoarthritis is more likely to develop as people get older, or play a physical sport (Lilja).
The two main types of osteoarthritis are:
- Primary: More generalised osteoarthritis that affects the fingers, thumbs, spine, hips and knees
- Secondary: Osteoarthritis that occurs after significant or macroscopic injury or inflammation in a joint
A degenerative issue in a hip is a form of osteoarthritis, something that is treatable and manageable if treated early in its development.
Osteoarthritis usually occurs when a micro trauma (injury at a microscopic level) to the joint or some other unknown factor triggers an immune reaction, which - in an ill-fated attempt to repair the damage - causes inflammation that leads to a breaking down of cartilage tissue that causes pain, swelling and deformity.
Cartilage is a firm rubbery material that covers the ends of bones in normal joints. It is primarily made up of water and proteins. The primary function of cartilage is to reduce friction in the joints and serve as a "shock absorber". The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed. It can do this because of its high water content.
In addition osteoarthritis can sometimes be caused by other factors:
- The joints may not have formed properly. This is increasingly thought to be to blame when osteoarthritis develops when a person is young or in midlife - there are often problems with the shape of the bones in the hip joint, which may be inherited. These abnormalities may be very small but enough to mean that it doesn’t work effectively as a ball-and-socket joint, leading to mechanical stresses in the joint.
- There may be genetic (inherited) defects in the cartilage or possibly in the immune system, making it react abnormally to damage in the joint.
When the cartilage is damaged - for example in a joint stressed by high repetitions of motion - attempts by the immune system to repair the damaged cartilage cause it to swell. The cartilage becomes thin, soft and cracked, exposing the bone beneath and leading to the formation of small cysts and new outgrowths of bone called osteophytes, which further disrupt the way the joint works and aggravate the problem. The joint space becomes narrowed, further altering the mechanics and adding to the stresses within the joint. Other tissues in the joint such as the surrounding membrane (the synovium) ligaments and tendons may also be affected. This degeneration is a gradual process that can be postponed if treated immediately.
Joint injuries are an unavoidable fact of life for NHL players. The pounding and twisting their joints have to endure during preseason workouts, camp, training, and the season plus playoffs can be absolutely devastating to the surrounding joint tissues.
When discussing “sport injuries” most of us think about the common broken bone or sprained ankle. There is, however, a more insidious kind of sport injury that can remain hidden for years before finally revealing the full extent of its damage. This kind of injury arises from the daily strain that exercise places on the joint and can lead to a lifetime of debilitating pain through the development degenerative joint disease, or arthritis.
When arthritis develops as a result of injuries, it is generally referred to as “secondary” osteoarthritis. This simply means that the deterioration of the cartilage was initially caused by a traumatic injury to the joint.
Each one of our 147 joints has cartilage protecting the bones from coming into contact with one another. It is this cartilage that takes the brunt of the pounding during heavy training. It is also the degradation of this cartilage that results in the development of arthritis.
So, what does all this have to do with Andreas Lilja? Athletes have an increased risk of developing secondary osteoarthritis as a consequence of sports injury.
Most of us continue playing sports or working out and endure the pain rather than taking positive steps to put an end to it. Being an NHL professional athlete I would expect players to look after their body as well as they can, after all a broken body, no ice time, no income. NHL players too often take the ‘play through it’ approach, and whilst it is commendable, it can cause serious damage down the track, exactly what Lilja is going through now. Pain killers will help a player get through the problem however, this is the wrong approach; a short term “solution” to a long term problem!
Since pain goes hand in hand with being athletic, the most common approach is to take a pain killer and let it go at that. What some players may not realise (and I put Lilja in this category) is that the relief offered by these drugs comes at a very high price. Over time, they all have dangerous and possibly even life threatening consequences.
The wisest approach is to attack joint disease at its origin, the way the body would. Glucosamine has been shown in recent clinical studies to rebuild damaged joints and diminish pain. In fact, higher quality forms of glucosamine can halt the pain in just a matter of days.
The smart athlete is already taking a glucosamine formula as a preventive measure. Given its low cost and availability without a prescription, it’s a smart move both for the short and long term.
Surgery can be used to correct the follow:
- Removal of foreign or loose bodies of cartilage derived from a broken or synovial chondromatosis (formation of multiple nodules of cartilage in the synovial membrane, being able to drop one into the joint space).
- To deal with the tears of the cup rim.
- Synovectomy, ie shaving of the synovial membrane, infections, rheumatic processes specific diseases that cause deposits in the synovium or synovial chondromatosis.
- Smoothing ulceration of cartilage, removing torn cartilage fragments about to break loose.
- The appearance of synovial fluid (viscous fluid that lubricates the joint) may be cloudy or contain loose bodies, usually broken cartilage. Synovial fluid can be analyzed to determine its composition.
- The appearance of the synovium (lining of the sac inside the joint and produces synovial fluid). In some cases, a sample (biopsy) for analysis under a microscope.
- The cartilage that lines the femoral head and acetabular cavity. It feels a special hook to see consistency and observed for injuries.
- The ring or rim that surrounds the cavity of the cup and serves to enhance the engagement with the head of the femur.
- The appearance of the bone of the femoral neck.
- The round ligament, which is a common thread running through the center the femoral head and acetabulum.