This is why goalies have bad hips.

This is why goalies have bad hips.

 

Being an NHL goalie without destroying your hips is near-impossible feat, and Nashville’s Pekka Rinne is no exception to the rule. The Predators announced last week that he’s out at least a month after arthroscopic hip surgery October 24 to clean out a bacterial infection in his surgically repaired left hip.

The curious thing about this is that Rinne had the hip done in May. How does a hip surgery five months ago lead to a joint infection? It generally doesn’t, which is why Rinne’s case is so interesting.* After last season ended, it was revealed that Rinne had been playing through pain all year. The official word was initially that he’d be rehabbing his hip, but shortly thereafter the official word was “jk guys, he just had surgery!

*You never want to be referred to as “interesting” in a medical capacity.

 

Hockey Hips: They suck

Hip surgery is relatively commonplace in NHL goalies (and Ryan Kesler – twice), and it generally has to do with labrum problems. The hip is a ball-and-socket joint, with the ball being the top of the femur, and the socket (or acetabulum) being the hole it sits in on the side of the pelvis. That hole is surrounded by a tough ring of cartilage called the labrum. The labrum makes the socket deeper, helps seal the joint together, and increases the surface area to spread out the load on the hip. It can also tear, which not only hurts but destabilizes the joint.

This is a normal hip, which you're unlikely to find in an NHL player.

This is a normal hip, which you’re unlikely to find in an NHL player.

Labrum tears can be a result of trauma, chronic stress, or being built wrong. A condition called femoroacetabular impingement (aka being built wrong) involves a femoral head or acetabulum (that’s the socket) that’s got some extra bone, meaning that instead of gliding smoothly against each other the bones smack together, and eventually injure the labrum and hurt like stink.

In Rinne’s case, GM David Poile said his hip had degeneration or deterioration in the cartilage, and that his procedure was more to prevent further damage than to fix any one huge injury. The surgery itself was a pretty commonplace hip arthroscopy – where tiny holes are made in the surrounding area, tiny cameras and instruments are inserted, and the joint is cleaned up (or repaired). Other goalies who’ve had hip surgery? Basically all of them.

 

Tim Thomas - Left hip labrum in May of 2010

Tim Thomas – Left hip labrum in May of 2010

 

Josh Harding - Hip labrum, April 2010.

Josh Harding – Hip labrum, April 2010.

As a side note, Josh Harding is also a Masterton winner and founded Harding’s Hope, a charity that raises money for and awareness of multiple sclerosis. He is a certified badass and nice dude.

For old times sake - Vesa Toskala! Hip labrum - March 2009.

For old times’ sake – Vesa Toskala! Hip labrum – March 2009.

 

For older times' sake - Dan Cloutier! Hip labrum - January, 2007.

For older times’ sake – Dan Cloutier! Hip labrum – January, 2007.

 

With the exception of Cloutier (who can apparently fly), all of the pictures above are great illustrations of why goalies have garbage hips. People just aren’t meant to bend like that night after night for years on end. Add in thinner goalie pads meaning less padding between them and the ice and the compete takeover of butterfly style and it’s a miracle any of them can walk.

 

Pekka Rinne: Successful graduate of the Mark Recchi School of Medicine

After their October 22 loss to Minnesota, Rinne had some soreness in his repaired hip. Soreness progressed to stiffness, which progressed to fever, which progressed to a trip to Vanderbilt for a joint aspiration and an MRI. A joint aspiration is a procedure that sounds far more horrifying than it really is – a doc sticks a needle in the joint and sucks out fluid, which is then examined for bacteria and other unwanted nasties. The aspiration and the MRI confirmed the infection, and Rinne underwent another hip arthroscopy. the procedure this time was to flush out the joint and assess for any damage to the repair he had in May. The word was that the hip was intact, so as long as the infection has been taken care of, he’s expected to be out for at least four weeks. Those four weeks will be spent with a PICC line in his arm (a great big long term IV placed under sterile conditions and ultrasound guidance) for IV antibiotics. Rinne has correctly noted in interviews that a joint infection is a big deal, because it can cause permanent damage to the joint.

 

It’s been five months. wtf.

No, really. WTF. This infection is a mystery. Post-operative infections are rare in hip arthroscopy, so much so that study after study with follow-up at two years showed no cases of infection. Even in massive hip surgeries like open total hip replacement the risk of infection is about two percent in elderly patients after a year. Clearly a healthy young elite athlete who had a minimally invasive procedure should be at extremely low risk. The odds of infection are greater in joints that have had injections (ie of steroids), repeated surgical procedures, patients who aren’t healthy at baseline, or in major procedures. It’s not likely that any of this applies to Rinne, but low risk or not, he had an infected hip. The infection could have been from contamination that was introduced during surgery but had been sneakily hiding out until now. It’s also possible an infection elsewhere in his body seeded his hip joint via the bloodstream, but that’s very unlikely  - Pekka Rinne is a healthy guy who’s probably not walking around with a bloodstream full of bacteria.

The upside to this very rare complication is that irrigation of infected joints followed by IV antibiotics works very, very well. There’s no reason to expect Rinne should be out longer than the anticipated four to six weeks.

 

Elsewhere around the league

Calgary’s Mark Giordano has been killin’ it this year, but unfortunately is now out six to eight weeks with a broken ankle. Not to be outdone, Lee Stempniak broke his too. Teamwork – you’re doing it wrong.

Rob Scuderi just had ankle surgery, so he’ll be enjoying Pittsburgh’s press box hot dogs for a while.

Minnesota’s Jonas Brodin broke his cheekbone with a puck to the face, but won’t need surgery. He’s not quite back yet, but he will be soon, and when he returns he’ll be in a full cage. I like to call that the Alexei Emelin special.

Teemu Selanne is out for two weeks after an accidental stick to the face ruined several of his beautiful, beautiful teeth. Contrary to what the media will have you believe, everybody does NOT love Raymond. Everybody loves Teemu.

Sam Gagner is back, and despite being -3 in the Oilers’ October 29 loss to the Maple Leafs, he is magnificent. You can’t tweet a picture of yourself so nasty that you inspire the creation of an injury disgustingness scale and not be considered magnificent. Impossible.