Results tagged ‘ Dr. Bryan Kelly ’

Why the long delay for A-Rod’s surgery? Here’s the answer

Alex RodriguezI know you might be stunned by this, but I never attended medical school. The fact that I still get a little uneasy at the sight of a paper cut probably ruled that career path out very early for me.

Dr. Bryan Kelly of the Hospital for Special Surgery did, though, and since he’s going to be performing Alex Rodriguez’s left hip surgery, it’s probably better that we all let him do the talking on this one.

We now know that the date for A-Rod’s surgery is set for Jan. 16 in New York, and many have wondered why there has been such a delay in getting him to the operating table, considering the injury affected him in the playoffs and was diagnosed in November.

The question was asked on a conference call Kelly and the Yankees held tonight. Like Mariano Rivera following his torn ACL in May, Rodriguez has been told to undergo four to six weeks of “pre-hab” strengthening exercises to prepare for surgery. Here’s Kelly offering some background on that:

“The easiest analogy is an ACL tear. If someone ruptures their ACL, the vast majority of orthopedic surgeons – and I’d say this is pretty much the standard of care – is to not operate during the acute injury phase. There’s a lot of inflammation, there’s a lot of bleeding in the joint, there’s a reduction in motion, and anytime there’s bleeding or injuries in a joint, there’s a problem that occurs in the body called arthrogenic pain inhibition which means that pain from the joint shuts down the muscles around it.

“Operating in an environment where there’s a lot of inflammation, a lot of swelling that results in limitations in motion affecting muscular shutdown, really compromises the ability of somebody to recover at a fast rate. When we go to the hip, the same exact principles apply. If you’re operating in an environment where there’s a lot of inflammation, a lot of compensatory shutdown of the muscles secondary to this mechanical problem, then operating earlier actually will frequently result in a more prolonged recovery afterwards because it takes longer for the muscles to respond and recover from the surgery.”

“So the ultimate issue is not, let’s do surgery as soon as possible, but what’s the best strategy to get somebody back to full function the fastest?”

And that explains the “pre-hab.” But there’s more, because with A-Rod, the doctors have also had to consider his 2009 surgery on the right hip and how this new procedure will play into that.

“The second thing is that Alex’s case is complicated by the fact that he has a hip that has already undergone surgery that has been successful. During the immediate post-operative period of time, he’s going to really have to rely on his right hip because there’s a period of protected weight bearing that can last anywhere from 10 days to four weeks, depending on how strong the muscle is going into it.

“We want to minimize the amount of time he’s going to spend relying on his right hip, because the last thing we want to do is compromise the thus-far successfully repaired right hip. He’s got a lot of complicating factors that make timing an issue.”

There you go; hopefully that clears some of the questions up. I’ll be going into more detail about other parts of the two-hour procedure tonight on, but here’s one more thing to note:

Kelly’s best guess is that Rodriguez will be back in the Yankees lineup around the All-Star break, but there’s no way to tell for sure. It could be sooner and it could take longer because every patient is different.

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