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Tour star needs a hip, just not now

By CURTIS KRUEGER
Published July 11, 2006

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ST. PETERSBURG - After battling excruciating hip pain for a year, Kevin Kalwary got hip-replacement surgery and now feels so good he plays racquetball six mornings a week.

But even he was surprised to hear that Floyd Landis, the leading American in this year's Tour de France cycling race, is suffering from such excruciating pain that he too needs a new hip - but not until he finishes this year's grueling race.

"There's not one person who wouldn't tell you that it's incredibly painful," to suffer the kinds of bone problems that lead to hip replacements, said Kalwary, 52, an investigator for Tampa attorney Barry Cohen.

"He has a tremendous amount of courage, and I think that's admirable," said Dr. Larry Lemak of the University of South Florida Medical School, who is director of the Sports Medicine and Athletic Related Trauma Institute. For other people hoping to rebound into an active lifestyle after hip problems, "it's very encouraging" to hear Landis' story.

Hip replacements are often recommended for patients who have degenerative bone disease that crumbles the bone in the ball-and-socket hip joint. They are not common in elite athletes who hope to return to top form. The most notable other case probably was Bo Jackson (see box, 6C).

Landis is currently second overall in this year's Tour, meaning that despite his ailment, he is competing in top form in one of the world's toughest competitions. In fact, he has as good a chance as anyone to win as it heads into the mountains this week.

Landis said he kept his condition secret to all but about 10 people before announcing it Monday during a rest day at the Tour. "My mom found out last week," he said.

The Tour de France is a 2,272-mile, 20-stage race that leads riders over the Alps and the Pyrenees. While the Tour is grueling, the mountains are the hardest part of all. Riders struggle up them in brutal heat and fly down them at incredible speed. Exhaustion and accidents are expected.

What's not expected is for an elite competitor like the 30-year-old cyclist to reveal he is suffering from avascular necrosis, also called osteonecrosis. Dr. Robert G. Hamilton, an orthopedic surgeon in St. Petersburg, said the condition "is death of a portion of bone."

Initially, the bone can be as strong as living bone, "but it collapses in time," Hamilton said.

Landis told the New York Times he often suffers from sharp pain. "When I pedal and walk, it comes and goes, but mostly it's an ache, like an arthritis pain. It aches down to my knee. The morning is the best time, it doesn't hurt too much, but when I walk it hurts, when I ride it hurts. Most of the time it doesn't keep me awake, but there are nights that it does."

He had surgery on his right hip two years ago that left one leg an inch shorter than the other. Despite leading his Swiss Phonak team, the pain is so great he takes elevators instead of stairs.

Landis' physiologist Allen Lim was quoted saying that if Landis does have hip-replacement surgery, "He will come back and be much, much stronger than he is now."

Others aren't so sure.

Kalwary, who is grateful for the hip-replacement surgery he had two years ago, said nonetheless "it's hard for me to believe that at that level of competitiveness he would come back."

"I guarantee there'll be some loss of function," Hamilton said. "A man-made product is not as good as the one that God made."

He said that "if you or I had a hip replacement and wanted to ride around St. Pete, we'd probably do just fine." Regaining the competitive edge at such an elite level might be harder.

Steve Raterman, a Tampa orthopedic surgeon who said he used to be a nationally ranked amateur cyclist, also said "it would be extremely difficult to try and function and compete at the level he's at with a hip that doesn't function well."

He said Landis may do better with "hip resurfacing," a procedure he performs. Instead of replacing the entire hip joint, the resurfacing procedure calls for resurfacing the existing bones with metal coating, meaning they hold together more naturally and last longer, he said.

Nancy Goodall, 58, of Clearwater thinks it's possible that a top athlete like Landis might actually rebound nicely. She bases this on her own experience. She got a new hip three months ago, and although she still feels some fatigue while walking, she also has experienced a wonderful relief from the pain she suffered beforehand.

"I don't think that that's out of the question," she said.

Information from the New York Times was used in this report.

[Last modified July 11, 2006, 06:19:22]