Tour de France Champ Faces Hip Surgery
Doctors explain why osteonecrosis is leading to hip replacement surgery for cyclist Floyd Landis.
Did Cycling Wear Out the Hip?
While it may seem as if all that bike riding before and after the accident
contributed or even caused Landis' problem, surprisingly, experts say this is
not the case.
"Cycling did not wear his hip out. There has never been a scientific
study showing that any sport leads to arthritis of any joint. Injury is what leads to
arthritis," says Bronson.
Moreover, he tells WebMD that continuing to ride may have actually helped
the problem, allowing Landis to maintain a significant range of motion, which
in turn allowed him to function better than if he were a couch potato.
Urbaniak tends to agree. "If you have a square peg in a round hole
continually causing friction it's going to advance the problem, but that said,
the continuous motion of the cycling may actually help lubricate the joint and
in that way reduce some of the potential for damage," he says.
While it appears as if Landis' condition is related to his previous training
injury, experts say there are other situations that can lead to osteonecrosis,
which commonly occurs between ages 30 and 50. A past traumatic injury such as
fracture or dislocation is a common cause for osteonecrosis.
Other Causes of Osteonecrosis
According to the National Osteonecrosis Foundation (NONF), some nontraumatic
causes of osteonecrosis include extended use of steroids and other
anti-inflammatory medications, alcohol abuse, radiation and chemotherapy, and
certain medical conditions including lupus, sickle cell disease, HIV infection, and
some cancers. Osteonecrosis can also occur from no known reason at all.
More importantly, however, when treated early on, it's possible to minimize
the damage caused by this condition and put off, or even prevent, the need for
One solution is a surgery Urbaniak developed in 1979 known as a "free
vascularized fibular graft" (FVFG). In this procedure, he says,
bits of bone and blood vessel are grafted from the lower leg and implanted into
the area where circulation is compromised.
"It works in over 80% of patients -- and it can usually hold off a hip
replacement for eight or 10 years, or sometimes indefinitely," says
While there are no established drug treatments for osteonecrosis, NONF
reports some medications are showing promise. They include bisophosphonates
(used to treat the bone thinning disorder osteoporosis), drugs used to treat high
blood pressure, as well as certain cholesterol-lowering and
Can Landis Return to Racing?
While no one is certain why Landis didn't treat the problem early on, what
remains is his immediate need for hip replacement.
And while the operation will clearly alleviate his pain, the question on
everyone's mind is will it prevent him from returning to cycling.
Surprisingly, most experts say not only will he be able to ride
competitively again, he could be back in the hot seat just months after