By Jeff Zrebiec and Aaron Wilson
The Baltimore Sun
8:44 PM EDT, July 30, 2013
The right hip fracture and dislocation Dennis Pitta suffered Saturday is an extremely rare injury for an NFL player and will force the standout Ravens tight end to miss the entire 2013-14 season.
But it shouldn't jeopardize his career, according to leading orthopedics and sports medicine experts contacted by The Baltimore Sun this week.
"With a professional athlete like Dennis, his rehabilitation protocol should allow for him to return to full capability by next season," said Dr. Derek Ochiai, an orthopedic hip surgeon based in Arlington, Va. "I would expect him to be ready by the middle of [next] summer. What they let him do as far as offseason stuff and training camp next year is obviously far ahead of him and up to the Ravens and Dennis. But with a lot of hard work and patience, he should be back."
Pitta had surgery Saturday night to remove a bone fragment in the area and to pop his hip back into place. Ravens coach John Harbaugh has ruled Pitta out for the season, but he said the 28-year-old could be ready to start rehabilitating the injury in six to eight weeks. He also hasn't heard any discussion that Pitta's career could be in jeopardy.
"The good news is that there's a fracture, but it's in the back part of the bone, and it's in the big part of the bone, and it's a very tight fracture," Harbaugh said. "So it didn't move at all. There's no ligament damage, no cartilage damage. … So it's good news."
Pitta hurt his hip while trying to catch a pass from Joe Flacco in the back of the end zone during an 11-on-11 red-zone drill. While veteran safety James Ihedigbo was defending the pass, there was little — if any — contact. However, Harbaugh said Pitta's knee was awkwardly caught under him when he hit the ground.
Hip dislocations are typically the result of extreme contact and more common in situations such as car accidents than in on-field injuries. Harbaugh said he read that there are only eight documented cases of dislocated hips in football. One of those, however, marred one of the most celebrated athletic careers ever.
Bo Jackson, the two-sport phenom who played outfield for the Kansas City Royals and running back for the Los Angeles Raiders, suffered the injury while being tackled in the 1990 NFL playoffs. Jackson had surgery and then started the rehab process, but he developed avascular necrosis, a disease resulting from the interruption of blood supply to the femoral head. Jackson, who never played professional football again and was a different baseball player upon his return to the majors, ultimately got his hip replaced.
"In Bo Jackson's case, he had a blood supply issue, and when that happens, sometimes you can get damage to the head of the ball-and-socket joint. And when that starts to break down, then the next thing you have to do is consider doing some kind of joint replacement," said Dr. Daryl Osbahr, an orthopedic surgeon and sports medicine expert at MedStar Union Memorial Hospital. "In trying to resume activities, when the blood supply has been compromised, that's when you get into more of a long-term issue. The hope of someone who had a hip dislocation is taking them into surgery in a very expeditious fashion, getting the hip relocated, treating any associated injuries and then the blood supply is something that over time hopefully maintains itself."
Osbahr noted that it was important for Pitta to have surgery quickly to make sure the blood supply to that area wasn't compromised.
Now, he said, it's all about giving Pitta time to heal.
"The first six weeks [after surgery] is more of a protective phase. You want to really protect that joint because obviously there has been a pathway for that hip to dislocate," Osbahr said. "After six weeks, it's mostly about your long-term ability to return to activities, getting your flexibility back, getting your strength back. Usually, that would take probably about six to eight weeks. Really, we're at the three-month mark at that point, and everything after that is kind of getting somebody back to playing quality. Minimum would probably be three months, maximum would probably be somewhere around five to six."
Dr. William Long, medical director of Orthopaedic Computer Surgery Institute at Good Samaritan Hospital in Los Angeles, said he believes that Pitta could return this season, though the Ravens have ruled that out.
"The most important thing that determines whether this athlete will recover completely or return this year is whether or not there is any damage to the soft tissues, and by that I mean the cartilage in the ball and in the socket," Long said. "If it's true that the cartilage is OK, he can recover completely because a fracture can heal stronger than it was before. The cartilage, if it's damaged, you'd never recover. You don't get cartilage back."
The Ravens have vowed to take it slow with the tight end to make sure he's fully healthy for the 2014 season and beyond. Pitta is a free agent after this season, but the Ravens have voiced interest in re-signing him to a long-term deal.
"This was a traumatic injury, but it sounds like it could have been even worse," Ochiai said. "The fact that they didn't have to cut through the muscle to remove the bone fragment will speed things up. It's still a long road ahead of him, but with a young athlete in his prime, that should be a positive factor and help him get back out there. The biggest thing is what happened already with a fast response to the injury to stabilize the hip joint. Now is the time for rest, recovery and rehabilitation to return to health."
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