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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 a hip replacement.

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 Urbaniak.

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 anticlotting medications.

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 surgery.

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