Inside Patrick Kane’s hip resurfacing surgery — and why it’s not right procedure for most

When Patrick Kane steps onto the ice for his first NHL game as a Detroit Red Wing on Thursday, Dr. Edwin Su will be watching "with a little bit of nervousness."

Su, an orthopedic surgeon who specializes in a hip resurfacing procedure that has helped pro athletes return to top form, operated June 1 on Kane's right hip at the Hospital for Special Surgery in New York City. Su told the Free Press that the joint was impinged, which means the ball of the femur was grinding against the cup bone of the hip.

"His case is basically one of accelerated deterioration just from the wear and tear that he's put on it, along with some of the structural problems of the hip, which can lead to cartilage breakdown," Su said of Kane, a 35-year-old right winger.

"Rather than a total hip replacement at such a young age, resurfacing is a great alternative. It's done for basically arthritis, or where the cartilage is worn down to the point that a patient has symptoms like pain and stiffness and limited range of motion."

Kane: 'My body feels good'

Kane played 19 games at the end of the last season for the New York Rangers, but spent the previous 15 years as a Chicago Blackhawks standout.

In his 1,161-game career, Kane scored 451 goals and was part of three Blackhawks Stanley Cup championship teams.

The Wings signed Kane to a one-year, $2.75-million contract at the end of November in the hopes that his surgery would be a success and he could bring some of his point-scoring special sauce to a team that's now in second place in the Atlantic Division of the Eastern Conference.

Kane has been cleared to resume his NHL career when the Wings play the San Jose Sharks on Thursday night at Little Caesars Arena.

"The exciting thing is my body feels good," Kane told Free Press reporter Helene St. James during an interview Monday. "So, it's just a big step in that direction and, you know, it might take some games to kind of get up to speed and just play at this level. So if it takes a couple of weeks, that's what it is. But, we'll get there eventually."

Surgery yields mixed results

Other NHLers also have undergone the procedure, some with more success than others.

"Ed Jovanovski may have been the first professional athlete from one of the major sports leagues to come back from a hip resurfacing," said Su, who also operated on the now-retired Florida Panthers defenseman in 2014.

"He came back for at least part of a season. We feel a lot more confidence in the implant, the protocols and the rehab to make it happen more consistently and confidently."

Jovanovski, a native of Windsor, Ontario, played 37 games after his surgery before leaving pro hockey in December 2015.

The second NHL player to make a return to the league after hip resurfacing was Nicklas Backstrom, who played 47 games after his 2022 hip resurfacing procedure. But with ongoing problems with that hip this season, Backstom's pro hockey career could now be over.

“Given my ongoing injury situation, I decided to take some time and step away from the game," he said in a statement released Nov. 1 by the Washington Capitals. "This is a difficult decision, but one that I feel is right for my health at this time."

Su said he didn't perform Backstrom's surgery, but told the Free Press that he did a hip resurfacing procedure on Carl Hagelin, whose last four seasons in the NHL also were with the Washington Capitals.

Hagelin was out for a year and a half after taking a stick to his left eye during a practice in March 2022. He had surgery on the eye and also had the hip resurfacing, hoping to be able to return to the game. But in an Aug. 30 Instagram post, he wrote: "It’s been an amazing ride but it ends here. Unfortunately my eye injury is too severe to keep playing the game I love."

Anaheim Ducks forward Ryan Kesler had the surgery in 2020, but never played pro hockey again.

"These athletes are incredible with their dedication and the commitment to the rehab, and it makes all the difference," Su said.

How hip resurfacing works

During Kane's procedure, Su told the Free Press that he made a large incision on the side Kane's leg near the gluteal muscle.

"We have to separate the muscle to get into the hip joint," he said. "I actually had to pop the ball out of the socket and dislocate the hip joint so I could look at the arthritic surfaces."

Once that was done, Su shaved away the surfaces of the joint. That reduced the size of the ball at the end of the femur and smoothed the hip socket, which had arthritis.

"Then I capped it like a tooth," Su said. "I put a metal ball on the bone of his femur. I put a metal socket on the bone of his pelvis, and then I put everything back together and he started his recovery."

Kane was "a perfect patient" for hip resurfacing, Su said, because he's so young and his bones are strong.

Total hip replacement v. hip resurfacing

Hip resurfacing, sometimes called hip shaving, is preferred over a total hip replacement for elite athletes, Su said, because it preserves more of the femur, uses a metal alloy made of cobalt and chromium that is "harder than titanium" and is less likely to break than the most common total hip replacement materials, which include both metal and plastic.

In contrast, total hip replacement "is not as conducive to impact activities like running and jumping. There's a potential that the rod in the thigh could either lead to ... some pain when they do impact activities or repetitive activities like hockey or collision sports, and could result in fracture of the bone around that implant, which would be a really big problem."

During hip resurfacing, Su said he tries to preserve as much as the bone as possible so if further surgery is needed later, the athlete has more options.

"Hip resurfacing, as opposed to a hip replacement, also has a larger ball," Su said, "... which leads to more stability of the joint. There's less of a chance of dislocation, which is another reason I think that I think it would be better for an athlete, especially in a contact sport."

In addition to several NHL players, the procedure also was used on pro tennis player Andy Murray, the NBA's Tiago Splitter, ultramarathoner David Jones, and Colby Lewis, an MLB pitcher who was able to add a couple years of big league play post-surgery.

Hip resurfacing not ideal for weekend warriors

Dr. Trevor Banka, an adult reconstructive orthopedic surgeon for Henry Ford Health, said that although hip resurfacing might make headlines among pro athletes, it's not for everyone.

"There are very narrow indications for the procedure," he said. "I don't want a weekend warrior or someone who's playing recreational hockey to say that because there's a number of professional hockey players, professional wrestlers, tennis players, cyclists and some basketball players who have had this, that this is what I need to get back to my recreational activity.

"I have plenty of patients who are in their in their ... late 30s, early 40s and 50s and 60s who are getting back to playing hockey with total hip replacements."

Banka said the metal used in hip resurfacing to cap the ball of the femur and create the lining of the hip socket can be problematic. When the two metal surfaces rub against one another in the joint, it can create metal ions. Some people have reactions to those ions, which can loosen the implant and cause tissue damage around the joint.

"It's not the right procedure for most patients. The reason being is the metal-on-metal articulation," Banka said. "There can be a very high complication rate during surgery. ... And even though it's bone preserving, it is anything but minimally invasive. It's actually a much, much larger incision, and it can lead to the metal-on-metal complications."

It's also not a procedure that should be done on young women, Banka cautioned, because those metal ions are a risk during pregnancy.

"That said, there are some surgeons in the country who are very skilled at this procedure, and they found that some patients can do very, very well with them and they can get back to a high level of activity," he said.

Kane and the Wings hope that is exactly what will happen for him when he resumes place at Little Caesars Arena later this week.

Kane's accelerated rehab

Kane, who was the No. 1 pick in the 2007 NHL Draft, was relentless in his rehabilitation, Su said.

"He accelerated everything," Su said. "We actually designed a special protocol of recovery for him, and ... he basically reset the timeline so that everything was much, much faster.

"He was walking right away," Su said. After that came extending his range of motion in the joint and strengthening it.

Kane stayed in New York for about a month after surgery to work daily with a therapist, to train on special equipment and began shooting pucks almost immediately, Su said. As soon as he could balance well enough, Kane was back on skates.

"He kind of combined everything all together. So he did range of motion, strengthening and he did hop-specific activity almost daily, which I think really, really did help," Su said.

For the average person undergoing hip resurfacing, Su said recovery would be about three months to be ready to return to recreational sports.

But for high-level athlete, it could be six to eight months before a person is ready for high-impact running and jumping, he said.

Kane crossed the six-month threshold Dec. 1.

"A lot of the power for skating has to come from the hips, the gluteal muscles and the hip joint," Su said. "So that's kind of the pivot point and there's a lot of torque on the hip joint.

"They have to do a lot of quick movements. So quick movements usually require rotational stopping ability and that also can put stress on the hip. There's obviously collisions, too. So all of that can lead to damage."

Still, Su said he's optimistic about Kane's chances of post-surgery success.

"He's a special breed of person, an athlete who is extremely dedicated and motivated to come back," Su said. "I think that plays a large role in hopefully his success in returning. I don't think everybody could do that. Hat's off to him for for really working hard through the recovery."

Contact Kristen Shamus: kshamus@freepress.com. Subscribe to the Free Press.

This article originally appeared on Detroit Free Press: Red Wings' Patrick Kane the 'perfect patient' for hip resurfacing