The unknown of life after surgery.

Every day, Ari Marken dives into the Pacific Ocean during his lunch break. He heads north towards the Santa Monica pier from lifeguard tower 26 while the sun reflects over the Golden Coast. When he comes home from work, he takes another swim, averaging two and a half miles per day in the open seas. This has become his main form of exercise… with the occasional added bonus of catching a pod of dolphins playing along his route in the open sea.

Ari’s kind eyes and deep tan show the zen of someone who spends much of their time enjoying the beach life. For years you could find him shredding on his surfboard, playing ultimate frisbee or volleyball, and running miles along the water’s edge with his bare feet splashing as the waves roll in.

He’s also a talented tennis player and passionate hockey player who has been playing with the same group of friends for over 15 years.

But in the past three years, this California boy has had to reevaluate and limit his activities because of the excruciating pain that radiates from his left hip. Osteoarthritis has forced him to change his “play hard” attitude.

Addressing the root cause

At 45 years old, Ari can’t tie his left shoe without contorting his body to avoid shooting pain. He bikes to Santa Monica High School, where he teaches upper level mathematics. But the repetitive, circular motion exacerbates his chronic pain because the cartilage in his hip joint is almost nonexistent.

Starting in his 20s, Ari was plagued with groin pulls. This type of injury is common in sports that require quick direction changes, like tennis, hockey, surfing, basketball, volleyball, and ultimate frisbee—all sports that were part of his weekly schedule.

Sports were an enormous part of Ari’s life. He had a successful tennis career at the University of California San Diego. After college, he was a tennis instructor at the Beverly Hills Tennis Club. He then earned a ranking, which led him to play abroad for a year with the French Tennis Federation.

About once or twice a year for the past two decades, these groin pulls sidelined Ari. He was told over and over to rest. Every doctor he saw chalked it up to his extreme athletic involvement. Diagnosis was based on superficial symptoms. No physician ever took the time to dive deeper into the root cause of his chronic injuries.

The diagnosis

At age 38, Ari saw a new primary care physician who ordered an X-ray, a routine exam no other health care provider ever felt was warranted despite his history of groin issues. The film showed that Ari had a disorder called femoralacetabular impingement (FAI). FAI creates multiple bony lesions that build up on the surface of the femur, causing abnormal contact in the joint during motion. Ari’s hips were tilted and the bone had cracked. The built-up calcium deposits had caused damage to bundles of nerve endings.

FAI is the leading cause of hip pain in young adults aged 15 to 50 years old and is linked with the development of osteoarthritis. Recurrent hip and groin injuries in athletes that play “overhead” sports, such as his beloved tennis, are a strong indicator of FAI. Use of the upper body, such as hucking a frisbee or hitting a top-spin forehand, requires rotation of the pelvis. The torque needed in almost every sport Ari enjoyed, coupled with untreated FAI, contributed to the development of his osteoarthritis.

Early diagnosis and treatment of FAI is critical in managing the pain and can delay or prevent osteoarthritis from forming. Unfortunately, by the time Ari was diagnosed, osteoarthritis had made a permanent home in his left hip joint, causing the bone to become diseased. The average person has a cushion of cartilage in their hip joint of 6mm. At 4mm, arthroscopic surgery is used to shave down the bones spurs and preserve the hip joint. The cartilage in Ari’s left hip measured at less than 3mm, leaving little hope for a minor surgery. He was told he would need a hip replacement sooner rather than later.

Navigating internal stigma

Hip replacement surgery was not what Ari wanted to hear.

“My self-confidence was wrapped up in sports,” 

he says. His biggest joy in life comes from all forms of exercise. The thought of not being active for six to nine months was depressing. When he was diagnosed with FAI and osteoarthritis, Ari kept the news to himself. The average age range for those who undergo hip replacement surgery is 60 to 80 years old, not an active person in their 40s. The majority of Ari’s friendships developed around athletic activities. Would they see him differently? As a weaker version of himself? Would he get left in the dust as they continued their active lives while he was in recovery? He hadn’t yet realized that he had an identity outside of being athletic.

Bargaining

Instead of opting for surgery, Ari thought he could manage the pain himself. He modified his playing strategy to cover up his limitations. “In frisbee, I used forced moves to appear athletic. I would dive to block the disc, which looked like a great effort on my part, but it allowed me to take longer to get up,” Ari admits. But this strategy didn’t always work, “I was always one step behind,” says Ari.   

Coming to terms

In the past three years, chronic pain from osteoarthritis dictated Ari’s involvement in sports, as much as he had fought so hard to push through it. He let go of basketball and surfing first. Next, he moved to playing ultimate frisbee on sand. But these changes didn’t prove to be any kinder on his body.

Osteoarthritis forced Ari to make the toughest decision of all. The sport that caused the most pain was also the sport he loved desperately: Ari retired his tennis racket and stepped off the court.

Still trying to hold on to his active life, he continued to swim, run, and play hockey. But by the spring of 2019, Ari couldn’t run a mile in a straight line.

He finally opened up to a hockey teammate about the seriousness of his hip problems. Without knowing it, his friend of over 15 years revealed that he had his hip replaced several years prior. He told Ari that he regretted not doing it sooner. That was the push Ari needed to see a surgeon and get serious about a hip replacement.

Making the decision

Ari made the appointment, now coming from a place of acceptance. Updated imaging showed the cartilage in his left hip joint had dwindled to 1mm—basically bone on bone contact. His right hip is trending in the same direction and will also need to be replaced.

Ari finally made the decision to get his left hip replaced with surgery scheduled over the 2019 holiday school break. The surgeon said he would need two months of recovery time, but Ari tried to bargain for two weeks. In the end, following doctor’s orders will improve the success of the surgery and reduce the odds of complications. His surgeon reinforced that a hip replacement is designed to help him walk without pain, not to turn him back into the athlete he once was.

Person before an athlete

Injuries are not the way any athlete wants to end their athletic pursuits. But the need for basic mobility and a life without unbearable pain is a choice that some athletes are forced to make. Ari has come to terms with this fork in the road of his life journey.

“I’m ready for it,” he says. “It’s time.”