What's Ahead for Dennis Pitta

Examining Dennis Pitta's hip dislocation and the complications he'll face in the coming months.

Every report on Dennis Pitta's hip injury was more worrisome than the last this afternoon. You could almost hear the collective groans from the Twitter community as the heavy hitters in the major media continually updated Pitta's condition. The news may continue to get worse before it gets better.

A dislocated hip is a complicated injury. When it is an isolated injury, it's very painful and can be difficult to fix without the help of multiple hands and strong medication to relax the surrounding muscles. When the dislocation is associated with fractures or injuries to blood vessels or nerves near the hip joint, time becomes critical.

Unfortunately, Pitta's injury wasn't an isolated dislocation.

Early in the afternoon, Pitta's hip had reportedly been relocated in its socket and the team was awaiting additional tests. At that point, there was still a hint of optimism that he might be able to return to play during the 2013 season. Had there been no associated injuries, a 3-4 month recovery timetable was still in play.

Shortly after those initial reports, however, Aaron Wilson tweeted that Pitta was in surgery. As I speculated on Twitter, the decision to take Pitta to surgery so quickly after his hip had been relocated was a very ominous sign. Not long after, Adam Schefter (and others) began reporting that Pitta's injury included a fracture in the hip and was likely season-ending.

Injuries to the hip joint that involve fractures are at risk of not healing well. The blood supply throughout the ball and socket joint -- either the pelvis (socket) or the upper part of the thigh bone (ball) -- is very sensitive to injury. Without a good blood supply, bone can't heal and the joint is at risk of a condition called avascular necrosis. In short, the bone dies and the joint degenerates. Even with further surgery, hip replacement is sometimes necessary to fix the joint. Also, fractures to the pelvis often damage the layer of cartilage protecting the joint and lead to the development of arthritis.

The risk of those complications will vary based on the location and severity of the fracture, with medical studies quoting an incidence of anywhere between 5-40%. But the risk of the most severe complications is significantly lessened when a dislocated hip is quickly put back in place and when any fractures are quickly repaired. One orthopedic text puts the risk after quick surgical action at less than 10%. That's why Pitta was taken into surgery so quickly. Presumably, the MRI after his hip was relocated showed the fracture and his surgeons wasted no time in addressing the additional injuries.

If that's not troublesome enough, it won't be known whether Pitta will develop any of these complications for weeks. At least three weeks and possibly six weeks or more. And though the early surgery will help, there's a little luck involved in avoiding problems with bone healing.

It's not yet known what kind of fracture Pitta may have (or if he has any associated soft tissue injuries like labral tears). We'll know more in the coming hours and days. Pitta cannot be put on the PUP list since he's already taken part in training camp practice. And I think it'll be difficult for the Ravens to feel comfortable using their designated to return IR slot on a player whose outcome won't be clear until many weeks into a long rehab period.

Continue to follow the news closely, but there's little chance we will see Pitta back this season. Hopefully, his recovery will proceed smoothly and he'll return to form in 2014.

Follow on Twitter @JeneBramel for breaking injury news, analysis and updates. Questions and comments are welcome by email at bramel@footballguys.com.


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