Dr. Schmalzried

Navy Chief Petty Officer Mike Carrol deployed to Iraq in 2007 and remains on active duty today, at 53, to train fellow reservists.

Mike Carroll couldn't touch his knees together. Couldn't play basketball with his children. Couldn't walk other than taking "a big limp," he said.

The former Navy SEAL wasn't going to let those limitations drown his dream of returning to the special-warfare compound in Coronado to help in the war effort.

At age 49 in 2006, Carroll wasn't the oldest SEAL to re-enlist after an absence. But he was certainly not the usual face in the recruiter's office.

Adding to the odds against him, he was packing two artificial hips.

Even with that weighing down his résumé, the Alpine resident deployed to Iraq in 2007 with his special-warfare team and remains on active duty today as a trainer of fellow reservists.

It was a long shot, Carroll is the first to acknowledge.

"If the dream's big enough, there's nothing that you can't overcome, especially with technology," said Carroll, now 53.

Being a SEAL, the Navy's elite sea-air-land combat force, is usually a young man's game.

The age ceiling for entry is 28. Highly sought-after candidates can get an age waiver up to 30. An enlisted SEAL looking to become an officer may receive a pass up to 33.

Carroll remembers seeing a Navy doctor a few weeks after the Sept. 11, 2001, attacks. Angered by the terrorist action, he wanted to get back on a SEAL team and use his 16 years of military experience.

Carroll, who ran a computer-based business after leaving the Navy, kept in shape over the years. He was roughly 6 feet and 183 pounds.

He told the physician that his joints felt fine. Then the doctor asked him to perform a few side lunges and knee bends.

"I couldn't do it," Carroll remembered. "The doctor said, ‘We can't take you Mike, you'd be a liability.' "

So Carroll basically gave up. Surgeons said he was too young for a hip replacement, which is usually reserved for older people because of the chance that the artificial parts will break down over time.

Carroll, a former senior chief petty officer, felt deflated. He had wanted to serve as an example of patriotism to his young sons. They knew he had been a SEAL but had never seen him go to work in combat boots.

Then one day a buddy called to point out an article about a new hip procedure. Carroll bought the magazine immediately.

By March 2004, he was on an operating table in Los Angeles. The treatment replaces only the outer part of the hip joint with metal. It can be a place holder for a future total hip replacement or, if it works, a permanent fix.

Carroll's surgeon, Dr. Thomas Schmalzried, said the former SEAL was basically the prototype for the procedure - someone still young and fit whose joints just gave out too early.

"Mike is a special person. I was proud that he was able to continue as a SEAL with two artificial hips," Schmalzried said.

After the surgery, Carroll managed to get age and medical waivers from the Navy, though he had to drop a rank.

His return took some convincing of re-enlistment officials, so he called on his former teammates. One of them was Cmdr. Roger Meek, who had become an officer at the special-warfare base in Coronado.

The higher-ups largely foresaw that Carroll's role would be training younger SEALs, which is what special-warfare veterans switch to as they finish their careers. But Meek said he wouldn't have recommended Carroll if he didn't believe it was safe to place another sailor's life in his hands, as SEALs do in the tight corners of combat.

"He's a very thorough and squared-away guy with a good reputation for getting things done," Meek said. "In our community, reputation is everything."

The surgery left Carroll with two hockey-stick-shaped scars on his hips, but no complications so far. He now leads daily fitness workouts for his unit.

Sure, the younger SEALs call him "grandpa." In Iraq, the second-oldest SEAL in Carroll's unit was only 36. Another sailor teases him that this story will appear on the cover of AARP magazine.

Carroll said he is living the dream, with a year to go until retirement.

"I think there's a little bit of respect there from the younger guys," he said. "When they ask me how old I am, they can't really believe I'm that old - at least that's what they say. Maybe they are just being nice."

He adds, grinning, "I feel like a 25-year-old man."


 

There is some data indicating that navigation can improve the accuracy of femoral component placement in hip resurfacing.  The real issue is "compared to what?"  For an inexperienced surgeon, navigation may help him avoid component positioning problems that have been associated with "the learning curve".  However, for an experienced surgeon, who has an established mechanical alignment system with a high success rate - it is difficult to demonstrate an advantage to him with a navigation system.  Further, the registration process takes a little time – so the cost-to-benefit ratio for the experienced surgeon in a busy O.R. is questionable.  The navigation systems are not hard to learn to use, even for old guys like me!

A bigger challenge is acetabular component positioning.  This is true for total hips, and even more important for resurfacing.  There are 2 parts to the acetabular positioning problem.  The first is identifying the desired position for that patient and the second is putting the cup in that position.  Keeping the pelvis in one position and finding accurate pelvic/acetabular landmarks can be challenging.  The lateral opening angle is the easier part.  Most surgeons today agree that between 40 and 50 degrees is desirable.  Version is more complicated because the desired acetabular version is dependent on femoral version.  Acceptable version is also related to the lateral opening angle and the resultant bearing contact area.  Again, the issue is experience.

If I have any doubt about component positioning, I get an intra-operative x-ray.  Admittedly, there can be some challenges to getting a good intra-operative view.   For what it’s worth, we did an x-ray review of my first 500 resurfacings (minimum 1 year follow-up).  I have never had a femoral neck fracture and all sockets are below 50 degrees lateral opening.

Best wishes.

Thomas P. Schmalzried, M.D.