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How Nicklas Backstrom became a believer in hip resurfacing surgery

Capitals center Nicklas Backstrom returned to action in January after offseason hip surgery. (Jonathan Newton/The Washington Post)
5 min

Eight months removed from hip resurfacing surgery, Washington Capitals center Nicklas Backstrom has no aches or pains, no more trouble sleeping or walking and no problem bending forward to tie his own skates. The 35-year-old says he is pain-free and enjoying a taste of normalcy as a crucial piece in Washington’s late-season push toward the playoffs.

Backstrom — who suffered chronic hip pain for years — has started to look like his old self after his return to the Capitals’ lineup in early January. Just being on the ice is a feat for the veteran center, who faced significant doubt — even from inside the organization — that he would be back in the NHL so soon.

“It’s amazing,” Backstrom said. “It’s been a long journey for me getting back, but at the same time I am here and I am the kind of guy that loves to live in the present and the type of guy that loves to play hockey. Body feels better and better every day. Getting more comfortable out there. It is just [about] starting to trust yourself.”

Backstrom scored his first goal of the season Sunday against Toronto and has recorded four assists in 10 games. He is showing he can still produce.

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“It has been a long haul for him,” Capitals General Manager Brian MacLellan said. “I think a lot of people at his age and his accomplishments and what he has accomplished in the game might have said: ‘This is a little too much. I would rather do this as a lifestyle moving forward rather than playing in the NHL at a high level.’ It would have been easy to say you know, ‘I’m done playing.’ ”

Backstrom first addressed issues with his hip in 2015, when he underwent arthroscopic surgery, a minimally invasive procedure. The issue flared up again at the end of the 2020-21 season.

MacLellan said he started to notice something was wrong during the 2021 playoff series against Boston. MacLellan picked up on Backstrom’s unusual gait in the locker room, the way he skated compared with years past and the amount of prep work he ended up doing on a daily basis just to dress for practices and games.

“He was going through a lot just to play,” MacLellan said.

Backstrom tried a couple of nonsurgical treatments to remedy the hip and resisted the idea of a hip replacement until the pain became too much. In mid-June he went to Koen De Smet, an orthopedic and trauma surgeon in Belgium who specializes in hip resurfacing.

Backstrom consulted with other professional athletes about the procedure, including tennis player Andy Murray, basketball’s Isaiah Thomas and a couple of hockey players in the Swedish Elite League.

De Smet has performed more than 6,000 hip resurfacing surgeries over the past 25 years. In a recent conversation with The Washington Post, De Smet said the surgery — which often scares younger athletes who are uncertain about long-term effects — can allow the patient to have a pain-free daily life, including competition in high-impact sports.

De Smet said he first met with Backstrom over Zoom. He talked about what he saw in Backstrom’s X-rays and explained why hip resurfacing could solve his chronic pain. He could tell Backstrom was at the height of his pain, with Backstrom unable to physically bend over 90 degrees; the cartilage in his bone was also gone, leaving the bone surfaces of the joint to grind together.

The resurfacing surgery creates more space between the joints, De Smet explained. In Backstrom’s case, De Smet used a method called metal-on-metal hip resurfacing in which a rounded metal cap is placed over the head of the femoral bone and the socket is lined with a metal shell.

“Metal-on-metal, it is like a cylinder in a car that you keep polishing,” De Smet said. “With the polishing, you get a smoother surface between the two metal surfaces, and you always have liquid between the two. They cannot get dry. If you put the prosthesis in the right spot, it will get better and better, and that smooth surface is becoming bigger and bigger, and in 10 to 15 to 20 years, you don’t have contact between the surfaces.”

De Smet said the next steps for Backstrom are fairly simple: Just live life.

If all goes well, he will have Backstrom send him an X-ray and bloodwork in five years, “and I will tell him [I’m] 97 percent sure that, Nicklas, everything is okay,’ ” De Smet said.

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After surgery, Backstrom was able to do full body workouts with weights after two months, and he was allowed to run after three. It was a quicker rehab time than Backstrom expected.

“Honestly, listen, it was the best thing for me, and the only thing I can say it is actually an incredible surgery if you look at it,” Backstrom said. “If you have issues, do your own research. I am not going to tell someone they should do it because I am back playing, but after the surgery the rehab is as important, and you have to be mentally ready to come back playing and have that mind-set — because if you are not, it could take longer.”

Washington will depend on Backstrom down the stretch, and his teammates have been firm believers in his path back to the league. Even the smallest signs of improvement were encouraging over the past month. Capitals captain Alex Ovechkin said it was nice not only to see him back on the ice but also playing soccer before games.

De Smet offered some final words of advice for his patient.

“He just should go for it,” De Smet said. “He just should go for it completely.”