I noticed a stinging tightness in both
hip joints after dancing, probably since I was about 40 years old. It
always went away with normal rest. I had full range of motion, strength, endurance,
etc. and so I thought this was what everyone felt after taking class or performing.
I really didn't have any significant pain or limitations until early in 2005,
when things went "downhill" extremely quickly.
My medical diagnosis was primary osteoarthritis, but
in the course of the actual surgery, Dr. Amstutz determined that I had undiagnosed
mild to moderate hip displasia as well.
In my year of trying to believe my osteoarthritis
was anything but osteoarthritis, I tried acupuncture (it helped briefly with
the pain) chiropractic adjustments (didn't help at all) prolotherapy (actually
made the inflammation in my hip joints a lot worse) massage (helped briefly with
the muscle tension) physical therapy (helped keep me as strong and flexible as
was possible) and dietary supplements (didn't help and were very expensive).
As my pain increased and my physical abilities
decreased, I stopped (in chronological order) doing full split penchees, doing
grand plie in fourth position, doing developees on a straight supporting leg,
taking class five days a week, taking class more than three days a week, taking
group class at all, doing a whole yoga class, teaching children's ballet, teaching
adult ballet, walking long distances, walking any distance beyond my mail box,
walking without the help of a cane, doing anything but staying in my house all
day, everyday and doing water aerobics in my spa and gentle range of motion work
with my stability ball in my bedroom. I couldn't go Christmas shopping in December
of 2005 because I couldn't walk in the stores. I had to bribe myself with tea
and chocolates to get through the pain it felt to decorate my Christmas tree
- it took a whole week to put a few lights and ornaments on that tree! If I needed
to go to the grocery store, I would find a parking spot close to a shopping cart,
so I could use that cart as a "walker" so I could buy the groceries
I needed. I had to force myself to stand at the sink to put on my makeup each
morning, and eventually I had to stop and sit down after about 10 minutes to
lessen the pain so I could continue again. My husband was my "knight in
shining armor" through all of this - he continued to help me in every way
he could.
My descent was very fast - from the time my
joints were finally bone on bone, it was only about one year before I reached
the physical "low" I described in the previous paragraph. I was fortunate
in a way, because I was able to maintain good strength and range of motion up
until that last year prior to surgery. I did not have a slow decline and therefore
was (relatively speaking) quite fit.
I really had no choice but to do some type
of joint replacement surgery - I could barely walk. It was either have surgery
or resign myself to a wheelchair.
I was quite relieved, however, when I read
about William Starrett and his return to professional dancing after bilateral
hip resurfacing. I remember crying with pain and frustration during one ballet
class, and a fellow dancer telling me point blank to "Just do the surgery
- You can't live like this!" I think many things came together for me that
helped me commit to the bilateral resurfacing with Dr. Amstutz - I learned of
the procedure, and the possibility of a dancing future FREE OF RESTRICTIONS traditional
hip replacement surgery can impose on a dancer, my husband and I had the money
required for this surgery (insurance paid a good portion, but we had to pay $6,500
up front, over and above what insurance would pay), and I had the support of
my whole family. William Starrett was very kind to call me before my
surgery to reassure me I was doing the right thing.
Also, Dr. Amstutz provided me with the
names and e-mail addresses of other post-op dancers whom I could contact. I traded
e-mails with three of them and they all are thrilled with the outcome of their
surgeries.
I chose Dr. Amstutz as a direct result
of reading William Starrett's story. I had no second thoughts, ever, about my
choice! I was in the hospital only three days (that was long enough - the food
was just terrible!)
I have two shiny, new Conserve Plus metal
on metal resurfacing prostheses.
I had no complications with either the
surgery or my stay in the hospital.
I LOVED working with the physical therapist
- I could walk with the aid of a walker, and get up and down stairs from day
one. I did not do well with morphine. It made me extremely nauseous, and so I
was switched to oxycontin. My surgery took seven hours, and I required the two
units of blood I had "banked" prior to the surgery.
XRay Post op, I was seen by
a visiting nurse at my home, to monitor vital signs, check for DVT, etc. every
few days, and I did in-home physical therapy everyday, from day four post op.
I saw Dr. Amstutz 18 days post op, and at that
time he cleared me to drive, begin water exercises, and begin out-patient physical
therapy. I went to Martha Spaulding Kern at Circle of Health Physical Therapy
in Lake Forest, CA for my early P.T. She did lymph system, and other general
body health work, as well as use the reformer for the actual physical rehab work.
After completing the initial functional physical therapy work, I began doing
my own "dancer rehab" (at one month post op). I have access to the
studio where I teach, so I would go there early in the morning, before regular
classes began, to do my own "barre".
In the beginning, I lasted all of about 25 minutes!
I put my pointe shoes on from the very beginning - I love to dance on pointe.
I have continued to work with physical therapists this whole year post op. After
doing the initial work, I went to Impact Rehab, a therapy group which specializes
in athletes, and did much more aggressive strengthening under their care. About
three months ago, I decided to explore myofascial release work - I am finding
it very useful and necessary as I still have quite a bit of scar tissue and fascial
restrictions. I am currently working with yet another physical therapist, Kinnery
Patel, in Laguna Hills who is helping me with the anterior pelvic tilt and muscle
imbalance issues I still am experiencing.
My biggest challenge now is range of motion.
I can reach a full split on each leg with relative ease, but my straddle splits
still have a ways to go. I'd say I'm about 90%. I also still have some tightness
across the front of each hip, and my arabesques are not yet at the height they
have always been. My left leg is still weaker than my right leg, and my pelvis
is still not completely evenly balanced.
At fourteen months post op, I am attending four
- five advanced ballet classes a week.
I can do all of the class - but it still doesn't look like I want it too! I am
working to get my extensions back up to where they were, and my grand allegro
is still weak. Strangely, my petit allegro and my turns are progressing the fastest!
I'm doing beats again and double pirouettes. I have no restrictions because of
the resurfacing components. The risk of dislocation is very low - about what
it would be for a person who has never had hip surgery. I can do any pose in
yoga, I can do fifth position, I can do anything I want except run a marathon
or bungee jump (I'm glad I've never considered doing these things!)
I practice and teach pilates, and I also practice
yoga. I do strength work with light weights 3-4 times a week, and walk my dog
everyday. If I were given the opportunity, I could prepare for and complete a
performance. At this stage, I would definitely have to pick and choose the choreography
- some things just don't look that good yet. I am still "evolving" post
op. I'm hoping my surgeon's prediction is right - that I will come back 100%.
I certainly am trying for that. I am grateful for so many small things: I can
teach pre-school ballet again (I had a class of 10 four year olds just this morning);
I can do the advanced pilates reformer work easily again (just last week someone
in class complimented me on my "flawless technique"); and I can easily
climb my stairs again! My husband is happy to have his active, trim wife back.
I was able to go Christmas shopping this past December and I didn't have to bribe
myself to decorate our tree!
I have been a lifelong, "pretty
darned good amateur", dancing in civic and regional ballet companies and
teaching both children and adults, and enjoying this art form since I was three.
I'm so happy to be able to enjoy it,
pain free, again.
Length of surgery - the resurfacing
surgery is indeed more technically challenging than a total hip replacement procedure.
My bilateral surgery was seven hours in length. However, there are surgeons who
complete the procedure in much less time. Two of the fastest are Koen DeSmet,
and Ronan Treacy, who both take well under an hour to do a single hip resurfacing
procedure.
Extent of surgery - the femoral
head is shaped to prepare it for the femoral cap, resulting in some bone loss.
It is not amputated, along with the femoral neck and part of the femur, as in
a total hip replacement procedure, and there is only a small guide stem inserted
into the femoral neck (see the picture of the Conserve Plus prosthesis included
here), not a long stem inserted into the femoral canal, as in a total hip replacement
system. There is a chance of femoral neck fracture, (statistically this is more
likely with less experienced surgeons) which is why it makes good sense to have
the surgery performed by a very experienced surgeon. Dr. Amstutz has performed
over 1000 successful resurfacing surgeries to date. As to the issue of increased
muscle trauma and scaring, I cannot speak for others, only for myself. I do have
scars that are about 6 inches in length. In the course of surgery the six deep
lateral rotators were detached and then re-attached. I did have bruising and
swelling. But as my story illustrates, I had an easy and quick recovery. Each
person responds differently to surgery - some have easy recoveries and some have
more difficult recoveries, no matter what surgical technique was employed.
Type of prosthesis - conserve
At this point in time, all resurfacing systems are metal on metal, similar to
the metal on metal large ball total hip replacement systems also available now.
The BioMet company has developed a completely cementless hip resurfacing prosthesis,
which some surgeons are now using. The Conserve Plus system that I received requires
a small amount of bone cement underneath the cap. As to the concern about metal
ions, here is what Dr. L.D. Dorr said at the 2004 meeting of the American Academy
of Orthopedic surgeons, when speaking about long-term studies of patients with
metal-on-metal total hip replacements:
There have been absolutely no complications,
not a single report of cancer, in 40 years of MOM THRs. No hypersensitivity,
no reports of increased pain due to "metal ions". For more information
on this issue (including the risk to people with kidney problems) please go to
http://www.mcminncentre.co.uk/ and http://www.hip_clinic.com/en/html/home_enhtml.
Ease of Revisability to THR - it has been suggested that it
is harder to revise a resurf to a thr. Because of tissue trauma and scaring.
Here is a study recently done that speaks to this concern: http://www.orthosupersite.com/.
Briefly summarized, it states "Resurfaced hips converted to THA show similar
clinical results primary total hip ... Converting resurfacing arthroplasty hips
to THA required similar operative times and length of postoperative hospitalization." This
is one of the main reasons I chose the resurfacing surgery - at the very least,
it buys me time - I can resume all of my activities with no restrictions, and
if I should need a revision at some point in the future, it will be like a primary
THR, not a revision from a THR, which requires even more of the femur to be removed
and a longer stem inserted into the remaining bone.
Here is another very good resource for information on both resurfacing and traditional
hip replacement surgery: http://www.jri-oh.com . This is the
site of Dr. Amstutz and also Dr. Thomas Schmalzried. Once at the site, you can
access a wealth of information by going to the Resource Library section. My suggestion
to any dancer contemplating any type of hip surgery is to get all the reliable
information you can - don't take someone's word for anything - get well documented
facts and proceed from there.
Don't be afraid to ask questions - this is your
body and your life!
|