Steve Minshall -
Amateur Ballroom Dancer
Anterior Approach THR Surgery
I welcome this entry about one dancer's personal experience with the anterior approach THR. This approach is not commonly performed in the USA, but clearly has some points to recommend it. Steve's journey towards THR begins with a injury, as many dancer's stories do. His hip degenerated because of poor blood supply to the damaged joint and then he was faced with the difficult decisions we confront when contemplating THR: when to have the surgery and where, what surgical approach and what prosthesis will be used. -NR
My experience with hip replacement is considerably different than most of the stories presented on the Dancer's Hips web page. First of all I am a man. Second, I am not a professional dancer but an amateur ballroom dancer. Third, and most important, is that I had a very different procedure, an anterior approach THR, than most have presented here. I believe my experience will greatly help some of you dancers who are looking at a hip replacement.
My Total Hip Replacement (THR) story begins almost four years ago when I fell at an ice rink. I am a very poor skater and as a result I took a good fall landing square on my left hip. At the impact I knew that I was severely injured but being the stupid male that I am I tried to get up and walk. My left leg felt like a painful wet noodle and I could not get up no matter how I tried or how much the kid with the whistle wanted me too. I crawled off of the ice and experienced severe nausea for a few minutes.
I got wheeled out to our car on a chair with rollers and managed to get into our car. We drove to the emergency room and my wife went in to see how long the wait was. She reported back that the wait was six hours. I told her to take me home, there was no way that I would wait in a chair for six hours with a bunch of sick people (please see reference to stupid male above.)
I spent a few days at home waiting for my leg to feel better. I watched a lot of television and got up occasionally to use the restroom. Again, being the stupid male, I was sure that I just had some muscle damage and that it would be getting better. On the fourth day at home muscle spasms created more pain than I could handle so we made a trip to the doctors office. The doctor suggested that an x-ray was in order and we went to the hospital to get that done.
I was walking into the hospital with my crutches and a very friendly security guard offered to wheel me in with a wheel chair. That was so thoughtful and nice... until he ran my foot into the floor at a corner. My scream must have woken up anyone that might have been asleep in the hospital.
The x-ray technicians seemed to be quite bored that day, that is, until they saw my x-ray. They got all excited and gathered around the film wondering how I ever walked in on crutches. From then on I was known as the guy who walked into the hospital with a broken hip. I guess people generally don't do that.
To make a long story short (too late) my hip was screwed back together. The surgeon said that the particular break was very bad and gave me a fifty-fifty chance of recovery. I was quite upset especially since my wife and I had just started to get into ballroom dancing. Six months later we took an Argentine Tango class. I was still using a cane to walk but I was able to complete the class albeit with some pain and difficulty.
At one year from surgery I was able to stop using the cane. For the next year my leg felt relatively good and at two years after surgery the surgeon pronounced it healed. Six months later I started to get some pain. At first it was tolerable and didn't interfere with our dancing. It was not long before I was using the cane again and eventually had to give up dance lessons and attending dances.
My surgeon said that the ball of the hip was deteriorating due to a loss of blood supply. The only remedy was a THR. He wanted me to wait five more years and to take pain medication and anti-inflammatory medication in the mean time. Now call me silly but I didn't think his approach was in the best interest of my general health and well being.
Fortunately I have very good medical insurance. My insurance company allows me to go to Stanford University for second opinions. I did my research and found that Doctor Michael Bellino was one of the hip experts at Stanford. A few phone calls and some faxing of records to his office was all it took to get him to see me.
(The anterior approach is usually performed on a special table. This one is on Dr. Joel Matta's patient education webpage. -NR)
Doctor Bellino specializes in the "Anterior Approach" for THR. The Anterior Approach is a revolution in the way hip replacements are done. Recover time to walking without a cane is around two weeks if the patient is in otherwise good condition. Two weeks as opposed to the year it took me with the hip repair! The decision was obvious, replace the hip, end the pain, regain my range of motion, get on with life and get back to dancing with my wife. The doctor recommended a ceramic/ceramic replacement and stated that that was what he would want put in his body if he had to have a THR.
The Anterior Approach is a very specialized procedure that a very limited number of surgeons are using. This approach requires a considerable amount of skill and training of the surgeon but has tremendous advantages over the other approaches used for THR. The THR is achieved by making a modest incision, about four inches, in the front of the body. The muscles are not cut or detached as they are in conventional hip replacement which is very important to a speedy recovery.
With the more conventional THRs there are a number of post-surgery restrictions such as:
1. Not crossing legs
2. Not turning the knee inward
3. Not bending past 90 degrees
4. Not bending over to pick up things
5. Not sitting in low seats such as a couch.
6. Not being able to put on socks or tying shoes.
7. Not being able to use a toilet without an elevated seat.
8. Must sleep with a pillow between the legs.
These restrictions are to prevent dislocating the hip. There are only two restrictions during recovery when the Anterior Approach is used for the THR:
1. Not turning the knee outward
2. Not extending the leg behind the hip
With these few restrictions it is allowable to do a number of things as soon as it is comfortable to do so. You can put on socks and shoes, bend over past 90 degrees, use the bathroom without special seats, sit in ordinary chairs, and not have to put a pillow between the legs when sleeping. When the surgeon discussed the restrictions with me he said that I would have to really work at it in order to dislocate the hip. Dislocations are much fewer in incidence when the Anterior Approach is used. The incision was closed, somehow, internally and with only tape on the skin surface, this methodology lets you use a shower as soon as you get home, which I appreciated immensely. The one real restriction left after recovery is not to extend your leg greatly behind you with the foot turned outwards. (This can pose significant difficulties for dancers who plan to continue to need turnout with the leg behind as in a ballet arabesque, etc. -NR)
Weight bearing ability after any hip surgery depends on many factors but in my case I was told that the implant would take my full weight immediately but discomfort would limit that for a while. My instructions for weight bearing were "as tolerated". The day after surgery I was able to walk with a walker for a couple of short trips. On the third day I was able to walk much further using crutches and was even able to practice going up and down stairs. I was discharged from the hospital to go home on the fourth day. They gave me some pain medication for the ride home and the two hour drive was quite comfortable and without pain.
The staff at Stanford seems to be very good at pain management. Waking up in the recovery room was un-eventful without any panic or anxiety. After the surgery I had minimal pain and was comfortable. For the first 6-8 hours after surgery I was given oral pain medications and several injections of morphine for good measure. After that oral medication was adequate. After I returned home, about 82 hours later, I did not have to take any more pain medication, not even Tylenol.
At home I was able to go up and down the stairs and take a shower the first day. I used crutches for about a week and then started to use a cane. At 2-1/2 weeks I was able to walk around the house on my own without a cane. I was instructed to take it easy for the first four weeks, to hang around in the house, get up often and do a few exercises for the hip muscles.
After a month of hanging around the house I was able to walk almost pain free. My wife and I began riding our tandem bike every evening for short trips around the neighborhood, building up my muscle strength. At seven weeks I wanted to go dancing but my wife wisely said no. Doctor Bellino released me to go dancing, taking it easy, at about ten weeks.
Steve and partner doing the tango.
It is now 14 weeks past the THR and we are attending dances and taking lessons. My hip feels better than it ever has since the accident and is very close to perfect. I can dance pain free. I have full range of motion. As far as dancing and normal activities are concerned I am back one-hundred percent!
So far I have described all the positive aspects of my experience and most of my experience has been very positive however this is major surgery and there have been some issues along the way. The effects of surgery gave me tiredness and weakness and on the second walk out of my room I experienced some nausea. The anesthesia procedures left me with a sore throat and a raspy voice for a day or two. My biggest discomfort in the hospital was gas pains in my intestines. At home I experienced sweats and chills for the first few nights. These things are all minor in my opinion and the sort of thing to be expected with any major surgery.
My recovery was expected to be good but it has surpassed all expectations. I believe the major reason for my positive experience and quick recovery has been prayer. Many people have been praying for my surgery and recovery. I think that attitude has a lot to do with it also. I have gone into this with the attitude that it is a big adventure and I think of the hospital as a full-service resort. I have a high tolerance to pain which helps a lot but I also try to have a good attitude about pain. This may sound strange but what I mean is that I believe pain to be mostly panic. Pain causes panic and that is what makes it so hard to handle. If you can get past the panic the pain becomes much more tolerable.
Before I had the surgery I had some fears and wondered sometimes if the THR was the right thing to do. After the surgery I have not once regretted it, quite the opposite. The pain I had before surgery is now gone. My legs are once again the same length which has made my other leg function better too. I feel better and better every day. From all I have heard and read everyone that has had the THR was been glad they did it and usually wish they had done it sooner.
No matter which procedure is used for the THR the end result is about the same, a pain free functional hip. I believe, from my experience and research, that the Anterior Approach is a far superior method for THR. With the Anterior Approach the recovery times are reduced from months to weeks. I believe that the skill of the surgeon is something to be considered carefully. I have complete confidence in Doctor Bellino and while many other surgeons would have done a more than adequate job I am very pleased to have had a surgeon with obviously exceptional skills and techniques.
If you are a dancer in need of a THR I exhort you to check out the Anterior Approach. The quick recovery will insure that you don't lose your dancing skills and conditioning. With almost no restrictions on movements you can return to dancing with little fear of dislocation and without the need to change much of anything in your steps. If at all possible I would try to get to see Doctor Michael Bellino at Stanford or Doctor Joel Matta in Los Angeles.
One last thing, I have ran into several people who said that they have had an "Anterior Approach" done for their THR but in talking to them it is obvious that they certainly did not, at least nothing like mine, so when you do your research or talk to a surgeon make certain you are talking about the exact procedure that is done by Dr. Matta or Doctor Bellino. There are many other doctors doing the procedure but these are they two that I am most familiar with. As I understand it is Doctor Matta who brought the procedure to the Untied States.
I wish the best for all who may need THR. I am sure you can find all the info you need on the internet but if you would like to contact me my email is: firstname.lastname@example.org.
Submitted September 17, 2006
My surgery was 15 months ago. All is well and the hip continues to improve although it is nearly perfect now. For most everything I do the hip is not an issue and generally I don't even notice it. I can do all kinds of activities without any discomfort. I seldom give the hip a thought now, even when doing heavy work. I have had a slight weakness of the leg that I notice when putting on shoes, but it is getting better all the time, it is very minor and almost gone now. I could do exercises for that but it is so minor that it just does not matter.
We went to "Camp Hollywood", a Swing/lindy-Hop dance camp, last month. The camp was very physically demanding with three days of dance classes and four evenings of dancing. I did notice that the hip had some slight discomfort by the end of the camp. Even so, the hip was not an issue for any of the activities there. Actually my feet hurt a lot worse! The discomfort went away in a few days and the hip actually feels better than ever after the camp.
I had my one year check-up and all is well. The doctor said I do not have ANY restrictions on motion or positions now. He said impact sports are to be avoided but walking and hiking are fine and he thinks ballroom dancing is a perfect exercise for me.
When dancing it does not hurt in any way, even Charleston kicks feel normal. We started working on a performance Tango routine back in November, about 6 months from surgery. For the most part the hip went un-noticed at that time but with some steps I could feel just a bit of discomfort, that is gone now. We performed the routine in April and the hip was perfect. We keep working on the routine, we are just amateurs, but we get better over time. The dance is out of the ordinary. It is titled "A Western Love Story in Tango" The music is Ennio Mericone's "The Good, The Bad, and The Ugly". We worked on it for a couple of months before presenting it to our instructors wondering if they would like it or think we were out of our minds. Turns out they liked it, a lot. I have a cowboy costume and my wife was a pseudo Native American costume. We performed it again in August. I thank God for the THR, without it I would not be walking well let alone do performance dancing.
One person asked about squeaking. It does not audibly squeak. However, I have recently noticed on a few occasions a sort of light vibration or rubbing sensation. It is obvious that it is coming from the ceramic on ceramic contact. I think it has only been two times that I noticed it. Both times it was when I was looking at the mail, half bent over and slowly straitening up. It is not at all painful or even annoying, just sort of a curiosity. I am not concerned. My understanding of materials is that bearing surfaces of common materials tend to do that sort of thing.
In summary I can say that at 15 months my hip is very close to perfect and I am very happy with it, very pleased with the surgery and recovery, and extremely impressed with my surgeon, Dr. Belino.
Now at 21 months I don't have to much to add. I have more strength in the leg than I have had in years and for all practical purposes it is as good as new for now. It has no effect whatsoever on dancing. The only time I notice that it is different than the other leg is when I put on my shoes, no big deal.
Submitted March 2008
It's been a long time since I sent an update...
It is now 4-1/2 years since my THR. There is not much to report. The hip is near perfect in all respects. I have done lifts in exhibition dancing without harm. I am still thrilled with the results.
I have included a new photo. I know it shows more of my wife/partner than me but it shows the power I can use with the THR (and she looks better than me). This was a Lindy exhibition almost 3 years post op.
Here is an excellent website on the Anterior Approach including a list of doctors around the country: http://www.newhipnews.com/physician/physicianNames.cfm
(And here is a helpful link about the procedure itself:
http://www.anteriorhip.net/ - NR)
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