Jodie Hawley : Hip Arthroscopy
Your Name: Jodie Hawley,age 37
Date of Surgeries: May 18, 2005
Surgeon: Dr. Long and Dr. Trauner are performing the surgery (together)
Hospital: Kaiser, Terra Linda
An early photo of me (I am front and center) at about eleven years of age in 'Junior Troupe'.
I danced semi-professional for 13 years and was still dancing for fun for many years until recently. My first job was teaching pre-ballet my freshman year in high school. I started dancing when I was five years old. I catorogize myself now as a former dancer. I'm a credentialed high school French teacher and licensed commercial real estate appraiser.
Prior to surgery
When did you first notice symptoms and what were they?
I experienced a stabbing pain deep in my right hip, in the groin area. I am not exaggerating when I describe this pain felt like a knife stabbing me in the groin. At first I thought I might have a torn hip flexor or psoas, and this was confirmed by a brief telephone consultation with a nurse practitioner who told me to stay off my leg and take aspirin. I began to experience pain and difficulty with stairs and walking long distances, difficulty with any legwork to the side (i.e., passé, developpé, etc). For a while I tried to "work through it" in class, and strangely when warmed up it didn't bother me, but after class when my muscles cooled and contracted I couldn't walk upstairs without the stabbing pain, and had trouble walking at all. I began to seriously feel "crippled". Symptoms increased over time, and worsened to the point where it hurt to get out of a chair. I decided to go to the doctor when one day I was on my feet, walking in San Francisco from the Embarcadero Ferry to downtown, running errands and suddenly... my entire right leg froze up and was seized with pain. I seriously could not walk and was doubled over with pain. I felt like I could not bend my leg. I had to lie down for about ½ hour, before my leg 'unseized'. Then I hobbled around in pain the rest of the day. After that incident, I started the process of getting a clinical diagnosis and a surgery date.
What was your medical diagnosis (traumatic osteoarthritis, congenital hip problem, avascular necrosis, etc)?
At first, the doctor diagnosed me as having tendonitis and said the usual "stay off your feet, take aspirin". When I told him I was having difficulty and pain with stairs he told me 'use the hand rail'. I returned for another session and was referred to orthopedics. This is typical of an HMO.
After my first referral I had MRI scans, which were inconclusive. Then I had an arthrogram, and a tear was detected in the labrum of my right hip, and there was a subchondral cyst in the upper thigh bone of my right leg. Then I was referred to a surgeon.
My first meeting with one of my surgeons was very negative. I was shown my hip x-ray and told I had an unusual amount of wear and tear on my hip sockets for someone my age and could probably expect to have a hip replacement in five to ten years and that I probably had arthritis. Finally: No more dancing! Upon hearing all this I burst out in tears. Then I got to hear about arthroscopic surgery and what it could and couldn't do, and that the doctor was basically going to cut out the damaged cartilage. I left feeling very depressed.
When I finally got my wits about me and started facing reality (i.e., that I was having trouble WALKING and needed to take care of this) I started wondering why I wasn't getting any physical therapy. My (unnamed) provider is notorious for letting details like this fall through the cracks, while telling you to 'stay off your leg' and 'take aspirin'. When I insisted on seeing a physical therapist (I am not kidding) the doctor said it probably wouldn't help me much! At my first session the therapist diagnosed me with a nasty case of tendonitis in my right leg.
I asked for a referral to meet with the assisting surgeon. He basically said the same thing as the first surgeon, but also pointed out that I probably have some very mild hip dysplasia issues, some mild arthritis in both hips, and that the femoral heads in both of my hips are starting to degenerate.
In sum, my diagnoses are as follows:
Torn labrum, right hip; subchondral cyst (pre-arthritic), upper right thigh bone; tendonitis, iliopsoas, right leg; very mild hip dysplasia issues, both hips; worn and possibly pre-arthritic or mildly arthritic hips/sockets, indicated by stiffness and decreased range of motion, both hips; mildly degenerative femur heads, both hips.
I am still trying to figure out how all of this happened...
Here are Jodie's passé pre-operatively.
Notice that on right leg photo there is diminished range of motion and the stance is changed due to stiffness in hip socket:
I tried so many things: MSM, Glucosamine, Primrose and Flaxseed oil, aspirin, Motrin and Tylenol, Pilates, physical therapy, Allegra Kent's Water Beauty Book exercises in pool, stretching, isometric exercise, and swimming. Meditation. Deep breathing. Prayer. Discipline (i.e., staying off my leg, which was really hard). Vicodin. Whining and complaining to whoever would listen; or stoically saying, "It will be fine, let's just get it over with!" Heating pads. Tiger Balm. Bengay.
The best thing I could do for myself, and also the hardest thing to do, was staying off my leg. I limited my walking, I sat around, I limited my trips up and down stairs. It seems ridiculous, but if you are used to being an active person it is the most difficult thing you could imagine. This, ironically, was also the worst thing I did for myself. During the year-long process of progressive pain and doctor appointments, I lost a total of approximately 5 ½ inches of muscle mass from my thighs. The irony of the situation is that people who should know better (even someone at the gym who knew about my problem) said, "You look great! You're so thin!" And I would get angry thinking to myself, I am so unhealthy right now, and it's going to take me a year to put back some decent muscle on my body! My thighs measured 15 inches in circumference before my surgery. When I was dancing/walking/running they measured 20.5 inches. This leads me to the most important thing I did for myself: I formed a support group of friends who either had similar (or worse) surgeries and had dance backgrounds. They were the ONLY ones who understood what I was going through.
How did you change your work habits, lifestyle to accommodate the hip problem?
I made myself stay off my right leg. I had a very hard time not exercising, and really wanted to go out and run or dance. I felt frustrated most of the time. At work I sat in a chair, if I stood I shifted my weight onto my left leg, which by the way, started to hurt too because suddenly I was over-using it to compensate for the right leg. I wore sneakers and only wore heels on special occasions. I stopped dancing, stopped running, and limited walking to the very minimum. I modified the way I got out of a chair-I used to 'hoist' myself up using my right leg, and I modified this so that I slowly lifted my body up using both legs on flat feet facing forward. I avoided stairs when possible, took elevators, and drove everywhere. Basically: I adopted the 'American' sedentary lifestyle, temporarily. The only aerobic exercise I did was swimming.
How long an interval was it from the onset of hip problems until surgery?
About two years, total. I was in denial most of the time until the pain got so bad I couldn't ignore it and I had to admit I wasn't even "functional" for a normal person (ie., couldn't walk for long periods, couldn't go up stairs). Then I finally started to tell my husband: I'm going to need surgery to fix this. This is a big problem. Then NINE months working through the bureaucracy of my health care provider (HMO) from first appointment to surgery date. A word of advice: deal with the problem right away, because things like this only get worse if untreated.
What factors, physical, emotional, financial, etc. influenced your final decision to have surgery?
I've always loved ballet, and dance has been a huge part of my life since I was a child. The possibility that I might never be able to dance again and might need a hip replacement in the future was shocking, frightening and upsetting. But, most importantly, I had to be able to function. I had to be able to do things like walk normally, go upstairs, and get out of a chair without going through a big, choreographed routine to avoid feeling like I was being stabbed with a knife in the groin. To deal with the lack of exercise, I tried to focus on other, ballet-like forms of exercise, like Pilates and the exercises in Allegra Kent's book, so I didn't feel like I had to give up dancing entirely. I need to know I can still be active in a way that I enjoy. Financially, things were fine. In fact, I felt like I was finally getting my money's worth out my insurance company. Emotionally, I did great. I did get crabby and frustrated occasionally, and I did feel depressed occasionally about not being able to dance and the situation in general. But by the time I finally got a surgery date, I was ELATED. I couldn't wait to get it over with. I invited all my friends over to visit me the week I recuperated at home and bought champagne.
Were there other dancers you spoke with that helped you?
My physical therapist helped me, and a former Martha Graham dancer, who had a hip replacement with relatively good success helped me a lot. A friend of mine who I danced with from the age of 12 at the STAGE THREE DANCE COMPANY in Arcata had a double hip replacement and is still dancing -she is very positive. My former teachers Sally Stevenson (who trained with LaVerne Krei, a contemporary of Bill Robinson) and Cynthia Mills (who trained at Ballet Celeste) were positive and supportive. Another adult ballet teacher of mine, Marika (formerly of the San Francisco Opera Ballet) had hip replacement as well, and made an incredible recovery. She was very inspirational.
What influenced your choice of surgeon?
I didn't really have a choice, as I belong to an HMO. In fact, I was reluctant to use the surgeon I was assigned to because he admitted to only having completed "3 to 4" hip arthroscopies. I felt much better that a second doctor, who performed many of these surgeries, and had worked with the Boston Ballet for several years, was assisting with the surgery. I consulted both doctors, and also an outside doctor. The doctors were stiff and somewhat negative, I felt. Perhaps this is because they want to prepare you for the worst case scenario. The worst news for me was that I was going to lose some cartilage. I just had to keep telling myself that every case is unique, and that I was determined to be active and dance again soon, and that I am young enough to recover fully and enjoy the benefits of the surgery (i.e., mobility, restored flexibility and range of motion, living pain free).
Here are some interesting photos from my hip surgery/arthroscopy. They show the torn and shredded cartilage, and also the red areas in the socket indicate further trauma/tears in the remaining cartilage.
They show the torn and shredded cartilage, and also the red areas in the socket indicate further trauma/tears in the remaining cartilage.
How long were you in the hospital?
I did not have to stay in the hospital overnight, though in retrospect they probably should be keeping people overnight, only for the first night after surgery. The entire procedure took 5 hours, including check-in, pre-op, surgery and post-op. The surgery took 2 1/2 hours, and during that time my leg was in traction.
What kind of prosthesis did you get (e.g., ceramic ball/ceramic liner? poly liner? highly-crossed linked poly liner? all metal?)?
Did you have any complications in the hospital?
Anything else to say about your in-patient experience?
Not an in-patient procedure with Kaiser.
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To prepare others who may have this surgery, here is a monthly breakdown of my post-operative recovery:
Month 1: Week 1 was very difficult and painful. I was in extreme pain the first two nights I came home from the hospital. I could not move without sharp stabbing pain in my hip, and my entire right thigh was swollen and painful from being in traction. The area where the arthroscopic incisions were made was also swollen and painful. I could not take care of myself. I was unable to even get water for myself, I could hardly walk on the crutches, and I could not carry anything. Putting weight on my leg was extremely painful. Sleeping was very difficult because when I moved the pain would wake me up, and several times during the night I woke myself up with loud groans and moans. I could not bend at the hips enough to sit and needed 24-hour assistance during the first four days. I experienced abdominal bloating and cramping from the pain killers and medications I was given at the hospital; this dissipated around day four. I took Vicodin every four hours the entire first week. The most disturbing thing that happened during this time was at my first physical therapy appointment because I experienced some kind of bizarre disconnect between my brain and my right hip and the surrounding muscles. The therapist asked me to move my leg to the side, and I couldn't because I felt incapable of isolating the muscle-it was as if my brain couldn't 'find' the mucles surrounding my hip. This was very frightening and upsetting to me and I experienced mild to severe depression which lasted the first month. I invited people to visit me, and several friends and family members came by-this was absolutely the highlight of the first week.
During Week 2 I experienced the same symptoms as week 1 but to a lesser degree. I still had difficulty walking or standing with crutches, minimal weight bearing was very painful, and I was incapacitated. I could not carry things, and could not bend easily at the hips. Sitting was still painful. PT was also painful.
By the end of Week 3 I experienced a marked improvement. I started feeling much better and more positive. No-one can tell you if the surgery is successful until well into the recuperation period, but I started feeling so much better that I began to believe I had undergone a very successful operation. I started stretching and was finally able to straighten my leg and also bend normally at the hip. Sitting felt more comfortable, and I was able to balance equally on both 'sitz' bones, though still experiencing a pinching feeling in the right hip.
By Week 4 I was walking on one crutch and feeling much better mentally and physically. I started swimming-gentle kick with the kickboard and treading water with an aqua-jogger made me feel much more optimistic and happy.
Week 5: DRAMA AND DEPRESSION. During week five, I experienced a slight regression in my progress. This is perhaps because I was overdoing it slightly. I realized that I had doubled my new exercises from the physical therapist, thinking that doing only '5 X 2' (ie., five exercises twice a day) couldn't be right, so I was doing 10 exercises twice a day. Also I overdid it in the pool. Then during this same week I experienced some attachments breaking up in the hip socket. As I understand it, the attachments are areas where the cartilage had begun to heal together, similar to scar tissue. It is normal for them to break up while resuming normal activity. However, when it happened I was scared because it was so painful. I thought there was something additionally wrong with my hip. ALSO during this month my hip was popping and cracking all the time-it sounded like popcorn popping. I became morose and depressed because my hip was now (in my perception) WORSE than before I had had the surgery. I cried at my physical therapy appointment during this week.
Week 6: Not much improvement from Week 5. Increasingly depressed. Back on crutch because I am worried that my hip is worse. Don't feel like doing my exercises because my hip popping and cracking frightens me and I'm afraid of injuring myself. Missed an appointment with my doctor because I was afraid he was going to tell me that I was not doing well. Called my physical therapist at least three times worried that my hip was worse. During this time my entire body was feeling 'off' because my gait had been comprimised for so long. My back hurt, my legs (both) hurt, my hips (both) hurt, my quads were tight and painful, my hip flexors as well were tight and painful. Additionally, I am furious with everyone because they keep telling me how 'great' I am doing. My physical therapist insisted that I give up the crutch even though I thought it was a good idea to start using it again and walking was somewhat painful. Also, was told by physical therapist that there are no 'restrictions on movement' at week six, so that I can start moving around. But I am too afraid to do much (see week 5-attachments breaking up).
Week 7: Seeing improvement again. Am now able to walk relatively normally out of the pool, feeling stronger and better. Hip cracking is subsiding. Exercises are less painful. Started working on stretching again and am seeing some relief from the tightness and pain in my hip flexors and quads. This week is the first time I feel like having the surgery was the right thing to do. Walking is becoming less painful, sitting fine, driving a car without pain or discomfort for the first time. Enormous appetite for the first time in a long time.
Week 8: Continued improvement from Week 7. By this time I am noticing a pattern in the healing process, in which I go through periods of ravenous hunger and feeling exhausted and sleeping for ten hours a night, then suddenly realizing that my leg has undergone an enormous amount of healing in a very short time. Attended my first Pilates class since the surgery, and was surprised to find it pain free and relatively easy to jump back in.
Week 9: Continued improvement, and continued pattern of ravenous hunger and exhaustion followed by exponential healing. Much more positive outlook. Again am glad I had the surgery, and now think that I have a good chance at an almost 100% return to the activity level I enjoyed before the procedure. Decided to attend my 20th high school reunion.
Week 10: Went on vacation with my husband to Napa. Was able to walk, swim, do my pool exercises, and some Pilates exercises. Then attended my high school reunion and SURPRISE! was able to swing dance with no pain. I was amazed. Don't tell my physical therapist, who specifically said "No dancing for a minimum of three months!!!".
Posted August 02, 2005
Week 11: During week 11 I was increasingly optimistic about my progress and recuperation. Again, this type of surgery is very difficult to deal with mentally, as there are no 'concrete' answers and you have to take a 'wait and see' approach. I saw a huge improvement in my gait, and was able to increase the length of my steps so that I finally feel like I am walking naturally. I was able to increase the amount of time I spent in the pool to about 45 minutes of aerobic activity and 15 to 20 minutes of strengthening and flexibility exercises. Also, I have been able (under the supervision of my physical therapist) to begin a program of modified ballet exercises at home, including a modified barre stretch series (modified in that I am keeping my leg below 45 degrees and not using fifth position), a plie series (I was able to incorporate grand plies at this time, but not in fifth position), and balancing exercises for strength. However, I have not been cleared to return to regular class at this time, in part because I do not feel like my hip is quite 'right' yet.
Week 12: THREE MONTHS. According to my physical therapist, the 'three month mark' is the minimum amount of down time required before returning to 'normal' activity. However, my therapist and I agree that ballet is NOT a normal activity, and we have agreed that I will continue with therapy and aquatics for at least another month or two before attempting many of the stretches I should be doing to be able to take a ballet class. This will give my hip additional time to heal and also give me time to continue building back some of the strength I've lost during the last year. I am able right now to do modified barre stretches at home; however, my hips (both right and left) are increasingly stiff from a lack of stretching, and my fifth position is embarrasing. I am not doing any movements in fifth position for the time being, as I need to stretch my hip flexors and build my upper thigh muscles adequately so that I don't 'roll' over my arches. The real challenge is going to be 'retraining' my body to be able to dance again with proper placement and technique. I have lost so much flexibility and strength that it will be quite difficult, and will require dilligence over an extended period of time (I am estimating about one year, while I continue to do physical therapy and aquatic therapy).
Posted August 25, 2005
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Month Four: Increasing Strength and Optimism.
During all of month four I have become increasingly strong and optimistic. I am still struggling with the ACCEPTANCE part of this process, and am still in "denial" that my hip will not be 100& of what it was. My doctor keeps reminding me that he never expected my hip to be any better than 80% of what it was before it was injured. I have yet to accept this mentally or physically, and am continually frustrated with my lack of flexibility. However, I am at this time pain free and able to walk, go upstairs, swim, lift weights, take Pilates classes and move about with ease.
I agreed, under the supervision of my physical therapist, to wait until after the four-month period to try taking ballet again. I am considering trying out a beginning, adult ballet class the first week of October, just to see how I do.
Regularly during this month I have had recurring dreams of dancing and performing. In one dream, I was dancing with a partner again (I haven't danced with a partner in years!) and was looking at my feet in ballet slippers-in perfect 5th position-as he lifted me in the air, and in my dream my body and hip felt like they used to and I was using my back and abdominal muscles to twist and straightening my injured leg down and pointing my toes to prepare to land in arabesque...no pain, perfect fifth, fabulous external rotation, strong legs, no fear of landing on my injured hip, expecting a perfect arabesque because I am flexible and strong... In another dream I was svelte and strong, and doing some kind of raunchy Bob Fosse dance onstage complete with fishnet stockings and character shoes and top hat, and had some kind of diva "look at me!" attitude. Then afterwards, I was smoking a cigarette backstage. Just like the old days!
These types of dreams make me depressed, because I don't know that I will ever be able to achieve this level of mind/body connection, artistic expression and fitness again.
Posted September 27, 2005
Approximately 8 months after surgery.
Generally, I have experienced an enormous reduction in the amount of pain I was feeling in my right hip. I am now pain-free, with the exception of general arthritis pain which is exacerbated by weather changes. Currently, I am not dancing, and am swimming and cycling for exercise. I am also taking Pilates and yoga for stretching and mobility, which seem to help.
My current symptoms are tightness in the hip, lack of mobility (I still have only approximately 2/3 of my original range of motion, pre-injury), and stiffness. I have completed a total of five months of physical therapy, ongoing aquatherapy, massage therapy, and supplement therapy (Glucosamine and MSM). My surgeon has encouraged me to stay away from dancing as the external rotation and extensions are a killer for my hip. Also bad: jumping, running, anything which turns the hip into a "shock absorber", forcing external rotation, etc. The goal here is joint preservation, and as it is clear I will need a hip replacement at some point, giving up dancing seems like a reasonable solution to me. I came to that decision after thinking seriously about, when do I want to have a total hip replacement? And my answer was, later rather than sooner for a variety of reasons, the most important being new technology is developed regularly, making the replacement implants stronger, lighter, and more durable; the surgery is becoming less invasive and painful, and the recovery is sooner with better results. Additionally, if I chose to dance I would most likely experience recurring symptoms including pain, as my cartilage will only continue to tear and give way, and there are other ways for me to be active and healthy which wonít cripple me.
I have taken a few "beginning ballet barre" courses, and have found that they are not pleasurable and I am frustrated by what I canít/am not supposed to do. I personally canít take ballet class without pushing myself, and I canít do a "half-assed" job at the barre, and I know that pushing myself will just increase the damage to my hip socket. Fifth position is out of the question. I canít stretch enough to do the splits anymore and my extensions reflect this. My external rotation is very compromised on my right side. Iím not supposed to be jumping. Etc, etc.
I have accepted that my hip is screwed up, and my primary goal is to put off a hip replacement for as long as possible while staying healthy and fit. There really is not much one can do for shredded cartilage and degenerative changes at this juncture in time. My one option would be a hip resurfacing which I am not willing to do right now. Rather, I am focusing on what I can do, how I can take care of my hip, and preserve my joint. The honest truth is, once you have torn cartilage and damaged your joint there are limited options, and I truly believe at this point the less you can do that is invasive, the better off you will be down the road. I have seen too many dancers who have continued on with injuries like mine, only to become debilitated later in life. It is a trade-off which must be considered carefully. Often we dancers donít look at the big picture in terms of our bodies. I myself am guilty of pushing my body beyond any concept of a "normal" comfort level for years, starting when I was a child, and I wasnít even a professional-I was doing it for fun! Smoking, dieting, joint-destroying impact, over-stretching, dancing while injured-these are activities we see everyday in the dance world which lead to problems later in life. I have always loved dance, and it is a beautiful, destructive art. Now my focus must be taking care of myself for the long-term.
Written: February 1, 2006
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