Marianne Jacuzzi Yoga Teacher (Former dancer)
Anterior Approach Bilateral Hips
Date of surgery: 3rd and 10th March 2014
Surgeon: Dr. Frédéric Laude
Hospital: CMC Paris V - France
Prior to surgery
When did you first notice symptoms and what were they?
The first pain in my hips started a long time ago, probably around 2001-2, when I was about 50. At that time and ever since, I've had a strong daily yoga practice, mostly ashtanga. In 1995, I stopped dancing. Up until that time, I had been a very devoted dancer, never professional but an avid amateur. I danced in some shows when I was younger, but mostly it was the routine of daily (and sometimes twice daily!) ballet class. I love ballet with a passion, but life has its seasons, and during the 1990's yoga began to be a part of my life too, gradually taking the place of my beloved ballet. (Though I hung up the pointe shoes for good, I have a brand new pair left over that I'm saving for my coffin!) But since the 1990's, I have been just as dedicated to my yoga practice as I was to ballet, and have been teaching yoga for 17 years.
Anyway, pain started to interfere with my yoga practice. I felt a cutting pain in my hip joint as I bent into it, mostly on the left side, but sometimes on the right too. I felt inner thigh pain and pain on the outside of the hip joint too. Walking--which I had always loved--was also feeling painful. Instead of my usual brisk stride, every step was an effort. I noticed restriction in movement too. I used to have 180° splits and a decent arabesque. The splits were going, and I could no longer lift my leg behind me beyond 45 °. (I also have degenerative discs in the lumbar spine.)
That acute time around 2001-2 passed, with lots of physiotherapy, acupuncture and strong yoga helping me. The restriction stayed though, and I thought it was due to the changes in my body caused by yoga practice replacing ballet. In hindsight, I know that was not the case. It was the beginning of the collapse of my hips. It is amazing that I lasted as long as I did. Over the years from 2002-2011, I'd have periods of time relatively pain-free. When my hip acted up, I'd go for my therapies, adjust my yoga practice, and eventually it would pass.
What was your medical diagnosis (traumatic osteoarthritis, congenital hip problem, avascular necrosis, etc)?
I had avascular necrosis of the femur head on both sides, with the left much worse than the right. I also had severe secondary arthritic degeneration (osteoarthritis). The x-ray I had in 2001-2 only showed arthritic degeneration. In 2009 I had an MRI done in India, which showed the avascular necrosis too. Then again in 2011, when my symptoms worsened, I had another MRI at home in Ireland, which showed that my condition had indeed become much worse!
What forms of treatment did you seek before considering surgery (chiropractic, acupuncture, medications, bodywork, physical therapy, herbs, etc)?
I had regular physical therapy all during those years 2001 up until my surgery in 2014. I also tried acupuncture, chiropractic, rolfing, the usual joint support supplements, ayurvedic herbs. You name it, I tried it! I started taking anti-inflammatories around 2005, sporadically at first and then daily towards the end. In 2011, nothing I tried would stop the pain. It was getting worse and worse no matter what I did. My physio said I needed surgery, but I was not ready to go down that path yet. I tried two other things first. In the summer of 2012, I went to an Ayurvedic Hospital in India. When that did not work, I tried experimental stem cell therapy, which took me through the spring and summer of 2013. (I was really reluctant to go for surgery. It was an invasive, permanent option, and I still trusted my body would heal.) I've written about this for my website. So for more details on my long healing journey, read it here:
How did you change your work habits, lifestyle to accommodate the hip problem?
Up until 2011, I just got on with everything as usual. I have a very high pain threshold, and I was not going to give up anything I love. I truly believe my yoga practice kept me going for a long, long time. It felt good to move my hips in all directions, even when walking was painful. Up until the summer of 2011, I was putting both feet behind my head daily.
My India trip of 2012 was difficult compared to earlier trips. Walking was always painful, so I'd opt for the rickshaw and pay extra everywhere to have my bags carried. When I got home, I went back to my usual teaching schedule, but teaching was getting painful too. I could no longer demonstrate many poses, and adjusting students in their poses was also becoming challenging. In late spring 2013, when I was going for the stem cell treatment, I had to give up teaching altogether. By that time, I could not walk without crutches. I have my own small yoga studio, and former students who had become teachers themselves came back to teach for me.
From that time until my surgery nearly a year later, I was really disabled. I couldn't do anything. Stairs with my crutches were a real challenge. It was painful to get in and out of the bath. It was a struggle to put on a pair of trousers. Cooking was difficult because I couldn't carry anything in the kitchen and manage my crutches at the same time. My hip hurt in bed too, waking me up with excruciating pain whenever I rolled over. All I could do without feeling pain was lie on the couch!
I was still doing a modified yoga practice up until the date of my surgery. I also hung upside down daily on my yoga trapeze. This was a godsend! It helped keep my back open and was the only thing I could do to stretch out!
How long an interval was it from the onset of hip problems until surgery?
As you can see above, nearly 15 years!
Three months before my surgery, Ellen Whelan, film student and sister of one of my students, asked if she could make a short video documentary about my yoga practice and hip condition. Here it is:
What factors, physical, emotional, financial, etc. influenced your final decision to have surgery?
Emotionally, I was at the end of my tether. Nothing else had worked, and I was worse than ever. I had resisted surgery for so long because I did not want to lose flexibility, but I had already lost so much. Surgery could only make me better. I had no other option. Financially, I was in a bad way. The stem cell treatments had depleted all my resources, so I was pretty desperate. I did not have health insurance either, so private care was out. The public care in Ireland did not appeal to me.
Were there other dancers you spoke with that helped you?
This website made all the difference. I am eternally grateful for having found it! I read everyone's story, and they all spoke to me on a heart level. I felt I had found a community of friends in all these dancers, whom I had never actually met! I related so well to so many things said. I must say, at that time of my greatest pain and greatest vulnerability, it was wonderful to come to this site and feel that there was hope. Unfortunately, most of the recommended surgeons were in the USA, which was not an option for me because of cost. But when I read Marta Castellanos, hope surged anew. She had her surgery in France, and she also had limited funds. If you ever read this Marta, thank you so much for telling your story! It made such a difference to me! You were so right. Dr. Laude was wonderful!
What influenced your choice of surgeon?
I heard about Dr. Laude from Maria Castellanos on this site. I went to his website and read it through and through. Fortunately, I speak French well enough, and I was really impressed with everything he said.
From all the stories on the dancerhip site, I knew I wanted surgery through the anterior approach. That was not an option in Ireland, but Dr. Laude is a real expert in this method. I really did a lot of research, and could see from many American sites that surgeons from the USA were going to him to train. In his FAQ section of Dr. Laude's website, he explains all the different surgical approaches. He also clarifies what is exactly the anterior approach he does, which does not cut any muscles. The "two-incision" anterior approach is not the same thing. It makes very interesting and important reading for anyone facing surgery. Everything he says about virtually no movement restriction is what finally gave me the courage to go forward with trust that I'd come out OK on the other side.
I made an appointment to see him in Paris in December 2013. This meeting confirmed everything I thought. Here was a surgeon I knew I could trust. The relief I felt was incredible. I left Paris with surgery set for 3 March on the left and 10 March on the right, 2014.
Also, a new scheme for cross-border care across the EU was going to pay for my surgery. This felt like a miracle.
How long were you in the hospital?
For bureaucratic reasons (not medical), Dr. Laude could not do both hips at the same time. But he could do them one week apart. I went in on a Sunday evening, had the surgery Monday morning and left Thursday morning. That was four nights in hospital. I then went to a hotel in Paris for three nights, to return the following Sunday and repeat the pattern. That last Thursday, I flew back to Dublin.
What kind of prosthesis did you get (e.g., ceramic ball/ceramic liner? poly liner? highly-crossed linked poly liner? all metal?)?
My prosthesis is ceramic on ceramic, with a titanium stem. The right side is 32 mm, the left 36mm. Because the left was so severely damaged, Dr. Laude needed to cut much more of the joint away. I was concerned that this discrepancy in size would make me feel uneven. He said it would not be a problem, and it has been fine. I don't feel any difference.
Did you have any complications in the hospital?
No, It was actually a really nice experience. The surgery I had dreaded so long turned out to be not so bad after all! Even though I was nervous before the surgery itself, once it was over, I really did enjoy my stay in hospital. The nurses and other staff were all so kind and helpful. The after surgery pain was totally bearable. Every day I walked the corridors with the physio, using one crutch. The food was not great. But I loved the morning coffee with my French newspaper. I had a nice TV and used the opportunity to improve my French!
Anything else to say about your in-patient experience?
I was really impressed by the organization and attention to detail. The one thing that did come up for me in terms of complications was low iron. After the first surgery, my iron dropped considerably. (It always tends to be low anyway, and after surgery this was normal.) However, in order to have the next surgery a week later, I needed a blood transfusion. But that went fine. No complications. My iron was OK afterwards, and I took supplements for a few months to bring it into the normal range.
Also, I had a spinal for the surgery, and am so glad I did not go for the general anesthesia.
Did you have any complications, especially unexpected difficulties, after you got home?
It took me longer to get back to normal walking than expected. Dr. Laude thought that was due to the fact I was on crutches for nearly a year coming up to the surgery and my muscles had atrophied. Though I walked across the room with no crutches 5 days after surgery, the following week I could no longer do so. My left knee and then my left foot were killing me! It was really depressing, as I thought I had traded one pain for another. The pain in my hips was gone, but the knee and foot were keeping me from walking. However, slowly that pain did pass too. After about 4 weeks I was walking with no crutches in the house. About the same time, I crossed my legs into full lotus! The flexibility was coming back, but strength was still lacking. Once strength improved, walking picked up. At 8 weeks, I started teaching again and was taking longer walks outside.
What steps did you take toward recovery? (Physical therapy, chiropractic, acupuncture, medications, bodywork, herbs, etc.)
I did cycling on a stationary bicycle, about 10 minutes 3 times a day. I did this for the first month. I also started back with a modified yoga practice immediately, slowly adding poses as my flexibility and strength improved. It was a gradual process, but it was amazing too how much came back, and soon too. I've had two physical therapy sessions since my surgery, and a few cranio-sacral sessions. I'm continuing with my usual supplements of joint support and ayurvedic herbs.
How long did it take you to really feel recovered (6 months, one year, two years?)
I felt really recovered for ordinary purposes at about 3 months, though I was still low on stamina and found long distance walking tiring. My yoga practice has been improving all the time. I'm not back to where I was at my highest point, around 2009-10, but I'm amazed I can do what I can do. Flexibility seems to be better than strength. Next month it will be one year. I can get two feet behind my head with assistance. Splits are not perfect, but they are coming along. Handstands are weak, and it is strength most of all that I feel I need to work on. Deep in my hips, all muscles are not firing as they used to, which is why I am finding it harder to get up into a handstand. But it is improving gradually.
Anything or any practitioners that you would highly recommend?
I recommend most highly Dr. Laude! He is a master surgeon. His hospital, CMC Paris V is tops too, a perfect record for no infections.
About dance class: Do you take dance classes?
No, but I wasn't for many years beforehand. I don't know how I'd be for jumping??? Shortly before my hip started getting really bad, I started ballroom dancing. I'd like to return to that and see how it feels. For now, I'm just doing yoga, a strong asana practice but without the jumping of ashtanga.
How much facility do you have?
Photo at 4 months post-op
Not bad . . . as I said above, I'm putting two feet behind my head. I'm also doing advanced twists and can sit in full lotus for nearly 30 minutes. I used to have great extensions, à la seconde up to my ear, but no more. However, I can lift well past 90°, and it is getting better all the time.
All post-THR patients are advised to limit impact on the joint and to avoid overcrossing the legs. Given that, do you actually modify your dance class? E.g., are there parts of the class that you skip (petite allegro, grand allegro?)? Do you use fifth position? Etc.
Do you do other physical exercise (e.g., Yoga, Pilates, biking, swimming, etc.)? If so do you modify what you do in these activities?
Dr. Laude said that for the first 2-3 months I needed to be careful with extension. That was the only movement restriction for the anterior approach. I was very careful as I introduced backbends back into my practice, starting at 2 months and increasing up to 3 months. Now I go full out with backbends, no restriction of any kind! I'm back to lots of brisk walking. I don't do any jumping. Grand allegro used to be my favorite part of ballet class, and I'd love to jump again. But at my age (63) perhaps I'm better not to press my luck and wait until I'm flying to heaven with those new ballet shoes I'm saving!
CLICK HERE to read about my yoga practice the year after surgery.
How has the surgery impacted you professionally, physically, emotionally, spiritually, and financially? Is your life different now? Did you have any outcome, good or bad, that was different from what you expected? Any other thoughts to share?
The stem cell therapy I tried depleted my financial resources. It was a part of my path, as I resisted surgery until the end and had to try everything before I'd submit to it. However, I wish in hindsight I'd found this site earlier and gone straight for the surgery. But at the time, I thought that if there was hope the stem cells would work, I had to try them. I was off teaching for nearly a year, and that did not help the finances either. But now I am back, and everything is going well again professionally. Spiritually, it has been a deep learning experience. Once again, you can read more about that on my website:
I feel fantastic since the surgery. Got my life back! I can hardly remember the physical feeling of all that pain and restriction, but I do remember the emotional trauma the whole long ordeal caused.
I encountered head on the limitations of life, a reality we all will face sometime, eventually. Life has a preciousness, a poignancy, and I intend to enjoy it as much as I can, for as long as I can. But I am acutely aware that I continue on borrowed time, and actually it has been that way all along, only I never really knew it in quite the same way.
Yoga Practice read about my yoga practice the year after surgery.
Seven Winds Yoga Website
More of Marianne's story
Dr. Laude webpage