Lesley Shneier - Bilateral Anterior Hips
Date of surgery: March 25, 2014 (left) and August 11, 2014 (right)
Surgeon: Dr Anthony Unger
Hospital: Sibley Memorial Hospital, Washington DC
Prior to surgery
When did you first notice symptoms and what were they?
I'm a "hobby dancer", that is to say that all my life I have taken dance classes, mostly ballet, and still take 3-4 ballet classes, as well as Pilates and Iyengar yoga several times a week. I also taught ballet, Pilates and stretch classes in the fitness center at work for about 20 years. I'm now 65 years young. I first pulled my groin muscles (adductor, Sartorius) on my right hip in 2010. This happened during a ballet class, doing a short, sharp, quick jump, i.e. the muscles went from bent to straight quickly, with a snap. X-rays showed no real damage, other than some osteoarthritis. I went for physical therapy, and the PT spent quite a lot of time adjusting my pelvic alignment. I recovered quite well, and continued with ballet classes, Pilates and yoga. But a year later, in 2011, I did the same thing, doing the same steps, on my left groin muscles.
What was your medical diagnosis (traumatic osteoarthritis, congenital hip problem, avascular necrosis, etc)?
With the second injury, X-rays showed increasing osteoarthritis and bone spurs in both hips. That year, 2011, I also had an MRI of both hips and my back, which confirmed the osteoarthritis. I also retired from work during the year, which gave me extra time to focus on rehabbing my body.
What forms of treatment did you seek before considering surgery (chiropractic, acupuncture, medications, bodywork, physical therapy, herbs, etc)?
I found my first PT, Andrew Ciccose who had started Mindspring PT in Falls Church VA. He worked really hard on pelvic alignment, including giving me some exercises to do at home to keep the alignment. When this wasn't enough, he suggested I see an osteopath. Since my daughter had had good experiences with an osteopath while studying for her BFA in performance dance in Toronto, I agreed. Initially, I saw the osteopath weekly, eventually being able to extend the time to 3-4 weeks between visits.
In 2012, I tore the medial and lateral meniscii in my right knee (second time), and had arthroscopic surgery. My PT spent more time working on my hips than my knee rehab. A year later, I thought I had torn something in my knee again. Luckily I hadn't. When I was sent to PT, this time I went to a group that specialized in working with dancers, Body Dynamics Inc, also in Falls Church VA. For another year or so, I continued with PT and monthly trips to the osteopath. I was still going to ballet, Pilates and yoga classes, and doing daily PT home exercises, so I thought I was actively doing something to help the problem. But, I could no longer do center work, turns or jumps as movement just hurt too much. Eventually, I realized that no one knew just how much pain I was in. I told my doctor I had reached my limit. He promptly sent me for more X-rays, and then told me "it ain't pretty". He sent me to Dr. Unger, who uses the anterior approach. I was so grateful to be told that I needed to have both hips replaced. Now I knew I wasn't being a "wimp", that there was a real reason for the pain, and, very importantly, that there was a solution to it.
How did you change your work habits, lifestyle to accommodate the hip problem?
I started modifying center work during ballet classes, often cutting out turns, and eventually not doing the jumps. My hips would be so sore they would burn, and by the end of barre I often felt I had no plié left. In yoga, I found increasingly that I had to move into poses very slowly, especially with my left leg. Standing up from sitting was a slow process of getting my hips under me. At times, one or other adductor would "stick" so that I couldn't even straighten up. I started looking at distances that I used to walk regularly, e.g. less than half a mile to the metro station, as being too far to walk. I eventually drove the half block to the local coffee shop! There were times when I got out of my car in the parking lot at the ballet studio, started limping to class, and then just turned around and went home as my hips hurt so badly. I became a hermit, staying at home, although I didn't realize that this had happened until after the surgery.
How long an interval was it from the onset of hip problems until surgery?
About 3 years
Were there other dancers you spoke with that helped you?
One of my teachers (Ethan Brown) had had his hip replaced. I was intrigued and inspired by what he could do in class afterwards. He also told me it could take a full year to feel the hips worked perfectly, and to find that I was no longer thinking about them being new. This was really useful to know. There were several other dancers at the studio who had had THR, who were also very encouraging. Once I knew I was going to have the surgery, I actually relaxed, knowing that there was a solution to my pain.
What influenced your choice of surgeon? How long were you in the hospital? What kind of prosthesis did you get (e.g., ceramic ball/ceramic liner? poly liner? highly-crossed linked poly liner? all metal?)?
My doctor told me to make sure I have the anterior approach. I hadn't heard of this, so did some research, and realized this was definitely the way to go. My PT's mother had recently had her hip replaced by Dr. Unger and was doing amazingly well. The Sibley Memorial Hospital has a specialty in joint replacement, even offering a pre-surgery joint replacement class, which was very instructive. So, putting all this together, I chose Dr. Unger and Sibley. Dr. Unger put in a ceramic ball with titanium post - it looks really pretty on the X-ray!
My left hip was replaced in March 2014. I spent 3 days in hospital, not including the day of surgery. During this time, I was amazed that there was no pain at all! My hip felt stiff, and the muscles didn't work too well at first. There was a list of exercises posted on the wall that patients were supposed to do every hour - like glute squeezes, tighten quads etc. And both PT and OT came twice daily. They taught me to walk with a walker and a cane, to climb stairs, get in and out of a car, and the shower. They showed me how to use various dressing tools, too.
Did you have any complications, especially unexpected difficulties, after you got home? What steps did you take toward recovery? (Physical therapy, chiropractic, acupuncture, medications, bodywork, herbs, etc.)
How long did it take you to really feel recovered (6 months, one year, two years?)? Anything or any practitioners that you would highly recommend?
My post-op recovery seems amazing, looking back just over 5 months. My daughter came home to look after me for 4 days. After that, I was on my own. I had in-home visits from the PT 2-3 times a week, and one visit from an OT. The home PT took me off the walker in the house, I could just use a cane at home, and the walker to go out. Just using the cane gave me so much more freedom as I could now carry my coffee or whatever instead of using two hands on the walker and needing someone else to bring me stuff.
At my two-week check-up, after the staples were removed, Dr. Unger said I could drive, and a week later I could go for out-patient PT. I went back to Body Dynamics for PT. I had so much time at home, which was good, but also frustrating in that it was early spring and I wanted to work in my garden but wasn't yet allowed to bend down. This period didn't last very long, and after my 6-week check up I was allowed to return to ballet, Pilates and yoga, and to kneel down to work in my garden.
Even at this time, I started begging Dr. Unger to replace my right hip. I now knew it was possible to be pain free, and wanted this on both legs. Although at first he just brushed my requests aside, at the time of my 3 month check-up, he said my right hip could only get worse, so it should be replaced. Yay! My next THR will now be on August 11, 2014 (see below for more on this).
Did you return to dancing professionally? About dance class: Do you take dance classes? How much facility do you have?
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?
I returned to ballet classes 7 weeks after surgery, though at first just barre. At first, my PT told me to work in parallel in arabesque, and only go degagé height. She also told me to work in first position, but my teacher (Julie Miles at Maryland Youth Ballet) suggested at least a little third position, so I would know which position came next. I was amazed at how easily my left hip worked, and found that I forgot to stay parallel in arabesque, my baby third positions soon became 5th, and my leg went higher and higher in developé front and side. But, my right hip played up a lot, and once I had a date for replacing the right hip, I gave up ballet, not wanting to develop any more compensating habits due to the increasing pain. I continued with yoga and Pilates - and PT - right up to the day before the surgery.
Second time around - right THR, August 11, 2014
Same surgeon and hospital.
Interestingly, I was more anxious the second time around. I knew the first few days would not be comfortable, I worried about the anesthesia, as I'd struggled to come round the first time. And I worried about taking oxycodone which had left me with continuous headaches which lasted for weeks. So a little knowledge of what was to come didn't help. To counteract these concerns, I tried to focus on how I would feel at the 2 week and 6 week mark, when I knew I'd be walking easily, probably without a cane - and, best of all, no pain in either hip!
Somehow, everything was different this time. While being checked in on the day, I told the nurse about the headaches from oxycodone and other similar drugs, like Vicodin. She made a big note of that. I also told the anesthetist about struggling to come round, and the headaches, and he said he'd see what he could do. When Dr Unger came to sign my right hip, I asked him if he would make sure my pelvis was level, that my legs were the same length, and that he would seat the new prosthesis as deep in the socket as he had the first one. He measured my legs there and then, and promised me a matching set.
The surgery went well, I came round far easier this time, and, though they did give me oxycodone that night, as soon as I got a headache, they took me off it and put me on tramadol instead (a synthetic opioid), which worked better for me (and has the advantage of not being as constipating as real opioids).
Once I was up and walking with the PT or the nurses, I noticed that the right hip felt differently than I remembered with my left. I moved more easily into and out of the bed or chair, I could slide my heel up higher, i.e. greater range of motion at hip and knee. And, of course, I wasn't as worried/afraid of moving with my new hip this time. Everyone at the hospital told me not to compare the hips or the surgeries, as each one is different. I really think that my right hip benefited from having had 5 months of hip PT prior to surgery.
Going home was the same, with my daughter again coming to stay with me for a few days - a bonus! Again I was allowed to drive after two weeks, which surprised me, as this time was my right hip. When Dr Unger looked at the x-rays at my two week check-up, he proudly said "look, a matched pair". He checked my leg length again, too. Indeed, a matching pair. What a gift.
As I write this, its 3 weeks after surgery. I'm longing to go back to yoga, Pilates and ballet, impatient to do things, yet at the same time, get very tired going for walks around the neighborhood several times a day. I tell myself that's because it's been years since I walked this much, so I need to build up the endurance and strength.
I'd be happy to talk to anyone who is contemplating THR, just contact me via email:
September 04, 2014