I was looking forward to interviewing William Starrett because he is one of the few people in this country to undergo hip resurfacing. Although this technique is popular in Europe, and has recently been introduced in Canada with some fanfare, it is not widely practiced here. Even in Europe, surgery with the currently recommended devices has only been in the last seven years. (To read more about this technique click here and be sure to read the article links.)
Since there is so little data about resurfacing, I wondered about William's personal experience some five years after his bilateral surgery. An exceptionally busy man, I caught up with him the day of the premiere of his new ballet Pocahontas. -NR
William Starrett wears many hats these days as Director of the Columbia City Ballet in South Carolina. In addition to his executive responsibilities he is a dancer, teacher, choreographer and community leader. Under his leadership his company's Educational Outreach Program has introduced ballet to more than 350,000 school children throughout the Southeastern United States. His current project, Off the Wall & Onto the Stage, will be a collaboration with the renowned Afro-American painter Jonathan Green. It is being warmly embraced by the arts community in South Carolina.
William first gained notice as a medalist in the First US International Ballet Competition in 1979. He then went on to dance with the Royal Winnipeg Ballet, American Ballet Theater, and the Joffrey Ballet as well as appearing as a guest artist in companies here and abroad. Since 1992 he has been the artistic director of the CCB.
Beauty of line, high extensions and big jumps were important to William in shaping his aesthetic as a dancer. Kirk Petersen was his model for the type of dancer he wanted to be. He saw himself as a trail blazer in this style of male dancing and he really pushed himself to achieve this look. The nobility of the style made him an easy choice for the regal Prince roles in the classic ballets such as Swan Lake, Cinderella and Giselle and he performed these roles all over the world.
Photos Courtesy of the Columbia City Ballet
William was an exceptionally flexible dancer. He now feels that this was a trait choreographers exploited to his own detriment. He was especially known for his grand jete, a greater than 180 degree spilt in the air (see photo). It has since been calculated that landing from such leaps put gigantic pressure on his hip joints equal to ten times his body weight. An exceedingly ambitious dancer, he pushed himself relentlessly and danced everywhere and as often as he could.
But over time performing became more difficult. The first clue William had that something was wrong was a loss in flexibility. He went to numerous doctors but no one he saw could figure out what was wrong. He sought alternative care in the form of chiropractic and massage and continued with the Pilates work that he had been doing for years.
Despite these efforts, his situation got progressively worse. In rehearsal he would walk through his roles to mark his positions, but would only dance in performances, often in terrible pain. He used pain killers, primarily NSAID during this time.
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William states emphatically that Water Therapy was what helped him the most in those final years of dancing before his surgery. By his estimate it kept him on stage another 2 years. He would do the barre under water and then dance through his choreography with the water's buoyancy to protect his joints.
Another technique that helped him to keep dancing during that difficult time of increasing disability was Visualization. His inspiration was the great Cuban ballerina Alicia Alonso who was able to dance despite being legally blind. William would lie in bed listening to the music and dance the ballet in his mind. His muscle memory was able to carry him through the actual performance.
A last factor that contributed to prolonging his performing career was that he had become the Artistic director of the CCB. Thus he could choose the works he could manage best in and make the choreographic changes that helped him get through.
Over the next five years, despite not dancing, his physical condition continued to worsen: he had increasing pain and stiffness until he was barely able to walk, and had trouble putting on his socks and tying his shoe laces. There were days that he had to crawl up his front stairs. If he dropped something on the floor it was so difficult to retrieve that he was often tempted to just leave it lie. He experienced himself as "an old man."
It had become clear that he had osteoarthritis and that the cartilage in his hip joints had been worn away. All he had left was bone against bone. Surgery was clearly indicated. Yet he dreamed of dancing again. He consulted his friend from his American Ballet Theater days, Bruce Marks, about what to do. Marks, who had a THR some years earlier, told him that with standard THR surgery he would never be able to return to a performance career.
At the time, William's orthopedist had just returned from a medical conference and was excited about what he had learned about a hip preserving surgery practiced in Europe that was being studied in the US called hip resurfacing. Since this surgery did not involve amputation of the head of the femur, but rather a remodeling of it, he might be able to do his big jumps again. Moreover, the metal cap that was cemented onto the femur head was the same size as the typical human femur head which meant there was no chance of dislocation. Thus after such a surgery there might be no restrictions on his mobility and the possibility of dancing again might be realized. There was a surgeon, Dr. Harland Amstutz in Los Angeles, who was one of the surgeons researching the technique in the US. As it happened, William was going to LA for work and a consultation was arranged. Although it had never before been attempted in the US, Dr. Amstutz agreed to resurface both hips simultaneously at William's request. No one could promise William that he would be able to dance again.
This event captured the interest of the media and Dateline NBC Television decided to follow William though his surgical ordeal and his attempt to return to the stage. The TV cameras were rolling when he went to sign the surgical release forms. It was only then that he learned of some of the possible negative outcomes of the procedure. Most alarming was that, to do the procedure, the surgeon planned to cut through the external rotators of the hip. That meant turnout, so essential for a ballet dancer, might be affected. Even worse, there might be some nerve damage that could affect the feet. Needless to say, this was unnerving news but he signed the papers.
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In June 1998, at the age of 44 and with a TV crew in tow, William under went his bilateral hip resurfacing. The surgery took 7½ hours. The plastic surgery stitching used to sew up the foot-long incisions on both sides added 1½ hours to the actual surgery. In the ICU, even before he went to a regular hospital room, William was made to stand up on his new hips. He recalls that getting to the side of the bed was excruciating. However, when he finally stood up for the first time post-op, be couldn't believe it: The pain in his hips was totally gone! He was completely relieved of the deep, aching pain that he had lived with for so long. The remainder of his hospital stay was marred by the effects of excessive blood loss. Although he had banked some blood to be transfused back after the surgery, he had lost more blood than was expected. He actually fainted on two occasions. Six days after the surgery he was sent home with a walker. He feels now that an extra day in the hospital would have made the transition to home easier.
Back at home he wore compression stocking ("for two whole weeks", he complains) and began his rehabilitation exercises. He notes that he was profoundly fatigued in those first weeks. This he attributes to still being followed by the TV crew, interacting with too many people and not resting enough.
Thereafter the rehabilitation went faster than anyone had expected: by the third week he was doing what the standard THR patient could do at six months. Amazingly he was back at the barre in August. Since he had resurfacing instead of a THR, he had no restrictions in terms of what he could attempt to do in class. He was allowed to do a full fifth position and to jump, etc. However, since he hadn't danced in five years, he had to fight hard to get back and the experience was very painful. For example, he hadn't been able to bend forward and stretch for five years so his hamstrings were very tight. Also, due to the incision of the external rotators, it took a lot longer to develop the strength to do a full passé. With hard work eventually most of his facility did return including the ability to do a relatively turned out passé on both sides.
On Feb. 5 1999, seven months after his bilateral hip surgery, William returned to the stage as Prince Charming in a performance of Cinderella to be aired before a TV audience of 22 million viewers. The pressure was enormous, but he pulled it off.
Mission accomplished, William was then able to take his time getting back into shape and get stronger. In the winter he did Nutcracker and slowly added roles back into his repertoire. In total he danced another four years. During that time he also took on more executive responsibilities in the company. As he aged he began to experience the normal pains and restrictions that older dancers all do. At 48 years of age he retired again, but this time it was a moment of his own choosing, not one dictated by disability.
What thoughts did he have in retrospect about what he might have done differently?
William now feels that he could have been more moderate. As he says on the Dateline NBC special about his surgery, the very moves that brought him success were the ones sabotaging his career. "At one point in my career, I thought the more pain I could take, the better dancer I would be," he says, "which is silly, because the pain is a warning."
In addition, as a teacher and company director, he now believes that family history is something that his dancers need to pay attention to. Dancers who have family members with osteoarthritis of the hip may be genetically predisposed and thus may need to moderate some of their training to protect a vulnerable joint. William's own father, a construction worker, former pole vaulter and overall athlete, had OA of the hip and had to have THR surgery.
(Suzanne Farrell in her autobiography makes the same point about her father, who also had a THR surgery. In her case, however, she believes her arthritis is totally genetic and that dancing had little to do with her needing to have surgery at an early age. - NR)
In concluding our conversation I asked William if he would recommend hip resurfacing to other dancers. He replied: "Absolutely. In a second! It was totally worth it." For him it would have been worth everything "to dance with my partner (Mariclare Miranda) even for three minutes."
Today he says that he has "so much freedom - to walk and run," and he is active as he wants. In fact, he starts his enormously busy day with a 2 mile walk. Listening to him speak on the morning of the premiere of his new ballet, he sounds like a man truly loving and living his life to the fullest, in his own way and in his own timing.
Columbia City Ballet's Website
After crippling arthritis, William Starrett is able to dance again : Savannah Morning News Interview (02/99)
Dateline NBC Show Excerpts: From the Totally Hip Newsletter archive #3 Dr. Harlan Amstutz(08/99)
Off the Wall & Onto the Stage: The website for the collaboration with painter Jonathan Green
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