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Ruth Ziegler- Ballet Teacher with Bilateral Resurfacing
 
Date of Surgery: April 6,2006
Surgeon: Harlan Amstutz, Head Joint Replacement Institute Los Angeles, CA
Hospital: Good Samaritan Hospital, Los Angeles, CA
 
Prior to surgery:
ruth I noticed a stinging tightness in both hip joints after dancing, probably since I was about 40 years old. It always went away with normal rest. I had full range of motion, strength, endurance, etc. and so I thought this was what everyone felt after taking class or performing. I really didn't have any significant pain or limitations until early in 2005, when things went "downhill" extremely quickly.
 
My medical diagnosis was primary osteoarthritis, but in the course of the actual surgery, Dr. Amstutz determined that I had undiagnosed mild to moderate hip displasia as well.
 
In my year of trying to believe my osteoarthritis was anything but osteoarthritis, I tried acupuncture (it helped briefly with the pain) chiropractic adjustments (didn't help at all) prolotherapy (actually made the inflammation in my hip joints a lot worse) massage (helped briefly with the muscle tension) physical therapy (helped keep me as strong and flexible as was possible) and dietary supplements (didn't help and were very expensive).
 
As my pain increased and my physical abilities decreased, I stopped (in chronological order) doing full split penchees, doing grand plie in fourth position, doing developees on a straight supporting leg, taking class five days a week, taking class more than three days a week, taking group class at all, doing a whole yoga class, teaching children's ballet, teaching adult ballet, walking long distances, walking any distance beyond my mail box, walking without the help of a cane, doing anything but staying in my house all day, everyday and doing water aerobics in my spa and gentle range of motion work with my stability ball in my bedroom. I couldn't go Christmas shopping in December of 2005 because I couldn't walk in the stores. I had to bribe myself with tea and chocolates to get through the pain it felt to decorate my Christmas tree - it took a whole week to put a few lights and ornaments on that tree! If I needed to go to the grocery store, I would find a parking spot close to a shopping cart, so I could use that cart as a "walker" so I could buy the groceries I needed. I had to force myself to stand at the sink to put on my makeup each morning, and eventually I had to stop and sit down after about 10 minutes to lessen the pain so I could continue again. My husband was my "knight in shining armor" through all of this - he continued to help me in every way he could.
 
My descent was very fast - from the time my joints were finally bone on bone, it was only about one year before I reached the physical "low" I described in the previous paragraph. I was fortunate in a way, because I was able to maintain good strength and range of motion up until that last year prior to surgery. I did not have a slow decline and therefore was (relatively speaking) quite fit.
 
Choosing surgery:
I really had no choice but to do some type of joint replacement surgery - I could barely walk. It was either have surgery or resign myself to a wheelchair. I was quite relieved, however, when I read about William Starrett and his return to professional dancing after bilateral hip resurfacing. I remember crying with pain and frustration during one ballet class, and a fellow dancer telling me point blank to "Just do the surgery - You can't live like this!" I think many things came together for me that helped me commit to the bilateral resurfacing with Dr. Amstutz - I learned of the procedure, and the possibility of a dancing future FREE OF RESTRICTIONS traditional hip replacement surgery can impose on a dancer, my husband and I had the money required for this surgery (insurance paid a good portion, but we had to pay $6,500 up front, over and above what insurance would pay), and I had the support of my whole family. William Starrett was very kind to call me before my surgery to reassure me I was doing the right thing. Also, Dr. Amstutz provided me with the names and e-mail addresses of other post-op dancers whom I could contact. I traded e-mails with three of them and they all are thrilled with the outcome of their surgeries.
 
The surgery:
I chose Dr. Amstutz as a direct result of reading William Starrett's story. I had no second thoughts, ever, about my choice! I was in the hospital only three days (that was long enough - the food was just terrible!) I have two shiny, new Conserve Plus metal on metal resurfacing prostheses. I had no complications with either the surgery or my stay in the hospital - I LOVED working with the physical therapist - I could walk with the aid of a walker, and get up and down stairs from day one. I did not do well with morphine. It made me extremely nauseous, and so I was switched to oxycontin. My surgery took seven hours, and I required the two units of blood I had "banked" prior to the surgery.
 
Life after surgery:
xray Post op, I was seen by a visiting nurse at my home,to monitor vital signs, check for DVT, etc. every few days, and I did in-home physical therapy everyday, from day four post op. I saw Dr. Amstutz 18 days post op, and at that time he cleared me to drive, begin water exercises, and begin out-patient physical therapy. I went to Martha Spaulding Kern at Circle of Health Physical Therapy in Lake Forest, CA for my early P.T. She did lymph system, and other general body health work, as well as use the reformer for the actual physical rehab work. After completing the initial functional physical therapy work, I began doing my own "dancer rehab" (at one month post op). I have access to the studio where I teach, so I would go there early in the morning, before regular classes began, to do my own "barre". In the beginning, I lasted all of about 25 minutes! I put my pointe shoes on from the very beginning - I love to dance on pointe. I have continued to work with physical therapists this whole year post op. After doing the initial work, I went to Impact Rehab, a therapy group which specializes in athletes, and did much more aggressive strengthening under their care. About three months ago, I decided to explore myofascial release work - I am finding it very useful and necessary as I still have quite a bit of scar tissue and fascial restrictions. I am currently working with yet another physical therapist, Kinnery Patel, in Laguna Hills who is helping me with the anterior pelvic tilt and muscle imbalance issues I still am experiencing. My biggest challenge now is range of motion. I can reach a full split on each leg with relative ease, but my straddle splits still have a ways to go. I'd say I'm about 90%. I also still have some tightness across the front of each hip, and my arabesques are not yet at the height they have always been. My left leg is still weaker than my right leg, and my pelvis is still not completely evenly balanced.
 
At fourteen months post op, I am attending four - five advanced ballet classes a week. I can do all of the class - but it still doesn't look like I want it too! I am working to get my extensions back up to where they were, and my grand allegro is still weak. Strangely, my petit allegro and my turns are progressing the fastest! I'm doing beats again and double pirouettes. I have no restrictions because of the resurfacing components. The risk of dislocation is very low - about what it would be for a person who has never had hip surgery. I can do any pose in yoga, I can do fifth position, I can do anything I want except run a marathon or bungee jump (I'm glad I've never considered doing these things!) I practice and teach pilates, and I also practice yoga. I do strength work with light weights 3-4 times a week, and walk my dog everyday. If I were given the opportunity, I could prepare for and complete a performance. At this stage, I would definitely have to pick and choose the choreography - some things just don't look that good yet. I am still "evolving" post op. I'm hoping my surgeon's prediction is right - that I will come back 100%. I certainly am trying for that. I am grateful for so many small things: I can teach pre-school ballet again (I had a class of 10 four year olds just this morning); I can do the advanced pilates reformer work easily again (just last week someone in class complimented me on my "flawless technique"); and I can easily climb my stairs again! My husband is happy to have his active, trim wife back. I was able to go Christmas shopping this past December and I didn't have to bribe myself to decorate our tree!
 
I have been a lifelong, "pretty darned good amateur", dancing in civic and regional ballet companies and teaching both children and adults, and enjoying this art form since I was three. I'm so happy to be able to enjoy it, pain free, again.
 
Submitted April 21, 2007
 
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Addendum:
 
Dr. Rabinowitz has encouraged me to add my bilateral hip resurfacing story to the Dancers Hips website so that dancers facing hip surgery will have the opportunity to read about others who have had this alternative to traditional hip replacement surgery. With her permission, I would like to respond to her reasons for not having the resurfacing by citing the information I have on the topics she mentions:
 
Length of surgery - the resurfacing surgery is indeed more technically challenging than a total hip replacement procedure. My bilateral surgery was seven hours in length. However, there are surgeons who complete the procedure in much less time. Two of the fastest are Koen DeSmet, and Ronan Treacy, who both take well under an hour to do a single hip resurfacing procedure.
 
Extent of surgery - the femoral head is shaped to prepare it for the femoral cap, resulting in some bone loss. It is not amputated, along with the femoral neck and part of the femur, as in a total hip replacement procedure, and there is only a small guide stem inserted into the femoral neck (see the picture of the Conserve Plus prosthesis included here), not a long stem inserted into the femoral canal, as in a total hip replacement system. There is a chance of femoral neck fracture, (statistically this is more likely with less experienced surgeons) which is why it makes good sense to have the surgery performed by a very experienced surgeon. Dr. Amstutz has performed over 1000 successful resurfacing surgeries to date. As to the issue of increased muscle trauma and scaring, I cannot speak for others, only for myself. I do have scars that are about 6 inches in length. In the course of surgery the six deep lateral rotators were detached and then re-attached. I did have bruising and swelling. But as my story illustrates, I had an easy and quick recovery. Each person responds differently to surgery - some have easy recoveries and some have more difficult recoveries, no matter what surgical technique was employed.
 
Type of prosthesis - conserve At this point in time, all resurfacing systems are metal on metal, similar to the metal on metal large ball total hip replacement systems also available now. The BioMet company has developed a completely cementless hip resurfacing prosthesis, which some surgeons are now using. The Conserve Plus system that I received requires a small amount of bone cement underneath the cap. As to the concern about metal ions, here is what Dr. L.D. Dorr said at the 2004 meeting of the American Academy of Orthopedic surgeons, when speaking about long-term studies of patients with metal-on-metal total hip replacements:
 
There have been absolutely no complications, not a single report of cancer, in 40 years of MOM THRs. No hypersensitivity, no reports of increased pain due to "metal ions". For more information on this issue (including the risk to people with kidney problems) please go to http://www.mcminncentre.co.uk/ and http://www.hip_clinic.com/en/html/home_enhtml.
 
Ease of Revisability to THR - it has been suggested that it is harder to revise a resurf to a thr. Because of tissue trauma and scaring. Here is a study recently done that speaks to this concern:  http://www.orthosupersite.com/. Briefly summarized, it states "Resurfaced hips converted to THA show similar clinical results primary total hip ... Converting resurfacing arthroplasty hips to THA required similar operative times and length of postoperative hospitalization." This is one of the main reasons I chose the resurfacing surgery - at the very least, it buys me time - I can resume all of my activities with no restrictions, and if I should need a revision at some point in the future, it will be like a primary THR, not a revision from a THR, which requires even more of the femur to be removed and a longer stem inserted into the remaining bone.
 
Here is another very good resource for information on both resurfacing and traditional hip replacement surgery: http://www.jri-oh.com . This is the site of Dr. Amstutz and also Dr. Thomas Schmalzried. Once at the site, you can access a wealth of information by going to the Resource Library section. My suggestion to any dancer contemplating any type of hip surgery is to get all the reliable information you can - don't take someone's word for anything - get well documented facts and proceed from there. Don't be afraid to ask questions - this is your body and your life!
 
Submitted June 18, 2007
 
Update July 1 2009
 
I'm now over three years post op and doing very well. Life is good for me - dancing most every day and still regaining bits and pieces here and there of my former strength and technique. I've come to believe that the actual surgery is the easy part of this whole joint deterioration, disability, surgery, re-hab journey we're on. I've learned so much about myself - some things I'd not wanted to face immediately. I chose to believe that my condition was hereditary, and not a function of anything I was or was not doing. Wrong! Now that I'm truly working correctly, I see that even though I was trying to work correctly and had training from some very gifted teachers, I was slowly wearing down the hip joint cartilage over the decades. Lesson learned however .... I am even more adamant about educating my students about the correct technique and not allowing them to do otherwise while in my class.
 
Ruth teaches ballet at the Maple Conservatory of Dance in Irvine, California.
 
You can contact Ruth at this email: kenruthz@sbcglobal.net
 
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