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Karen Goodman: Anterior Bilateral Hip Replacement
 
Karen post-opIt is four months since I had anterior bi-lateral THR, and a couple of months since I stopped being amazed and grateful every single time I moved. That means I am feeling so well and normal that I can take my walking and mobility for granted now and then......in a good way. In a very good way.
 
I can now do a few 1st postion grands plies and even smooth rondes de jambes. At three months, I was doing lunges along with spinal rotations and port de bras. That was the first time in a couple of years that I felt really like I was dancing in the sense that my entire body was engaged in large, open, rhythmic movements. I hadn't even thought about moving like that again. It was exciting and profound to once again reconnect with my physicality as a dancer, to feel all the synapses still there and the ease of going in and out of the positions. It so energized me, I could hardly sleep.
 
Many friends attribute my surprisingly quick recovery to being a dancer, but credit belongs to the surgeon, Dr. Joel Matta, and the surgery, so I'll start my story there and work backwards to my history.
 
THE ANTERIOR APPROACH: The great thing about the anterior approach is that no muscle or tendon is cut or detached, so there is less trauma and less that needs to heal. The incisions run vertically 2 1/2 (mine) to 4 inches. They start from about an inch lateral (to the outside of) and slightly distal (lower) to the anterior superior iliac spine (where I feel my hipbones begin). All work is done through these incisions, facilitated by the special table that Dr. Matta helped design (the photo of the table below is from Dr. Matta's site). The implants recommended for me were titanium stems with ceramic balls and sockets, since ceramic causes the least amount of debris as they move against each other. Closing the incision are about six subcutaneous stitches which later dissolve. A glue that stays put for several weeks until the incision is healed covers them. It slowly breaks down and what is left can be easily peeled or rubbed off. I could shower when at home, just letting the water run on the incisions. No other care for them was necessary.
table
 
There were few post-op precautions. Getting into the car required, as my PT at the hospital instructed, only sitting down on the side of the seat before rotating to face front and then bringing both legs in. It was not necessary to keep my hips higher than my knees or to avoid the 90 degree position, or to not cross my legs, concerns I didn't know about until reading the stories on this site. All Dr. Matta said to avoid were extreme stretches, although dislocation is relatively difficult to achieve, and no running. Activity is on a can-do basis. I went back to PT six days after the surgery, began driving short distances in two weeks, gave up my cane in three. In a month I once again had the stability to control my shopping cart in the market.
 
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MY EXPERIENCE START TO FINISH: I went to Dr. Joel Matta's office, the Orthopedic Center in St. John's Health Center in Santa Monica, in August 17, 2006. The first order of business was new x-rays. Put up on a light box in an examining room, I was left alone to contemplate them. In x-rays 4 and 8 years ago, I had seen some deterioration of the cartilage. Now I saw no cartilage at all. When Dr. Matta came in, he confirmed that absence.
 
Dr. Matta struck me as serious, focused, matter-of-factly confident without any sense of pretense or hyperbole. Looking at the x-rays, he said that I could have had the surgery 2 years ago, but that having waited would not change the outcome. He suggested that since both hips were equally bad he could replace them at the same time. Hmmm, scary but interesting. I asked about the chance of infection and he said that his own patient rate was 1 in 1150 for a deep infection around the hip, but a more superficial and minor one not affecting the hip could be more common. He mentioned the possibility of femur breakage while hollowing it out and putting in the stem, and said there was a 2% chance of that, with almost all of those being minor cracks that quickly heal. I liked that he had statistics available. He even did a 3rd position grand plie and said that I would be able to do that again. We dancers deal in gesture. I cannot think of a more thoughtful and communicative gesture than that. But then, he is also a teacher, and just like when I demonstrated for my students, I felt that he wanted me to really get it -- to get what I could have again. He calmly and unhurriedly answered every question I had and said to please call if I had others.
 
I did call twice and my husband once. We spoke with Dr. Anthony Brown, who had been taking notes at the meeting with Dr. Matta. He had been in practice for six years using the lateral approach, and is now a Fellow with Dr. Matta, to learn the anterior. I found it useful to have his added perspective. My concern was operating on both hips at once. He said that with lateral surgeries, he favored one at a time, but that in the last month, his own mind had been changed after seeing such positive results. He also said something that instantly made sense -- gait training would be better on two new hips, rather than trying to walk with one still-bad hip. Since much of my pain was from overcompensating muscles from neck down to calf, the chance to not aggravate them further was very appealing.
 
However, I had to get by my first instinct and conventional wisdom which is to think mainly about everything that could go wrong. I wouldn't want to have two hip infections would I? That would mean taking out both implants until the infections were gone, as Dr. Matta had explained. My last concern came from being in an early stage of osteoporosis (which, when I consulted with my specialist later, turned out to be only in my hips). I asked if we did both and the first femur broke, would they continue to the second one. Dr. Brown said that was a good question and to please hang on while he checked with Dr. Matta, who called it a "gold-star question." The answer was that he would stop at one so that I could heal and not be so incapacitated.
 
karenA doctor friend suggested asking to speak to a patient as much as possible like me who had had the bi-lateral. Within a few days, Dr. Brown called with the name and number of a woman who had just been in for her 6 week check-up. I called her immediately and her husband said she would call me later when she got back from school. School? Already? A 60 year old teacher, she had just gone back for orientation before the start of the school year......7 weeks after having both hips replaced. Her story amazed me: she left the hospital with one cane after 3 days, walked up a steep flight of steps to her bedroom upon returning home, took no further pain medication and was now walking 2 miles. Wow!! Sign me up!! Feeling that the benefits outweighed the risks and that the risks were manageable, I soon made the earliest appointment I could for the bi-lateral surgery.
 
Shortly after, I received a packet of information including instructions to donate 2 pints of blood. I gave one pint 4 weeks in advance, allowing time to take iron and recover before the surgery. My husband gave the other. None was needed during surgery, but the next day I became anemic which was noted and transfusions begun before I woke up from my first night's sleep. The pre-op physical was in Dr. Matta's office, as he has associated with an internal medicine group who not only did that, but oversaw recovery with one assigned doctor, checking me daily in the hospital.
 
The anesthesiologist called me the night before the surgery to ask if I was allergic to any anesthetics and to discuss the choices. I didn't know since I'd only been hospitalized to give birth to my son, for which I had an epidural. He said I could have an epidural, instead of a general anesthetic, therefore not needing to be on a respirator. That sounded good, except I didn't think I wanted to be conscious while they removed the tops of my femurs. No problem, they'd just sedate me as well. He said the epidural entrance would allow them to put in a 24 hour dose of morphine after the surgery. That could cause side effects but they were treatable. I figured I'd tested my high pain threshold enough and opted for the morphine. It left me somewhat itchy for a couple of days even with Benedryl. However, I never experienced any serious pain at all from then to now.
 
Surgery was on Tuesday at 10 am and took about 2 hours, 50 minutes. I woke up in my room around 3:30 pm. Both Dr. Matta and Dr. Brown saw me the day after surgery, and Dr. Brown daily after that as Dr. Matta was speaking out of town. My first walk, Wednesday morning, was with a walker, but not before doing the basic in-bed glute, quad, abduction and adduction exercises, (which I continued for several weeks). A wide belt was put around my waist, so the PT could hold on to me just-in-case, while we made our way the distance of a couple of rooms. Between the incisions, swelling and grogginess, I felt like I'd never walked before. Each leg was carrying an extra 5 pounds of swelling, (which flushed out of my system in two days about two weeks later.) Later that day I was able to walk to the bathroom aided by a nurse once and then with just my walker. Thursday, I tried crutches, then a cane and walked farther. Friday morning, we walked farther still and practiced going up a couple of steps. Dr. Brown said I could stay another day or be discharged. I felt confident enough to leave and did about 1pm.
 
I came home using one cane walking more like March of the Penguins than Project Runway, but walking nevertheless. In terms of pain after I left the hospital, I took a couple of Tylenol for a couple of days and that was it. Any discomfort from the incisions was minor. I was, as we used to say, on a natural high. Surgery is always frightening; the idea of losing my hips, dysfunctional as they were, was unsettling, but here I was a few days later, alive and feeling not at all like I had artificial parts. They felt like me and I was giddy with relief and excitement.
 
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WHAT I'VE LEARNED:
1) Surgery and anesthesia are traumatic, despite this being a less traumatic procedure. It takes a lot out of you. I had a nice big plasma-screen tv in my room but never watched it, nor read the books I'd brought or wore the new pajamas. We all recover at our own rates, depending on one's general health. While it is important to physically challenge ourselves enough, it is equally important to be patient. At four months, I know that while I am beyond thrilled by my progress, the recovery process is not yet complete, so I push myself, but not as I used to.
2) This is an expensive proposition, so have insurance, be clear about what it covers and what your other resources are. Dr. Matta's fee was only a small percentage of the cost. The hospital's charge for the implants was half of the bill. There are many tests and different doctors billing for them.
3) I had to wear compression hose 23 hours a day for 6 weeks to guard against blood clots, and given a pair to put on just before the surgery. Within two weeks, I could put them on myself. If they got annoying, I'd roll them down briefly.
4) If you need to, get your teeth cleaned and have any other invasive procedures before the surgery, as you won't be able to for three months afterwards. You will need to take a dose of antibiotics directly before any dental work for 2 years. The mouth has its own bacteria. With dental work, they are released into the body in larger than normal amounts and can take up residence around the implants where for a while, there is no longer any blood flow to fight infection.
5) Have a grab bar installed for the shower or tub and get a bath mat.
6) A bedside commode, especially if you are having the bi-lateral, was a real boon. I was able to purchase it through the discharge nurse, and I used it for 3 weeks at night. It also fits over the toilet, and was helpful there during the day with it's extra height and arms to help you boost yourself up to standing.
7) Be sure to have someone to be with you pretty much all the time for the first week or so, and everything you really need at bedside, including lots of water.
 
A good side effect: As I was taking Boniva for early-stage osteoporosis, I consulted with my doctor who treats it. He said that since my only bone-density problem was my hips, he didn't think I'd need to continue the Boniva. He did suggest it might be useful to take it for a few more months to perhaps aid in bone growth around the protheses, but that this was new territory and I should also consult with the surgeon. Dr. Brown did some research, talked to a researcher at UCLA, but there is no standard on this yet, so I did take the Boniva for another 2 months, as at least. all agreed, it couldn't hurt. I will certainly continue to monitor my bone density.
 
Karen GoodmanA BRIEF HISTORY: I have loved and wanted to dance since I took a class when I was two and a half. It spoke to me and hasn't stopped, whether choreographing, teaching performing, writing, filming. I didn't take dance classes again until college, deciding as a senior that I needed to make my career in dance. I left Detroit for the M.A. program in dance at UCLA. Although trying to keep things in perspective, having started so "late," I really wanted to perform. Things went better than I'd imagined, and I joined former NY choreographer Gloria Newman's company.
 
After school, I taught and was a founding member of Eyes Wide Open Dance Theater. I went to NY to study and soon joined Rudy Perez 's company. Rudy is one of the original post-modernists from the Judson Church group. Returning to LA, I co-founded Danceworks Studio, which I had for 21 years. Rudy moved to LA, so I danced with him and started my own company. I also made a number of solos, including four that were full-length, receiving for one an NEA Choreographer's Fellowship and other grants and awards.
 
I had always been very careful about turnout, having seen on others what could go wrong, and had an excellent sprung floor in my studio. However, when I was about 50, I would occasionally and only momentarily, feel as though my left leg was about to buckle as it took weight. This happened during teaching when it is hard to stay warm. I was also beginning to need to get new shoes every six months. If they wore down at all, that would bother my hip and back. The next year I had my first x-ray, saw there was some cartilage damage and was told that this was probably congenital, but to consider slowing down. PT was prescribed, which I did while continuing to teach and create solos that pushed my limits. PT, Advil and my work kept me going.
 
The 20 year lease at my studio was up in 1999 and being in a previously undistinguished area that became too expensive--Melrose Ave--I had to close it. By then, there was more pain, but it read to me mainly as chronic neck and back spasms. By 2002, I thought that if I just took it easier, my muscles would stop hurting. A year later I hurt more and began weekly PT and later, acupuncture as well. Both helped considerably. My PTs, Erin McGuire and Clare Frank, and acupuncturist, Dr. Catherine Aquino at Back in Balance Physical Therapy in LA, had done a wonderful job of keeping me going without any pain meds, but the reality became that I was losing range and flexibility and spending more and more time exercising or resting. Like so many dancers, I don't give up so easily and it was Erin who finally said it was time to see an orthopedist. And so, to the happy end of this story which is ..........
 
A NEW BEGINNING: (written with Erin McGuire) I continue with PT and acupuncture. My therapists use a treatment method called Reflexlocomotion. This approach is based on motor patterns we all develop during our first year of life; stabilization, grasping, rolling, creeping, crawling and walking. By placing the patient in specific positions and then applying pressure to the appropriate zones, the muscles that support these basic activities are automatically activated. The neuromuscular pattern is stimulated in the brain, which allows re-education to begin. The patient can then feel the correct movement, and therefore avoid using incorrect, or compensatory muscle patterns which often are the culprit for pain, injury and poor performance. By learning to use the correct motor patterns, he/she will have proper joint mechanics for optimal performance which limits the strain on the musculoskeletal system.
 
February 10, 2007
 
Links:
Karen's website
Dr. Joel Matta
Reflexlocomotion
Karen Goodman' website
Karen's site about Yiddish Dance Video
 
Erin McGuire,PT OCS
6711 Forest Lawn Dr
Los Angeles, CA 90068
(323) 851-7876
 
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