A Joint Decision
What you should know about hip and knee replacement surgery
The pain in Amy Giordano’s knees had become constant and, almost without even knowing it, she had acclimated herself to the daily pain. “My body had self-adjusted, so you couldn’t tell that I had no knees anymore,” says the director of the Gus Giordano Dance School in Chicago. After years of using her arms to pull herself up out of chairs, leaning heavily on railings to get down stairs and watching students from the sidelines because her knees lacked the strength to even pull her up from a plié, she decided to have knee replacement surgery—on both her knees.
After a lifetime of dancing, many teachers are confronted with the possibility of joint replacement surgery, whether in the knee or hip. Most become necessary as a result of arthritis, but also common among dancers is hip dysplasia—a deformity where the ball of the hip joint isn’t set as deeply in the socket. The condition results in greater flexibility and faster wear on the cartilage.
Facing the possibility of joint surgery may be frightening. But Giordano says total knee replacement changed her life and let her get back to the business of being a teacher. If you become a candidate for surgery, it will help to understand what to expect. Here is an overview of three common joint replacement surgeries, and a heads-up about the decisions you will face.
Total Hip Replacement
A total hip replacement (THR) is a procedure in which the entire femoral head (the ball end of the hip joint) is removed completely and replaced with an implant. The implant is placed by affixing a stem to the femoral canal, which supports the ball; a cup is then placed in the acetabulum (socket) side of the joint. Dr. William Jaffe, clinical professor and vice chairman of orthopaedics at the NYU Hospital for Joint Diseases, says that a THR “is a reliable operation for relief of pain and restoring people to the activities of daily living, but it will not allow a serious dancer to go back to high-impact activity.”
The recovery is surprisingly quick. “If I operate in the morning, the patient is walking that afternoon,” says Jaffe. “Most patients go home on the third day after surgery.” Full recovery time varies, but most patients will achieve their prearthritic range of motion within a year. And with huge strides being made in materials, it’s reasonable to expect an implant to last 30 years.
Patients should pursue low- and non-impact activities post-surgery, such as walking, swimming and elliptical training. While grand jetés may be out of the question, Jaffe says that many of his dancer patients are still very active as teachers. You can expect to be back in the studio (with a modified activity level) within weeks if you’re feeling up to it.
Instead of removing the entire femoral head as is done in a THR, hip resurfacing involves replacing a small amount of bone from the ball with a metal layer about four millimeters thick. A similar layer of metal is placed in the socket. This procedure is not widely practiced and is somewhat controversial, but proponents of the method feel it has distinct benefits.
Dr. Thomas Gross, a specialist in hip and knee surgery at the South Carolina Joint Replacement Center and a national leader in the development of hip resurfacing, believes it is often a better option for a younger patient, who is more likely to require a new hip replacement in her lifetime. The second surgery will be easier with more of the bone intact. He also argues that this procedure makes the hip more stable, minimizing the possibility of dislocation and increasing the patient’s ability to reach higher activity levels.
Hip resurfacing is more complex and has a higher complication rate than THR. So, if you think hip resurfacing is for you, it’s essential you go to a doctor who specializes in the procedure.
A knee replacement is a more difficult procedure to undergo. “A knee replacement gets rid of pain, but it’s not going to take you to that same level of a near-normal joint,” says Gross. He explains that the knee, divided into three parts, is a more complex joint than the hip. If only one of those compartments is worn out, a partial knee replacement can be done, but this is extremely rare. A total knee replacement is usually necessary—requiring that approximately an eight-millimeter layer of the knee be removed to insert the implant.
Recovery time depends on how far gone the joint is, says Gross. “The number-one predictor of range of motion after knee replacement is what the preoperative range of motion was.” Muscles and tendons that surround the knee are affected by the lack of mobility in an arthritic joint, which can’t be repaired with a joint replacement. Physical therapy before the operation can help prepare muscles for post-
Gross advises physical therapy for about a month after knee replacement surgery with continued independent exercises to maximize results. Giordano found that including strengthening exercises in her daily routine improved her mobility and helped manage pain. Though recovering from two surgeries has been painful, she says it has been worth it, even in the earliest, most difficult phases of recovery. “I could see already that my knees were going to have strength, and I could trust them.” DT
What Is Arthritis?
Arthritis is inflammation of the joints characterized by stiffness and the erosion of cartilage. A layer of cartilage covers the end of the bone in any joint, and it protects the end of the bone as it moves against other bones in the joint. Breakdown of this cartilage results in the bones rubbing directly against one another, sending a pain signal to your brain.
Most knee replacements use metal-on-plastic implants, but the range of materials used for hip implants varies greatly—from metal to plastic to ceramic. In August 2010 two types of metal-on-metal hip implants were recalled after they were discovered to have abnormal wear resulting in metallic particles entering the tissues surrounding the implant. Some doctors feel that other metal-on-metal implants are still a good option—and metal is the only material that is used for hip resurfacing.
Particulate debris as a result of wear can be minimized by the newest plastics, which are often infused with antioxidants. Many surgeons have a preferred method and may not present all choices, so it’s prudent to education yourself about options before consulting with your doctor.
American Academy of Orthopaedic Surgeons: orthoinfo.aaos.org
Surface Hippy: www.surfacehippyinfo.com
Kathleen McGuire is a dance writer based in Pittsburgh.
Photo: Amy Giordano teaches in sneakers, post-surgery, because they are the best for her knees. (by Cheryl Mann Photography, courtesy of Amy Giordano)