If the words “hip replacement surgery” inspire a twinge of panic, read on: The topic is cloaked in misconceptions. Dancers endure more injuries on the job than, say, bankers, but are we all-after decades of plies, leaps, and extensions-fated to the operating table by age 50? No, say our experts. Proper mechanics and dietary choices are key; listening to pain and slowing down in the face of injury can go a long way. Interestingly, however, genetics-not career choice-is still the strongest determinant of hip arthritis.
Dance Magazine spoke with Dr. Mark Sinnreich, orthopedic surgeon and lead medical consultant for Miami City Ballet; Dr. William Jaffe, Clinical Professor and Vice Chairman of Orthopedics at NYU Hospital for Joint Diseases and an expert in total hip replacement who has helped in their design; and Ruth Solomon, Dance Medicine Research Coordinator, Division of Sports Medicine, Harvard Medical Center. Additional information was adapted from the website of the Harkness Center for Dance Injuries (www.med.nyu.edu/hjd/harkness). The International Associatoin for Dance Medicine & Science also has a helpful website (www.iadms.org).
-Signs of arthritis are decreased range of motion; deep and aching pain in the groin (which refers to the socket) or thigh pain (which refers to the ball) and the surrounding muscles; joint stiffness; increased pain when you are dancing, and continuous pain when at rest. An X-ray can confirm a diagnosis of arthritis.
-Decrease inflammation naturally with a diet high in glucose, fish oils, and Omega-3 fatty acids, says Dr. Sinnreich. Keep bones strong with calcium.
-Maintain flexibility in the hip joints, as well as strengthen muscular balance on both legs. Avoid repetitive trauma when you sense an injury coming on.
-Ruth Solomon adds that pelvis tilts (which open up the anterior hip) and core strengtheners, which stabilize and balance the area, may also help. (Pilates is great for this.)
-If you are too young for a hip replacement, you have a variety of options. With the help of a doctor, you can manage the pain with topical analgesic products and NSAID’s (non-steroids), which reduce both pain and inflammation. But remember: NSAID’s will mask the pain and can eventually lead to further tissue injury if the area goes untreated.
Years of turn-out may cause hip arthritis: “There have been no studies to my knowledge to confirm that hypothesis,” says Dr. Sinnreich. “There are also none to refute it, but I think all dancers would get arthritic hips if this was a risk factor.” Dr. Jaffe agrees: “I doubt if external rotation in a finely trained dancer would cause a problem.”
I can’t get a hip replaced before a certain age
: “There is no age limit for hip replacement surgery,” says Dr. Jaffe. “But we are reluctant to do hip replacements in young active patients unless they are severely disabled. In those cases we do the procedure with the understanding that they will require additional revision surgery at a later date.”
If I dance, I am doomed to need my hips replaced by age 50
: Even with all the wear and tear that dancers endure, genetics still play the biggest role in determining whether you are at high risk for arthritis. “If you’re going to get it,” says Dr. Sinnreich, “you’re going to get it.”
Hip Resurfacing is a good option for younger dancers
: Not true, says Dr. Jaffe. There is a false assumption that hip resurfacing (see below) has a longer lifespan than a total hip replacement (which lasts a minimum of 15 years). Other downsides? Resurfacing does not allow for increased physical activity; the procedure is almost as invasive as hip replacement surgery; and you still run the risk of dislocating the hip post-op.
Labral Tear: a tear in the fibrocartilage that interfaces between the head of the femur and the acetabulum, or socket. “It can get torn with various injuries such as in the extremes of motion that a dancer may encounter,” says Dr. Jaffe. A tear can be repaired with arthroscopic surgery. It may lead to arthritis.
: a congenital condition which results in a shallow hip socket that does not effectively enclose the head of the femur. “In the milder forms,” says Dr. Jaffe, “it increases the risk of developing secondary osteoarthritis in adulthood. This condition is much more common in women.” Dancers who are naturally very turned out may have this.
: An alternative to total hip replacement. The head of the femur is not removed, but “is ground down to a smaller ball,” says Dr. Jaffe. “A metal ball is cemented over the remaining head fragment to articulate with the previously placed, artificial (metal) socket.”