Joint Replacement Tips for Dancers

Jay Aland has had one hip and both knees replaced. Although there is much information available from the usual sources concerning these surgeries, there are a few things overlooked, and some more which are mentioned but not emphasized in proportion to their significance. Here are my personal observations (not checked or audited by any qualified medical persons).

  1. WHEN to replace the joint? At the conjunction of your Orthopedist, your insurer, your pain, and how much dancing you’re missing.  If it’s going in the direction of replacing it sometime, then when you’re losing dancing time, it is the time.  Whenever you do it, you won’t regret it (once the pain is finished).  Get the shots and drugs to keep you dancing now, but they are temporary, so plan the permanent solution.  As soon as I knew definitely that a new joint was in my future, I scheduled it ASAP.
  2. COST is expensive; you need good insurance. If this is the beginning of the path into medical treatment, then buy the best coverage.  Medicare with Type F Supplement for me; EVERYthing is covered.  If this is a one-time venture into the world of medicine, low premiums may be the way to go.  In my experience, you’re starting on a long path.
  3. SURGEONS all cost you the same; get the best. My favorite is Gottsman; DeCook is famous and some say he is the best.  There are many good ones around here; ask around and figure out what is most important to you.  It changes from time to time.
  4. HOSPITAL selection . . . Northeast Georgia Medical Center is the best at preventing infection. They are totally OCD about it; and this is what is important to me.  Most joint failures are due to infection, and prevention programs are getting better every year.  Today I would never tolerate what was considered the best just 10 years ago.  Look for massive innovation, the latest methods and equipment, and deeply committed personnel.  Infection is the killer.
  5. PAIN is not a big deal, but you have to manage to keep it below the level of interfering with your Physical Therapy. If you do the PT, you will get back to dancing.  If you don’t, your joint may be permanently stiff.  PT hurts, and it’s a lot of work, but you MUST do it.  Start walking on it within hours of surgery – not days – and stay active. But do not overdo it! No need to impress your PT. Don’t be in pain.  You need the Drugs – like Percocet – so make arrangements to get refills before you get low (you can’t drive to the drugstore when you’re taking drugs, and your surgeon will require that you personally pick up the prescription from him, and the pharmacy will require that you personally deliver the prescription and pick up the pills.  Getting refills may be the most complicated part of this whole procedure.  Plan ahead).
  6. ICE is the other pain treatment. Apply bags of ice, or frozen ice-packs, for 20 minutes max. (for danger of frost bite) at least 4 times a day. Your refrigerator cannot make ice fast enough for you, and, here again, you can’t drive to the grocery for more ice. Stockpile ice in advance.  I use a Breg Polar Care Cube which I packed up and took home with me from the hospital, or you can buy it on Amazon for $300 new or $75 used. You can apply the Breg constantly, day and night since it runs at 39º. There are other good ways to do the ice, but if you’re not doing the ice, you’re not saving yourself anything.
  7. DRUGS strong enough may also make you crazy. You need someone close at hand, whom you trust, to tell you when it’s time to take drugs, make any necessary decisions, do any required driving, and maybe remind you of where you are, and who you are, and how you got yourself here.
  8. CONSTIPATION is the other side effect of pain medications. I never get constipation, but with Percocet I do, so I start on Milk of Magnesia as soon as I can get it smuggled into the hospital.  This is what works for me; you may do it a different way; but I made the HUGE mistake of waiting for them to get me something, and I won’t do that again.
  9. Then, there’s more good stuff, although it’s mostly my own opinions.
  10. SCHEDULE a week of getting around with a walker, and maybe more. My second week I kept a reacher/grabber handy which I could use as a cane if I needed it. Canes are cheap enough at the grocery.  The worst pain should be done in 2 weeks.
  11. TAKE PAIN MED enough to stay ahead of the pain; don’t get behind the curve, playing catch-up. Stop it only when you want to be able to drive.
  12. SAFETY is whatever is required to DON’T FALL DOWN. Do whatever you have to do. Go as slow as necessary. Suction cup grab-bars can help a lot in the shower, like Safe-Er-Grip Bath and Shower Handle for $13 at Amazon.
  13. While you’re doing exercises anyway, work the Transverse Abdominis also, if you ever get lower back pain.
  14. Dancers have more lower body flexibility and strength, and can heal faster, but they don’t want any long term joint stiffness. Work it many times a day, to extend your range of motion, and then ice it. Don’t stress it so much that you’re left in pain.
  15. Here’s a fun INVENTION . . . Take 2 plastic shopping bags (like you get from Kroger). Tie them together by pulling one bag through the handles of the other, then pull that same bag through its own handles. Put your wounded foot in one bag, and pull the bottom of the other to do heel slides, bend that sore joint, lift your leg into the bed, and all without dragging your heel over the sheets. Perhaps the most important PT exercise is bending your knee to get full range of motion. This will do it.
  16. PTs (Physical Therapists) are highly skilled and well trained. In the first – crucial – week, your PT can help you the most, answer your questions, etc. Trust your PT.  And engender your PT’s trust in you.  If you don’t have that mutual trust, get a different PT.
  17. Only very strong drugs can make it possible to remain active in the first couple of weeks (and you do need to remain active). Hydrocodone and Acetaminophen 7.5-325 is often prescribed for the first week at a dosage of 1-2 tablets every 4-6 hours. I start with 2 every 6 hours, and then stretch the time in between – up to 8 hours or so in the week. As a refill they often prescribe Oxycodone and Acetaminophen 7.5-325 at a dosage of 1 tablet every 4-6 hours. The “…codones” are too strong to manage, so they diminish the effect by mixing in Tylenol (Acetaminophen). Oxycodone can really knock you out, which is why they say “1” rather than “1-2”. The second week is a good time to start taking less and less, anyway; as long as the pain doesn’t stop you from being active. . . . or so I have heard; don’t take my word for any of this.
  18. Wikipedia says that drinking alcohol while taking the “. . . codones” may cause you to stop breathing. Enough said.
  19. You are totally responsible for the choices you make regarding your medical care; there is no one else to blame. You may decline any and all forms of care, including drawing blood, taking any medications, etc. while not losing any other forms of care. You do not have to do it their way. Needless to say, you also can’t make them do their job your way; they are responsible for the choices they make.
  20. The muscles and tendons around your joints go to great lengths to protect the joints and bones; you may have noticed that when you fall the biggest pains might be in muscles which were trying to save you from hitting too hard. As your joints deteriorate, the muscles, tendons and ligaments nearby bond together into protective shells around them, and sometimes you can’t tell whether the joint is hurting, or if it’s just the surrounding muscles, tendons and ligaments. Before putting your Orthopedist to work on the failing joint, you might want to get your massage therapist to release all the surrounding tissue, so you can focus on the right problem. To learn more about hip and knee joints, their tendons, the I T Band, etc. watch “DON’T Foam-Roll Your IT Band!” on YouTube by Eric Lichtfuss, especially if you don’t know the function of the T F L.