IADMS New York 2002   [back to the Category]

Total hip replacement in dancers   [read the french version]

Author :   Rietveld, MD, & Al.

Total hip replacement in dancers

Inge R. A. E. Buyls, BA (dance) and A.B.M.(Boni) Rietveld, MD, BA (mus.)
Netherlands Medical Centre for Dancers and Musicians
The Hague, The Netherlands


In a previous study van Dijk et al. found no significant difference in degenerative changes in the hip joints of former professional female dancers and pair matched controls (1).

Rietveld found 15% (n=14/66) hip complaints in dancers of 45 years of age and older; 43% (n=6/14) of these hip injuries were due to degenerative changes in the hip joints. Of this group 50% (only three) had a total hip replacement (THP). These are included in this study.

It comes as no surprise that the number of total hip replacements in active dancers and dance-teachers is relatively low, even in a dedicated Medical Centre for Dancers and Musicians. We reviewed the 8 active dancers and dance-teachers who had a total hip replacement between July 1993 and March 2001. There were 7 female dancers and 1 male; the mean age was 53 (49 – 59) years. There were no dysplastic hips or epiphysiolysis cases.

Although the group is very small and can only serve as a retrospective clinical pilot study, there were some interesting observations: 7 had a unilateral osteoarthritis of the left hip, which is significant even in this small group. The female dance-teacher who had the operation on the right side is the youngest (49 years at her first operation), she has a bilateral osteoarthritis and is scheduled to have her left total hip replacement in January 2002, two years after the first, at 51 years of age. Mean follow-up was 3 years (8,4 years to 9 months). There were no postoperative dislocations or infections. All resumed their dance(-teaching) activities or are still in the rehabilitation process.

Problems encountered in this group were a leg length discrepancy in absence of an adduction contracture and in favor of the operated leg: this may be caused by the combination of hypermobility and the orthopaedic surgeon trying to achieve the proper tension between the hip components during operation, in order to avoid postoperative luxation. Although the original pain was gone in all, there was some subjective disappointment in the speed of the postoperative rehabilitation, although that was objectively normal and often faster in comparison to non-dancer patients: This may be due to their high demands as dancers and a too optimistic expectation in view of the very favorable results of THP in the, usually much older, general population.


It is concluded that better rehabilitation guidelines are needed for dancer-patients. It is also concluded that the fact, that in all dancers with unilateral osteoarthritis the left hip was involved, may reflect a tendency of using the left leg mostly as standing leg. This may be circumstantial evidence that strenuous physical activity may lead to osteoarthritis, but then only in predisposed individuals, given the low numbers overall in dancers. More research on the results of THP in the relatively young dancers and dance-teachers should be done, preferably in a multicenter prospective survey.

References:


1. Dijk van CN et al.: Degenerative Joint Disease in Female Ballet Dancers. Am J.Sports Med 23: 295-300, 1995.
2. Rietveld ABM: Dance Injuries in the Older Dancer: Comparison with Younger Dancers. J Dance Med Sci 4 (1): 16-19, 2000